The Relationship Between Child Physical Abuse and Victimization in Dating Relationships:

Psychological Trauma: Theory, Research, Practice, and Policy
2013, Vol. 5, No. 6, 562–569
© 2013 American Psychological Association
1942-9681/13/$12.00 http://dx.doi.org/10.1037/a0030968
The Relationship Between Child Physical Abuse and Victimization in
Dating Relationships:
The Role of Experiential Avoidance
Devika Fiorillo, Anthony Papa, and Victoria M. Follette
This document is copyrighted by the American Psychological Association or one of its allied publishers.
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
University of Nevada, Reno
Research has demonstrated a relationship between childhood physical abuse and subsequent victimization in dating relationships. However a prior history of abuse does not necessarily result in revictimization and knowledge regarding the mechanisms that increase vulnerability for victimization in the form of
dating violence is limited. The current study examined the relationship between child physical abuse,
dating violence, general distress, and experiential avoidance, in an undergraduate student sample of 314
women. Physical abuse in childhood was associated with significantly higher rates of victimization in
dating relationships, and experiential avoidance mediated the relationship between child physical abuse
and revictimization. Higher levels of general distress was associated with cumulative experiences of child
physical abuse and dating violence, compared with child physical abuse without dating violence. The
current findings suggest that revictimization in the form of dating violence may be linked to exacerbated
distress in women who are physically abused as children and that prevention and treatment programs on
college campuses may benefit from targeting experiential avoidance with survivors of interpersonal
trauma.
Keywords: child physical abuse, dating violence, revictimization, experiential avoidance
dinal correlates of dating violence and information about clinical
resources. There has been less emphasis enhancing behavioral
repertoires that could reduce the risk for revictimization and the
impact on measurable outcomes has been limited (Cornelius &
Resseguie, 2007). Because of gaps in the information on behavioral change related to risk reduction, there exists a critical need for
further research in this area.
The prevalence of victimization in dating relationships and
related outcomes are important concerns for all young adults, and
those with histories of child physical abuse face an even greater
risk of victimization in dating relationships (Vézina & Hébert,
2007). Despite these observations, the research in this specific area
of revictimization is limited. Among individuals with a history of
interpersonal violence, little is known about the cumulative impact
of physical abuse in childhood combined with the experience of
dating violence, although negative outcomes have been associated
with each (Amar & Gennaro, 2005; Kaplan, Pelcovitz, & Labruna,
1999; Springer, Sheridan, Kuo, & Carnes, 2007), and additional
increase in distress has been documented in relation to cumulative
experiences of childhood physical abuse and intimate partner
violence (Banyard, Williams, & Siegel, 2001; Follette, Polusny,
Bechtle, & Naugle, 1996). Additionally, the field is limited in
sound theoretical formulations and empirical work examining specific factors that may explain or mediate the relationship between
the victimization experiences, which could have important implications for prevention and intervention. Prevention programs
aimed at reducing dating violence have primarily focused on
education regarding incidence and prevalence of abuse and attitu-
Dating Violence
Dating violence has been identified as a pervasive problem
among adolescents and young adults. Studies measuring the prevalence of dating violence in student samples suggest that approximately 20% to 48% of individuals have experienced victimization
in the form of some physical violence in their dating relationships,
with most studies conceptualizing violence as behaviors with
intention or perceived intention of causing physical pain or injury
(Amar & Gennaro, 2005; Harned, 2002). Studies examining prevalence of dating violence separately in high school and college
students have estimated slightly higher rates of 20%–30% in
college students, compared with 10%–25% in high school students
(Cornelius & Resseguie, 2007). In one study by Chan, Straus,
Brownridge, Tiwari, and Leung (2008) which consisted of a large
international sample of university students from 22 different countries, the proportion of students who reported being physically
assaulted by a dating partner ranged from 14% to 39%, with a
median of 26%. Even higher rates have been found when a more
broad definition of dating violence has been used to include
psychological or emotional abuse, with one study on a sample of
college and university students reporting an incidence of 79.1% for
all forms of psychological abuse (DeKeseredy & Kelly, 1993).
Despite the variability that is observed across studies, which can be
This article was published Online First February 4, 2013.
Devika Fiorillo, Anthony Papa, and Victoria M. Follette, Department of
Psychology, University of Nevada, Reno.
Portions of this project were presented at the International Society for
Traumatic Stress Studies, November 2008, Chicago, Illinois.
Correspondence concerning this article should be addressed to Devika
Fiorillo, Department of Psychology, University of Nevada, Reno, Reno,
NV 89557. E-mail: devika.fiorillo@gmail.com
562
This document is copyrighted by the American Psychological Association or one of its allied publishers.
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
CHILD PHYSICAL ABUSE AND DATING RELATIONSHIPS
attributed in part to differences in how dating violence has been
defined, the phenomenon is widespread and is of significant concern in college students as well as the general population.
The experience of victimization in dating relationships can have
a number of negative impacts on mental health. The range of
psychological difficulties that have been suggested to have a
relationship with dating violence include PTSD, depression, anxiety, substance use, disordered eating, risky sexual behavior, and
suicidality (Ackard & Neumark-Sztainer, 2002; Callahan, Tolman,
& Saunders, 2003; Carlson, McNutt, Choi, & Rose, 2002; Chan et
al., 2008; Coker et al., 2002; Golding, 1999; Roberts, Klein, &
Fisher, 2003; Silverman, Raj, Mucci, & Hathaway, 2001). Studies
on women from college student populations, specifically, have
also shown that those victimized in dating relationships report
greater psychological distress and mental health symptoms, and
reduced self-worth, compared with their nonvictimized counterparts (Amar & Gennaro, 2005; Clements, Ogle, & Sabourin, 2005;
Coffey, Leitenberg, Henning, Bennett, & Jankowski, 1996). Furthermore, dating violence has been identified as a risk factor for
experiencing subsequent violence in dating or marital relationships
(Gagné, Lavoie, & Hebert, 2005; Hendy et al., 2003; Smith, White,
& Holland, 2003). Given the increased risk for revictimization,
there is need for identifying risk factors that are associated with
dating violence and conceptualizing the relationship of these variables using a testable theoretical model.
Revictimization: Childhood Physical Abuse as a Risk
Factor
The study of revictimization, defined generally in this case as
the experience of victimization among those with prior histories of
trauma, has received increased attention in recent years (Duckworth & Follette, 2011; Widom, Czaja, & Dutton, 2008). Studies
have shown that a history of childhood physical abuse frequently
acts as a risk factor for subsequent exposure to dating violence
(Ehrensaft et al., 2003; Hendy et al., 2003; Stith et al., 2000;
Vézina & Hébert, 2007; Whitfield, Anda, Dube, & Felitti, 2003).
One study by Gover, Kaukinen, and Fox (2008) examined a large
college sample of 2,305 male and female participants and found
that 32% of those with histories of childhood physical abuse
reported subsequent physical violence victimization in romantic
relationships compared with 18% of those without such histories.
The authors also found that physical abuse in childhood was
associated with the increased likelihood of being victimized for
women, but not for men in their sample.
Despite the significant link between physical abuse in childhood
and subsequent physical revictimization in the form of dating
violence, there have been few empirical attempts to test specific
theories to explain this relationship (Wekerle & Wolfe, 1998;
Wekerle et al., 2001; Wolfe, Wekerle, Reitzel-Jaffe, & LeFebvre,
1998). Furthermore, although there is a significant increased risk
for individuals who experience child abuse to experience revictimization, there is variability in outcomes, and many individuals
with child abuse histories are not subsequently revictimized. This
variability in outcomes suggests that we may be able to identify
important risk factors that are modifiable and that can decrease the
risk for revictimization. Moreover, there are other long-term impacts of child abuse that may result in comorbid outcomes that
should also be considered in prevention programs (Kessler, Davis,
563
& Kendler, 1997; Spatz Widom, Dumont, & Czaja, 2007). Identifying individual factors that act as potential moderators and
mediators in this relationship can lead to more targeted treatment
and prevention programs.
Experiential Avoidance
One construct that has been conceptualized as a mediator of the
relationship between childhood abuse and later victimization is
experiential avoidance (EA) (Polusny & Follette, 1995). EA is
defined as the process that occurs when an individual is unwilling
to remain in contact with negatively evaluated private experiences
(e.g., thoughts, feelings, or memories, bodily sensations, behavioral dispositions) and engages in attempts to reduce, numb, or
alleviate such experiences (Hayes, Wilson, Gifford, Follette, &
Strosahl, 1996). Although the use of avoidance strategies may
provide some relief in the short term, research suggests that longterm use of EA results in a number of negative consequences,
including depression, anxiety, and substance abuse as well as other
forms of psychological distress (Hayes et al., 1996; Wilson, Follette, Hayes, & Batten, 1996). The construct of EA has been
considered particularly relevant to trauma in that the exposure to
significant stressors can results in a diverse range of outcomes
including PTSD and problems such as depression, substance
abuse, suicide, and other behaviors that are diverse in topography
but that may all serve a similar function (Chapman, Gratz, &
Brown, 2006; Hayes et al., 1996; Marx & Sloan, 2005; Polusny &
Follette, 1995; Polusny, Rosenthal, Aban, & Follette, 2004;
Salters-Pedneault, Tull, & Roemer, 2004; Tull, Gratz, Salters, &
Roemer, 2004; Tull & Roemer, 2003).
Conceptually, the link between early abuse and later revictimization can be understood in terms of childhood learning
experiences. Childhood is thought to be a critical time period
for learning emotion regulation in the context of interactions
between children and their caregivers (Cole, Martin, & Dennis,
2004). Parenting practices observed in physically abusive
parent– child relationships may play an integral role in the
development of emotion regulation/coping capacities. High levels of EA may be especially likely to develop in the context of
childhood physical abuse, because physical harm by caretakers
may be accompanied by a range of aversive private experiences,
where love, fear, and distrust may all be interwoven. In this
context of learning and vulnerability, individuals may learn to
cope with difficult private experiences by adopting a coping
style marked by EA. Research has found that individuals with
histories of physical abuse in childhood use EA to a greater
degree than their nonabused counterparts (Gratz, Bornovalova,
Delany-Brumsey, Nick, & Lejeuz, 2007). Avoidance coping has
been associated with a range of trauma related outcomes by
researchers using a range of theoretical orientations (Clements
& Sawhney, 2000; Krause, Kaltman, Goodman, & Dutton,
2008; Swan & Snow, 2003).
Theoretically, heightened and chronic reliance on EA could
function to increase risk for further interpersonal violence for
several reasons. Over reliance on cognitive and emotional suppression as avoidance strategies to deal with painful thoughts and
emotions, including trauma related symptoms, have been associated with paradoxical increases in the thoughts being avoided and
further intensification of distress. The cognitive attention that is
FIORILLO, PAPA, AND FOLLETTE
This document is copyrighted by the American Psychological Association or one of its allied publishers.
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
564
taken up by chronic suppression may interfere in the process of
awareness to the current moment, including the ability to recognize
or respond to risks in the environment. Additionally, the chronic
suppression of emotions when in the context of dating relationships may prevent the individual from contacting the adaptive
functions that their ongoing emotional experiences may signal,
including emotions that may highlight risk or need for flight from
a relationship. Furthermore, rather than relieve distress, the continuing increase in suffering associated with suppression may
further overwhelm the regulating capacities of the individual who
may already have problems in coping with distress in a healthy
manner. In addition to internal attempts to avoid, EA can also be
marked by a number of external behaviors, including alcohol
use—to avoid aversive experiences, which could further disengage
an individual from the current environment and contribute to the
increased risk for revictimization. Despite the relevance of EA in
the relationship between child physical abuse and dating violence,
its role as a mediator has yet to be examined.
Current Study
The goals of the current research are to extend the existing
empirical knowledge on dating violence, particularly as a phenomenon of revictimization in the aftermath of child physical
abuse. The study uses a relatively conservative definition of
dating violence by limiting the measurement of acts to physically violent behaviors, without considering acts that represent
emotional abuse, and does not document the actual occurrence
of bodily harm. Although all forms of physical and psychological abuse are worthy of consideration, measurement issues
associated with assessing the broad range of behaviors that can
be considered abusive, led us to focus on a more restricted
range of physical violence. By focusing on a sample of women,
this study incorporates recommendations in the literature which
emphasize separate studies of men and women due to concerns
about gender specific effects (Harned, 2002; Jackson, 1999;
Katz, Kuffel, & Coblentz, 2002). The primary aim of the
current study is to assess the role of EA in relation to dating
violence and child physical abuse in a college sample. By
identifying theoretical variables that could be useful in prevention and treatment programs, the study can shed light on an
important problem that student health centers frequently address on college campuses. Specifically, this study tested a
model of revictimization in which EA mediated the link between child physical abuse and dating violence. Additionally,
the current study assessed general distress as an outcome relative to child physical abuse, dating violence, and cumulative
victimization in the form of both types of interpersonal violence. The cumulative trauma model, which suggests that interpersonal victimization in both childhood and adulthood is
associated with increased clinical distress beyond what is observed with single experiences of trauma, has garnered support
in the trauma literature (Banyard et al., 2001; Follette et al.,
1996). Such a pattern has not been previously examined with
regard to cumulative experiences of child physical abuse and
dating violence.
Method
Participants and Procedure
The sample consisted of 314 undergraduate women from a
midsize western state university. Participants were recruited from
introductory psychology classes for extra credit via an online
recruitment system that included brief information regarding the
study. The number of individuals who were exposed to the initial
online recruitment is not recorded, and therefore we are not able to
report the rate of response. Of those participants who signed up to
receive further details regarding the study, none refused to participate. The study design was cross-sectional, with participants
completing the survey in a secure lab setting. To mitigate the
possibility of social stigmatization and encourage honest responding, we ensured there was no identifying record of participants
having taken part in the study by obtaining oral consent instead of
written consent. This consent procedure was carried out with the
approval of the institutional office of human research protection.
Mean age of participants was 19.9, and 96% reported being heterosexual. Ethnicity of the sample was primarily Caucasian
(74.5%), followed by Latina (8.9%), Asian American/Pacific Islander (7.3%), African American/Black (3.2%), Native American
(1.6%), and other (4.5%), with these numbers being fairly representative of the demographics of the university as a whole.
Measures
Our two main outcome variables of interest were general distress and self-reported experiences of dating violence. General
distress was measured with the Global Severity Index (GSI) of the
widely used, Brief Symptom Inventory (BSI; Derogatis, 1975).
The GSI combines information about the number of endorsed
symptoms and perceived intensity level as a measure of overall
psychological distress. The scale has demonstrated high test reliability for the whole scale (.90; Derogatis, 1993). In this study,
Cronbach’s alpha was .96. Our other outcome was Dating Violence (DV), as measured by the16-item Safe Dates Physical Violence Victimization Scale (SDPVVS; Foshee et al., 1996). The
SDPVVS measures victimization in past or current dating relationships, assessing four categories of victimization (relatively mild
physical victimization, moderate physical victimization, severe
physical victimization, and sexual victimization). For each item in
the measure, respondents rate the frequency of their experiences on
a scale from which total scores or dichotomous scores can be
obtained. The measure possesses high internal consistency with
Cronbach’s alpha of .91 (Foshee et al., 1998, 2000), which was
consistent in the current study, with alpha of .90. Information on
dating violence from the SDPVVS was used in this study to
categorize participants into a DV or non-DV group. Items that
were part of the mild physical violence or sexual violence subscales were not scored as DV.
Our distal variable was child physical abuse as assessed with the
use of the physical assault subscale of the Conflict Tactics Scale
(CTS1; Straus, 1979). The CTS1 is a well validated, widely used
measure in the study of family violence including physical violence in parent– child relationships (see Straus & Hamby, 1997).
Participants endorsed (yes/no) if they had ever been pushed,
grabbed, shoved, or slapped as a measure of lower level behaviors
This document is copyrighted by the American Psychological Association or one of its allied publishers.
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
CHILD PHYSICAL ABUSE AND DATING RELATIONSHIPS
that some consider a measure physical/corporal punishment. Experiences such as being hit, beat up, choked, and threatened with
a knife or a gun were included in the measure of more serious child
physical abuse (CPA). CPA was defined in this study as any
endorsement of serious physical violence at the hands of family
members or a caretaker on the physical abuse subscale. Because of
the difficulty in clearly identifying the function, intent, and severity of behaviors that are included in the low-level violence/punishment subscale of the CTS, these were not included in our
analyses. This is not meant to minimize the potential negative
impact of those behaviors, but rather the more conservative definition of violence is used in order to protect against charges of
overly inflated statistics of abuse. Moreover, CTS scales have
subscales that were created under the presumption that the greater
harm results from the acts in the more severe subscales (Straus,
2007). The distinction between the minor and severe assaults has
been supported by factor analyses with a significant body of
literature indicating that the etiology and treatment of minor violence differs from severe assaults (Gelles, 1991; HoltzworthMunroe & Stuart, 1994; Johnson & Ferraro, 2000).
Finally, our hypothesized mediator of the relationship between
CPA and adult dating violence, EA, was measured using the
Acceptance and Action Questionnaire-II (AAQ-II; Bond et al.,
2011). The AAQ-II demonstrates good psychometric properties
with a mean Cronbach’s alpha of .84 across six samples (Bond et
al., 2011), a 3- and 12-month test–retest reliability of .81 and .79,
respectively (Bond et al., 2011), convergent validity with measures
of general health (e.g., r ⫽ ⫺.67 with the Symptom Checklist10R), and measures of suppression and emotional disturbances
(e.g., r ⫽ ⫺.75 with the Beck Depression Inventory). In our study
reliability was .87 and demonstrated good convergent validity with
the GSI (r ⫽ ⫺.68).
Results
Prior to analyses, variables were examined for accuracy of data
entry. Missing values for the BSI and AAQ-II were replaced with
the mean score of the remaining items, if the number of missing
values were less than 5% of the total possible values (Tabachnick
& Fidell, 2001). Missing values on the CTS or SDPVVS were not
imputed because of the dichotomous nature of coding. Three
participants did not provide sufficient information to score the
CTS, and another three did not complete the SDPVVS. Two
participants did not provide enough information to score the BSI,
and three did not complete the AAQ-II and were excluded from
our ANOVA and mediation analyses. Because the participants
could submit their materials and leave the study at any point in
time without need to give an explanation (a requirement of our
IRB), the reasons for noncompletion of particular items are not
known.
Prevalence of CPA and DV
One hundred thirteen women (36.7%) reported a history of child
physical abuse (see Table 1), and 82 (26.6%) women reported a
history of moderate to severe dating violence (see Table 2). Of the
113 women with a child abuse history, 39 (34.5%) reported a
history of moderate to severe dating violence. Of the 195 who
reported minor or no child abuse history, 43 (22.1%) reported
565
Table 1
Prevalence of Individual Items of Child Physical Abuse
Child physical abuse item
1.
2.
3.
4.
5.
6.
Kicked, bit, or hit with a fist
Hit or tried to hit with an object
Beat up
Burned or scalded
Threatened with a gun or knife
Used a gun or knife
Note.
Number
Percent
68
97
31
4
7
0
21.7
30.9
9.9
1.3
2.2
0
Participants could endorse multiple items.
being the victims of moderate to severe dating violence. Differences in the rate of dating violence among women with versus
without a history of child physical abuse was significant, ␹2(1,
306) ⫽ 5.67, p ⬍ .05.
The Relationship of CPA and DV to General Distress
In order to examine the differences in levels of general distress
according to each specific type of interpersonal violence and
cumulative experiences of victimization, women were divided into
the following four groups: (1) no child physical abuse or dating
violence victimization (No CPA or DV; n ⫽ 151), (2) child
physical abuse only (CPA-only; n ⫽ 74), (3) dating violence
victimization only (DV-only; n ⫽ 42), and (4) both child physical
abuse and dating violence victimization (CPA ⫹ DV; n ⫽ 39;
Table 3). Analysis of variance indicated a significant difference in
general distress between the four groups, F(3, 305) ⫽ 17.07, p ⬍
.01 (see Table 3). Post hoc analyses using the Scheffé test indicated that participants without either victimization experience (No
CPA or DV; M ⫽ .51, SD ⫽ .47) differed significantly from all the
other groups in the level of general distress, compared with CPAonly, F(3, 302) ⫽ 5.02, p ⬍ .01 (M ⫽ .82, SD ⫽ .58), DV-only,
F(3, 302) ⫽ 6.23, p ⬍ .001 (M ⫽ .94, SD ⫽ .74), and the CPA ⫹
DV group, F(3, 302) ⫽ 12.97, p ⬍ .001 (M ⫽ 1.14, SD ⫽ .67).
The CPA-only group did not differ from DV only, F(3, 302) ⫽ .39,
p ⬎ .05 (Table 3). The revictimized CPA and DV group differed
significantly from those with a history of CPA only, F(3, 302) ⫽
2.42, p ⬍ .05, but did not differ significantly from the DV-only
group, F(3, 302) ⫽ .55, p ⬎ .05. Thus, among those with a history
of child physical abuse, revictimization in the form of dating
violence was associated with greater levels of general distress
compared with child physical abuse only.
Does EA Mediate the Relationship Between CPA and
DV?
To test whether EA mediated the relationship between child
physical abuse and DV victimization, we assessed a mediator
model using procedures outlined by Baron and Kenny (1986).
Using this method, we found that there was a significant difference
in the effect of history of childhood physical abuse on DV when
including EA as a mediator (c ⫽ .06, p ⬍ .05, c= ⫽ .44, p ⬎ .10,
Aroian test z ⫽ 1.97, p ⬍ .05; Figure 1; Table 3). However, due
to the cross sectional nature of this data, we analyzed an alternative
model assessing if the relationship between childhood physical
abuse and EA was mediated by history of dating violence in order
to rule out reverse causal effects. The result indicated that this
FIORILLO, PAPA, AND FOLLETTE
566
This document is copyrighted by the American Psychological Association or one of its allied publishers.
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
Table 2
Prevalence of Individual Items Measuring Dating Violence
According to the Level of Severity
Dating violence item
Level of violence
Number
Percent
1. Physically twisted arm
2 Slammed or held
against a wall
3 Kicked
4 Bent fingers
5 Bit
6 Tried to choke
7 Burned
8 Hit with a fist
9 Hit with something
hard besides a fist
10 Beat up
11 Assaulted with a knife
or a gun
Moderate
37
11.8
Moderate
Moderate
Moderate
Moderate
Severe
Severe
Severe
51
13
18
23
26
3
18
16.2
4.1
5.7
7.3
8.3
1
5.7
Severe
Severe
17
15
5.4
4.8
Severe
6
1.9
were revictimized in the form of dating violence is also comparable to what has previously been reported in the literature (Gover et
al., 2008).
Consistent with prior research, the results obtained in this study
show that experiencing either childhood physical abuse or dating
violence, when compared with no reported history of such victimization, is associated with greater levels of psychological distress
(Amar & Gennaro, 2005; Kaplan et al., 1999). The study adds to
the literature on cumulative experiences of interpersonal victimization, with our findings demonstrating that a history of both child
physical abuse and dating violence, is related to poorer psychological functioning, in comparison to a childhood history of physical abuse only. This finding supports the results in a growing
number of studies documenting the phenomenon of cumulative
distress in relationship to traumatic experiences (e.g., Follette et
al., 1996; Scott-Storey, 2011). Part of what makes our study
unique is the documentation that the combined experiences of
child physical abuse and dating violence also can have a cumulative impact, which has not previously been investigated.
Although differences were found in general distress scores between those with combined experiences of dating violence and
childhood physical abuse compared with childhood physical abuse
only, the combined victimization group did not differ from those
with a history of dating violence only. Some researchers have
discussed the possibility of differential impact of separate types of
victimization on cumulative distress, suggesting that some but not
all types of traumatic experiences impart an additive effect on
symptoms (Scott-Storey, 2011). One potential explanation for the
lack of difference between those victimized in dating relationships
only compared with both types of victimization, in this sample,
could be that more proximal abuse experiences will be associated
with greater symptomology.
An important new finding in from this research is the demonstration of the role of EA as a mediator linking childhood physical
abuse and victimization in later dating relationships. This finding
broadens the understanding of one specific pathway through which
child physical abuse may result in greater likelihood of dating
violence and highlights the importance of interventions designed
to address a range of issues in the repertoires of individuals with a
history of abuse. Interventions that emphasize awareness and ac-
Note. Participants could endorse multiple items. Items reflecting relatively mild physical victimization or sexual victimization in the Safe Dates
Physical Violence Victimization Scale are not presented because they were
not included in these analyses.
model was not viable (c ⫽ ⫺5.74, p ⬍ .001, c= ⫽ ⫺5.39, p ⬍
.001, Aroian test z ⫽ 1.53, p ⬍ .05). Together these analyses
suggest that EA does mediate the relationship between history of
childhood physical abuse and experience of DV.
Discussion
The results in the current study provides additional evidence that
victimization in dating relationships, when considering moderate
to severe physically abusive experiences, is fairly prevalent in the
college student population and is associated with long-term distress. The data on rates of dating violence found in this study are
consistent with prior studies, which have revealed similar rates of
violence in dating relationships in undergraduate samples (Cornelius & Resseguie, 2007). The current findings also indicate that
experiencing physical abuse in childhood is a distal risk factor for
being victimized in dating relationships. Moreover, our finding
that 26% of women with a history of child abuse in this sample
Table 3
Summary of ANOVA and Follow-Up Scheffé Test for General Distress and Experiential Avoidance
Variables/Groups
General distress
1. No CPA or DV
2. CPA only
3. DV only
4. CPA & DV
Total
Experiential avoidance
1. No CPA or DV
2. CPA only
3. DV only
4. CPA & DV
Total
n
M
151
74
42
39
306
.51
.82
.93
1.14
.72
150
72
43
38
303
56.89
49.79
51.91
49.71
53.60
SD
F(df)
p value
Scheffé
.47
.58
.74
.67
.61
17.07 (305)
.000
4 ⬎ 1ⴱⴱ, 2ⴱ
3 ⬎ 1ⴱⴱ
2 ⬎ 1ⴱⴱ
7.99
11.55
11.78
10.53
10.34
11.61 (302)
.000
4 ⬍ 1ⴱⴱ
3 ⬍ 1ⴱⴱ
2 ⬍ 1ⴱⴱ
Note. Experiential avoidance is reversed scored on the Acceptance and Action Questionnaire-II; lower scores refer
to greater experiential avoidance. CPA ⫽ child physical abuse; DV ⫽ dating violence.
ⴱ
p ⬍ .05. ⴱⴱ p ⬍ .01.
CHILD PHYSICAL ABUSE AND DATING RELATIONSHIPS
Experiential Avoidance
.602**
Child Physical Abuse
.03*
-----------.06*---------------------Dating Violence Victimization
This document is copyrighted by the American Psychological Association or one of its allied publishers.
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
.44ns
Figure 1. Model with experiential avoidance as the mediator of child
physical abuse and dating violence victimization. Experiential avoidance
mediated the relationship between child physical abuse and dating violence
victimization. Values presented are standardized regression coefficients
(␤s). The value on the dotted line represents the coefficient for the direct
(i.e., unmediated) path. ⴱⴱ p ⬍ .01; ⴱ p ⬍ .05; ns ⫽ nonsignificant.
ceptance of emotions, changes in how the individual relates to his
or her thoughts, improved distress tolerance skills and emotion
regulation strategies, and mindfulness of the current moment including the identification of goals and values in regard to intimate
relationships can provide a foundation for decreasing the risk for
revictimization as well and related psychological distress. Acceptance and Commitment Therapy (ACT; Hayes, Strosahl, & Wilson, 1999) is a treatment that is particularly relevant in regard to
these issues as it is designed to reduce EA and increase psychological flexibility. Moreover, ACT-based interventions can assist
individuals in behavioral activation related to self-care. The emphasis on behavioral skills aimed at reducing EA could help in
filling the gap that has currently been noted in prevention efforts
aimed to reduce risk of victimization in dating relationships generally and also in the context of a childhood history of physical
abuse. Although ACT has some preliminary data to support it as a
promising therapy for trauma-related symptoms (Batten & Hayes,
2005; Twohig, 2008), there are several other treatments that focus
specifically on PTSD. For instance, Cognitive Processing Therapy
(CPT; Resick & Schnicke, 1992) focuses on recalling, reexperiencing, and processing trauma-related events.
Although the current research provides important new data,
several limitations of the study warrant attention. First of all, the
current study utilized retrospective and cross-sectional methodology, which restricts the generalizability of the findings. The design, in which all the variables were assessed at a single time point,
limits our ability to establish a temporal relationship between our
variables of interest. Although the finding regarding the role of EA
as a mediator is theoretically supported, stronger empirical demonstrations of the relationship between child physical abuse and
victimization in dating relationships, and in particular the role that
EA plays in increasing risk for revictimization, necessitates that
utilization of longitudinal designs. Another methodological limitation inherent in this study concerns the use of self-report inventories as measurement tools. It is possible that the extent to which
the variables were associated in this study may have been artificially inflated, because of possible shared method variance in
measurement. In future studies, utilization of a behavioral measure
of EA could counteract concerns regarding method variance. However, it should be noted that similar findings have been reported in
several studies (Ghimire & Follette, 2011).
567
Because information regarding the severity and frequency of
victimization experiences were not obtained, the relationship of
these specific variables to the outcome could not be established.
Some studies have suggested that the frequency, duration, and
severity of abuse are associated with more severe long-term negative outcomes (English et al., 2005; Malinosky-Rummell & Hansen, 1992). However, the data are mixed in this area, and these
inconsistencies in the literature may well be related to difficulties
in reliable measurement of abuse-related variables. The lack of
information regarding co-occurring victimization is also a limitation given the research literature, which indicates that it is related
to poorer outcomes (Scott-Storey, 2011). Additional lack of information regarding the current relationship status of the respondents
obfuscates differences that may have occurred due to reporting
experiences with a current partner compared with past partners.
Although we make reference to other behaviors such as substance
use that may be connected to the relationship between child abuse
and dating violence, we did not measure such variables in our
study. Further work in the area should focus on assessment of
additional variables that either moderate or mediate long-term
outcomes.
Although the study was composed entirely of college students,
a focus on developing effective prevention and intervention programs for use on a college campus has been one important part of
our work. Thus, although there are some limits to the generalizability of the data in our study, it is certainly relevant to the large
numbers of students on college campuses across the country where
college counseling centers are increasingly called on to provide
services for a range of student problems. Limited campus resources and the need to provide interventions with some empirical
foundation make it important to demonstrate areas of specific
student need.
The research presented here provides additional support for the
specific role of EA in increasing risk for dating violence, particularly among survivors of childhood physical abuse. In addition,
there is supplementary evidence for the cumulative impact of a
history of repeated trauma exposure. Although efforts to identify
processes that increase risk for victimization continue at an individual level, it is also important that we broaden our attention the
prevention of abuse and to the larger environmental and sociopolitical context in which interpersonal violence exists.
References
Ackard, D. M., & Neumark-Sztainer, D. (2002). Date violence and date
rape among adolescents: Associations with disordered eating behaviors
and psychological health. Child Abuse & Neglect, 26, 455– 473. doi:
10.1016/S0145-2134(02)00322-8
Amar, A. F., & Gennaro, S. (2005). Dating violence in college women:
Associated physical injury, healthcare usage, and mental health symptoms. Nursing Research, 54, 235–242. doi:10.1097/00006199200507000-00005
Banyard, V. L., Williams, L. M., & Siegel, J. A. (2001). The long-term
mental health consequences of child sexual abuse: An exploratory study
of the impact of multiple traumas in a sample of women. Journal of
Traumatic Stress, 14, 697–715. doi:10.1023/A:1013085904337
Baron, R. M., & Kenny, D. A. (1986). Moderator-mediator variables
distinction in social psychological research: Conceptual, strategic, and
statistical considerations. Journal of Personality and Social Psychology,
51, 1173–1182. doi:10.1037/0022-3514.51.6.1173
This document is copyrighted by the American Psychological Association or one of its allied publishers.
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
568
FIORILLO, PAPA, AND FOLLETTE
Batten, S. V., & Hayes, S. C. (2005). Acceptance and commitment therapy
in the treatment of comorbid substance abuse and post-traumatic stress
disorder: A case study. Clinical Case Studies, 4, 246 –262. doi:10.1177/
1534650103259689
Bond, F. W., Hayes, S. C., Baer, R. A., Carpenter, K. M., Guenole, N.,
Orcutt, H. K., . . . Zettle, R. D. (2011). Preliminary psychometric
properties of the Acceptance and Action Questionnaire–II: A revised
measure of psychological inflexibility and experiential avoidance. Behavior Therapy, 42, 676 – 688. doi:10.1016/j.beth.2011.03.007
Callahan, M. R., Tolman, R. M., & Saunders, D. G. (2003). Adolescent
dating violence victimization and psychological well-being. Journal of
Adolescent Research, 18, 664 – 681. doi:10.1177/0743558403254784
Carlson, B. E., McNutt, L. A., Choi, D. Y., & Rose, I. M. (2002). Intimate
partner abuse and mental health: The role of social support and other
protective factors. Violence Against Women, 8, 720 –745. doi:10.1177/
10778010222183251
Chan, K. L., Straus, M. A., Brownridge, D. A., Tiwari, A., & Leung, W. C. (2008).
Prevalence of dating partner violence and suicidal ideation among male
and female university students worldwide. Journal of Midwifery &
Women’s Health, 53, 529 –537. doi:10.1016/j.jmwh.2008.04.016
Chapman, A. L., Gratz, K. L., & Brown, M. Z. (2006). Solving the puzzle
of deliberate self-harm: The experiential avoidance model. Behaviour
Research and Therapy, 44, 371–394. doi:10.1016/j.brat.2005.03.005
Clements, C., Ogle, R., & Sabourin, C. (2005). Perceived control and
emotional status in abusive college student relationships: An exploration
of gender differences. Journal of Interpersonal Violence, 20, 1058 –
1077. doi:10.1177/0886260505277939
Clements, C. M., & Sawhney, D. K. (2000). Coping with domestic violence: Control attributions, dysphoria, and hopelessness. Journal of
Traumatic Stress, 13, 219 –240. doi:10.1023/A:1007702626960
Coffey, P., Leitenberg, H., Henning, K., Bennett, R. T., & Jankowski,
M. K. (1996). Dating violence: The association between methods of coping
and women’s psychological adjustment. Violence and Victims, 11, 227–238.
Coker, A. L., Davis, K. E., Arias, I., Desai, S., Sanderson, M., Brandt,
H. M., & Smith, P. H. (2002). Physical and mental health effects of
intimate partner violence for men and women. American Journal of
Preventive Medicine, 23, 260 –268. doi:10.1016/S07493797(02)00514-7
Cole, P. M., Martin, S. E., & Dennis, T. A. (2004). Emotion regulation as
a scientific construct: Methodological challenges and directions for child
development research. Child Development, 75, 317–333. doi:10.1111/j
.1467-8624.2004.00673.x
Cornelius, T. L., & Resseguie, N. (2007). Primary and secondary prevention programs for dating violence: A review of the literature. Aggression
and Violent Behavior, 12, 364 –375. doi:10.1016/j.avb.2006.09.006
DeKeseredy, W. S., & Kelly, K. (1993). The incidence and prevalence of
woman abuse in Canadian university and college dating relationships.
Canadian Journal of Sociology, 18, 137–159. doi:10.2307/3341255
Derogatis, L. R. (1975). Brief Symptom Inventory. Baltimore, MD: Clinical
Psychometric Research.
Derogatis, L. R. (1993). BSI Brief Symptom Inventory. Administration,
Scoring, and Procedures Manual (4th ed.). Minneapolis, MN: National
Computer Systems.
Duckworth, M. D., & Follette, V. M. (2011). Retraumatization: Assessment, treatment, and prevention. Routledge, NY.
Ehrensaft, M. K., Cohen, P., Brown, J., Smailes, E., Chen, H., & Johnson,
J. G. (2003). Intergenerational transmission of partner violence: A 20year prospective study. Journal of Consulting and Clinical Psychology,
71, 741–753. doi:10.1037/0022-006X.71.4.741
English, D. J., Upadhyaya, M. P., Litrownik, A. J., Marshall, J. M.,
Runyan, D. K., Graham, J. C., & Dubowitz, D. (2005). Maltreatment’s
wake: The relationship of maltreatment dimensions to child outcomes.
Child Abuse & Neglect, 29, 597– 619. doi:10.1016/j.chiabu.2004.12.008
Follette, V. M., Polusny, M. A., Bechtle, A. E., & Naugle, A. E. (1996).
Cumulative trauma: The impact of child sexual abuse, adult sexual
assault, and spouse abuse. Journal of Traumatic Stress, 9, 25–35. doi:
10.1002/jts.2490090104
Foshee, V. A., Bauman, K. E., Arriaga, X. B., Helms, R. W., Koch, G. G.,
& Linder, G. F. (1998). An evaluation of Safe Dates, an adolescent
violence prevention program. American Journal of Public Health, 88,
45–50. doi:10.2105/AJPH.88.1.45
Foshee, V. A., Bauman, K. E., Arriaga, X. B., Helms, R. W., Koch, G. G.,
& Linder, G. F. (2000). The safe dates project. The Prevention Researcher, 7, 5–7.
Foshee, V. A., Linder, G. F., Bauman, K. E., Langwick, S. A., Arriaga,
X. B., Heath, J. L., McMahon, P. M., & Bangdiwala, S. (1996). The Safe
Dates Project: Theoretical basis, evaluation design and selected baseline
findings. American Journal of Preventive Medicine, 12, 39 – 47.
Gagné, M. H., Lavoie, F., & Hebert, M. (2005). Victimization during childhood
and revictimization in dating relationships in adolescent girls. Child
Abuse & Neglect, 29, 1155–1172. doi:10.1016/j.chiabu.2004.11.009
Gelles, R. J. (1991). Physical violence, child abuse, and child homicide: A
continuum of violence, or distinct behaviors? Human Nature, 2, 59 –72.
doi:10.1007/BF02692181
Ghimire, D., & Follette, V. M. (2011). Revictimization: Experiences related to child, adolescent, and adult sexual trauma. In M. D. Duckworth,
& V. M. Follette, (Eds.), Retraumatization: Assessment, treatment, and
prevention (pp. 317–344). New York, NY: Routledge.
Golding, J. M. (1999). Intimate partner violence as a risk factor for mental
disorders: A meta-analysis. Journal of Family Violence, 14, 99 –132.
doi:10.1023/A:1022079418229
Gover, A. R., Kaukinen, C., & Fox, K. A. (2008). The relationship between
violence in the family of origin and dating violence among college
students. Journal of Interpersonal Violence, 23, 1667–1693. doi:
10.1177/0886260508314330
Gratz, K. L., Bornovalova, M. A., Delany-Brumsey, A., Nick, B., &
Lejuez, C. W. (2007). A laboratory-based study of the relationship
between childhood abuse and experiential avoidance among inner-city
substance users: The role of emotional nonacceptance. Behavior Therapy, 38, 256 –268. doi:10.1016/j.beth.2006.08.006
Harned, M. S. (2002). A multivariate analysis of risk markers for dating
violence victimization. Journal of Interpersonal Violence, 17, 1179 –
1197. doi:10.1177/088626002237401
Hayes, S. C., Strosahl, K., & Wilson, K. G. (1999). Acceptance and
commitment therapy: An experiential approach to behavior change.
New York, NY: Guilford Press.
Hayes, S. C., Wilson, K. G., Gifford, E. V., Follette, V. M., & Strosahl, K. (1996).
Experiential avoidance and behavioral disorders: A functional dimensional approach to diagnosis and treatment. Journal of Consulting and
Clinical Psychology, 64, 1152–1168. doi:10.1037/0022-006X.64.6.1152
Hendy, H. M., Weiner, K., Bakerofskie, J., Eggen, D., Gustitus, C., &
McLeod, K. C. (2003). Comparison of six models for violent romantic
relationships in college men and women. Journal of Interpersonal Violence, 18, 645– 665. doi:10.1177/0886260503251180
Holtzworth-Munroe, A., & Stuart, G. L. (1994). Typologies of male
batterers: Three subtypes and the differences among them. Psychological Bulletin, 116, 476 – 497. doi:10.1037/0033-2909.116.3.476
Jackson, S. M. (1999). Issues in the dating violence research: A review of
the literature. Aggression and Violent Behavior, 4, 233–247. doi:
10.1016/S1359-1789(97)00049-9
Johnson, M., & Ferraro, K. (2000). Research on domestic violence in the
1980’s: Making distinctions. Journal of Marriage and the Family, 62,
948 –963. doi:10.1111/j.1741-3737.2000.00948.x
Kaplan, S. J., Pelcovitz, D., & Labruna, V. (1999). Child and adolescent
abuse and neglect research: A review of the past 10 years. Part 1:
Physical and emotional abuse and neglect. Journal of the American
This document is copyrighted by the American Psychological Association or one of its allied publishers.
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
CHILD PHYSICAL ABUSE AND DATING RELATIONSHIPS
Academy of Child & Adolescent Psychiatry, 38, 1214 –1222. doi:
10.1097/00004583-199910000-00009
Katz, J., Kuffel, S. W., & Coblentz, A. (2002). Are there gender differences
in sustaining dating violence? An examination of frequency, severity,
and relationship satisfaction. Journal of Family Violence, 17, 247–271.
doi:10.1023/A:1016005312091
Kessler, R. C., Davis, C. G., & Kendler, K. S. (1997). Childhood adversity
and adult psychiatric disorder in the US National Comorbidity Survey.
Psychological
Medicine,
27,
1101–1119.
doi:10.1017/
S0033291797005588
Krause, E. D., Kaltman, S., Goodman, L. A., & Dutton, M. A. (2008).
Avoidant coping & PTSD symptoms related to domestic violence exposure: A longitudinal study. Journal of Traumatic Stress, 21, 83–90.
doi:10.1002/jts.20288
Malinosky-Rummell, R., & Hansen, D. J. (1993). Long-term consequences
of childhood physical abuse. Psychological Bulletin, 114, 68 –79. doi:
10.1037/0033-2909.114.1.68
Marx, B. P., & Sloan, D. M. (2005). Pertitraumatic dissociation and
experiential avoidance as predictors of posttraumatic stress symptomatology. Behaviour Research and Therapy, 43, 569 –583. doi:10.1016/j
.brat.2004.04.004
Polusny, M. A., & Follette, V. M. (1995). Long-term correlates of child sexual
abuse: Theory and review of the empirical literature. Applied & Preventive Psychology, 4, 143–166. doi:10.1016/S0962-1849(05)80055-1
Polusny, M. A., Rosenthal, M. Z., Aban, I., & Follette, V. M. (2004).
Experiential avoidance as a mediator of the effects of adolescent sexual
victimization on negative adult outcomes. Violence and Victims, 19,
109 –120. doi:10.1891/vivi.19.1.109.33238
Resick, P. A., & Schnicke, M. K. (1992). Cognitive processing therapy for
sexual assault victims. Journal of Consulting and Clinical Psychology,
60, 748 –756. doi:10.1037/0022-006X.60.5.748
Roberts, T. A., Klein, J. D., & Fisher, S. (2003). Longitudinal effect of
intimate partner abuse on high-risk behavior among adolescents. Archives of Pediatric Adolescent Medicine, 157, 875– 881. doi:10.1001/
archpedi.157.9.875
Salters-Pedneault, K., Tull, M. T., & Roemer, L. (2004). The role of
avoidance of emotional material in the anxiety disorders. Applied and
Preventive Psychology, 11, 95–114. doi:10.1016/j.appsy.2004.09.001
Scott-Storey, K. (2011). Cumulative abuse: Do things add up? An evaluation of the conceptualization, operationalization, and methodological
approaches in the study of the phenomenon of cumulative abuse.
Trauma, Violence, & Abuse, 12, 135–150. doi:10.1177/
1524838011404253
Silverman, J. G., Raj, A., Mucci, L. A., & Hathaway, J. E. (2001). Dating
violence against adolescent girls and associated substance use, unhealthy
weight control, sexual risk behavior, pregnancy, and suicidality. Journal
of the American Medical Association, 286, 572–579. doi:10.1001/jama
.286.5.572
Smith, P. H., White, J. W., & Holland, L. J. (2003). A longitudinal
perspective on dating violence among adolescent and college-age women. American Journal of Public Health, 93, 1104 –1109. doi:10.2105/
AJPH.93.7.1104
Spatz Widom, C. S., DuMont, K., & Czaja, S. J. (2007). A prospective
investigation of major depressive disorder and comorbidity in abused
and neglected children grown up. Archives of General Psychiatry, 64,
49 –56. doi:10.1001/archpsyc.64.1.49
Springer, K. W., Sheridan, J., Kuo, D., & Carnes, M. (2007). Long-term
physical and mental health consequences of childhood physical abuse:
Results from a large population-based sample of men and women. Child
Abuse & Neglect, 31, 517–530. doi:10.1016/j.chiabu.2007.01.003
569
Stith, S. M., Rosen, K. H., Middleton, K. A., Busch, A. L., Lundeberg, K.,
& Carlton, R. P. (2000). The intergenerational transmission of spouse
abuse: A meta analysis. Journal of Marriage and Family, 62, 640 – 654.
doi:10.1111/j.1741-3737.2000.00640.x
Straus, M. A. (1979). Measuring intrafamily conflict and violence: The
Conflict Tactics (CT) Scales. Journal of Marriage and the Family, 41,
75– 88. doi:10.2307/351733
Straus, M. A. (2007). Conflict tactics scales. In N. A. Jackson (Ed.),
Encyclopedia of Domestic Violence (pp. 190 –197). New York, NY:
Taylor & Francis Group.
Straus, M. A., & Hamby, S. L. (1997). Measuring physical and psychological
maltreatment of children with the Conflict Tactics Scales. In G. Kaufman
Kantor & J. Jasinski (Eds.), Out of the darkness: Contemporary research
perspectives on family violence. Thousand Oaks, CA: Sage.
Swan, S. C., & Snow, D. L. (2003). Behavioral and psychological differences among abused women who use violence in intimate relationships.
Violence Against Women, 9, 75–109. doi:10.1177/1077801202238431
Tabachnick, B. G., & Fidell, L. S. (2001). Computer-assisted research
design and analysis. Boston, MA: Allyn & Bacon.
Tull, M. T., Gratz, K. L., Salters, K., & Roemer, L. (2004). The role of
experiential avoidance in posttraumatic stress symptoms and symptoms
of depression, anxiety, and somatization. Journal of Nervous and Mental
Disease, 192, 754 –761. doi:10.1097/01.nmd.0000144694.30121.89
Tull, M. T., & Roemer, L. (2003). Alternative explanations for emotional
numbing of posttraumatic stress disorder: An examination of hyperarousal and experiential avoidance. Journal of Psychopathology and
Behavioral Assessment, 25, 147–154. doi:10.1023/A:1023568822462
Twohig, M. P. (2009). Acceptance and commitment therapy for treatmentresistant posttraumatic stress disorder: A case study. Cognitive and
Behavioral Practice, 16, 243–252. doi:10.1016/j.cbpra.2008.10.002
Vézina, J., & Hébert, M. (2007). Risk factors for victimization in romantic
relationship of young women: A review of empirical studies and implications for prevention. Trauma, Violence, & Abuse, 8, 33– 66. doi:
10.1177/1524838006297029
Wekerle, C., & Wolfe, D. A. (1998). The role of child maltreatment and
attachment style in adolescent relationship violence. Development and
Psychopathology, 10, 571–586. doi:10.1017/S0954579498001758
Wekerle, C., Wolfe, D. A., Hawkins, L., Pittman, A.-E., Glickman, A., &
Lovald, B. E. (2001). Childhood maltreatment, posttraumatic stress
symptomatology, and adolescent dating violence: Considering the value
of adolescent perceptions of abuse and a trauma mediational model.
Development and Psychopathology, 13, 847– 871.
Whitfield, C. L., Anda, R. F., Dube, S. R., & Felitti, V. J. (2003). Violent
childhood experiences and the risk of intimate partner violence in adults:
Assessment in a large health maintenance organization. Journal of
Interpersonal Violence, 18, 166 –185. doi:10.1177/0886260502238733
Widom, C. S., Czaja, S. J., & Dutton, M. A. (2008). Childhood victimization and lifetime revictimization. Child Abuse & Neglect, 32, 785–796.
doi:10.1016/j.chiabu.2007.12.006
Wilson, K. G., Follette, V. M., Hayes, S. C., & Batten, S. V. (1996). Acceptance
theory and the treatment of survivors of childhood sexual abuse. National Center for PTSD Clinical Quarterly, 6, 34 –37.
Wolfe, D. A., Wekerle, C., Reitzel-Jaffe, D., & Lefebvre, L. (1998). Factors
associated with abusive relationships among maltreated and nonmaltreated youth. Development and Psychopathology, 10, 61– 85. doi:
10.1017/S0954579498001345
Received January 7, 2012
Revision received June 14, 2012
Accepted October 6, 2012 䡲