Victims as victimizers: Physical aggression by persons with a history of childhood abuse

Background: Substance abuse has been called the dominant characteristic of families involved in child abuse cases, but the frequency with which childhood victims become adult victimizers remains uncertain. Objective: To examine whether a history of childhood sexual or physical abuse is associated with becoming a victimizer (ie, abusing or assaulting others) as an adult. Methods: Interview data were collected from 439 persons in Providence, RI, from July 1997 through March 1998 who had a history of intravenous drug use. Victimizers were defined as adults who had ever physically abused or assaulted a family member or sexual partner (eg, kicked, hit, choked, shot, stabbed, burned, or held at gunpoint). We compared persons who had a history of victimizing others with those who did not have such a history by bivariate and multivariate analyses. Variables included demographic factors as well as a history of sexual or physical abuse before the age of 16 years. Results: The prevalence of childhood physical or sexual abuse was 51% for women and 31% for men. Seventeen percent of our subjects reported being victimizers. Among persons who reported being victims of either physical or sexual childhood abuse, 28% victimized others; among those who denied a history of childhood abuse. 10% victimized others. Two thirds of victimizers reported being intoxicated while assaulting others. When we used logistic regression to control for sex, having children, education, race, and history of incarceration, childhood abuse was significantly and independently associated with becoming a victimizer (odds ratio, 3.6; 95% confidence interval, 2.1- 6.1). Conclusions: Large numbers of intravenous drug users, both men and women, have victimized family members or sexual partners. We confirm a high rate of childhood abuse among this population and demonstrate that among intravenous drug users past abuse is associated with becoming a victimizer as an adult. Primary care providers should be alert to this cycle of violence.