Child Sexual Abuse - The Effects Of Child Sexual Abuse

Effects on Children and Adults

According to the American Psychological Association (APA), children who have been sexually abused exhibit a range of symptoms (Understanding Child Sexual Abuse: Education, Prevention, and Recovery, Washington, DC, October 1999). The immediate effects may include thumb sucking and/or bed wetting; sleep disturbances; eating problems; and school problems, including misconduct, problems with performing schoolwork, and failure to participate in activities.

The APA also detailed long-term effects of childhood sexual abuse. Adult victims of childhood sexual abuse may suffer from depression, sexual dysfunction, and anxiety. Anxiety may manifest itself in such behaviors as anxiety attacks, insomnia, and alcohol and drug abuse. Adult survivors of childhood sexual abuse also report revictimization, as rape victims or as victims of intimate physical abuse.

A Longitudinal Study of the Effects of Child Sexual Abuse

In the first study of its kind, researchers sought to determine the impact of child sexual abuse on adult mental health, parenting relationships, and the adjustment of the children of mothers who had been victims of childhood sexual abuse (Ron Roberts, Tom O'Connor, Judy Dunn, Jean Golding, and the ALSPAC Study Team, "The Effects of Child Sexual Abuse in Later Family Life: Mental Health, Parenting and Adjustment of Offspring," Child Abuse & Neglect, vol. 28, issue 5, May 2004). Roberts et al. investigated 8,292 families, a subsample of the Avon Longitudinal Study of Parents and Children (ALSPAC), a continuing study of women and their families in Avon, England. The participating women had self-reported experiences of sexual assault before adolescence. Four family groups were included:

• Single mother families (9% of the study sample)—Consist of a nonmarried woman with no partner and her children
• Biological families (79.5%)—Consist of two parents and their biological children with no other children from previous relationships
• Stepmother/Complex stepfamilies (4.6%)—Consist of fathers with at least one biological child (living in the household or visiting regularly) who is not the biological offspring of the mother
• Stepfather families (6.9%)—Consist of a mother and at least one biological child (living in the household or visiting regularly) who is not the biological offspring of the father

The study revealed that more than a quarter (26%) of survivors of child sexual abuse had teen pregnancies. These women were disproportionately likely to be currently living in a nontradional family—single mother families (3%) and stepfather families (2.9%)—than to be living in biological families (1.3%). The researchers did not have a similar finding when it came to stepmother/complex stepfamilies. In this group just 0.8% reported child sexual abuse. They surmised that a woman who has experienced child sexual abuse tends to choose a partner without children because she might feel inadequate to take care of more children.

Child sexual abuse also has consequences on the adult survivors' mental health. Mothers who reported child sexual abuse were likely to report more depression and anxiety and lower self-esteem. These mental problems in turn affect the mothers' relationship with their children and the children's adjustment. Mothers with a history of child sexual abuse reported less confidence in themselves and less positive relationships with their children. The children were hyperactive and had emotional, peer, and conduct problems.

High-Risk Sexual Behaviors in Adolescent Girls

A sample of 125 adolescents ages twelve to seventeen comprised the subjects of a study designed to examine the sexual at-risk behaviors of female adolescents who had experienced sexual abuse (Caroline Cinq-Mars, John Wright, Mireille Cyr, and Pierre McDuff, "Sexual At-Risk Behaviors of Sexually Abused Adolescent Girls," Journal of Child Sexual Abuse, vol. 12, no. 2, 2003). The researchers administered a self-report questionnaire that asked about the subjects' sexual activities, which did not involve sexual abuse experiences. Then the subjects were interviewed regarding their sexual abuse experiences, including information about the perpetrator (both family and nonfamily members), frequency and duration of abuse, severity of the abuse, and whether or not they told someone of the abuse.

Among offending family members, fathers were the perpetrators in 30.4% of incidents. Stepfathers and extended family members each were responsible for 28.8% of the sexual abuse, and brothers accounted for another 9.6% of abuse. The victims experienced more than one incident of sexual abuse, with the mean number of perpetrators per victim being 1.8. The mean age for the start of abuse was 9.3 years. More than one-third (36.8%) of the victims experienced sexual abuse before age eleven.

More than half (55.3%) of the participants reported being sexually active. More than half (54.5%) had their first consensual intercourse before the age of fifteen. The rate of pregnancy was 15%. The researchers found three sexual abuse characteristics that were associated with the adolescents' sexual at-risk behavior. Adolescents who experienced childhood sexual abuse involving penetration were more than thirteen times as likely to have been pregnant and twice as likely to have more than one consensual partner in the past year. Having been abused by more than one perpetrator (in one or more incidents) was also closely associated with at-risk behaviors—pregnancy (eight times as likely), more than one consensual sexual partner (four times as likely), and irregular condom use (three times as likely). Finally, physical coercion during abuse increased the odds of pregnancy (four times as likely), more than one consensual sexual partner (five times as likely), and irregular condom use (three times as likely).

Relationship between Male Child Sexual Abuse and Teen Pregnancy

More than 4,100 men in a primary care setting were interviewed regarding whether or not they had ever impregnated an adolescent girl (Robert F. Anda, Vincent J. Felitti, Daniel P. Chapman, Janet B. Croft, David F. Williamson, John Santelli, Patricia M. Dietz, and James S. Marks, "Abused Boys, Battered Mothers, and Male Involvement in Teen Pregnancy," Pediatrics, vol. 107, no. 2, February 2001). The study found that men with a history of childhood sexual or physical abuse or of witnessing physical abuse of their mother were more likely to have been involved in teenage pregnancy. About 19% of the men reported ever getting a girl pregnant during adolescence and adulthood. The girls were between twelve and nineteen years old. About 59% of the men were age twenty or older at the time they impregnated the girls.

One-fourth (25.5%) of men who experienced childhood sexual abuse indicated having impregnated teen girls, compared to 17.8% of those who had not been sexually abused as children. Those whose sexual abuse was characterized by physical force or threat of harm were about twice as likely to have impregnated a teenage girl. Those who were abused at age ten and under showed an 80% increased risk of getting a teenage girl pregnant.

Effects of Abuse by Females

Myriam S. Denov of the University of Ottawa, Ontario, Canada, conducted a qualitative study of the long-term effects of childhood sexual abuse by women. Unlike quantitative research, which involves collecting samples of quantitative data and performing some form of statistical analysis, qualitative research is based on a smaller sample of individuals and does not represent the general population. However, according to Denov, the qualitative approach "is particularly appropriate for a study of this nature as it can give depth and detail of phenomena that are difficult to convey with quantitative methods" ("The Long-Term Effects of Child Sexual Abuse by Female Perpetrators: A Qualitative Study of Male and Female Victims," Journal of Interpersonal Violence, vol. 19, no. 10, October 2004).

The study sample consisted of seven males and seven females, who ranged in age from twenty-three to fifty-nine years. The sexual abuse occurred when they were fourteen years old or younger. All participants reported at least one incident of sexual abuse by a lone female perpetrator. Five participants reported having been sexually abused by more than one lone perpetrator. Nine participants were abused by a female relative—six by their mother, two by their mother and grandmother, and one by his mother and sister. Four participants were abused by an unrelated person—three by a babysitter and one by a nun at a local church. While the study concerns abuse perpetrated by women, half (or seven) of the participants reported having also been sexually abused by a man (in a separate incident from the abuse by women)—four by their father, two by an unrelated male babysitter, and one by his older half-brother.

The sexual abuse started, on average, at age five and ended, on average, at age twelve. It lasted about six years. Five participants were abused more than once a week, three were abused once a week, and four were abused once a month. Two participants reported a single episode of abuse. All participants reported mild abuse (for example, kissing in a sexual way and sexual invitations). In addition, ten reported moderate abuse (genital contact or fondling [without penetration] and simulated intercourse). Nine participants experienced severe abuse (such as intercourse and penetration with fingers or objects).

Denov observed that, while many effects of sexual abuse by females seem similar to that by males, female sexual abuse has long-term effects that are unique. Of the fourteen study participants, just one (a male) indicated he did not feel damaged by the sexual abuse by a woman. The other thirteen said they felt damaged by the abuse. All seven participants who were also abused by males reported that the sexual abuse by women was more damaging. The effects of child sexual abuse included substance abuse (used to "silence their rage and numb the pain"), self-injury, thoughts of suicide, depression, and rage. All victims reported a great mistrust of women and a discomfort with sexual intimacy. Most of the female victims were confused about their sense of identity and self-concept. Five of seven said that, as young girls, they did not want to grow up to be women. Four women confessed that they continued to deny their femininity, one victim admitting that she dressed in an unwomanly fashion because she would be safest to herself and to others. Twelve participants feared they might sexually abuse their own children. In fact, two men and two women reported having sexually abused children. One man and three women decided not to have children.

Male Victims' Perception of Childhood Sexual Abuse and Clinical Findings

Dr. Holmes's review of studies of male child sexual abuse ("Sexual Abuse of Boys: Definition, Prevalence, Correlates, Sequelae, and Management," Journal of the American Medical Association, vol. 280, no. 21, December 2, 1998) found that only 15% to 39% of victims who responded to the studies thought that they were adversely affected by the sexual abuse. The victims stressed that the adverse effects were linked to the use of force, a great difference in victim–perpetrator age, or cases in which the perpetrator was much older, or the victim was very young. Dr. Holmes noted, however, that negative clinical results (in contrast to what the studies'subjects reported) included posttraumatic stress disorder, major depression, paranoia, aggressive behavior, poor self-image, poor school performance, and running away from home.

Dr. Holmes also found a connection between sexual abuse and subsequent substance abuse among male victims. Sexually abused males were also more likely to have sex-related problems, including sexual dysfunction, hypersexuality, and the tendency to force sex on others. He surmised that the discrepancy between the respondents' perceptions of the negative consequences of their sexual victimization and those discovered in clinical outcomes may be due to several factors. Dr. Holmes observed that perhaps abused males believe they have failed to protect themselves as society expects them to do. Instead of owning up to their failure, they resort to not giving much gravity to their experiences. Moreover, if the victims had experienced pleasure while being abused, they may be confused by their feelings about it.

A Risk for Substance Abuse

Studies have shown that childhood abuse increases the risk for substance abuse later in life. A five-year study by McLean Hospital researchers in Belmont, Massachusetts, uncovered how this occurs (Carl M. Anderson, Martin H. Teicher, Ann Polcari, and Perry F. Renshaw, "Abnormal T2 Relaxation Time in the Cerebellar Vermis of Adults Sexually Abused in Childhood: Potential Role of the Vermis in Stress-Enhanced Risk for Drug Abuse," Psychoneuroendocrinology, vol. 27, no. 1–2, January 2002). Anderson et al. found that the vermis, the region flanked by the cerebellar hemispheres of the brain, may play a key role in the risk for substance abuse among adults who have experienced child abuse. The vermis develops gradually and continues to produce neurons, or nerve cells, after birth. It is known to be sensitive to stress, so that stress can influence its development.

The researchers compared young adults ages eighteen to twenty-two, including eight with a history of repeated childhood sexual abuse (CSA) and sixteen others as the control group. Using functional magnetic resonance imaging (fMRI) technology, the researchers measured the resting blood flow in the vermis. They found that the subjects who had been victims of CSA had diminished blood flow. Anderson and his colleagues suggested that the stress experienced with repeated CSA may have caused damage to the vermis, which in turn could not perform its job of controlling irritability in the limbic system. The limbic system in the center of the brain, a collection of connected clusters of nerve cells, is responsible for, among other things, regulating emotions and memory. The damaged vermis, therefore, induces a person to use drugs or alcohol to suppress the irritability.

Since the CSA subjects had no history of alcohol or substance abuse, Anderson and his colleagues wanted to confirm their findings, which linked an impaired cerebellar vermis and the potential for substance abuse in CSA victims. The researchers analyzed test data collected from the 537 college students recruited for the study. They found that students who reported frequent substance abuse showed higher irritability in the limbic system. They also exhibited symptoms usually associated with drug use, including depression and anger.

A Risk for Illicit Drug Use

A total of 1,478 noninjecting female sexual partners of male injection-drug users were the subjects of a study by Robert C. Freeman, Karyn Collier, and Kathleen M. Parillo ("Early Life Sexual Abuse as a Risk Factor for Crack Cocaine Use in a Sample of Community-Recruited Women at High Risk for Illicit Drug Use," American Journal of Drug and Alcohol Abuse, vol. 28, no. 1, February 2002). Nearly two-thirds (63.7%) of the women reported having used crack cocaine. The researchers found that an equal proportion of all women had suffered sexual abuse before age twelve (39.5%) and during adolescence (38.8%). Overall, nearly 22% were sexually abused during both childhood and adolescence.

While Freeman et al. found a relationship between childhood sexual abuse and lifetime crack use, they found no direct link between sexual abuse during adolescence and lifetime crack use. They did find, however, some indirect connections between the two. Female teens who were victims of sexual abuse were more likely to run away, and these runaways were more likely to use crack because of the type of people with whom they associated.

Sexual Revictimization

Abused females were the subjects in a longitudinal study that examined the impact of child sexual abuse on female development. This was the first prospective study that followed children from the time sexual abuse was reported through adolescence and into early adulthood (Jennie G. Noll, Lisa A. Horowitz, George A. Bonanno, Penelope K. Trickett, and Frank W. Putnam, "Revictimization and Self-Harm in Females Who Experienced Childhood Sexual Abuse: Results from a Prospective Study," Journal of Interpersonal Violence, vol. 18, no. 12, December 2003). Referred by child protective services agencies, the participants experienced sexual abuse by a family member before the age of fourteen. The median age at the start of sexual abuse was seven to eight years, and the median duration of abuse was two years. The group consisted of eighty-four abused children and a comparison group of eighty-two children. Two yearly interviews followed the first assessment of the group. A fourth interview was conducted four to five years after the third interview.

Noll et al. noted that this study was the first to provide information about the revictimization of child sexual abuse survivors not long after their abuse (seven years after the abuse when the participants were in their adolescence and early adulthood). The study found that participants who had been sexually abused during childhood were twice as likely as the comparison group to have experienced sexual revictimization, such as rape or sexual assault, and almost four times as likely to harm themselves through suicide attempts or self-mutilation. They also suffered about 1.6 times more physical victimization, such as domestic violence. Compared to the nonabused group, the abused group reported 20% more significant lifetime traumas sub-sequent to being sexually abused. Significant lifetime traumas reported by the participants included separation and losses (for example, having family or friends move away or die), emotional abuse and/or rejection by family, natural disasters, and witnessing violence.

The researchers observed that childhood sexual abuse is the "strongest predictor of self-harm" even when other types of abuse are present. They surmised that the victims may have negative feelings toward their own body and want to hurt it. They wrote that some researchers believe victims may want to reveal internal pains through outward manifestation of self-harm. Others wish to re-experience feelings of shame.

Jeremy Coid, Ann Petruckevitch, Gene Feder, Wai-Shan Chung, Jo Richardson, and Stirling Moorey surveyed a large sample of women to determine whether childhood sexual and physical abuse increases the risk of revictimization ("Relation between Childhood Sexual Abuse and Physical Abuse and Risk of Revictimization in Women: A Cross-Sectional Survey," The Lancet, vol. 358, no. 9280, August 11, 2001). A survey involving more than 1,200 women ages sixteen to eighty-five was conducted in primary care practices in London, England. Fifty-four percent of the respondents were white.

The researchers found that women who had a history of unwanted sexual intercourse before age sixteen were more likely to experience intimate partner violence and rape. Those who had been severely beaten before age sixteen by their parents or caregivers reported adult abuse in the form of intimate partner violence, rape, and other traumatic experiences. The women also reported a co-occurrence of sexual and physical abuse both during childhood and adulthood.