Original ArticlesChildhood Sexual Abuse and Adult Defensive FunctioningCallahan, Kelley L. PhD*; Hilsenroth, Mark J. PhD†Author Information *Victims of Violence Program, Harvard Medical School, the Cambridge Health Alliance, Somerville, MA; and †Derner Institute of Advanced Psychological Studies, Adelphi University, Garden City, New York. Supported by a grant from the Fund for Psychoanalytic Research of the American Psychoanalytic Association to the second author. An earlier version of this paper was presented at the Society for Personality Assessment midwinter meeting in March 2003 in San Francisco, California. Send reprint requests to Kelly L. Callahan, PhD, Victims of Violence Program, Harvard Medical School, the Cambridge Health Alliance, 26 Central Street, Somerville, MA 02143. E-mail: [email protected]. The Journal of Nervous and Mental Disease: July 2005 - Volume 193 - Issue 7 - p 473-479 doi: 10.1097/01.nmd.0000168237.26124.47 Buy Metrics Abstract Differences in defensive functioning between those who reported a history of childhood sexual abuse (CSA) and those who did not was examined in a naturalistic treatment-seeking sample of adult outpatients (N = 67). Defensive functioning and childhood sexual abuse history were rated by clinicians and external raters utilizing the DSM-IV Defensive Functioning Scale and the Abuse Dimensions Inventory, respectively, based on information gathered as part of a larger therapeutic assessment. Individuals reporting a history of CSA were found to use more major image-distorting level defenses than the non-CSA group, and abuse severity was also related to greater use of major image-distorting level defenses. Those reporting a history of CSA relied more on defenses indicative of impairment in realistic perception of self and others. This defensive style likely contributes to the greater difficulties in interpersonal functioning and psychological problems in adulthood. © 2005 Lippincott Williams & Wilkins, Inc.