Access Type

Open Access Dissertation

Date of Award

January 2018

Degree Type


Degree Name




First Advisor

Linda Lewin


Background and purpose: Childhood sexual abuse (CSA) is an existing social problem that affects children worldwide, leading to poor psychological outcomes in adulthood. Childhood adversities including CSA account for 44.6% of childhood and 26%–32% of adult-onset psychiatric disorders. Furthermore, CSA is the second leading cause of posttraumatic stress disorder (PTSD) and influences an array of other outcomes such as depression, anxiety, hostility, and low self-esteem. Worldwide, approximately 8%–13% of girls have experienced sexual abuse. According to the few studies conducted in Arabic countries, CSA ranges from 7%–27%. Coping with CSA is a well-studied factor in regard to its impact on females’ experience of CSA and long-term psychological outcomes. Nonetheless, there is a paucity of research on coping with CSA among female survivors of Arabic descent. There are multiple factors that influence coping with CSA, such as the characteristics of CSA, culture, and social reactions. The purpose of this study was to explore CSA characteristics, Arabic culture values and beliefs, social reaction to abuse disclosure, coping, and psychological outcomes among female CSA survivors of Arabic descent.

Theoretical framework: This study was guided by the Folkman and Lazarus stress and coping model. The model consists of the antecedent factors, mediating process, and short- and long-term effects. The antecedent factors for this study were CSA characteristics, Arabic culture, and social reactions to CSA disclosure. The mediating process was coping with CSA. To fulfill the purpose of the study, the long-term effect at the psychological domain was selected.

Methods: Utilizing a convergent mixed-method design, 19 Arabic female survivors of CSA were enrolled in the study through health and counseling centers, universities, and social media. Women were included in the study if they were 18 years and older, were of Arabic descent, had a history of CSA before age 17, and were fluent in English. Qualitative data were collected first by individual semi-structured face-to-face, phone, and email interviews that lasted 1-2 hours. The interview guide was developed by the researcher and included questions about CSA characteristics, Arabic culture and acculturation, social reactions to CSA disclosure, coping, and long-term psychological outcomes. To collect quantitative data of social reaction to CSA, acculturation, coping, depressive symptoms, and PTSD, the women completed validated surveys online. A password-protected email account was created to send the surveys to the women and receive the completed questionnaires. The qualitative data was analyzed by content analysis. The credibility of the study was achieved by peer review and triangulation. Descriptive statistics and correlation were used for quantitative data. The qualitative and quantitative results were merged in a matrix for convergent mixed-method analysis.

Results: The majority of the women in this study had experienced contact familial CSA without penetration. The women identified sexuality, family ties, family honors, perception of CSA and survivors of CSA as some of the Arabic values and beliefs that influenced them as Arabic survivors of CSA. Family, hospitality, and respect were some of the Arabic values that were honored by the women. The women were more attracted to the Arabic culture than the American culture as reflected in the high mean score for acculturation. The survivors employed multiple strategies to cope with their CSA during adulthood. However, quantitative data indicated that self-controlling, distancing, and positive reappraisal were the most frequent coping strategies employed during adulthood. CSA recall and triggers, sleep issues, and interpersonal issues such as low self-esteem, lack of trust, feeling of insecurity, and sexual issues were the long-term psychological outcomes reported by the survivors. Quantitatively, the sample had mild depressive symptoms and moderate PTSD.

Conclusion: CSA is an existing problem among Arabic females and leads to negative outcomes. Arabic female survivors employed a wide range of coping strategies during adulthood. The findings of this study expand the current state of science on how Arabic female survivors of CSA cope with their experience and the long-term psychological outcomes influenced by the CSA characteristics, culture, acculturation, and social reactions to CSA. The findings of this study can be used to design culturally sensitive programs that aim to prevent CSA and treat survivors of Arabic descent.

Included in

Nursing Commons