As indicated in the proposed model, sexual memories influence explicit cognitive processes (second order), such as sexual self-schemas, sexual fantasies, sexual likes and dislikes, and sexual scripts. Sexual self-schemas are blueprints of how people make sense of the sexual self and provide them with a map to understand their responses to sexual stimuli. While sexual schemas belong mostly to first-order processes because they are implicit and nonvolitional, schemas are also partially conscious and can be shaped by explicit memories derived from second-order processes. Indeed, a number of psychotherapies have focused on the reconstruction of schemas through the use of volitional, conscious, secondary processes .
Two studies used methodologies derived from social psychology to increase our understanding of how women with a history of CSA see their sexual selves and how these views impact sexual responses. In these studies, sexual self-schemas were assessed with both direct and indirect measures [27,28]. Direct methods, such as self-reported questionnaires on sexual schemas (Sexual Self-Schema Scale ) and sexual beliefs, were used in a sample of women with (N = 34) and without (N = 22) a history of CSA. The romantic/passionate sexual self-schema mediated the relationship between CSA and negative affect during sexual activities with a partner . The other schemas assessed (i.e., open/direct and embarrassment/conservatism) were not associated with the sexual function of CSA survivors. These results were independent from symptoms of depression and anxiety, providing evidence that depression and anxiety are not necessary for the development of sexual problems in CSA survivors.
It is possible that, in CSA survivors, sexuality is not associated with passion and romance and therefore the motivation for engaging in sexual activities may be dependent on schemas not identified by the questionnaires used. Indeed, we know from studies on men and women that there are numerous reasons why people engage in sexual activities other than pleasure, such as emotional closeness, social status, stress reduction, expression of emotions, etc. . An investigation of motivations for sex may reveal interesting information about differences between the sexual views of women with and without a history of CSA.
Another limitation of these results is that the questionnaires required individuals to provide a general rating of their views of their sexual selves. Thus, a woman who conceives herself passionate with strangers but not with her partner would score similarly to a woman who feels mildly passionate with strangers and with her partner. Also, it is likely that sexual self-schemas that explain the hypo- and the hypersexuality of CSA survivors may not be captured by the three schemas measured in the questionnaire used. For example, the literature has pointed out that CSA survivors often report feeling like “damaged goods” or “dented” by the sexual abuse.
A main limitation of the methodology of this study is the impact of demand characteristics on the participants’ responses. It is possible that CSA survivors may have tried to appear more sexually open and comfortable than they really are, or they may have tried to appear more troubled by their sexual problems. To address this limitation, a second study on the cognitive responses associated with explicit sexual self-schemas was performed using indirect measures of women's views of sexuality and of the sexual self . Indirect measures are considered more robust to demand characteristics because participants do not know what the experimenters are measuring. The indirect measure adopted in this study was the computerized analysis of language participants used in sexually relevant text entries (Linguistic Inquiry Word Count [LIWC]). Social psychologists repeatedly found a significant association of word choice with personality characteristics and psychopathology . LIWC is a software program that counts words falling into preestablished, reliable, linguistic categories created by expert raters. Some examples of categories featured in LIWC include food, sex, body, first person pronouns, communication, and positive emotions.
This method was considered complementary to self-administered questionnaires because questionnaires are more strongly affected by demand characteristics than linguistic analyses. When women write about a suggested topic, it is likely that demand characteristics play a role in the content of their writing, but it is less likely to affect the words they select. For example, when women describe an emotion, they can choose to write “I do not like him” or “I dislike him.” The concepts described by these two sentences are similar but the word selection is different. Social psychology studies found that the word selection is linked to personality characteristics and cognitive styles more than the content. Words chosen during communication are assumed to be the product of words belonging to the cognitive networks most commonly used by that individual. For example, depressed individuals with suicidal thoughts are more likely to ruminate on their problems and for this reason show higher rates of first person pronouns . Similarly, optimistic individuals asked to describe a sad event tend to use words such as “not happy,” rather than “gloomy” because the word “happy” is part of cognitive networks more commonly used and therefore more readily available. This concept can be extended to areas other than emotions. Based on previous studies, we investigated rates of words indicating “positive affect,”“negative affect,”“sex,” and “body” in texts written on three topics: (i) a story in response to an ambiguous picture suggesting sexual topics; (ii) a sexually explicit topic; and (iii) a nonsexual topic.
Women with (N = 27) and without (N = 22) a history of CSA wrote a story in response to an ambiguous picture depicting a woman sitting on a bed looking outside a window while a man, approaching her from behind, is reaching for her hair. This picture has reliably pulled for sexual stories when used in our sexuality laboratory, thus we expected this to be a relatively ambiguous way to stimulate sexually relevant language in the participants. In the stories written by CSA survivors, LIWC counted less “sex” words compared to stories written by women in the comparison group. This result could indicate suppression of sexual thoughts in CSA survivors. It is unclear whether this suppression would occur during first- (implicit sexual memories) or second-order processes (explicit sexual memories). An inhibition of first-order cognitive responses would result in distraction from the sexually related stimuli, which would prevent second-order processes. However, it is also feasible that first-order processes are intact while volitional cognitive processes push sexual thoughts away. Indeed, trauma survivors with PTSD symptoms often push away trauma-related thoughts or memories.
The linguistic analysis revealed that women with a history of CSA used significantly more “negative affect” words when writing about the ambiguous picture. Words like “in love” and “tender and sweet” were more common in the stories written by the comparison group. Words like “fight,”“feeling trapped,”“prisoner,”“being forced,” and “sad” were more common in the essays written by the CSA group. The CSA group also used less “body” words compared to women with no history of CSA. More “negative affect” words and less “body” words were positively correlated with low sexual desire, suggesting that hyposexual problems in CSA survivors are associated with the inhibition of thoughts related to “body” and the excitation of “negative affect.”
In the sexually explicit essay, women wrote about their sexual fantasies. This topic was selected to examine the words chosen when participants explicitly focused on positive aspects of sexuality. We were interested in whether the explicit recall of positive sexual thoughts could override the responses associated with negative implicit sexual memories. Indeed, the percentage of negative affect words in the essays written by CSA survivors did not significantly differ from those written by the comparison group, suggesting that women were able to inhibit negative sexual memories that may have otherwise emerged. However, CSA survivors used less positive affect words. This result parallels what we observed in the IAT study in that sex was not necessarily associated with negative valence but was not strongly associated with positive valence. A potential clinical implication of these results is the importance for CSA survivors with sexual problems to develop positive implicit and explicit sexual memories.
In the nonsexual essay, women wrote about their previous day. This neutral topic was used for comparison with the other essays to ensure that the patterns previously noticed were specific to sexual thoughts. Indeed, no differences were observed in “negative affect,”“positive affect,” or “body” words. Interestingly, CSA survivors used more “sex” words in the nonsexual essay than the comparison group. This result may be the product of cognitive associations that link uncommon stimuli to sex.
In summary, the affective and cognitive responses active during second-order processes differ between women with and without a history of CSA. Those CSA survivors who experience themselves as not passionate or romantic report negative affect during sexual activities with their partners. Also, stimuli that most people associated with sex constructs activated negative affect in CSA survivors. When describing positive sexual thoughts, CSA survivors used significantly less positive affect words than the comparison group. Finally, nonsexual stimuli stimulated more sexual thoughts in CSA survivors than the comparison group.