Karen Was Sexually Abused by Her Father at the Age

Karen was sexually abused by her father at the age of 5. She developed a severe separation anxiety reaction whenever her mother tried to leave. As an adult, Karen developed a dissociative disorder due to the same abuse. This is an example of how the same factor, in this case abuse, can be ________

A) both a sufficient and a necessary cause.
B) both a reinforcing contributory cause and a punishing contributory cause.
C) both a primary and a secondary process.
D) both a proximal and a distal causal factor.