A process model for understanding adaptation to sexual abuse: the role of shame in defining stigmatization.

While sexual abuse in childhood places the individual at-risk for a variety of problems, research indicates wide variation in victims' adjustment. Limited work is available that attempts to systematically explain processes by which children adjust to the trauma. Few studies have been undertaken to examine any theory about what causes children to be symptomatic. This article presents a theoretical and testable model that specifies psychological processes related to the traumagenic dynamics of stigmatization in child and adolescent victims of sexual abuse. The model proposes that sexual abuse leads to shame through the mediation of cognitive attributions about the abuse and shame, in turn, leads to poor adjustment. Three factors, social support, gender, and developmental period are hypothesized to moderate the proposed stigmatization process. Developmental and clinical research supporting the model is reviewed, specific hypotheses are made, and the relevance of developmental psychopathology for future theory and research is discussed. Unless future research elucidates the process and circumstances whereby the experience of sexual abuse leads to poor adjustment, little progress will be made toward developing more effective treatments.