Skip to main content

Advertisement

Springer Nature Link
Log in

Childhood Maltreatment and Sexual Risk Taking: The Mediating Role of Alexithymia

  • Original Paper
  • Published:
Archives of Sexual Behavior Aims and scope Submit manuscript

Abstract

Childhood maltreatment is a significant predictor of sexual risk taking. The nature of this relationship is not fully understood; however, emotion dysregulation may play an important role. We tested the role of difficulty identifying and describing feelings (i.e., alexithymia) on the relationship between childhood maltreatment and sexual risk taking. Specifically, we hypothesized two mechanisms, one in which alexithymia is related to sexual risk taking via negative urgency and alcohol use and a second one in which alexithymia is related to sexual risk taking via neediness. The participants for this study were 425 sexually active college undergraduates (303 females, 122 males) between the ages of 18 and 25 years. The results of a structural equation model indicated that alexithymia accounted for a significant part of the relationship between child maltreatment and sexual risk behavior. Moreover, the relationship between alexithymia and sexual risk taking was fully accounted for by two separate paths. First, negative urgency and subsequent alcohol use partially mediated the relationship, and the second effect was accounted for by needy interpersonal style. Adverse experiences during childhood can impair emotional functioning and contribute to behavioral and interpersonal dysregulation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  • Abbey, A., Saenz, C., & Buck, P. O. (2005). The cumulative effects of acute alcohol consumption, individual differences and situational perceptions on sexual decision making. Journal of Studies on Alcohol, 66, 82–90.

    Article  PubMed  PubMed Central  Google Scholar 

  • American College Health Association. (2011). American College Health Association National College Health Assessment: Reference Group Executive Summary. Retrieved October 19, 2012 from http://www.acha-ncha.org/docs/ACHA-NCHA-II_ReferenceGroup_ExecutiveSummary_Spring2011.pdf.

  • Baer, J. S., Kivlahan, D. R., Blume, A. W., McKnight, P., & Marlatt, G. A. (2001). Brief intervention for heavy-drinking college students: 4-Year follow-up and natural history. American Journal of Public Health, 91, 1310–1316. doi:10.2105/AJPH.91.8.1310.

    Article  PubMed  PubMed Central  Google Scholar 

  • Bagby, R., Taylor, G. J., & Parker, J. A. (1994). The twenty-item Toronto Alexithymia Scale: II. Convergent, discriminant, and concurrent validity. Journal of Psychosomatic Research, 38, 33–40. doi:10.1016/0022-3999(94)90006-X.

    Article  PubMed  Google Scholar 

  • Barkham, M., Hardy, G. E., & Startup, M. (1996). The IIP-32: A short version of the inventory of interpersonal problems. British Journal of Clinical Psychology, 35, 21–35. doi:10.1111/j.2044-8260.1996.tb01159.x.

    Article  PubMed  Google Scholar 

  • Bensley, L., Van Eenwyk, J., & Simmons, K. (2000). Self-reported childhood sexual and physical abuse and adult HIV-risk behaviors and heavy drinking. American Journal of Preventive Medicine, 18, 151–158.

    Article  PubMed  Google Scholar 

  • Brody, S. (2003). Alexithymia is inversely associated with women’s frequency of vaginal intercourse. Archives of Sexual Behavior, 32, 73–77.

    Article  PubMed  Google Scholar 

  • Brown, J. L., & Vanable, P. A. (2007). Alcohol use, partner type, and risky sexual behavior among college students: Findings from an event-level study. Addictive Behaviors, 32, 2940–2952.

    Article  PubMed  PubMed Central  Google Scholar 

  • Burton, C. M., Pedersen, S. L., & McCarthy, D. M. (2012). Impulsivity moderates the relationship between implicit associations about alcohol and alcohol use. Psychology of Addictive Behaviors, 26, 766–772. doi:10.1037/a0028742.

    Article  PubMed  PubMed Central  Google Scholar 

  • Catania, J. A., Paul, J., Osmond, D., Folkman, S., Pollack, L., Canchola, J., … Neilands, T. (2008). Mediators of childhood sexual abuse and high-risk sex among men-who-have-sex-with-men. Child Abuse & Neglect, 32, 925–940. doi:10.1016/j.chiabu.2007.12.010.

  • Centers for Disease Control and Prevention. (2014). STDs in adolescents and young adults. Retrieved from http://www.cdc.gov/std/stats12/adol.htm.

  • Cloitre, M., Scarvalone, P., & Difede, J. (1997). Posttraumatic stress disorder, self- and interpersonal dysfunction among sexually retraumatized women. Journal of Traumatic Stress, 10, 437–452.

    PubMed  Google Scholar 

  • Cooper, M. (2002). Alcohol use and risky sexual behavior among college students and youth: Evaluating the evidence. Journal of Studies on Alcohol, 63(Suppl. 14), 101–117.

    Article  Google Scholar 

  • Cyders, M., & Smith, G. (2008). Emotion-based dispositions to rash action: Positive and negative urgency. Psychological Bulletin, 134, 807–828. doi:10.1037/a0013341.

    Article  PubMed  PubMed Central  Google Scholar 

  • Deckman, T., & DeWall, C. N. (2011). Negative urgency and risky sexual behaviors: A clarification of the relationship between impulsivity and risky sexual behavior. Personality and Individual Differences, 51, 674–678. doi:10.1016/j.paid.2011.06.004.

    Article  Google Scholar 

  • Deliramich, A., & Gray, M. (2008). Changes in women’s sexual behavior following sexual assault. Behavior Modification, 32, 611–621.

    Article  PubMed  Google Scholar 

  • Dimeff, L. A., Baer, J. S., Kivlahan, D. R., & Marlatt, G. (1999). Brief alcohol screening and intervention for college students (BASICS): A harm reduction approach. New York: Guilford Press.

    Google Scholar 

  • Dvorak, R. D., Lamis, D. A., & Malone, P. S. (2013). Alcohol use, depressive symptoms, and impulsivity as risk factors for suicide proneness among college students. Journal of Affective Disorders, 149, 326–334. doi:10.1016/j.jad.2013.01.046.

    Article  PubMed  PubMed Central  Google Scholar 

  • Fink, E. L., Anestis, M. D., Selby, E. A., & Joiner, T. E. (2010). Negative urgency fully mediates the relationship between alexithymia and dysregulated behaviours. Personality and Mental Health, 4, 284–293. doi:10.1002/pmh.138.

    Article  Google Scholar 

  • Flannery, D., Ellingson, L., Votaw, K. S., & Schaefer, E. A. (2003). Anal intercourse and sexual risk factors among college women, 1993–2000. American Journal of Health Behavior, 27, 228–234.

    Article  PubMed  Google Scholar 

  • Forhan, S. E., Gottlieb, S. L., Sternberg, M. R., Fujie, X., Datta, S., McQuillan, G. M., … Markowitz, L. E. (2009). Prevalence of sexually transmitted infections among female adolescents aged 14 to 19 in the United States. Pediatrics, 124, 1505–1512.

  • Gagnon, J., Daelman, S., McDuff, P., & Kocka, A. (2013). UPPS dimensions of impulsivity: Relationships with cognitive distortions and childhood maltreatment. Journal of Individual Differences, 34, 48–55. doi:10.1027/1614-0001/a000099.

    Article  Google Scholar 

  • Gaher, R. M., Arens, A. M., & Shishido, H. (2013). Alexithymia as a mediator between childhood maltreatment and impulsivity. Stress and Health,. doi:10.1002/smi.2552.

    PubMed  Google Scholar 

  • Gaher, R. M., Hofman, N. L., Simons, J. S., & Hunsaker, R. (2013). Emotion regulation deficits as mediators between trauma exposure and borderline symptoms. Cognitive Therapy and Research, 37, 466–475. doi:10.1007/s10608-012-9515-y.

    Article  Google Scholar 

  • George, W. H., Davis, K., Masters, N., Jacques-Tiura, A. J., Heiman, J. R., Norris, J., … Andrasik, M. P. (2014). Sexual victimization, alcohol intoxication, sexual-emotional responding, and sexual risk in heavy episodic drinking women. Archives of Sexual Behavior, 43, 645–658. doi:10.1007/s10508-013-0143-8.

  • Gidycz, C. A., Hanson, K., & Layman, M. J. (1995). A prospective analysis of the relationships among sexual assault experiences: An extension of previous findings. Psychology of Women Quarterly, 19, 5–29.

    Article  Google Scholar 

  • Gratz, K. L., Bornovalova, M. A., Delany-Brumsey, A., Nick, B., & Lejuez, C. W. (2007). A laboratory-based study of the relationship between childhood abuse and experiential avoidance among inner-city substance users: The role of emotional nonacceptance. Behavior Therapy, 38, 256–268.

    Article  PubMed  Google Scholar 

  • Green, B., Krupnick, J., Stockton, P., Goodman, L., Corcoran, C., & Petty, R. (2005). Effects of adolescent trauma exposure on risky behavior in college women. Psychiatry, 68, 363–378.

    Article  PubMed  Google Scholar 

  • Grello, C. M., Welsh, D. P., & Harper, M. S. (2006). No strings attached: The nature of casual sex in college students. Journal of Sex Research, 43, 255–267.

    Article  PubMed  Google Scholar 

  • Gullette, D. L., & Lyons, M. A. (2006). Sensation seeking, self-esteem, and unprotected sex in college students. AIDS Care, 17, 23–31. doi:10.1016/j.jana.2006.07.001.

    Article  Google Scholar 

  • Hillis, S., Anda, R., Felitti, V., & Marchbanks, P. (2001). Adverse childhood experiences and sexual risk behaviors in women: A retrospective cohort study. Family Planning Perspectives, 33, 206–211.

    Article  PubMed  Google Scholar 

  • Hillis, S., Anda, R., Felitti, V., Nordenberg, D., & Marchbanks, P. (2000). Adverse childhood experiences and sexually transmitted diseases in men and women: A retrospective study. Pediatrics, 106, E11. doi:10.1542/peds.106.1.e11.

    Article  PubMed  Google Scholar 

  • Hipwell, A., Stepp, S., Chung, T., Durand, V., & Keenan, K. (2012). Growth in alcohol use as a developmental predictor of adolescent girls’ sexual risk-taking. Prevention Science, 13, 118–128. doi:10.1007/s11121-011-0260-3.

    Article  PubMed  PubMed Central  Google Scholar 

  • Hu, L., & Bentler, P. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus. Structural Equation Modeling, 6, 1–55.

    Article  Google Scholar 

  • Johnson, N. L., & Johnson, D. M. (2013). Factors influencing the relationship between sexual trauma and risky sexual behavior in college students. Journal of Interpersonal Violence, 28, 2315–2331. doi:10.1177/0886260512475318.

    Article  PubMed  Google Scholar 

  • Kline, R. B. (2011). Principles and practice of structural equation modeling (3rd ed.). New York: Guilford Press.

    Google Scholar 

  • Lamoureux, B. E., Palmieri, P. A., Jackson, A. P., & Hobfoll, S. E. (2012). Child sexual abuse and adulthood-interpersonal outcomes: Examining pathways for intervention. Psychological Trauma: Theory, Research, Practice, and Policy, 4, 605–613. doi:10.1037/a0026079.

    Article  Google Scholar 

  • Lane, R. D., & Schwartz, G. E. (1987). Levels of emotional awareness: A cognitive-developmental theory and its application to psychopathology. American Journal of Psychiatry, 144, 133–143.

    Article  PubMed  Google Scholar 

  • Lewis, M., Kaysen, D., Rees, M., & Woods, B. (2010). The relationship between condom-related protective behavioral strategies and condom use among college students: Global- and event-level evaluations. Journal of Sex Research, 47, 471–478. doi:10.1080/00224490903132069.

    Article  PubMed  PubMed Central  Google Scholar 

  • Lieberman, M. (2007). Social cognitive neuroscience: A review of core processes. Annual Review of Psychology, 58, 259–289. doi:10.1146/annurev.psych.58.110405.085654.

    Article  PubMed  Google Scholar 

  • Little, T. D., Cunningham, W. A., Shahar, G., & Widaman, K. F. (2002). To parcel or not to parcel: Exploring the question, weighing the merits. Structural Equation Modeling, 9, 151–173.

    Article  Google Scholar 

  • Loas, G., Corcos, M., Stephan, P., Pellet, J., Bizouard, P., Venisse, J., … Jeammet, P. (2001). Factorial structure of the 20-item Toronto Alexithymia Scale: Confirmatory factorial analyses in nonclinical and clinical samples. Journal of Psychosomatic Research, 50, 255–261. doi:10.1016/S0022-3999(01)00197-0.

  • Lynam, D. R., Smith, G. T., Whiteside, S. P., & Cyders, M. A. (2006). The UPPS-P: Assessing five personality pathways to impulsive behavior (Technical Report). West Lafayette, IN: Purdue University.

    Google Scholar 

  • MacDonald, T. K., MacDonald, G., Zanna, M. P., & Fong, G. (2000). Alcohol, sexual arousal, and intentions to use condoms in young men: Applying alcohol myopia theory to risky sexual behavior. Health Psychology, 19, 290–298. doi:10.1037/0278-6133.19.3.290.

    Article  PubMed  Google Scholar 

  • MacKinnon, D. P. (2008). Introduction to statistical mediation analysis. New York: Erlbaum.

    Google Scholar 

  • Maisto, S. A., Carey, M. P., Carey, K. B., Gordon, C. M., & Schum, J. L. (2004). Effects of alcohol and expectancies on HIV-related risk perception and behavioral skills in heterosexual women. Experimental and Clinical Psychopharmacology, 12, 288–297. doi:10.1037/1064-1297.12.4.288.

    Article  PubMed  PubMed Central  Google Scholar 

  • Marlatt, G. A., Baer, J. S., Kivlahan, D. R., Dimeff, L. A., Larimer, M. E., Quigley, L. A., … Williams, E. (1998). Screening and brief intervention for high-risk college student drinkers: Results from a 2-year follow-up assessment. Journal of Consulting and Clinical Psychology, 66, 604–615. doi: 10.1037/0022-006X.66.4.604.

  • Merrill, L., Guimond, J., Thomsen, C., & Milner, J. (2003). Child sexual abuse and number of sexual partners in young women: The role of abuse severity, coping style, and sexual functioning. Journal of Consulting and Clinical Psychology, 71, 987–996.

    Article  PubMed  Google Scholar 

  • Messman-Moore, T., Walsh, K., & DiLillo, D. (2010). Emotion dysregulation and risky sexual behavior in revictimization. Child Abuse and Neglect, 34, 967–976.

    Article  PubMed  Google Scholar 

  • Metcalfe, J., & Mischel, W. (1999). A hot/cool-system analysis of delay of gratification: Dynamics of willpower. Psychological Review, 106, 3–19.

    Article  PubMed  Google Scholar 

  • Muthén, L. K., & Muthén, B. O. (2012). Mplus statistical modeling software: Release 7.1. Los Angeles, CA.

  • Neal, D. J., & Fromme, K. (2007). Event-level covariation of alcohol intoxication and behavioral risks during the first year of college. Journal of Consulting and Clinical Psychology, 75, 294–306. doi:10.1037/0022-006X.75.2.294.

    Article  PubMed  Google Scholar 

  • Pao, M., Lyon, M., D’Angelo, L., Schuman, W., Tipnis, T., & Mrazek, D. (2000). Psychiatric diagnoses in adolescents seropositive for the human immunodeficiency virus. Archives of Pediatrics and Adolescent Medicine, 154, 240–244.

    Article  PubMed  Google Scholar 

  • Paradis, A., & Boucher, S. (2010). Research on interpersonal problems and codependency: Child maltreatment history and interpersonal problems in adult couple relationships. Journal of Aggression, Maltreatment & Trauma, 19, 138–158. doi:10.1080/10926770903539433.

    Article  Google Scholar 

  • Patrick, M., & Maggs, J. (2009). Does drinking lead to sex? Daily alcohol-sex behaviors and expectancies among college students. Psychology of Addictive Behaviors, 23, 472–481.

    Article  PubMed  PubMed Central  Google Scholar 

  • Purdie, M., Norris, J., Davis, K., Zawacki, T., Morrison, D. M., George, W. H., & Kiekel, P. A. (2011). The effects of acute alcohol intoxication, partner risk level, and general intention to have unprotected sex on women’s sexual decision making with a new partner. Experimental and Clinical Psychopharmacology, 19, 378–388. doi:10.1037/a0024792.

    Article  PubMed  PubMed Central  Google Scholar 

  • Ravert, R. D., Schwartz, S. J., Zamboanga, B. L., Kim, S., Weisskirch, R. S., & Bersamin, M. (2009). Sensation seeking and danger invulnerability: Paths to college student risk-taking. Personality and Individual Differences, 47, 763–768. doi:10.1016/j.paid.2009.06.017.

    Article  Google Scholar 

  • Sanders, B., & Becker-Lausen, E. (1995). The measurement of psychological maltreatment: Early data on the Child Abuse and Trauma Scale. Child Abuse and Neglect, 19, 315–323.

    Article  PubMed  Google Scholar 

  • Satterwhite, C., Torrone, E., Meites, E., Dunne, E., Mahajan, R., Ocfemia, M., … Weinstock, H. (2013). Sexually transmitted infections among US women and men: Prevalence and incidence estimates, 2008. Sexually Transmitted Diseases, 40, 187–193. doi:10.1097/OLQ.0b013e318286bb53.

  • Scimeca, G., Bruno, A., Pandolfo, G., Mico, U., Romeo, V. M., Abenavoli, E., … Muscatello, M. A. (2013). Alexithymia, negative emotions, and sexual behavior in heterosexual university students from Italy. Archives of Sexual Behavior, 42, 117–127. doi:10.1007/s10508-012-0006-8.

  • Scott-Sheldon, L. J., Carey, M. P., & Carey, K. B. (2010). Alcohol and risky sexual behavior among heavy drinking college students. AIDS and Behavior, 14, 845–853.

    Article  PubMed  PubMed Central  Google Scholar 

  • Senn, T., & Carey, M. (2010). Child maltreatment and women’s adult sexual risk behavior: Childhood sexual abuse as a unique risk factor. Child Maltreatment, 15, 324–335. doi:10.1177/1077559510381112.

    Article  PubMed  PubMed Central  Google Scholar 

  • Shields, A., & Cicchetti, D. (1998). Reactive aggression among maltreated children: The contributions of attention and emotion dysregulation. Journal of Clinical Child Psychology, 27, 381–395.

    Article  PubMed  Google Scholar 

  • Shipman, K. L., Schneider, R., Fitzgerald, M. M., Sims, C., Swisher, L., & Edwards, A. (2007). Maternal emotion socialization in maltreating and non-maltreating families: Implications for children’s emotion regulation. Social Development, 16, 268–285.

    Article  Google Scholar 

  • Shipman, K., Zeman, J., Penza, S., & Champion, K. (2000). Emotion management skills in sexually maltreated and non-maltreated girls: A developmental psychopathology perspective. Development and Psychopathology, 12, 47–62.

    Article  PubMed  Google Scholar 

  • Shishido, H., Gaher, R. M., & Simons, J. S. (2013). I don’t know how I feel, therefore I act: Alexithymia, urgency, and alcohol problems. Addictive Behaviors, 38, 2014–2017. doi:10.1016/j.addbeh.2012.12.014.

    Article  PubMed  Google Scholar 

  • Simoni, J., & Ng, M. (2000). Trauma, coping, and depression among women with HIV/AIDS in New York City. AIDS Care, 12, 567–580.

    Article  PubMed  Google Scholar 

  • Simons, J. S., Maisto, S. A., & Wray, T. B. (2010). Sexual risk taking among young adult dual alcohol and marijuana users. Addictive Behaviors, 35, 533–536. doi:10.1016/j.addbeh.2009.12.026.

    Article  PubMed  Google Scholar 

  • Simons, J. S., Wills, T. A, & Neal, D. J. (2011, August). In Alcohol intoxication and sexual behavior: Findings from an experience sampling study. Poster presented at the meeting of the American Psychological Association, Washington D.C.

  • Spitzer, C., Siebel-Jurges, U., Barnow, S., Grabe, H., & Freyberger, H. (2005). Alexithymia and interpersonal problems. Psychotherapy and Psychosomatics, 74, 240–246. doi:10.1159/000085148.

    Article  PubMed  Google Scholar 

  • StataCorp. (2013). Stata statistical software: Release 13. College Station, TX: StataCorp.

    Google Scholar 

  • Stoner, S. A., Norris, J., George, W. H., Morrison, D. M., Zawacki, T., Davis, K., & Hessler, D. M. (2008). Women’s condom use assertiveness and sexual risk-taking: Effects of alcohol intoxication and adult victimization. Addictive Behaviors, 33, 1167–1176.

    Article  PubMed  PubMed Central  Google Scholar 

  • Substance Abuse and Mental Health Services Administration. (2011). Results from the 2010 National Survey on Drug Use and Health: Summary of National Findings.

  • Tabachnick, B. G., & Fidell, L. S. (2007). Using multivariate statistics (5th ed.). Boston: Allyn & Bacon/Pearson Education.

    Google Scholar 

  • Taylor, G. J., Bagby, R., & Parker, J. (1997). Disorders of affect regulation: Alexithymia in medical and psychiatric illness. New York: Cambridge University Press.

    Book  Google Scholar 

  • Thorberg, F., Young, R. D., Sullivan, K. A., Lyvers, M., Connor, J. P., & Feeney, G. X. (2010). A psychometric comparison of the Toronto Alexithymia Scale (TAS-20) and the Observer Alexithymia Scale (OAS) in an alcohol-dependent sample. Personality and Individual Differences, 49, 119–123. doi:10.1016/j.paid.2010.03.018.

    Article  Google Scholar 

  • Turchik, J. A., & Garske, J. P. (2009). Measurement of sexual risk taking among college students. Archives of Sexual Behavior, 38, 936–948. doi:10.1007/s10508-008-9388-z.

    Article  PubMed  Google Scholar 

  • Turchik, J. A., Walsh, K., & Marcus, D. (2014). Confirmatory validation of the factor structure and reliability of the Sexual Risk Survey in a large multi-university sample of U.S. students. International Journal of Sexual Health, 27, 93–105. doi:10.1080/19317611.2014.944295.

    Article  Google Scholar 

  • Vanheule, S., Desmet, M., Meganck, R., & Bogaerts, S. (2007). Alexithymia and interpersonal problems. Journal of Clinical Psychology, 63, 109–117. doi:10.1002/jclp.20324.

    Article  PubMed  Google Scholar 

  • Vanheule, S., Vandenbergen, J., Verhaeghe, P., & Desmet, M. (2010). Interpersonal problems in alexithymia: A study in three primary care groups. Psychology and Psychotherapy: Theory, Research and Practice, 83, 351–362. doi:10.1348/147608309X481829.

    Article  Google Scholar 

  • Watson, L. B., Matheny, K. B., Gagné, P., Brack, G., & Ancis, J. R. (2013). A model linking diverse women’s child sexual abuse history with sexual risk taking. Psychology of Women Quarterly, 37, 22–37.

    Article  Google Scholar 

  • Wilson, H. W., Woods, B. A., Emerson, E., & Donenberg, G. R. (2012). Patterns of violence exposure and sexual risk in low-income, urban African American girls. Psychology of Violence, 2, 194–207. doi:10.1037/a0027265.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Psychology, University of South Dakota, 414 East Clark St., Vermillion, SD, 57069, USA

    Austin M. Hahn, Raluca M. Simons & Jeffrey S. Simons

Authors
  1. Austin M. Hahn
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Raluca M. Simons
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jeffrey S. Simons
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Austin M. Hahn.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hahn, A.M., Simons, R.M. & Simons, J.S. Childhood Maltreatment and Sexual Risk Taking: The Mediating Role of Alexithymia. Arch Sex Behav 45, 53–62 (2016). https://doi.org/10.1007/s10508-015-0591-4

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10508-015-0591-4

Keywords