Summary

No experience of child sexual abuse (CSA) is the same and the impacts of being abused vary greatly across survivors. Nonetheless, CSA is an Adverse Childhood Experience that may have lasting effects on a survivor's physical health (e.g., chronic health problems; risky health behaviors), emotional well-being (e.g., depression; anxiety; fear), relationships (e.g., challenges in establishing mutual, healthy, positive relationships), or other aspects of development (e.g., affect regulation difficulties). Effects may appear during, or not until after, the abuse has stopped, and/or at various periods in adult development. Believing the survivor's reports and providing support are critical in the healing process.

Variation in Experiences

Interest in the long-term effects of being sexually abused as a child has a long history in mental health.  After Freud’s first thoughts about it in the late 1880s, it received periodic mention in the professional literature until the late 1980s when an explosion of work took place resulting in what today is a massive body of research.  

From the outset it is important to appreciate that the impact of sexual abuse varies greatly across people.  Sexual abuse of youth is wrong for many reasons beyond the emotional or mental health impact it has on youth.  It is a crime which violates basic human rights. It is the use of power, manipulation, deceit, bribery, or force to gain sexual access to another person. It can involve a peer or a person of a different age.  It is often a betrayal in which an older person or person with power over the youth (due to size, maturity, or social or relationship status) uses a young person for sexual purposes.  It can create a feeling of being stigmatized as others react to the knowledge that a young person has been abused. Often, it becomes a secret that the young person has to carry which causes a sense of separation from family and friends, and even from one’s self.  

Some survivors of sexual abuse develop significant problems throughout life.  Many do not.  Some survivors experience problems with emotions, behaviors, or cognitions (thoughts).  Some problems are short-lived and others may be experienced for longer periods of time. 

Emotional Reactions to Abuse

In all cases where sexual abuse of a young person takes place, the young person and those who love the young person experience negative emotional reactions to the abuse such as anger, powerlessness, a sense of betrayal, embarrassment, shame, or fear. Some reactions may develop from the physical act of being abused, or from the process of grooming (someone who should have cared for the youth or been trustworthy was not). Some feelings may be related to the youth’s not being protected from the abuse, or from uncomfortable or negative reactions that others may have when learning that someone was abused as a youth.  

Emotional reactions to being abused and to telling others about the abuse are normal, understandable, and communicate why sexual abuse of youth is wrong.  No one has the right to abuse.

These reactions are not inherent parts of the person, and should be understood and expressed so that they may be released. The support of loved ones, peers, and mental and behavioral health professionals can help survivors accept and understand their emotional reactions as part of the healing process.  

The support of loved ones, peers, and mental and behavioral health professionals can be pivotal in a survivor's healing process.

Many survivors turn the traumatic experience of being abused into a source of personal growth. Nonetheless it is important for survivors and those who care about them to understand that sexual abuse can have one or more negative symptoms, unless and until the abuse stops and healing takes place.

Sexual abuse can have one or more negative symptoms, unless and until the abuse stops and healing takes place.

The human spirit is a remarkable thing which can and most often does overcome adversities.  In a very real way adversities like sexual abuse can create a detour in life path but they need not create a permanent change in direction.  Several important points need to be kept in mind about the impact of negative experiences such as sexual abuse.

• Many survivors do not experience significant problems as a result of the abuse.
• When problems do occur they can be short lived or take place over longer periods of time.
• Some problems do not present until later in the survivor’s life; often not until well into adulthood. 
• The specific problem(s) experienced by the victim depend on many different factors, mostly outside of the control of the survivor.
• Believing the survivor’s report and providing support are critical in helping the healing process.
• The relationship between a problem and the abuse can be understood, and a path to healing can be planned. The help of a trauma-informed therapist can be instrumental in the healing process.

The Effects of Childhood Experiences

Several overarching principles guide our understanding of the effects of childhood experiences:

• We now recognize that a number of adverse childhood experiences negatively impact human development.  In terms of their effects, it can be meaningless to prioritize or privilege one type of adverse experience over others. However recent research has suggested that physical and sexual abuse add small but statistically significant increased negative impact compared to other adversities.1
• Adversities experienced by the child or that are a part of the child’s environment can increase their risk for experiencing negative effects of sexual abuse. Indeed some adversities which impact the capacity of parents to protect their youth or which increase needs in the child may make a child more vulnerable to being sexually abused.
• The experience of being abused varies dramatically across children in terms of frequency, duration, relationship between the child and preparator, the actual sexual behavior, and other factors.
• Regardless of the specifics of the sexual abuse, many youth who are abused are negatively impacted as a result of the abuse; either while it is going on or into the future. Often this lasts through the rest of their development until the process of healing has begun, in which the negative experience may be turned into a source of personal growth.
• When we speak of suffering we do not just refer to symptoms like depression, anxiety, or other health and mental health issues but also that it is extremely distressing to be used by another person and to have to keep that abuse a secret from loved one and friends.
• Suffering and other negative impacts on the quality of life are inherently a subjective experience and it is impossible to compare one abused person’s experiences against another’s. 

The aspects of abuse which can have a negative impact on youth development vary across youth but include:

• Betrayal
• Powerlessness
• Manipulation and deceit
• Premature sexualization
• Maintaining a secret from parents and friends
• Isolation and alienation from others and “normal life”
• Coercion, force, threat of force, other threats
• Altered self-capacities of identify, affect regulation, and identity which have their own negative effects.

The effects of sexual abuse may appear during the abuse, after the abuse has stopped, and/or at various points in adulthood. To date, research has yielded limited understanding of when these effects appear in a survivor’s life.

The effects of sexual abuse may appear during the abuse, after the abuse has stopped, and/or at various points in adulthood.

Most aspects of mental health are multiply determined, such as symptoms and mental health problems.  As significant as sexual abuse can be, it interacts with aspects of the person including the life history of the youth. 

A child may have lost one parent though parental incapacity (e.g., alcoholism) or death and be abused by an adult who appears to replace the lost parent but turns out to abuse the youth.  Both these experiences can be associated with negative symptoms or problems.  Another youth may have a close and open relationship with two parents but be abused by the Pastor of the family, leading them to carry a traumatic secret that negatively impacts the parent-youth relationship.

Childhood sexual abuse, and indeed all adversities, can negatively impact youth and adult development.  There appears to be no aspect of life which cannot not be impacted by the experience of childhood sexual abuse. Mental health professionals have personally favored theories about human behavior and may apply those theories (e.g., cognitive behavioral or psychodynamic).  There is no single theory of etiology or the causes of various symptoms.  Professionals may use different perspectives to approach assisting youth with the problems resulting from childhood sexual abuse (see Why is it good to talk about the abuse?).

Potential Areas of Development Impacted by Abuse

As a brief overview, the following areas of human development can be impacted by the experience of being sexually abused in youth:

• Negative emotions, including depression, fear, anxiety, and others
• Coping behaviors, including substance abuse, gambling, high risk sexual behavior
• Affect regulation difficulties, including being unable to manage negative feelings, becoming overloaded (flooded with negative emotions), or experiencing deterioration in one’s normal state of being.
• Negative cognitions and beliefs about the self and world, such as powerlessness, hopelessness, self-criticism,  self-blame, thinking one is damaged, the world is unsafe, or others cannot be trusted.
• Identity, including how one sees positive and negative aspect of the self, feeling whole or damaged, or seeing oneself as an object to be used rather than a free and independent person.
• Relatedness, which is the capacity to identify people to whom it is safe to relate, including challenges in being able to establish a mutual, healthy, positive relationship, or to solve problems which arise in the relationships and maintain mutuality over time.
• Parenting behaviors, including maintaining a healthy balance between protection of youth and over controlling development for fear that your child will be abused.
• Health behaviors, including risky health behaviors, poor self-care, undiagnosed chronic minor physical health problems, or chronic health problems.
• Post-traumatic responses, including hypervigilance, difficulty sleeping, intrusive images, thoughts, or feelings associated with the abuse, numbing, dissociation, avoidance of reminders, or traumatic nightmares.

 

For further reading, see also:

• Beitchman, J., Zucker, K., Hood, J., DaCosta, G., Akman, D., & Cassavia, E. (1992). A review of the long-term effects of child sexual abuse. Child Abuse & Neglect, 16, 101-118.
• Briere, J. N., & Scott, C. (2014). Principles of trauma therapy: A guide to symptoms, evaluation, and treatment (DSM-5 update). Sage Publications, Thousand Oaks, CA.
• Kendall-Tackett, Williams, & Finkelhor. (1993). Impact of sexual abuse on children: A review and synthesis of recent empirical studies. Psychological Bulletin, 113(1), 164-180.
• Neumann, D., Houskamp, B., Pollock, V., & Briere, J. (1996). The long-term sequelae of childhood sexual abuse in women: A meta-analytic review. Child Maltreatment, 1(1), 6-16.
• Paolucci, E., Genuis, M., & Violato, C. (2001). A meta-analysis of the published research on the effects of child sexual abuse. The Journal of Psychology, 135(1), 17-36.
• Saunders, B., Villeponteaux, L., Lipovsky, J., Kilpatrick, D., & Veronen, L. (1992). Child sexual assault as a risk factor for mental disorders among women: A community survey. Journal of Interpersonal Violence, 7(2), 189-204.
• Stein, J., Golding, J., Siegel. J., Burnam, M., & Sorenson, S. (1988). Long-term psychological sequelae of child sexual abuse: The Los Angeles Epidemiologic Catchment Area Study. In G.E. Wyatt & G.E. Powell (Eds.), Lasting effects of child sexual abuse (pp. 135-154). Newbury Park, CA: Sage Publications.
• Thompson, M., Arias, I., Basile, K., & Desai, S. (2002). The association between childhood physical and sexual victimization and health problems in adulthood in a nationally representative sample of women. Journal of Interpersonal Violence, 17(10), 111-1129.
• Ullman, S.E. (2004). Sexual assault victimization and suicidal behavior in women: a review of the literature. Aggression and Violent Behavior, 9, 331-351.

• 1. Fergusson, D. M., McLeod, G. F., & Horwood, L. J. (2013). Childhood sexual abuse and adult developmental outcomes: Findings from a 30-year longitudinal study in New Zealand. Child abuse & neglect, 37(9), 664-674.