Date violence and date rape among adolescents: associations with disordered eating behaviors and psychological health

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Abstract

Objectives: The goal of the study was to assess the prevalence of date violence and rape in adolescents, to examine associations between date violence and rape and disordered eating behaviors and psychopathology, and to determine if these associations remain significant after controlling for sociodemographic characteristics and other physical and sexual abuse by an adult.

Method: A Minnesota school-based sample of 81,247 boys and girls in 9th and 12th grades completed the 1998 Minnesota Student Survey.

Results: Overall, approximately 9% of girls and 6% of boys had experienced date violence or rape. Significant differences across race and grade were found. Date violence and rape is associated with higher rates of disordered eating behaviors and suicidal thoughts and attempts, and lower scores on measures of emotional well-being and self-esteem. Over 50% of youth reporting both date violence and rape also reported attempting suicide. Controlling for race and age, adolescents who have experienced both date violence and rape were more likely to use laxatives (OR: girls = 5.76; boys = 28.22), vomit (OR: girls = 4.74; boys = 21.46), use diet pills (OR: girls = 5.08; boys = 16.33), binge eat (OR: girls = 2.15; boys = 5.80), and have suicidal thoughts or attempts (OR: girls = 5.78; boys = 6.66) than their nonabused peers. These odds were weakened but remained significant after controlling for other abuse by an adult. Furthermore, a greater percentage of girls and boys who reported an abusive dating experience also reported repeat victimization (physical or sexual abuse perpetrated by an adult) when compared to their peers without an abusive dating experience.

Discussion: Abusive experiences during dating relationships may disrupt normal developmental processes, including the development of a stable self-concept and integrated body image during adolescence. This disruption manifests itself through thoughts, feelings, and behaviors. Further research should explore effects of adverse adolescent dating experiences.

Résumé

Objectifs: Evaluer la prévalence de la violence et du viol lors de sorties entre adolescents; examiner les associations entre la violence et le viol, les comportements alimentaires perturbés et la psychopathologie; déterminer si ces associations restent significatives après avoir contrôlé les caractéristiques sociodémographiques ainsi que la présence d’autres sévices physiques et sexuels exercés par un adulte.

Méthode: Un échantillon de 81,247 garçons et filles fréquentant des écoles du Minnesota en 9ième et 12ième année a rempli l’enquête 1998 sur les étudiants du Minnesota.

Résultats: Dans l’ensemble, 9% des filles et 6% des garçons ont connu l’expérience de la violence et du viol lors de sorties. On a trouvé des différences significatives au niveau de la race et du niveau scolaire. La violence et le viol pendant les sorties sont associés avec des taux plus élevés de comportements alimentaires perturbés ainsi que d’idées et de tentatives de suicide et avec des scores plus bas dans les mesures concernant le bien-être émotionnel et l’estime de soi. Au delà de 50% de jeunes qui ont mentionné à la fois violence et viol lors de sorties ont aussi mentionné avoir tenté de se suicider. En contrôlant la race et l’âge on voit que les adolescents qui ont connu à la fois l’expérience de la violence et du viol semblent plus que leurs pairs non-abusés, susceptibles d’utiliser des laxatifs (OR: filles = 5.76; garçons = 28.22), de vomir (OR: filles = 4.74; garçons = 21.46), d’utiliser des pilules de régime (OR: filles = 5.08; garçons = 16.33), d’être boulimiques (OR filles = 2.15; garçons = 5.80), et d’avoir des idées de suicide et/ou de faire des tentatives de suicide (OR: filles = 5.78; garçons = 6.66). Ces nombres ont été abaissés, mais sont restés significatifs après avoir contrôlé l’existence d’autres abus par un adulte. De plus, un plus grand pourcentage de filles et de garçons qui ont signalé avoir subi des abus lors de sorties ont aussi signalé une victimisation répétée (physique et/ou sexuelle avec un agresseur adulte) comparativement avec leurs pairs qui n’avaient pas eu l’expérience d’abus lors de sorties.

Discussion: Les expériences d’abus dans les relations lors de sorties peuvent perturber le processus d’un développement normal, ce qui inclut l’évolution d’une conscience de soi stable et d’une image du corps bien intégrée durant l’adolescence. Cette perturbation se manifeste dans des pensées, des sensations et des comportements. Des recherches ultérieures devraient explorer les effets d’expériences défavorables lors des sorties entre adolescents.

Resumen

Objetivos: Evaluar la prevalencia de violencia de pareja y violaciones entre adolescentes. Examinar las posibles asociaciones entre violencia de pareja y violación con trastornos de la conducta alimenticia y psicopatologı́a. Determinar si estas asociaciones permanecen significativas después de controlar las caracterı́sticas sociodemográficas y la ocurrencia de tipos de maltrato fı́sico o sexual por un adulto.

Método: Una muestra de 81.247 chicos y chicas de una escuela de Minnesota que acudı́an a clases de noveno a duodécimo grado completaron la Encuesta de Estudiantes de Minnesota 1998.

Resultados: En total aproximadamente un 9% de las chicas y un 6% de los chicos han experimentado violencia de pareja y/o violación. Se observaron diferencias significativas en cuanto a edad y raza. La violencia de pareja y la violación están asociadas con tasas más elevadas de trastornos de la alimentación, pensamientos e intentos de suicidio y puntuaciones más bajas en medidas de bienestar emocional y autoestima. Más del 50% de jóvenes que notifican violencia de pareja o violación también notificaron intentos de suicidio. Después de controlar la raza y la edad, se observa que los adolescentes que han experimentado violencia de pareja y violación tenı́an más tendencia que sus compañeros no maltratados a utilizar laxantes (odds ratio: chicas = 5.76; chicos = 28.22), tener vómitos (OR: chicas = 4.74; chicos = 21.46), conductas bulı́micas (OR: chicas = 2.15; chicos = 5.80), utilizar pastillas para adelgazar (OR: chicas = 5.08; chicos = 16.33), y a tener pensamientos y/o intentos de suicidio (OR: chicas = 5.78; chicos = 6.66). Los resultados permanecen significativos después de controlar otros tipos de maltrato por parte de adultos. Además, en comparación con los adolescentes sin experiencias de violencia de pareja, un mayor porcentaje de chicas y chicos que notifican violencia de pareja también notifican abuso sexual o fı́sico perpetrado por un adulto.

Discusión: Las experiencias de maltrato durante las relaciones de pareja entre adolescentes pueden alterar procesos normales del desarrollo, incluyendo el desarrollo durante la adolescencia de un autoconcepto estable y una imagen del cuerpo integrada. Estas alteraciones se manifiestan en los pensamientos, sentimientos y conductas. Investigaciones futuras deben explorar los efectos de las experiencias adversas de relación de pareja entre adolescentes.

Introduction

While studies focusing on abuse perpetrated by adults have made significant contributions to our understanding of adolescent mental health, there is a dearth of research addressing the experiences of both girls and boys regarding peer-related offenses such as date violence and rape. It is unclear if all abuse experiences (physical and sexual, perpetrated by adults or peers) manifest in problems, or if specific abuse experiences place individuals at increased risk for a wealth of psychological complications. Date-related abuse experiences may be an overlooked form of child abuse since they may not typically be queried in screenings for sexual and physical abuse. As the rates of date-related physical violence and sexual assault may be as high as 39% in adolescents Bergman 1992, DeKeseredy and Schwartz 1994, Foshee 1996, O’Keefe et al 1986, Reuterman and Burcky 1989, Roscoe and Callahan 1985, Silverman et al 2001, it is very important to understand the prevalence and comorbid psychopathology to these abusive experiences, singly and in the context of repeat victimization.

Prevalence rates of childhood sexual abuse (CSA) are estimated to be approximately 27% for females and 16% for males in the US (Finkelhor, Hotaling, Lewis, & Smith, 1990). These experiences are usually defined as an unwelcome sexual experience committed by an adult to a child or minor. Peer-to-peer violence experiences are typically reported separately in prevalence estimates. Estimates of physical violence on dates in adolescents range from 7% to 39% Bergman 1992, DeKeseredy and Schwartz 1994, Foshee 1996, O’Keefe et al 1986, Reuterman and Burcky 1989, Roscoe and Callahan 1985, and of sexual assault or rape on a date range from 3% to 23% for girls and 2% to 4% for boys Bergman 1992, Canterbury et al 1993, Davis et al 1993, DeKeseredy and Schwartz 1994, Vicary et al 1995. By including date-related physical and sexual violence in definitions of abusive experiences, researchers and clinicians can broaden their understanding and better address the psychological problems that may be associated with abuse.

Adolescence is a time of multiple developmental challenges surrounding normative body changes, psychological and emotional expression, and social milestones such as dating. The incorporation of these changes is important toward the development of a stable self-concept. However, traumatic events exacerbate the difficulty of these developmental challenges and can lead to impairments in behaviors, thoughts, and feelings (Wekerle & Wolfe, 1999). While there is a wealth of literature addressing traumatic events such as childhood abuse as perpetrated by an adult, little is known about peer-related violent events. It is likely that any disruption to an individual’s self-concept, their trust within a relationship, and their sense of power and control over what happens to their body will lead to ill effects.

The relation between CSA and psychological problems among children and adolescents has been well documented Beitchman et al 1992, Kendall-Tackett et al 1993, Watkins and Bentovim 1992. Significant associations have been found between CSA and depression Beitchman et al 1992, Kendall-Tackett et al 1993, Levitan et al 1998, Moyer et al 1997, disordered eating behaviors Ackard et al 2001, Chandy et al 1996, French et al 1995, Moyer et al 1997, Perkins and Luster 1999, self-esteem Kendall-Tackett et al 1993, Moyer et al 1997, and suicidality Beitchman et al 1992, Chandy et al 1996, Kendall-Tackett et al 1993. Furthermore, several studies have addressed the association between physical abuse and psychological problems in adolescents, and have found evidence for an association between physical abuse and depressed mood (Levitan et al., 1998) and disordered eating behaviors Ackard et al 2001, Neumark-Sztainer et al 2000, Perkins and Luster 1999. However, the associations between date violence and rape and psychological problems are less clear.

Only a few large population-based studies have examined associations between abuse in dating relationships and psychological problems. In a study by Coker and colleagues (2000), 5414 high school students in South Carolina were asked to complete the Youth Risk Behavior Survey, in which date violence was assessed with the following question: “Being physically beaten up (like hitting, kicking, or throwing someone down) can sometimes happen with a person you are dating or going out with. During the last 12 months, how many times were you physically beaten up by the person you date or go out with?” Approximately 9% of females and 5% of males reported being the victim of violence on a date. Experiencing date violence was associated with poorer quality of life, overall dissatisfaction with life and with friends, and suicidal ideation and attempts for adolescent females. For adolescent males, date violence was associated with dissatisfaction with life, poor perceived physical health, and suicidal ideation.

Thompson, Wonderlich, Crosby, and Mitchell (2001) also used the Youth Risk Behavior Survey to collect data on 2629 high school females attending public schools in North Dakota. Date violence was assessed by asking, “Have you ever had a dating situation become violent with hitting or force used?” Approximately 14% of girls in the study reported violence on a date. Females who reported a violent dating situation were three times as likely to engage in purging behavior, and nearly two times as likely to use diet pills for weight control than females who did not report a violent dating experience. Unfortunately, high school boys were omitted from this study.

The Youth Risk Behavior Survey was also administered in Massachusetts in 1997 and 1999 to girls in 9th through 12th grades. Silverman and colleagues (2001) found that approximately 20% of girls reported an abusive dating experience, and that date violence and rape was associated with increased risk of substance use (4–5 times greater than girls not abused), unhealthy weight control behaviors (3–4 times greater), sexual risk behaviors (2–8 times greater), and suicidality (7–9 times greater). Once again, boys were not included in the analyses.

Although it is important to assess the prevalence of and factors associated with date-related physical and sexual abuse, there is also the question of whether violence in dating relationships is an indicator of repeat victimization Boney-McCoy and Finkelhor 1995, Wolfe et al 1998. Studies examining multiple abuse experiences among adolescents have estimated that 4.9% of girls and 2.5% of boys reported a history of both physical and sexual abuse (Ackard et al., 2001), and that the cumulative effect of multiple abuse experiences has been found to be associated with higher rates of psychopathology Ackard et al 2001, Boney-McCoy and Finkelhor 1995.

The current study expands upon the limited body of research in this area by using a larger sample that allows us to stratify results by gender, and a survey that assesses date violence, rape, and repeated victimization (other abuse experiences), and seeks to answer three questions: What is the prevalence of date-related violence and rape among adolescent boys and girls? What is the association between date violence and date rape and disordered eating behaviors, self-esteem, emotional well-being, and suicide? Are these associations weakened when age, race, and other abuse experiences (both physical and sexual as perpetrated by an adult) are taken into account?

Section snippets

Study population and design

Participants in this study included a statewide sample of 81,247 students (40,301 boys and 40,946 girls) in 9th and 12th grades in Minnesota. They completed the 1998 Minnesota Student Survey, a survey administered by the Minnesota Department of Children, Families, and Learning to all 6th, 9th, and 12th grade students in Minnesota public schools. As date violence and rape questions were asked only of 9th and 12th grade students, 6th graders were omitted from the current study. Most of the

Results

Overall, 91.4% of girls and 94% of boys reported no date violence or rape experiences. However, 4.2% (n = 1718) of girls and 2.6% (n = 1048) of boys reported violence on a date, 1.4% (n = 589) of girls and 1.2% (n = 471) of boys reported rape on a date, and 3% (n = 1216) of girls and 2.2% (n = 882) of boys reported both date violence and date rape.

Discussion

In the current study, nearly 9% of girls and 6% of boys reported some type of abusive date-related experience. Consistent with other studies that have found higher rates of disordered eating behaviors and other psychological distress among adolescents who have been either sexually abused Chandy et al 1996, French et al 1995, Levitan et al 1998, Moyer et al 1997, Neumark-Sztainer et al 2000 or physically abused Ackard et al 2001, Levitan et al 1998, Neumark-Sztainer et al 2000 by adults, or

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