Pergamon

Child Abuse& Neglect,Vol. 19, No. 2, pp. 177-189, 1995

Copyright 1995Elsevier ScienceLtd
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COMPARATIVE P S Y C H O P A T H O L O G Y OF WOMEN
WHO EXPERIENCED INTRA-FAMILIAL VERSUS
EXTRA-FAMILIAL SEXUAL ABUSE
THERESE G R E G O R Y - B I L L S
Department of Educational Psychology, University of Houston, Houston, TX, USA
M E L A N I E RHODEBACK
Rhodeback and Associates, Friendswood, TX, USA

Abstract--The Diagnostic Inventory of Personality and Symptoms (DIPS) was used to assess psychopathology in a
clinical sample of 30 women with histories of intra-familial sexual victimization, 22 women with histories of extrafamilial sexual victimization, and 30 women with no victimization experiences. The present study examines whether
the relative/nonrelative issue is significant to the impact of sexual victimization experiences. A clinical comparison
of two point code types indicated that both sexually abused groups could be characterized as suffering an Affective
Depressed-Dissociative Disorder. However, profile shapes produced for the intra- and extra-familial abused groups
differed. A discriminant function developed via step wise selection procedures incorporated 12 of the 14 scales,
correctly classifying 94% of the individuals (49 of 52) as members of the extra or intra-familial groups. Profile
analyses, discriminant analyses, clinically descriptive comparisons, and post hoc analyses of individual scales all
revealed that psychopathology is much more evident in those who have experienced sexual abuse. Methodological
considerations are highlighted and implications for treatment and research are addressed.
Key Words--Incest, Sexual abuse, Psychopathology, Dissociation.
INTRODUC~ON
M A N Y R E C E N T S T U D I E S have investigated the persistent, negative impact of childhood
and adolescent sexual victimization on later adult psychological functioning and adjustment
(Briere, 1992; Ellenson, 1986; Gelinas, 1983; Gorcey, Santiago, & McCall-Perez, 1986; Hays,
1985; Herman, Russell, & Trocki, 1986; Westerland, 1992). These investigations have assumed
five basic forms: (a) Qualitative descriptive and interpretive reports of clinical observations
(Brooks, 1985; Ellenson, 1986; Gelinas, 1983; O'Brien, 1987; Sloan & Leichner, 1986; Summit & Kryso, 1978); (b) Quantitative investigations o f psychopathology using instruments
such as the M M P I (Meiselman, 1980; Scott & Thoner, 1986; Tsai, Feldman-Summers, &
Edgar, 1979); (c) Comparative research among victims of sexual abuse and nonvictimized,
maladjusted samples (Brooks, 1985; Gorcey et al., 1986; Meiselman, 1980; Scott & Thoner,
1986; Tsai et al., 1979; Winterstein, 1982); (d) Comparisons of psychological functioning and
adjustment among w o m e n who experienced sexual abuse in clinical versus nonclinical samples
(Herman, Russell, & Trocki, 1986; Tsai et al., 1979); and (e) Research on the various circumstances associated with the experience of sexual abuse (Courtois & Watts, 1982; Sloane &
Received for publication December 6, 1989; final revision received November 5, 1993; accepted November 20, 1993.
Requests for reprints should be addressed to Therese Gregory-Bills, Ph.D., 8923 Hickory Hill Avenue, Lanham, MD
20706.
177

178

T. Gregory-Billsand M. Rhodeback

Karpinski, 1942; Tsai et al., 1979). Several scholars have addressed the initial consequences
of incest and sexual abuse (Adams-Tucker, 1982; Anderson, Bach, & Griffith, 1981; Brooks,
1985; DeFrancis, 1969; Friedrich, Urquiza, & Beilke, 1986). Others have addressed the long
term consequences (Browne & Finkelhor, 1986; Courtois, 1979; Ellenson, 1986; Gelinas, 1983;
Gorcey et al., 1986; Tsai & Wagner, 1978).
The empirical literature is quite consistent in demonstrating the negative impact of sexual
molestation on emotional functioning and adjustment (Adams-Tucker, 1982; Herman et al.,
1986; Scott & Thoner, 1986). However, as portrayed in the literature review of Browne and
Finkelhor (1986) attempts to describe variations in impact as a derivative of circumstances
have led to inconsistencies. LaBarbera, Martin, and Dozier (1980), Henderson, (1983), Pelletier
and Handy (1986), and Emslie and Rosenfeld (1983) are among those clinicians who suggest
that inconsistent findings may be attributed to an exclusive research focus on the sexual
component of the abuse as the factor responsible for the psychological damage. The familial
circumstances are frequently neglected and in many studies, the source of victimization itself
(e.g., family member or nonrelative/stranger) is not distinguished. Children and adolescents
may have experienced sexual abuse perpetrated by family members (intra-familial abuse) or
by individuals external to the family (extra-familial abuse). This key experiential difference
may be manifest in distinguishable psychological impairment and functional adjustment.
Studies by Finkelhor (1979, 1984) and Gruber and Jones (1983) comprise the relatively
limited efforts aimed at describing the family characteristics associated with extra-familial
abuse. According to their research efforts, marital conflicts, disruptions of the family unit,
poor maternal relations, and the absence of a parent were characteristics strongly related to
extra-familial child abuse. The absence of the mother was a particularly important risk factor.
Family characteristics associated with intra-familial sexual abuse (incest) have been studied
much more extensively than those associated with extra-familial sexual abuse (Emslie &
Rosenfeld, 1983; Forward & Buck, 1978; Goodwin, Cormier, & Owen, 1983; Pelletier &
Handy, 1986; Sgroi, 1982; Stern & Meyer, 1980). These families are characterized by social
isolation, secrecy, and blurred generational and role boundaries. Children growing up in these
types of families are frequently witness to female powerlessness and male dominance and
control. The children often take on parenting roles resulting in problems with their own
emotional and social development.
Potential differences in the nature and extent to which extra- or intra-familial abuse may
impact later psychological functioning and adjustment are deducible from the literature. For
example, the intra-familial impact of betrayal of trust and the pathological family relational
dynamics associated with intra-familial abuse have not been characteristically related to victims
of extra-familial abuse. Conversely, consequences of greater fear (Browne & Finkelhor, 1986)
and more severe trauma (Brothers, 1982) have been reported when the perpetrator is a stranger
or is less well-known to the victim. There is no intent to suggest that one form of abuse is
more harmful than another in any absolute sense. Rather, the intent is to suggest that there
are differences in the type of harm caused by different sources of abuse, and ultimately,
differences in the form of psychopathology manifested.
The purpose of this study is to contribute to a better understanding of the potentially different
effects that intra- versus extra-familial sexual abuse may have on psychological functioning
and adjustment. Two research questions are posed: (a) Do the psychological profiles of individuals with histories of intra- and extra-familial abuse differ? (b) Are the psychological profiles
of these two groups distinguishable from those individuals who have not experienced sexual
abuse? Answers to these questions provide information of relevance to understanding, treatment
and directions for future research efforts.

Intra-family versus extra-familysexual abuse

179

METHOD

Subjects
Participants in this study were recruited from mental health agencies, incest survivor groups
and private therapists in the Houston, Texas area. Participants comprising the clinical, nonsexually abused group (N = 30) were screened to ensure that they had not been victims of
sexual abuse. The extra-familial group was composed of women who reported experiences of
childhood sexual abuse by individuals who were not in kinship roles (N = 22). The intrafamilial group was composed of women reporting childhood or adolescent incest (N = 30),
wherein a definition of incest provided by Sgroi, Blick, and Porter (1982) was invoked. This
definition suggests that incest includes any form of sexual activity performed between a child
and a parent or stepparent, extended family member or surrogate parent (common law spouse,
foster parent). The crucial psychosocial dynamic imbedded within this definition is the exploitation of a child's dependency needs by persons in kinship roles.

Measures
Participants with histories of intra- and extra-familial sexual victimization independently
completed questionnaires which asked them to provide background information about themselves and their experiences pertaining to the abuse. Data were gathered on the following
variables: present age, highest degree attained, length of time in therapy, age of abuse onset,
duration of the abuse, degree of violation, the involvement of violence and force, relation to
perpetrator, whether they told anyone about the abuse, and if so, whether the support was
positive or negative. The degree of violation was measured in keeping with a category typology
defined by Russell (1983):
1. Least Serious Sexual Abuse included experiences ranging from kissing, intentional sexual
touching of the buttocks, thigh, leg or other body part, including contact with clothed
breasts or genitals, whether by force or not;
2. Serious Sexual Abuse, included experiences ranging from forced digital penetration of the
vagina to nonforceful breast Contact or simulated intercourse; and
3. Very Serious Sexual Abuse included experiences ranging from intercourse, oral genital
contact to anal intercourse, whether by force or not.
Those who had not been sexually abused (the control group) provided data on the following
variables: present age, highest degree attained, length of time in therapy, and whether or not
they had been sexually victimized. All participants completed the Diagnostic Inventory of
Personality and Symptoms (DIPS) (Vincent, 1985). This is a brief, 171-item test of psychopathology consisting of a 4-item validity scale, 11 scales that correspond to Axis I Diagnostic
Categories of the DSM III (APA, 1980) and three Character Disorder Scales corresponding
to a collapsed version of the Axis H Diagnosis of the DSM III (Vincent, 1987a). Scale rifles
and descriptions are provided in Figure 1. This instrument was selected for the following
reasons: (a) It contains a standardized measure of dissociation. This measure is important in
evaluating the impact of abuse on adult functioning because dissociation is a commonly
employed coping strategy associated with abusive experiences (Brier, 1992; Maltz & Holman,
1987; O'Brien, 1987; Westerlund, 1992). (b) The instrument contains standardized measures
of distinctive clinical symptoms found in individuals with earlier experiences of sexual victimization. Symptoms such as somatization, anxiety, drug abuse, alcohol abuse, and depression
are all manifestations of the emotional and psychological impact of experiences of sexual
victimization (Briere, 1992; Briere & Runtz, 1988; Brooks, 1985; Gelinas, 1983).

180

T. Gregory-Bills and M. Rhodeback

1) Alcohol Abuse.

The nature and extent of alcohol dependency

2) Drug Abuse.
The nature and extent of drug abuse
3) Schizophrenic Psychosis.
Psychological alienation, confused thinking and reality distortion
4) Paranoid Psychosis.
Suspiciousness, wariness, resen*~nt and anger; hypervigiliance and hostile paranoia
of psychotic proportions; guarded; oversensitivity

5) Affective Depression.
Marked feelings of dysphoria; loss of interest or pleasure; depression is likely
6) Affective Excited.
Elevated expansive mood; easily irritated; restless; distraction and hyperactivity; manic features may
he present; apt to be restless; energetic and distractable; irritable agitation
7) Anxiety Disorder.
Anxiety; tension and apprehension; compulsion, panic; Feelings of anxiety
8) Somatoform Disorder.

Indicates psychosomatic component; Significant symptoms are expressed in any actual or reported
incidence of illness
9) Dissociative Disorder.

Feelings of unreality; depersonalization; problems with identity

10) Stress Adjustment.

Amount of environmental stress in past year such as death of spouse, marriage, disabled, chronic illness,
pregnancy
11) Psychological Factors Affecting Health.

Number of conditions in which psychological factors often contribute to onset of problems;person is apt
to physiological illness under stress such as ulcers, arrhythmia, migraines, asthma; arthritis or nausea
12) Withdrawn Character.
Significant eccentricities; apt to be withdrawn suspicious and isolated; unusual presentation of self may
he present; significant discomfort in interpersonal relationships due to fear distrust or apathy. Paranoid,
schizotypal, schizoid, or avoidant personality
13) Immature Character.
Dramatic, emotional or erratic; hedonistic, impulsive, emotionally labile and exploitative; irresponsible
and self centered ranging from ego-centric self-indulgence and neglect of responsibility to substance
abuse and legal problems. Difficulties in sustaining long term relationships and marital difficulty;
histrionic, narcissistic, and antisocial or borderline personality
14) Neurotic Character.

Anxious or fearful cluster of DSM III: overconscientious; sensitive; passive and rigid; negative toward
self and chronically anxious; stable family life and capable of forming lasting relationships; avoidant,
dependent, compulsive or passive aggressive
Figure 1. DIPS scales and scale descriptors.

The instrument was developed from the description and criterion sections for the various
disorders o f the Diagnostic and Statistical Manual of Mental Disorders III (DSM III) (American
Psychological Association, 1980), thus ensuring content validity. Comparisons o f mean profiles
produced by normal subjects, private patients, and Veteran's Administration patients have
indicated that the instrument was able to differentiate normality from abnormality, thus indicating criterion validity. Principal components analysis o f the instrument produced three factors,
accounting for 70% o f the total item variance, indicating an internally consistent instrument,
and evidence of construct validity. The instrument has been subject to test-retest, yielding a
reliability coefficient o f .78 (Vincent, 1985).

Procedure
Participants were asked to complete the DIPS and the retrospective, anonymous questionnaire
containing the background measures. The instruments were accompanied by a cover letter that

Intra-family versus extra-family sexual abuse

181

Table 1. Background Characteristics for the Extra-Familial, lntra.Familial, and Control Groups

Present Age
18-25 years
26-33 years
34-41 years
42-48 years
Education
<High School
High School
Some College or Technical School
Bachelors Degree
Some Graduate Work
Masters Degree
Ph.D. Degree
Years of Therapy
<1 year
1-2 years
2.5-5 years
6-10 years
11- 15 years
16-20 years

Extra-Familial
N = 22

Intra-Familial
N = 30

Control
N = 30

5
7
6
4

23
32
27
18

4
13
8
5

13
43
27
17

8
10
8
4

27
33
27
13

0
5
8
4
0
5
0

0
23
36
18
0
23
0

2
6
11
6
2
I
2

7
20
37
20
7
3
7

0
4
11
6
5
3
1

0
13
37
20
17
10
3

3
10
6
1
1
1

14
46
27
5
5
5

6
3
8
11
1
l

20
10
27
37
3
3

5
4
11
8
2
0

17
13
37
27
7
0

d e s c r i b e d the research project, the researcher and their rights as subjects. The purpose o f this
study was presented to the subjects as an investigation to obtain information on the impact o f
sexual v i c t i m i z a t i o n on adult adjustment. It was e x p l a i n e d that the study was d e s i g n e d to
facilitate understanding and treatment.
Participants were requested to c o m p l e t e the questionnaire in their h o m e s and return in a
sealed e n v e l o p e ( p r o v i d e d b y the investigator) within 2 weeks. These were m a i l e d to, or p i c k e d
up b y the researcher. Subsequently, the D I P S scale scores were tallied b y hand utilizing the
scoring sheet d e s i g n e d for the instrument. The profiles were screened for validity by e x a m i n i n g
the validity scale contained in the DIPS. A l l participants p r o d u c e d valid profiles.

RESULTS

Background Variables
F r e q u e n c y distributions constructed from data collected on the b a c k g r o u n d variables relevant
to all three groups are p r o v i d e d in T a b l e 1. T a b l e 2 includes distributions for those b a c k g r o u n d
variables applicable o n l y to the extra- and intra-familial groups. A s indicated in Table 1, all
three groups were similar in terms o f age and education.
P r e l i m i n a r y statistical analyses were c o n d u c t e d to assess which, if any, o f four b a c k g r o u n d
variables should be e m p l o y e d as covariates in analyses d e s i g n e d to c o m p a r e the p s y c h o p a t h o l o g y o f intra- and extra-familial sexually a b u s e d groups. The results o f the p r e l i m i n a r y analyses
r e v e a l e d that the groups d i d not differ in the a m o u n t o f therapy received, t (50) = - 1 . 1 9 , p
> .20 and the severity o f the sexual violation, X 2 (2) = 3.84, p > .10. The two groups were
distinguishable with respect to the average age the sexual abuse began, t (50) = 3.31, p <
.01 and the duration o f victimization, t (50) = - 2 . 7 4 , p < .01. Participants c o m p r i s i n g the
intra-family group tended to b e y o u n g e r at the t i m e o f initial abuse, ( M e a n age o f 5), and
sexually abused for a l o n g e r time p e r i o d ( M e a n o f 8.13 years) than those w h o were m e m b e r s

182

T. Gregory-Bills and M. Rhedeback

Table 2. Background Characteristics Relevant to the Extra-Famillal and Intra-Familiai Groups

Age of Abuse Onset

0-3 years
4-7 years
8-11 years
12-15 years
16-17 years
Duration
Once
3-11 months
1-2 years
3-5 years
6-10 years
11-15 years
16-28 years
Degree of Violation
1 Least Serious Sexual Abuse
2 Serious Sexual Abuse
3 Very Serious Sexual Abuse
Told or Kept Secret
Told
Kept Secret
Support or No Support
Told and Supported
Told and Not Supported (blamed, not believed, sent away)

Extra-Familial
(N = 22)

Intra-Familial
(N = 30)

0
13
2
4
3

0
59
9
18
14

10
12
7
1
0

33
40
23
3
0

3
2
4
7
5
1
0

14
9
18
32
23
5
0

0
1
7
5
8
5
4

0
3
23
17
27
17
14

0
5
17

0
23
77

2
11
17

7
37
57

6
16

27
73

10
20

33
67

2
4

33
67

2
8

18
80

o f the extra-familial group ( M e a n age o f 8.8 and M e a n duration o f 4.09 years). Nevertheless,
there was no statistically significant multiple correlation b e t w e e n factor scores derived from
a principle c o m p o n e n t s analysis o f the 14 measures and age the abuse began, (R = .27), F (3,48)
= 1.26, p > .05, nor was there a significant m u l t i p l e correlation b e t w e e n these c o m p o n e n t s and
the duration o f the abuse, (R = .34), F (3,48) = 2.04, p > .05. The three-factor principal
c o m p o n e n t s solution rather than the 14 i n d i v i d u a l m e a s u r e s were e m p l o y e d in these p r e l i m i n a r y
analyses b e c a u s e there was a desire to c o n s e r v e an e x p e r i m e n t - w i s e error rate that w o u l d have
been greatly inflated had p r e l i m i n a r y analyses i n v o l v e d 28 significance tests (14 measures X
2 b a c k g r o u n d variables). These p r e l i m i n a r y analyses indicated that there was no statistically
valid reason for e m p l o y i n g either age the abuse b e g a n or duration o f abuse as covariates in
analyses d e s i g n e d to c o m p a r e extra- and intra-familial a b u s e d groups on measures o f p s y c h o p a thology.
Profile analyses ( G e i s s e r & Greenhouse, 1959; Stevens, 1986) were e m p l o y e d to test two
hypotheses: (a) The p s y c h o l o g i c a l profiles o f the intra- and extra-familial groups w o u l d differ,
and (b) the p s y c h o l o g i c a l profiles o f those not abused w o u l d differ f r o m the c o m b i n e d intraand extra-familial groups. To ensure that the interaction w o u l d not be a scaling artifact,
individual scale scores were standardized prior to analyzing the profiles. In addition, discriminant analyses and canonical correlations were e m p l o y e d as analytical strategies for describing
the nature o f group differences and the strength o f the relation b e t w e e n the measures o f
p s y c h o p a t h o l o g y and group m e m b e r s h i p .

Comparison of Intra- and Extra-Familial GrouPs

A c o m p a r i s o n o f the extra- and intra-familial groups r e v e a l e d that the profiles were not
parallel, T 2 (13, 38) = 1.20, F = 3.50, p < .005. This result supports the assertion that extra

Intra-family versus extra-family sexual abuse

183

Table 3. Descriptive Statistics, Step-Wise Discrlminant Analyses and Post-Hoe Results for the lntra and Extra
Familial Group Comparisons

Stepwise Discrminant Analysis

Extra-Familial

Intra-Familial

Scale

Mean

SD

Mean

SD

Structure
Coefficients

Entry
Order

Alcohol Abuse
Drug Abuse
Schizophrenic Psychosis
Paranoid Psychosis
Affective Depression
Affective Excited
Anxiety Disorder
Somatoform Disorder
Dissociative Disorder
Stress Adjustment
Disorder
11) Psychological Factors
Affecting Physical
Health
Character Disorder Scales
12) Withdrawn
13) Immature
14) Neurotic

1.27
0.86
3.32
3.96
12.05
2.32
9.86
4.55
4.00
2.09

1.35
1.13
1.56
2.94
4.81
1.21
2.61
1.57
2.29
1.57

1.07
1.77
2.97
2.70
11.53
1.93
10.43
4.47
4.23
1.80

1.72
2.70
2.39
2.04
5.34
1.44
5.32
3.52
3.31
1.75

.39
-.96
N.E.
-.34
-.81
.45
-1.10
.55
-1.00
.36

11
2
10
5
9
8
7
3
6

ns
ns
ns
ns
ns
ns
ns
ns
ns
ns

3.00

.76

2.77

2.19

.36

12

ns

7.23
2.32
12.73

2.16
1.17
2.68

4.70
2.83
10.77

3.12
2.96
4.10

1.34
N.E.
1.47

11

*
ns
ns

1)
2)
3)
4)
5)
6)
7)
8)
9)
10)

t-Test

* Boneferroni inequality of .15 applied to control type 1 error; p < .01.

N.E. = not entered into the step-wise discriminant analysis model.
ns = not statistically significant,

and intra-familial sexual abuse victims experience different psychological symptoms. The
canonical correlation between group membership and the 14 measures was .81, ~(2 (12) =
46.18, p < .001, thus indicating that more than 64% o f the variance in the scales separated
these two groups. A step-wise discriminant model indicated that, despite high intercorrelations
among the 14 measures o f psychopathology, all but two contributed variance separating the
two groups. The intra- and extra-familial groups were distinguishable on the basis o f a model
that jointly considered Withdrawal, Drug Abuse, Dissociative Disorder, Neuroses, AffectiveDepression, Stress Adjustment Disorder, Somatoform Disorder, Anxiety Disorder, AffectiveExcited, Paranoid Psychosis, Alcohol Abuse, and Psychological Factors Affecting Physical
Condition. Mean scores for each scale and the results o f the discriminant analysis are provided
in Table 3.
The discriminant model resulted in a 94% hit rate when employed to classify participants
into the extra- and intra-familial groups. O f the 30 intra-familial subjects and 22 extra-familial
subjects, 97% (29) and 91% (20), respectively, were correctly classified. Post hoe comparisons
o f the 14 scale scores were conducted so that a description o f group differences on each
individual scale might be provided. An error rate o f . 15 was divided among the 14 comparisons
in keeping with the Boneferroni approach to controlling a Type I error rate, resulting in a
group difference only on the Withdrawn Character Disorder scale.
Considered collectively, the profile analyses, discriminant analyses, and post hoc comparisons o f the 14 scale scores, indicate that in order to detect differences in the psychological
functioning o f intra- and extra-familial abused groups, it is necessary to evaluate an entire
profile as a linear function o f psychological measures. It is the profile, rather than an individual
variable that captures the principle psychological differences. A clinical interpretation o f the
intra- and extra-familial groups' psychological state was made by invoking the traditional
strategy for describing a DIPS psychological profile. D I P S ' scales one through 11 were first
reviewed to identify the two scales which, after transformation to T scores, the groups scored

184

T. Gregory-Bills and M. Rhodeback

o

-..42-

Intra-Familial

Extra-Familial " - - - - - Control

90

. D
x
t

80
/'+"

p
I

x
70

j~

8
60

50

40
AA

DA

SP

PP

AD

I'

AE

AX

SO

DD

SA

PC

WC

lC

NC

Category

PP

Alcohol Abuse
Drug Abuse
Schizophrenic Psychosis
ParanoidPsychosis

AE
AX
SO
DD

AD

Affective Depressed

SA
PC

AA
DA
SP

Affective Exciled
Anxiety Disorders
Somatoform Disorders
Dissociative Disorders
Stress Adjustment Disorders
Psychological Factors Affecting
Physical Condition

WC
IC
NC

WithdrawnCharacter
lmmaturc Character
NeuroticCharacter

Figure 2. Diagnositic inventory of personality and symptons.

the highest and in excess of a 70 T-Score. Two point code types are traditionally used in clinical
descriptions of DIPS psychological profiles and correspond to typical diagnoses described in
the DSM III (Duthie & Vincent, 1986; Williams, Coker, Vincent, Duthie, Overall, & McLauglin, 1988). Whereas interpretations of 2 point code types made from scales 1-11 corresponded
to an Axis I diagnosis in the DSM III, interpretations of 2 point code types made from scales
12-14 corresponded to an Axis II diagnosis. Figure 2 provides graphic results of the T-scores
associated with the group means for all three groups.
This descriptive assessment indicates that both the intra- and extra-familial groups scored
the highest on the Affective-Depressed (AD) and Dissociative Disorders (DD) scales. An ADDD two point code type (also referred to as a 5 - 9 code type) represents a primary Axis I
diagnosis in which the persons reported marked feelings of dysphoria and a significant loss
of interest or pleasure. They were likely to have very significant depression accompanied by
a very significant amount of dissociative phenomena. Feelings of unreality were present,
depersonalization was likely and problems with identity were indicated.
Applying the two point code type interpretive scheme to the three character disorder scales,
withdrawn (12); Immature (13); and Neurotic (14), the results indicate that the extra-familial,
sexually abused group scored in excess of a T-70 on the Neurotic and Withdrawn scale. The
intra-familial abused group scored in excess of a T-70 only on the Neurotic scale. As previously
indicated, a significant difference was obtained for the Withdrawn scale, thus providing preliminary statistical support for a clinical distinction in the Axis 2 diagnosis.
The Withdrawn-Neurotic code type that characterizes the extra-familial group indicates a
combination of oversensitivity and social withdrawal with anxiety and passivity that is most
apt to be seen in individuals with an avoidant personality (Vincent, 1987b). The Neurotic code
type that characterizes the intra-familial group correspond to the anxious or fearful cluster of the
DSM III personality disorders such as avoidant, dependent compulsive, and passive aggressive
disorders. Such individuals are described by Vincent (1987b) to be overconscientious, sensitive,

Intra-family versus extra-family sexual abuse

185

Table 4. Descriptive Statistics, Step-Wise Discriminant Analyses and Post Hoc Results for the Combined Extra
Familial Group Comparison with the Non-Abused (Control) Group

Extra-Intra
Familial

Stepwise Discriminant
Analysis
Nonabused

Scale

Mean

SD

Mean

SD

Structure
Coefficients

Alcohol Abuse
Drug Abuse
Schizophrenic Psychosis
Paranoid Psychosis
Affective Depression
Affective Excited
Anxiety Disorder
Somatoform Disorder
Dissociative Disorder
Stress Adjustment
Psychological Factors
Affecting Physical
Health
Character Disorder Scales
12) Withdrawn
13) Immature
14) Neurotic

1.15
1.35
3.11
3.23
11.75
2.10
10.19
4.50
4.13
1.92
2.87

1.56
2.21
2.06
2.51
5.08
1.35
4.36
2.83
2.90
1.671
1.73

.90
.73
1.33
1.43
5.90
1.47
6.03
2.30
.87
1.80
1.63

1.42
1.60
1.16
1.22
4.33
1.72
3.67
2.65
1.01
1.69
1.47

N.E.
-.50
N.E.
N.E.
.59
N.E.
N.E.
.36
.69
-.39
N.E.

5.77
2.62
11.60

3.01
2.37
3.67

2.53
1.57
7.27

1.98
1.92
4.18

N.E.
N.E.
N.E.

1)
2)
3)
4)
5)
6)
7)
8)
9)
10)
11)

Entry
Order
4
2
5
1
3

t-Test
ns
ns
*
*
*
ns
*
*
*
ns
*

*
ns
*

*p < .01, 80 df where an error rate of .15 was divided among 14 comparisons.
N.E. = not entered into the step-wise discriminant analysis model.
ns = not statistically significant.

passive, and rigid. Persons o f this profile type are also described to be negative towards
themselves and chronically anxious.

Comparisons of the Combined Extra- and Intra-Familial Groups with the Non-Abused,
Control Group
A c o m p a r i s o n o f the c o m b i n e d extra- and intra-familial groups with the nonabused, control
group revealed that these profiles were not parallel, T 2 (13, 68) = .50; F = 2.62, p < .005.
This result replicates previous research that has shown that victims o f sexual abuse experience
clinical s y m p t o m s differing from those w h o have not been abused (Gelinas, 1983; G o r c e y et
al., 1986; H e r m a n et al., 1986). Table 4 illustrates m e a n scale scores for the control group as
well as the c o m b i n e d intra- and extra-familial groups. In summary, the p s y c h o l o g i c a l profiles
are distinguishable.
The canonical correlation b e t w e e n group m e m b e r s h i p and the 14 variables, when the two
groups were c o m p o s e d o f the control (those who had not been abused) and the c o m b i n e d
intra-extra familial groups was .65, X 2 (5) = 42.34, p < .001, thus indicating that 42% o f the
variance in the scale scores separates the groups.
A step-wise discriminant m o d e l was e m p l o y e d to explore and describe group differences
b e t w e e n the c o m b i n e d extra- and intra-familial victims, with those w h o had not been sexually
abused. The results are presented in Table 4. A s indicated, only 5 o f the 14 variables were
n e e d e d to distinguish these groups, including those designed to measure Dissociative Disorder,
Affective Depression, Stress Adjustment, Drug Abuse, and S o m a t o f o r m Disorder. I m p l i e d is
that the remaining variables a d d e d no variance to group separation b e y o n d that which these
five variables contributed. The m o d e l resulted in an 87% hit rate, with 85% o f those subject
to abuse (44 o f 52) being correctly classified and 90% o f those not being abused (27 o f 30)
being correctly classified.

186

T. Gregory-Billsand M. Rhodeback

The graphic illustration provided in Figure 2 indicates that the nonabused, control group
profile was completely within the normal range, that is a T score of less than 70 on all 14
measures, and is clearly distinguishable from those who had been sexually victimized. Post
hoc comparisons of scale score means indicate that individuals comprising the combined extraand intra-familial groups produced significantly higher scores on 9 of the 14 measures of
psychopathology, including Schizophrenic Psychosis, Paranoid Psychosis, Affective Depression, Anxiety Disorder, Somatoform Disorder, Dissociative Disorder, Psychological Factors
Affecting Physical Condition, Withdrawn Character, and Neurotic Character. The groups did
not differ on scales designed to measure Alcohol Abuse, Drug Abuse, Affective-Excited, Stress
Adjustment, and Immature Character Disorder.

DISCUSSION
It was hypothesized that the psychological profiles of individuals with histories of intraand extra-familial abuse would differ. The results support the hypothesis. Profile shapes produced for the intra- and extra-familial abused groups differed, and a discriminant function
developed via step wise selection procedures incorporated 12 of the 14 scales; however, post
hoc comparisons of 14 scale means revealed a statistically significant difference on only one,
the Withdrawn Character Disorder scale, and a clinical comparison of two point code types
indicated that both groups could be characterized as suffering a 5 - 9 disorder (AffectiveDepressed-Dissociative). Although seemingly contradictory, the profile and discriminant analyses differ from the post hoc comparisons of individual scales and clinical descriptions in that
they make use of a linear combination of the variables and do not ignore the intercorrelations
among the 14 measures. While differences on most of the 14 scales are not large enough to
produce significant results individually (perhaps due to small group n sizes), a linear combination of the intercorrelated variables does provide enough reliable variance to permit distinguishing the profiles, and to produce a function that correctly classifies 94% of the individuals (49
of 52) as members of the extra- or intra-familial groups. Some caution is necessary in interpreting the discriminant model and the classification rates since the subject to variable ratio is
less than desirable, and there exists a need to cross validate the discriminant function. Cross
validation through replication of the study would serve as a highly instructive avenue for
additional research.
The existence of a linear function which differentiates extra and intra-familial groups is not
surprising, however, the nature of the observed differences are somewhat unexpected. For
example, the extra-familial group scored higher than the intra-familial group on the Withdrawn
Character Disorder scale, one of three scales used in formulating an Axis II diagnosis. Indeed,
the extra-familial group scored higher than the intra-familial group on nine of the 12 variables
comprising the discriminant function, although individual comparisons of scale means were
not necessarily large enough to achieve statistical significance.
The direction of the difference on the Withdrawn scale may reflect a generalized withdrawal
response to the arousal of extreme fear, as would be the case if a stranger assaulted (such as
rape) the child. It is also possible that sensitive material and the defensive structure of the
respondent distorted the self-evaluative data. If memory has been flawed because of massive
denial or repression, self perceptions may produce an entirely inaccurate assessment of psychological adjustment. Unfortunately, this possibility bears on all research efforts aimed at defining
the psychopathological implications of sexual victimization. Response bias may also occur if
the type of abuse (extra- vs. intra-familial) is nested within different forms of therapeutic
interventions. This and other potential forms of selection bias emphasize the need for replication
using alternative subject sources.

Intra-family versus extra-family sexual abuse

187

The notion of an "incestuous family" provides a conceptual framework for understanding

the effects of sexual abuse within the family. Familial circumstances may also serve as a
conceptual framework for understanding the severity of pathology observed in the extrafamilial group. Extra-familial abuse is, alone, a traumatic experience. When combined with
familial circumstances that inhibit the child from talking about the victimization, or when
blamed and not supported by the family (as was the case for the majority of the extra-familial
group who told family members of their experiences), the trauma is likely to be aggravated.
Further, it have been suggested that extra-familial abusers intuitively select those whose character and emotional development have been impaired due to family dysfunction (Finkelhor,
1984; Forward & Buck, 1978). Whether or not the family serves as a gateway to extra-familial
abuse, or aggravation of a trauma unrelated to family dysfunction is worthy of further research,
and necessary for further understanding the psychopathology observed in this study.
The study indicates that contradictory results may be obtained if investigators ignore methodologically distinctive ways of analyzing differences between intra- and extra-familial, sexually
abused groups. This may be due implicitly to the statistical procedures, or possibly attributable
to the existence of differences so subtle in the psychopathologies of the intra- and extrafamilial groups that more powerful analyses, such as profile and discriminant analyses are
necessary to detect them. This is an important question bearing on the treatment of these
individuals since an understanding of these subtle differences may be critical to effective
therapeutic intervention. At the very least, this study indicates that it is a question worthy of
additional inquiry.
The hypothesized difference between those who had been sexually abused and those who
had not been abused were clearly supported. The results offer none of the interpretive complexities found when attempting to compare intra- and extra-familial group differences. The profile
analyses, discriminant analyses, clinically descriptive comparisons, and the post hoc analyses
of individual scales all reveal that psychopathology is much more evident in those who have
been victims of sexual abuse. The results complement previous research findings that have
demonstrated differences between sexually abused and nonsexually abused psychopathology
(e.g., Briere & Runtz, 1988). The results also strongly point to the significance of dissociative
and depressive symptomology among individuals who have had experiences of sexual abuse
identified both clinically (Gelinas, 1983; Herman et al., 1986; Maltz & Holman, 1987; O'Brien,
1987) and, more recently, empirically (Briere & Runtz, 1988; Gregory-Bills, 1990). These
investigations have related the chronic depression to long term low self esteem, unresolved
feelings of shame and guilt, experiences of powerlessness and unexpressed anger. Dissociation
is described to have been a coping mechanism learned during the abuse (Maltz & Holman,
1987). In many cases, dissociation becomes a general and automatic response to other situations
in which strong emotions are evoked (Maltz & Holman, 1987; O'Brien, 1987). A future study
might include another population with expected pathological deviancy in the analysis. This
would serve to address the uniqueness of depressive and dissociative symptoms to individuals
with experiences of sexual victimization.

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R~um6---French abstract not available at time of publication.

Resumen--El Inventario Diagn6stico de Personalidad y Sintomas (DIPS) fue utilizado para evaluar la psicopatologla
de una muestra clfnica de 30 mujeres con historias de victimizaci6n sexual intra-familiar, 22 mujeres con historias
de victimizaci6n extrafamiliar, y 30 mujeres sin experiencias de victimizaci6n. El presente estudio examina si el
aspecto familiar/no familiar es significativo para las consecuencias de las experiencias de victimizacion sexual. Una
comparaci6n clfnica del c6digo de dos puntos indic6 que ambos grupos abusados podffan caracterizarse como sufriendo
un Desorden Depresivo-Disociativo-Afectivo. Sin embargo, los perfiles producidos por los grupos intra y extra
familiares eran diferentes. Una funci6n discriminativa se desarroll6 via procedimientos de selecci6n que incorpor6
doce de las catorce escalas, clasific6 correctamente el 94% de los individuos (49 de 52) como miembros de grupos
intra o extra familiares. Los an~lisis de los perfiles, an~lisis discriminativos, comparaciones clinicamente descriptivas,
y an~lisis pos hoc de las escalas individuales revelaron que la psicopatologfa es mucho mas evidente en aquellos que
han tenido la experiencia de abuso sexual. Se destacaron las consideraciones metodol~igicas y se discutieron las
implicaciones que tienen para el tratarniento y la investigaci6n.