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