Table 1.

Coping strategies employed by adult CSA victims: Summary of study characteristics and empirical findings.

Section 1: How Do Adult Abuse Victims Cope with Child Abuse Experiences?
Study	Size and Source of Study Sample	Definition of CSA			Measure of Coping	Major Findings Regarding Descriptions of Coping Strategies Utilized by Participants with a History of CSA
		Nature of Abusive Acts	Upper Age Limit	Age Difference Required
Bogar & Hulse-Killacky, 2006	10 female sexual abuse victims; recruited via referrals and fliers at three universities	Abused “during childhood by someone known to them	NR	NR	Qualitative interview transcribed and coded.	Determinants of resiliency were interpersonal skills, competence, high self-regard, spirituality, and helpful life circumstances. Processes that facilitated resiliency were coping strategies, refocusing and moving on, active healing, and achieving closure
Brand, Warner, & Alexander (1997)	101 female incest victims; newspaper ads	abuse “in childhood or adolescence” by family member or someone older living in the home	NR	NR	Interview adapted from Incest History Questionnaire	Most common coping strategies included: behavioral sublimation, avoidance of abuser, emotional expression, cognitive avoidance, dissociation, emotional suppression, verbal confrontation, rumination, withdrawal, addictive behaviors, and seeking social support.
DiLillo, Long & Russell (1994)	66 female college students; recruited from psychology department	“any sexual activity”	Under 13	5+ years; 10+ years if victim aged 13–16	Ways of Coping Checklist-Revised	Intrafamilial victims used more problem- and emotion-focused coping (wishful thinking, self-blame, and self-isolation) and a greater number of additional strategies that did not load on either factor compared to extramfamilial victims.
DiPalma (1994)	15 incest victims self-identified as “high-functioning”; snowball technique	self-id of “sexual abuse by a family member during childhood or adolescence”	NR	NR	Two semi-structured interviews, coping categorized as data was collected.	Childhood coping included: attempts to stop abuse, avoidance, psychological escape, and compensation. Adult coping included: breaking away and creating own dreams, cognitive coping, self-discovery, and revisiting the past.
Futa, Nash, Hansen, & Garbin (2003)	196 female undergraduates with a history of CPA, CSA, both, or no abuse	any experience on the Childhood Experiences Form (e.g., shown sexually explicit material to vaginal intercourse)	Under 14	4+ years	Ways of Coping Checklist-Revised	All groups used distancing and self-blame. CSA group used more self-isolation than CPA and the no abuse groups. CSA group low in social support seeking, tension reduction, problem-focused coping, and wishful thinking coping.
Himelein & McElrath (1996)	Study 1: 180 female college students; Study 2: 20 of Study 1 CSA victims (put in high- vs. low-adjustment groups	“contact sexual experiences” (fondling, attempted intercourse, intercourse	Under 15	5+ years	Study 1: Mastery Scale, The Optimism Scale Study 2: semi-structured interview	Study 1: Greater perceptions of internal control and higher unrealistic optimism predicted better adjustment. Study 2: Four long-term coping strategies used by resilient CSA victims: disclosure, minimization, positively reframing the abuse, and refusing to dwell on the past.
Leitenberg Gibson & Novy (2004)	828 female undergraduates experiencing 0–3+ types of abuse or adverse events	“any sexual activity involving genital contact”; physical contact required	Under 16	5+ years or use of physical force	Coping Strategies Inventory	When coping with current stressor, disengagement (problem- and emotion-focused) but not engagement strategies positively correlated with number of abuse experiences.
Morrow & Smith (1995)	11 females recruited from therapists working with CSA victims	self-id as ‘abuse victim’; “varied from a single incident …to …ongoing sadistic abuse”	NR	NR	Qualitative interview transcribed and coded. 7 participants involved in focus groups on coping.	Two strategies identified: (1) keeping from being overwhelmed by threatening feelings (e.g., reducing intensity, avoidance, release) and (2) managing helplessness, powerlessness, and lack of control (e.g., reframing, mastery, control other areas of life, rejecting power).
Perrott, Morris, Martin, & Romans (1998)	40 females; “randomly selected from electoral rolls” in New Zealand	“any unwanted sexual experience” ranging from nongenital contact to intercourse	Under 16	“someone older or bigger”	Qualitative interview involving open-ended questions, which were transcribed and coded.	Identified six coping styles: deliberately suppressing, reframing, working through abuse, seeking support, talking about abuse, and coping on own. Reframing related to father/stepfather perpetrator and intercourse; avoidance or suppression related to attempted intercourse/intercourse; self-blame to chronic abuse or earlier age of onset.
Romans, Martin & Morris (1999)	173 female CSA victims & 178 controls; recruited from Otago Women’s Health Survey study	“any unwanted sexual experience”	Under 16	“someone older or bigger”	Defense Style Questionnaire, which assesses psychological coping strategies	CSA victims demonstrated increased use of following defenses: autistic fantasy, displacement, projection, passive aggressiveness, and acting out compared to nonvictims.
Section 2: How Do Coping Strategies Relate to Long-term Outcomes of Abuse?
Bonanno, Noil, Putnam, O’Neill, & Trickett (2003)	103 females (48 CSA victims, 55 nonabused) aged 11–25 who were part of an ongoing longitudinal study of effects of CSA	“abuse involved genital contact and/or penetration; and perpetrator was a family member…”	NR	NR	Repression: Taylor Manifest Anxiety Scale & Marlow-Crowne Social Desirability Scale; affective-autonomic response discrepancy. Dissociation: adolescent version of Dissociative Experiences Scale	Nondisclosers of CSA tended to score as “repressors,” while CSA disclosers reported greater dissociative scores. Repressive coping positively correlated with both positive and negative facial expressions; dissociative coping inversely correlated with emotional expression. Dissociation positively associated with PTSD, internalizing, and externalizing symptoms, whereas repression negatively correlated with internalizing and externalizing symptoms.
Brand & Alexander (2003)	101 female incest victims; recruited via newspaper ads.	“abuse in childhood or adolescence by a family member or” older coresiding individual	NR	NR	Ways of Coping Checklist	Emotion-focused coping used more than problem-focused. Avoidance and seeking social support positively associated with adult dysfunction, whereas distancing associated with less dysfunction (after controlling for abuse characteristics).
Coffey et al., (1996)	666 females; randomly selected and sent questionnaires	“any sexual activity involving physical contact”	Under 16	5+ years or use of physical force	Coping Strategies Inventory	CSA victims reported greater use of disengagement coping and demonstrated greater psychological distress compared to controls. Disengagement related to Increased duration and level of sexual activity and accounted for unique variance in current psychological distress.
Filipas & Ullman (2006)	577 female students recruited from introductory psychology/ criminal justice courses 166 CSA; 411 non-CSA	Sexual contact occurring prior to age 14 with a perpetrator at least 5 years older	Under 14	5+ years	Questionnaire designed to assess cognitive and behavioral coping	Increase CSA severity associated with more self- blame, maladaptive coping (withdrawing from people, acting out sexually, using alcohol or drugs, acting out aggressively), and PTSD symptoms. Maladaptive coping predicted PTSD and revictimization.
Griffing et al. (2006)	219 female domestic violence victims; 40% reported CSA	Positive response to items on Childhood Trauma Questionnaire	NR	NR	Coping Strategies Inventory-Short From	CSA associated with increased use of disengagement strategies (wishful thinking, self-criticism, social withdrawal) when compared to non-CSA. Disengaged coping associated with depression and low self-esteem.
Huang, Zhang, Momartin, Huang, & Zhao, 2008	471 female Chinese inmates		NR	NR	Trait Coping Style Questionnaire	CSA and negative coping both predicted PTSD severity after controlling for personality characteristics
Johnson & Kenkel (1991)	45 female incest victims, recruited from treatment settings, ages 13–18	not specified; “female incest victims…currently in treatment”	NR	NR	Ways of Coping Checklist (wording modified for age appropriateness)	Wishful thinking most significant coping predictor of global distress. Tension-reduction and distancing related to increased distress; seeking social support related to increased therapist-rated psychopathology.
Johnson, Sheahan, & Chard (2003)	86 females “seeking…therapy for symptoms related to…sexual abuse.	“unwanted or forced sexual contact (i.e., fondling, oral sex and/or intercourse)”	Under 13	5+ years or 10+ if victim aged 13–16	Coping Strategies Inventory	Approach positively correlated with passive aggressive and histrionic personality disorder (PD); avoidance positively correlated with PTSD severity and avoidant, dependent, borderline, paranoid, schizotypal and schizoid PD as well as CSA victims diagnosed with PTSD.
Klein & Janoff-Bulman (1996)	23 male and female undergraduates reporting physical, emotional, or sexual abuse; 23 controls.	self-reported physical or sexual abuse described as “extremely traumatic”	NR	NR	Personal narrative and Constructive Thinking Inventory	Avoiding dwelling on abuse and overgeneralizing associated with lower psychological distress. Abuse group reported increased psychological distress, though no differences in coping abilities. Use of “other” pronouns in narratives positively related to adaptive coping strategies.
Leitenberg, Greenwald, & Cado (1992)	54 female nurses in New England responding to mailed questionnaires.	“any sexual experience”	Under 15	5+ years, minimum age 16	Questionnaire designed for study, with items pertinent to CSA.	Emotional suppression and denial most common coping methods. Denial, emotional suppression, cognitive rumination, and avoidance associated with greater psychological distress, after controlling for abuse characteristics.
Murthi & Espelage (2005)	116 college women reporting child sexual abuse	Contact sexual experiences occurring before age 12 with someone older than 16 or with family member	Under 12	Perpetrator older than 16	Ways of Coping Questionnaire	Social support from family and friends was found to moderate associations between CSA and personal sense of loss associated with alexithymia and depression.
Oaksford & Frude (2003)	Phase II: 11 female undergraduates in the UK; Phase III: same 11 CSA victims	“broad definition…that included peer abuse, but excluded experiences of mutual sexual exploration…”	NR	NR	Phase II: Ways of Coping Checklist-Revised; Phase III: semi-structured interview	Wider range of coping, problem-focused coping and self-blame related to poorer adjustment. Immediate strategies: psychological escapes, support, action-oriented, and cognitive appraisal. Long-term strategies: same as immediate, with addition of positive reframing.
Sigmon, Greene, Rohan, & Nichols (1996)	19 male and 58 female CSA victims recruited form local and national support groups		NR	NR		Avoidance coping most commonly used strategy among CSA victims; avoidance coping related to increased anxiety, depression, and posttraumatic symptoms. Women endorsed greater use of emotion-focused coping whereas men endorsed greater acceptance.
Silver, Boon, & Stones (1983)	77 female incest victims; recruited using newspapers, posters, announcements	“explicit sexual contact between a female child and father or other adult male serving in father role”	NR	NR	Self-assessment of resolution of feelings; search for meaning (2 open-ended questions)	Finding meaning associated with less distress, and increased social adjustment, self-esteem, and resolution of abusive experiences. Continued search for meaning associated with increased distress, impairment in social functioning, and lower self-esteem and resolution of abuse experiences.
Ullman & Filipas (2005)	733 male and female students recruited from introductory psychology/ criminal justice courses; 167 CSA; 566 non-CSA	Sexual contact occurring prior to age 14 with a perpetrator at least 5 years older	Under 14	5+ years	Questionnaire designed to assess cognitive and behavioral coping	Women who delayed disclosure had greater PTD severity than those who disclosed sooner; for men, this relationship was non-significant. Among male and female abuse victims, maladaptive coping predicted increased PTSD after controlling for abuse characteristics.
Ullman, Townsend, Filipas, & Starzynski (2007)	636 community women	Unwanted sexual experiences prior to age 18 (distinguished between CSA and ASA)	Under 18	NR	Brief COPE	Using SEM, negative social reactions of others and avoidant coping are strongest predictors of PTSD
Walsh, Blaustein, Grant Knight, Spinazzola, & can der Kolk (2007)	73 undergraduate females recruited through flyers and internet postings	Sexual abuse as indicated by the Childhood Trauma Questionnaire	Under 16	NR	Ways of Coping-Revised	Positive coping strategies (summary of problem-focused coping, seeking social support, and focusing on positive) associated with decreased likelihood of experiencing adult sexual coercion
Wright, Crawford, & Sebastian (2007)	60 mothers with sexual abuse histories recruited through flyers, newspapers, and internet postings	Adult mothers who had experienced childhood sexual abuse	NR	NR	Coping Strategy Indicator; open-ended questions about resolution of CSA, benefits of coping, and meaning derived from abuse	Avoidant coping associated with more depressive symptoms; women who reported that abuse was unresolved were more likely to use avoidant coping; finding meaning in the experience was associated with less social isolation and better adjustment
Section 3: Do Coping Strategies Mediate Relations Between CSA and Adult Adjustment?
Draucker (1995)	149 females; questionnaires sent to clinicians	not specified; women attending “sexual abuse groups” in 18 major metropolitan areas	NR	NR	The Cognitive Adaptation Scale	Stigmatization and powerlessness directly related to meaning and indirectly related to guilt and social introversion. Finding meaning and sense of mastery related to less guilt and isolation in adulthood. Mastery related to decreased interpersonal victimization.
Fortier et al., (2009)	99 female undergraduates with a history of CSA	sexual touching,kissing, or oral, anal, or vaginal intercourse with an individual 5 or more years older before age of 14, or with someone 10 or more years older if victim was 14 to 17 years, or any of the aforementioned activities experienced against their will, regardless of the difference in age or relationship to the perpetrator	17 or under	5+ years if victim was 14 or younger, 10+ years if victim was 14–17 years old, no age	Coping Strategies Inventory difference if experiences were against will of victim	Avoidant coping mediated relationship between CSA and traumatic distress, which in turn, was associated with sexual revictimization in adulthood. Specifically, severity of CSA predicted use of avoidant coping strategies, which in turn predicted traumatic distress in adulthood. Increased traumatic distress was associated with increased risk for coercive sexual revictimization.
Frazier et al., (2004)	88–98 females; presenting at an ER for sexual assault	“any sexual activity they did not want to happen”	Under 12	NR	Coping Strategies Inventory; Religious Coping Scale	Positive life changes associated with use of approach coping and sense of control over recovery. Social support positively related to approach coping, control over recovery, precautions against future assault, and decreases in avoidant coping.
Gibson & Leitenberg (2001)	106 female undergraduates, experienced adult sexual assault within past year	CSA: “sexual experiences” with physical contact; Adolescent sexual abuse (ASA): “sexual victimization”	CSA: Under 12; ASA: 14–17	CSA/ASA: 5+ years or forced sexual activity	Coping Strategies Inventory	Disengagement related to increased psychological distress and PTSD symptoms. History of CSA related to disengagement and feelings of stigma and powerlessness in response to adult sexual assault. Stigma found to mediate relationship between history of CSA and use of disengagement.
Guezlow, Cornett, & Dougherty (2002)	144 female undergraduates (44 CSA, 144 nonvictims)	sexual contact; “anything ranging from playing ‘doctor’ to sexual intercourse”	Under 16	5+ years or no consent, use of force or coercion	Coping Inventory for Stressful Situations	CSA indirectly related to global self-worth through paternal support. For CSA victims, paternal support indirectly related to global self- worth through its effects on emotion-focused coping.
Merrill, Guimond, Thomsen, & Milner (2003)	547 female U.S. navy recruits	“any sexual contact…with a family member or with a nonfamily member”	Under 14	5+ years	How I Deal With Things Scale	Positive relationship between CSA severity and avoidant and self-destructive coping. Self- destructive coping related to dysfunctional sexual behavior and increased number of sex partners, and avoidance associated with increased sexual concerns and decreased numbers of sex partners
Merrill, Thomsen, Sinclair, Gold, & Milner (2001)	4,098 female U.S. Navy recruits, 28% (N=1,134) experienced CSA.	sexual kissing/ touching; made to touch sexual parts; oral, anal, or vaginal intercourse, anal or vaginal penetration	Under 14	5+ years	How I Deal With Things Scale	Self-destructive and avoidance coping positively related to psychological symptoms. Constructive coping negatively associated with symptomatology. Negative coping mediated relationship between abuse severity and adjustment.
Runtz & Schallow (1997)	191 female and 110 male undergraduate, reporting physical or sexual abuse	“sexual contact” involving lack of consent (determined by age, power, victim view as abusive or negative)	Under 15 or lack of consent	5+ years older or 10+ years if between 15- 18	Coping: How I deal with Things	Expressing emotion and actively seeking change associated with positive psychological functioning. Self-destructive and avoidance coping associated with impaired psychosocial functioning. Mediating effects of social support only supported for CPA.
Steel, Sanna, Hammond, Whipple, & Cross (2004)	285 males and females recruited from non- patient (college), psychiatric outpatient, and psychiatric inpatient settings	“unwanted or forced sexual contact during childhood or adolescence”	Under 18	NR	Ways of Coping Questionnaire, Attributional Style Questionnaire	The coping strategies of accepting responsibility and confrontive coping mediated relationships between specific abuse characteristics (i.e., relationship to perpetrator, force, age of onset, and frequency of abuse) and psychological distress.
Wyatt & Newcomb (1990)	111 females, contacted by random-digit dialing of telephones.	“sexual body contact,” including fondling and attempted or completed vaginal or oral intercourse	Under 18	5+ years or contact not desired or involving coercion	Immediate negative responses to abuse and internal attributions	Coping strategies of immediate negative responses and internal attributions fully explained the impact of abuse characteristics (e.g., age of last abuse, duration, and psychological coercion) on long-term negative outcomes.