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It is difficult to determine relative degree of severity” in the findings (p. 260). Type o f sexual act. The conventional wisdom which suggests that the type of sexual activity is related to the level of trauma is generally supported in the literature. Browne and Finkelhor (1986) and Green (1993) review eight articles which demonstrate that intercourse generally leads to more clinical problems than does touching. In fact, Bagley and Ramsey’s community study found “penetration to be the 22 The Impact o f Multiple Childhood Trauma single most powerful variable explaining severity of mental health impairment, using a composite of standardized instruments” (in Browne & Finkelhor, 1986, p.

Like other forms of abuse, its effects can be devastating. The most clear-cut, isolated effect of psychological abuse alone seems to be to decrease self-esteem.

The literature consistently reports the significant relationship between physical abuse and oppositional and nonviolent criminal behavior (see reviews by Conaway & Hansen, 1989, Knutson 1995; Malinosky-Rummell & Hansen, 1993). Rogeness, Amrung, Macedo, Harris, and Fischer (1986) found that significantly more male and female children receiving psychiatric services who were victims of physical abuse were diagnosed with conduct disorder. Interestingly, more nonabused (vs. abused) females received the diagnosis of dysthymia in that same study.

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