Abstract
Childhood abuse and neglect are pervasive problems among girls and young women that have numerous health consequences. Research suggests that sexual minority women are more likely than heterosexual women to report childhood abuse and neglect, but little is known about which sexual minority women are at greatest risk for these early adverse experiences. Using data from a pooled sample of women in a national probability study and in a large community-based study of sexual minority women designed to replicate the national study’s methodology (pooled n = 953), we investigated rates and characteristics of childhood sexual abuse, physical abuse, and neglect among women from five sexual identity groups. As predicted, heterosexual women reported significantly less childhood abuse and neglect than did women who identified as mostly heterosexual, bisexual, mostly lesbian, or lesbian. We found considerable variability across the sexual minority subgroups, including severity of abuse, highlighting the need for research that distinguishes among these groups. To the extent that differences reported by women in the sample reflect the actual prevalence and severity of abuse experiences, sexual identity group differences in childhood abuse have important clinical and public health implications.
Conservative estimates suggest that approximately 40% of women experience physical abuse as children and at least 8% experience childhood sexual abuse (CSA; Tjaden & Thoennes, 2000). These adverse childhood experiences have long-lasting physical and mental health consequences that continue into adulthood (Arias, 2004; Moeller, Bachmann, & Moeller, 1993; Scott-Storey, 2011), including greater risk of adult depression (Fogarty, Fredman, Heeren, & Liebschutz, 2008; Roosa, Reinholtz, & Angelini, 1999), obesity (Noll, Zeller, Trickett, & Putnam, 2007; Williamson, Thompson, Anda, Dietz, & Felitti, 2002), chronic fatigue (Romans, Belaise, Martin, Morris, & Raffi, 2002), and adult-onset chronic health conditions including heart disease, asthma, and diabetes (Scott et al., 2011). Childhood abuse experiences also serve as a risk factor for adult revictimization (Desai, Arias, Thompson, & Basile, 2002; Gidycz, Coble, Latham, & Layman, 1993), which further increases the likelihood of psychological and physical health problems (Arata, 2000; Fogarty et al., 2008). A growing number of studies have documented sexual orientation disparities in rates of childhood abuse (Austin, Jun et al., 2008; Balsam, Rothblum, & Beauchaine, 2005; Hughes, Johnson, & Wilsnack, 2001). Balsam et al. (2005) examined childhood abuse in lesbian, gay, and bisexual (LGB) participants by comparing them with their heterosexual siblings. These researchers found that sexual minority status was significantly associated with each of the childhood abuse measures, including sexual and physical abuse by parents or caretakers, with LGB participants reporting greater abuse. Notably, sexual orientation accounted for significant variance in victimization beyond the effect of family, suggesting that even within the same household sexual minorities are at greater risk of abuse than are their heterosexual siblings. Using a similar sibling-matched design, Stoddard, Dibble, and Fineman (2009) also found higher rates of CSA and childhood physical abuse (CPA) among lesbians than among their heterosexual sisters. Whereas 20.4% of lesbians reported CPA, only 10.0% of their heterosexual sisters did. Similarly, 26.6% of lesbian participants reported CSA, compared to 15.7% of heterosexual participants.
CSA and CPA Severity and Characteristics
Not only do prevalence rates of childhood abuse differ, but research findings suggest that sexual minority women experience more severe forms of abuse than do heterosexual women (Austin, Jun et al., 2008; Balsam et al., 2005; S. C. Wilsnack, Kristjanson, Hughes, & Benson, 2012). In Austin, Jun et al.’s (2008) study of women from the Nurses’ Health Study II, bisexual and lesbian women reported a greater frequency of physical abuse in both childhood (before age 11) and adolescence (ages 11 to 17) than did heterosexual women. Lesbian women who reported physical abuse in childhood were also more likely than heterosexual women to experience physical revictimization in adolescence. Comparing CSA experiences, bisexual and lesbian women were more likely than heterosexual women to report both unwanted sexual touching and forced sexual activity during childhood, but the ratio of sexual minority women’s rates to heterosexual women’s rates was larger for forced, and presumably more severe, sexual experiences. Of the women who reported sexual abuse as children, lesbian and bisexual participants were more likely than heterosexual women to report sexual revictimization in adolescence. These findings are of concern, especially given that greater abuse severity is related to a greater likelihood of negative mental health outcomes (Kendler et al., 2000; Zink, Klesges, Stevens, & Decker, 2009).
Variations Across Sexual Minority Subgroups
There is growing recognition among researchers that sexual minority women are a heterogeneous group and that researchers should examine similarities and differences within sexual minority populations. In support of this, researchers have documented significant differences in health risk behaviors among subgroups of sexual minority women (Hughes, Szalacha, & McNair, 2010; McCabe, Hughes, Bostwick, West, & Boyd, 2009; McNair, Kavanagh, Agius, & Tong, 2005). For example, in a study of substance use in a national probability sample of Australian women, although all three sexual minority subgroups reported greater substance use compared to exclusively heterosexual women, women who identified as mainly heterosexual or bisexual were at greater risk of substance use on more outcome measures than were lesbian women (Hughes, Szalacha, & McNair, 2010).
Examining differences in victimization between mostly heterosexual and exclusively heterosexual predominately African American and Latina young women, Austin, Roberts, Corliss, and Molnar (2008) found that young women who identified as mostly heterosexual were substantially more likely than those who identified as exclusively heterosexual to report CSA (45% vs. 15%). In Balsam et al.’s (2005) study of LGB adults and their heterosexual siblings, although lesbian and bisexual women were more likely than their heterosexual sisters to report CSA, rates of CSA did not differ significantly between lesbian and bisexual women.
Even less research has examined subgroup variations in CPA. Saewyc et al. (2006) analyzed data from seven high-school-based surveys and found that, in the four surveys that included information on physical abuse, bisexual and lesbian girls were more likely to report CPA than were heterosexual girls. In one survey, more bisexual and lesbian girls reported CPA than did mostly heterosexual girls. Additionally, although two of the four surveys found lower odds of CPA among bisexual girls compared with their lesbian peers, there were no differences between bisexual and lesbian youth in the other two.
Neglect is a form of childhood abuse that has received very little attention in research with sexual minorities even though it is strongly associated with negative mental health outcomes (Horwitz, Widom, McLaughlin, & White, 2001). In the only study, to our knowledge, to assess sexual identity subgroup differences in childhood neglect, Hughes, McCabe et al. (2010) did not find significant differences among lesbian, bisexual, and heterosexual women in self-reported childhood neglect. However, results showed a significant interaction between childhood neglect and sexual identity in predicting adult alcohol abuse: lesbian women who reported neglect had 30 times the odds of past year alcohol dependence as heterosexual women who reported this experience, suggesting that the effects of childhood neglect may differ by sexual orientation.
Potential Explanations for Sexual Orientation Differences in Rates of Childhood Abuse
Differences in childhood abuse rates between heterosexual and sexual minority women have lead some authors to speculate that childhood abuse, particularly CSA, may be causally related to minority sexual orientation (Cameron & Cameron, 1995; Gundlach, 1977; Tomeo, Templer, Anderson, & Kotler, 2001). This perspective lacks empirical evidence (Friedman et al., 2011; Wilson & Widom, 2010). In the only study to address this question prospectively, Wilson and Widom (2010) used data from the child welfare system to examine whether CSA, CPA, and/or childhood neglect were associated with a greater likelihood of same-sex cohabitation or same-sex sexual partners in adulthood. These investigators found no sexual orientation differences between women who were maltreated as children and those who were not.
Another explanation for differences in rates of childhood abuse is that children who go on to identify as a sexual minority are more likely to be targets of abuse due to homophobic and sexist societal attitudes. Specifically, gender atypical appearance and behaviors may contribute to higher rates of childhood abuse in sexual minorities (Balsam et al., 2005). For example, adults who negatively perceive gender atypicality may use physical violence as a means of punishing girls who do not conform to societal norms and standards. Consistent with this explanation, D’Augelli, Grossman, and Starks (2006) found that lesbian and bisexual youth who reported gender atypicality as children (66% of the female sample) were more likely to be verbally and physically victimized than those who did not. Awareness of one’s sexual minority status at a young age may also lead some youth to use alcohol or other drugs as a method of coping with stigma and discrimination—behaviors that, in turn, can increase risk of sexual victimization (Balsam et al., 2005).
Finally, sexual minority girls who wish to explore their sexuality with a same-sex partner may seek out an older partner because it seems safer to approach such an individual (Rind, 2001). Using Wyatt’s CSA criteria, such age-discrepant sexual encounters would be considered abuse if the child was under age 13 and the partner was 5 or more years older (Wyatt, 1985).
The factors that contribute to sexual orientation differences in childhood victimization are important to consider when analyzing CSA, CPA, and neglect. Lesbians, bisexual women, and mostly heterosexual/lesbian women may differ on gender atypicality, femininity, and other variables that may be related to childhood victimization. With greater information on sexual minority subgroup differences, researchers can more accurately describe the childhood abuse experiences of sexual minority women and better understand the factors that contribute to sexual orientation differences in abuse.
The Present Study
Currently, there is not enough information about sexual identity subgroup differences in childhood abuse to draw firm conclusions. Relatively few researchers include questions that assess the full range of minority sexual identity; most ask only about lesbian and bisexual identity, and these researchers frequently combine lesbian and bisexual women (or all nonheterosexual women) in analyses to increase statistical power. Greater knowledge of subgroup differences has the potential to improve understanding of risk factors for childhood abuse and to provide information that can be used to develop more effective prevention and intervention strategies. For example, health care providers could be encouraged to collect information about sexual orientation and/or gender atypicality among child patients and become more alert to the possibility of childhood abuse and neglect among at-risk groups.
To address current gaps in the literature, we compared prevalence and characteristics of CSA, CPA, and childhood neglect in five sexual identity groups (exclusively heterosexual, mostly heterosexual, bisexual, mostly lesbian, and exclusively lesbian). The five-category sexual identity question is a modified Kinsey scale that was extensively pretested prior to use in the Chicago Health and Life Experiences of Women (CHLEW) and National Study of Health and Life Experiences of Women (NSHLEW) studies (Skrocki, 1996). The use of multiple sexual identity categories is supported by numerous studies that have demonstrated variations in health outcomes and behaviors across sexual identity subgroups (e.g., McCabe, Hughes, Bostwick, Morales, & Boyd, 2012; McNair et al., 2005; S. C. Wilsnack et al., 2008). Based on previous research, we expected that rates of abuse would be higher in all four sexual minority subgroups than in exclusively heterosexual women. Given the relative dearth of information about sexual minority subgroup differences, our remaining analyses were exploratory.
Data are from a pooled sample of women from a national probability study and a large community-based study of sexual minority women that was designed to replicate the national study’s methodology. Combining data from these studies provided a unique opportunity to compare rates and characteristics of childhood abuse and neglect across sexual identity groups and to identify subgroups at greatest risk.
Method
Study Samples
NSHLEW
The NSHLEW is 20-year longitudinal study of women in the U.S. general population designed to assess predictors and consequences of hazardous drinking. Data were collected every 5 years in 1981, 1986, 1991, 1996, and 2001. Additional subsamples of women aged 21 to 30 were added in 1991 and 2001. Detailed information about the study design and retention rates are reported elsewhere (R. W. Wilsnack, Kristjanson, Wilsnack, & Crosby, 2006; S. C. Wilsnack, Klassen, Schur, & Wilsnack, 1991). The data were statistically weighted to adjust for variations in nonresponse rates by sampling unit and by age, ethnicity, education, and marital status.
In the NSHLEW, face-to-face interviews were conducted by female interviewers in participants’ homes or other private settings. For consistency with previous NSHLEW surveys, participants in the 2001 survey provided verbal consent to participate. All procedures were reviewed and approved by the University of North Dakota Institutional Review Board.
CHLEW
The CHLEW is a 14-year longitudinal study that replicated and extended the NSHLEW by examining risk and protective factors for hazardous drinking in a sample of 447 sexual minority women, aged 18 or older, in the greater Chicago metropolitan area. Recruitment for the study targeted clusters of networks, including formal community-based organizations (LGB, women’s health, and social organizations), informal community social groups, and individual social networks (including networks of women who participated in the study). Recruitment strategies included a variety of methods such as advertisements in local LGB and mainstream newspapers, notices posted on lesbian-related Internet bulletin boards, and flyers posted in churches, bookstores, and distributed at LGB cultural events. A concerted effort was made to recruit women who had traditionally been underrepresented in studies of sexual minority women’s health (women of color and older women), by working closely with a variety of informal social groups (e.g., Affinity, Amigas Latinas, Women of All Cultures Together [WACT], Gray Pride) and using newspaper advertisements that targeted these groups.
Face-to-face interviews were conducted in the participants’ homes or other private settings by trained female interviewers. As in the national study, questions about potentially sensitive topics such as physical and sexual abuse were asked toward the end of the interview, when rapport was well-established. Women in the CHLEW provided written consent to participate. All procedures were reviewed and approved by the University of Illinois at Chicago Institutional Review Board. All data for the current analyses are from Wave 1 (baseline) of the CHLEW (see Hughes et al., 2006, for additional information about the study design and data collection).
Pooled NSHLEW and CHLEW sample
To maximize the comparability of CHLEW and NSHLEW participants, we selected cases for the pooled sample based on age and residence. Because nearly all CHLEW participants were from Chicago or the surrounding suburbs, we limited the pooled sample to participants who reported living in large- or medium-sized cities or suburbs near a large city. As a result, 14 CHLEW participants and 544 NSHLEW participants were excluded from the pooled sample. To maximize the samples’ comparability on age, we excluded 25 CHLEW participants aged 18 to 20, one CHLEW participant aged 83, and 30 NSHLEW participants aged 71 and older, resulting in age ranges of 21 to 70 for both samples.
Sexual identity subgroups
Both the CHLEW and the NSHLEW assessed sexual identity using the question: “Recognizing that sexuality is only one part of your identity, how do you define your sexual identity?” Response options were “exclusively lesbian,” “mostly lesbian,” “bisexual,” “mostly heterosexual,” and “exclusively heterosexual.” Although women who identified as bisexual (or heterosexual or transgender) during screening for eligibility were excluded from the CHLEW study, in the actual interviews, 11 women identified as bisexual and were retained for our analyses. All of the exclusively heterosexual and mostly heterosexual participants in the pooled sample are from the NSHLEW study and the vast majority of the mostly lesbian and exclusively lesbian-identified participants are from the CHLEW study (11 bisexual, 5 mostly lesbian, and 8 exclusively lesbian women are from the NSHLEW). The final pooled sample included 953 participants. Of these, 482 (50.6%) identified as exclusively heterosexual, 42 (4.4%) identified as mostly heterosexual, 22 (2.3%) as bisexual, 111 (11.6%) as mostly lesbian, and 296 (31.1%) as exclusively lesbian.
Measures
The NSHLEW and CHLEW interview questionnaires included detailed questions about drinking patterns and drinking-related problems, as well as possible antecedents, correlates, and consequences of drinking, such as lifetime experiences of abuse, social roles, and physical and mental health.
CSA
We assessed rates and characteristics of CSA using questions about experiences of eight sexual activities before age 18 (ranging from exposure and exhibitionism to anal or vaginal penetration). To avoid suggesting sexual abuse, terms such as abuse or sexual abuse were not used in any of these questions. Using Wyatt’s (1985) criteria, CSA was defined as (1) any intrafamilial sexual activity before age 18 that was unwanted by the participant, or that involved a family member 5 or more years older than the participant, or (2) any extrafamilial sexual activity that occurred before age 18 and was unwanted, or that occurred before age 13 and involved another person 5 or more years older than the participant.
Age of onset was assessed by determining the youngest reported age of any of the sexual activities that met Wyatt’s criteria for CSA. We defined early onset of CSA as occurring before age 8, a conservative marker of the onset of puberty. Participants who met Wyatt’s criteria were asked follow-up questions about their most distressing experience including the number of perpetrators, frequency, duration, use of physical force, and physical consequences such as pain, cuts/bruises, or broken bones. All participants were asked whether they perceived themselves to have been sexually abused in childhood.
CPA and neglect
Participants were asked whether they were physically hurt by their parents or other family members (aunts/uncles, grandparents, siblings, cousins) when they were growing up. Those who answered “rarely,” “sometimes,” “often,” or “very often” were asked whether they perceived that they were physically abused when they were growing up.
All participants (not just those who reported that they perceived themselves to have been physically abused) were asked about their parents’ usual methods of disciplining them when they were growing up. Here we focus on the three methods most likely to result in physical or psychological harm: “spanked or hit with belt, switch, or other object”; “beat up, punched, choked, or threw me down”; and “neglected my basic needs (food, clothing, shelter, love).”
Data Analysis
The NSHLEW sample was weighted to address selection probabilities (e.g., the oversampling of heavier drinking women; see R. W. Wilsnack et al., 2006, for details). For the analyses reported here, we weighted the CHLEW sample to reflect the age and education structure of the NSHLEW sample (S. C. Wilsnack et al., 2008). We did not weight based on race/ethnicity because women of color were deliberately oversampled in the CHLEW study. We created dichotomous variables for each of the childhood abuse measures. We constructed cross-tabulation tables using SAS 9.2 (SAS Institute Inc., 2008) to assess differences in the proportions of childhood abuse characteristics across the five sexual identity groups. We used Rao-Scott chi-square analyses to adjust for cluster sampling. We computed post hoc comparisons by conducting chi-square analyses on pairwise comparisons for all five sexual identity groups. Given the large number of post hoc analyses, we used a modified Bonferroni correction (Holm, 1979) to adjust significance levels so as not to violate an overall alpha level of .05 for the family of post hoc tests (10 pairwise comparisons for each characteristic).
Results
Table 1 summarizes the demographic characteristics of the sample stratified by sexual identity subgroup. The five sexual identity groups differed on age, race/ethnicity, education, income, and place of current residence.
Demographic Characteristics Overall and by Sexual Identity Subgroup.
Note: The sample is restricted to women aged 21 to 70 living in large- or medium-sized cities or in suburbs near a large city. Values have been adjusted and rounded due to fractional weighting, and thus frequencies may not add up to total frequencies and percentages may not add up to 100. Percentages are based on valid percentages; missing values have been excluded.
Chi-square tests of sexual identity group differences significant at p > .001.
In Table 2, we report the rates and characteristics of CSA for women in the five sexual identity subgroups who met Wyatt’s (1985) criteria for CSA. Exclusively heterosexual women were less likely to meet criteria for CSA than were women in each of the four sexual minority groups. Post hoc analyses revealed that exclusively heterosexual and mostly heterosexual women did not differ significantly in rates of CSA, but exclusively heterosexual women were significantly less likely to experience CSA than were bisexual (χ2 = 13.79, df = 1, p = .0002), mostly lesbian (χ2 = 28.28, df = 1, p < .0001), and exclusively lesbian (χ2 = 66.05, df = 1, p < .0001) women.
Self-Reported Prevalence and Characteristics of Childhood Sexual Abuse (CSA) Among Women by Sexual Identity Subgroup.
Note: Arabic superscripts indicate that the percentages with different superscripts by row are significantly different from one another.
**p < .01. ***p < .001.
Sexual minority women also reported indicators of more severe CSA. Sexual minority women as a group were more likely to report genital contact than were exclusively heterosexual women. Post hoc analyses showed that exclusively heterosexual, mostly heterosexual, and bisexual women reported similar rates of genital CSA and vaginal/anal penetration. Mostly lesbian and exclusively lesbian women reported significantly higher rates of genital CSA (mostly lesbian: χ2 = 28.29, df = 1, p < .0001; exclusively lesbian: χ2 = 60.06, df = 1, p < .0001) and vaginal/anal penetration (mostly lesbian: χ2 = 14.42, df = 1, p = .0001; exclusively lesbian: χ2 = 18.93, df = 1, p < .0001) than did exclusively heterosexual women.
Among women who met Wyatt’s criteria for CSA, there were significant differences in age of onset of CSA by sexual identity group with exclusively lesbian women more likely to report early age of onset of CSA than exclusively heterosexual women (χ2 = 15.82, df = 1, p < .0001). For the most distressing CSA event, we found statistically significant group differences for number of perpetrators (two or more vs. one), frequency (more than once vs. once), and duration (1 year or more vs. less than 1 year). Post hoc analyses of number of perpetrators, frequency, and duration of CSA showed that mostly lesbian (χ2 = 20.50, df = 1, p < .0001; χ2 = 8.12, df = 1, p = .004; χ2 = 9.62, df = 1, p = .002, respectively) and exclusively lesbian (χ2 = 21.00, df = 1, p < .0001; χ2 = 17.52, df = 1, p < .0001; χ2 = 12.16, df = 1, p = .0005, respectively) women were more likely than exclusively heterosexual women to report these indicators of more severe CSA. Bisexual women were also more likely than exclusively heterosexual women to report that their most distressing CSA experience involved two or more perpetrators (χ2 = 9.20, df = 1, p < .005). Differences in experiences of physical force or physical injury associated with the CSA event did not differ significantly across the sexual identity groups.
Sexual minority women were also more likely than exclusively heterosexual women to report that they perceived themselves to have been sexually abused in childhood. Post hoc analyses revealed that exclusively lesbian women were more likely to report self-perceived CSA than were exclusively heterosexual women (χ2 = 26.07, df = 1, p < .0001).
Table 3 summarizes comparisons of the rates and characteristics of CPA and neglect across the five sexual identity groups. We found significant sexual identity group differences in being spanked/hit with a belt/object, being beat/punched/choked, in self-perceptions of CPA, and in having one’s basic needs neglected.
Self-Reported Prevalence and Characteristics of Childhood Physical Abuse (CPA) and Neglect Among Women of Five Sexual Identity Subgroups.
Note: Arabic superscripts indicate that the percentages with different superscripts by row are significantly different from one another.
p < .05. ***p < .001.
Post hoc results indicated that exclusively heterosexual and mostly heterosexual women were not statistically different on any of the CPA and neglect measures. Mostly lesbian and exclusively lesbian women were more likely to report being spanked/hit with a belt than were mostly heterosexual women (χ2 = 10.45, df = 1, p = .001; χ2 = 18.65, df = 1, p < .0001, respectively) and exclusively heterosexual women (χ2 = 13.93, df = 1, p = .0002; χ2 = 54.75, df = 1, p < .0001, respectively). Bisexual, mostly lesbian, and exclusively lesbian women were more likely than heterosexual women to report that they were beaten/choked/punched as children (bisexual: χ2 = 22.03, df = 1, p < .0001; mostly lesbian: χ2 = 16.36, df = 1, p < .0001; exclusively lesbian: χ2 = 23.92, df = 1, p < .0001) and were more likely than exclusively heterosexual women to report that their basic needs were neglected during childhood (bisexual: χ2 = 62.29, df = 1, p < .0001; mostly lesbian: χ2 = 12.16, df = 1, p = .0005; exclusively lesbian: χ2 = 49.18, df = 1, p < .0001). Bisexual women were more likely to report that their basic needs were neglected than were mostly heterosexual (χ2 = 8.55, df = 1, p = .003) and mostly lesbian (χ2 = 9.65, df = 1, p = .002) women. Bisexual, mostly lesbian, and exclusively lesbian women were also more likely to perceive being physically abused as children than were exclusively heterosexual women (bisexual: χ2 = 22.33, df = 1, p < .0001; mostly lesbian: χ2 = 20.46, df = 1, p = .0001; exclusively lesbian: χ2 = 44.02, df = 1, p < .0001).
Discussion
This article contributes to a small but growing literature on sexual identity disparities in violence and victimization. Consistent with previous studies, we found that exclusively heterosexual women were less likely than bisexual, mostly lesbian, and exclusively lesbian women to report CSA, CPA, and childhood neglect. Exclusively heterosexual women also reported less severe abuse experiences. There was, however, variability in abuse rates and characteristics across the sexual minority subgroups.
Exclusively lesbian and mostly lesbian women reported significantly higher rates of CSA and more severe experiences than did exclusively heterosexual women. CSA rates and severity for mostly heterosexual women generally fell between those of exclusively heterosexual women and the bisexual, mostly lesbian, and exclusively lesbian subgroups and did not differ significantly from either exclusively heterosexual women or from other sexual minority women. Bisexual women had higher rates of self-perceived CSA and report a greater number of perpetrators during their most distressing event compared to exclusively heterosexual women. Bisexual women also reported the highest overall CSA prevalence, longest duration, and highest rates of use of physical force, although these differences did not reach statistical significance. Based on the raw percentages, and considering the small sample size, low statistical power may account for some of the nonsignificant findings.
Exclusively lesbian, mostly lesbian, and bisexual women were also more likely to report CPA and to report more severe abuse and neglect than were exclusively heterosexual women. As with CSA, rates and characteristics of physical abuse and neglect did not differ significantly for mostly heterosexual and exclusively heterosexual women. Bisexual women’s reported experiences of CPA were more similar to those of exclusively lesbian and mostly lesbian women than on CSA variables, and bisexual women reported the highest rate of childhood neglect (36%) of all sexual identity groups.
Several explanations for sexual-orientation-related disparities, including those described earlier in this report, may illuminate sexual minority subgroup differences observed in the current study. For example, researchers have suggested that gender-atypical appearance and behaviors may contribute to higher rates of childhood abuse in sexual minorities (Balsam et al., 2005) and preliminary evidence supports this claim (D’Augelli et al., 2006; Lehavot, Molina, & Simoni, 2012). It is possible that among sexual minority subgroups, girls who later identify as exclusively or mostly lesbian are more likely to express gender atypicality than girls who later identify as bisexual or mostly heterosexual, partially explaining differences in childhood abuse rates. In support of this hypothesis, there is evidence to suggest that lesbian women are more likely to identify as “butch” or masculine than are bisexual women (Levitt & Bridges, 2007; Rosario, Schrimshaw, Hunter, & Levy-Warren, 2009).
Bisexual and mostly heterosexual self-identified youth appear to have different substance use trajectories than youth who identify as exclusively gay/lesbian or exclusively heterosexual (Marshal, Friedman, Stall, & Thompson, 2009). It is possible that these different substance use trajectories lead to different rates of victimization as youth, given greater exposure to risky situations and the possibility of parental punishment that can result from substance use.
Differences in sexual identity formation and development may also moderate abuse risk among sexual minority subgroups. D’Augelli (2003) found that lesbian and bisexual youth who self-identified earlier in life or disclosed their sexual identity to others earlier reported more lifetime sexual orientation-related victimization than those who self-identified later or disclosed their identities later, respectively. Although D’Augelli did not compare lesbian and bisexual women, women from different sexual identity subgroups are believed to have distinct sexual identity formation trajectories (Diamond, 2000; Rosario et al., 2009) that may confer differing levels of risk or protection relative to childhood abuse.
Future Research Directions
Variability of childhood abuse experiences across sexual orientation subgroups highlights the importance of research that examines subgroup differences. This article represents a valuable step in this direction. Additional research is needed that examines causal factors related to subgroup differences such as theory-driven prospective designs and, when prospective data are unavailable, retrospective cross-sectional studies designed to tease out the mechanisms underlying these explanations. Consistent with the growing emphasis on intersectionality of gender, sexual, and racial/ethnic identity (Balsam, Molina, Beadnell, Simoni, & Walters, 2011; Stirratt, Meyer, Ouellette, & Gara, 2008), future studies should also examine the intersection of racial/ethnic and sexual minority identities in childhood abuse outcomes. Balsam, Lehavot, Beadnell, and Circo (2010) found that African American and Latino/a LGB individuals were more at risk for childhood abuse than were Caucasian LGBs, suggesting that race/ethnicity may play an important role in the childhood abuse experiences of sexual minority women. Also, although we assessed subgroup differences in age of onset, distinguishing between abuse that occurred before and after age 8, we did not examine characteristics of abuse separately in childhood and adolescence, as other researchers have done (e.g., Austin, Jun et al., 2008). Given that abuse occurring at different developmental stages may have different implications for health and well-being (Crane & Duggan, 2009; McClellan et al., 1996; Schoedl et al., 2010), future research should examine outcomes separately by developmental stage whenever possible.
Study Limitations
Our study is limited by the relatively small numbers of bisexual and mostly heterosexual women in the sample. With greater power, we may have found more statistically significant differences, especially in comparisons with bisexual women. Small subgroup sizes also limited our ability to assess and compare demographic differences across the sexual identity groups. Women from different sexual identity groups had overall differences in demographic characteristics, and given the statistical analyses used, we were unable to control for this variability. Future studies are needed to examine the intersections of age, race/ethnicity, socioeconomic status, and place of residence with sexual identity on childhood abuse and neglect.
The study is also limited in its reliance on self-report data. It is possible that higher rates of childhood abuse and neglect among sexual minority women may be attributable, at least in part, to greater willingness to acknowledge and report this experience. In coming to terms with their sexual orientation, sexual minority women often spend considerable time reflecting on issues of identity and authenticity, and research suggests that the majority of sexual minority women, particularly lesbian women, have been in therapy or counseling (Cochran, Mays, & Sullivan, 2003; Hughes, Haas, Razzano, Cassidy, & Matthews, 2000), which could increase these women’s awareness of and comfort disclosing abuse. We attempted to address this issue by basing our measures of CSA and CPA on questions about childhood “experiences” as opposed to direct questions about “abuse,” but some limitations of self-reported childhood experiences remain.
Given that the majority of sexual minority women in this sample were recruited from the community, this study is subject to the inevitable limitations of “convenience” sampling. In particular, the sample may not be representative of the total population of sexual minority women, in that it likely excludes women who have not disclosed their minority sexual identity or who are not comfortable participating in a study of sexual minority women (Meyer & Wilson, 2009).
Finally, cross-sectional studies are inherently limited by their inability to determine the temporal order of study variables. Given that studies have documented substantial fluidity of sexual identity, attraction, and behavior among women (Diamond, 2000), this limitation is particularly salient in studies such as ours that attempt to examine and compare risks across sexual minority subgroups. While our results represent differences in childhood abuse of women who currently identify as “bisexual,” “mostly heterosexual,” and so forth, it is possible that these women’s sexual identities have and will continue to change.
Conclusion
Findings from this study provide new and important information about potential sexual identity subgroup differences in childhood abuse. Given the alarmingly high rates of CSA and CPA among women in general, and among sexual minority women in particular (Austin, Jun et al., 2008; Balsam et al., 2005; Corliss, Cochran, & Mays, 2002), as well as the long-term negative sequelae associated with these childhood experiences (Kendler et al., 2000; Zink et al., 2009), understanding which subgroups of women are at greatest risk is critically important. Such information can inform targeted prevention and intervention strategies aimed at reducing childhood abuse and assisting adult survivors of childhood abuse. In addition, it is important that we devote attention to protective factors and resilience. Although many sexual minority women have experienced childhood abuse and neglect, the majority appear to be coping well, which may be due in part to greater openness or willingness in seeking out therapy or counseling. Focusing on protective mechanisms can inform prevention and intervention strategies by highlighting effective coping strategies.
It is also important to consider the role that societal attitudes toward sexual minority individuals play in higher rates of childhood maltreatment. Primary prevention may include working to change homophobic and sexist responses to gender-atypical children. Widespread awareness of the potentially higher rates of childhood abuse and neglect among sexual minority girls and young women—and greater understanding of the reasons for these disparities—is the first step in this process.
Footnotes
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
This research was supported by National Institute on Alcohol Abuse and Alcoholism grants K01 AA00266 and R01 AA13328 (to Tonda L. Hughes) and R01 AA004610 (to Sharon C. Wilsnack). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute on Alcohol Abuse and Alcoholism or the National Institutes of Health.