The Impact of Child Sexual Abuse: Effects
Research into the effects of CSA has produced varied and often conflicting results. While some investigators have stated that they found CSA victims to be only “slightly less well adjusted than controls” (Rind et al., 1998, p. 22), most researchers agree that the emotional, psychological, and social impact of CSA is often very serious and intense (Webster, 2001). Much of the scientific controversy exists around the “research-level precision” of the research, with methodological problems rampant in the literature. Sample population problems, such as the sole use of clinical versus non-clinical, abused persons versus non-abused persons, problems with self-report versus clinician report, differences between volunteer, university student and community samples, cross-sectional designs, different definitions of abuse, corelational designs, and the frequent lack of a control group, have all muddied the validity of findings and made it difficult to draw sound conclusions (see Callahan, Price & Hilsenroth, 2003; Corbett & Harris, 1995; Kuyken, 1995; Rind, & Tromovitch, 1997; Wagner, 1997; and Widom, 1995). The possibility of coexisting mental illness has made it difficult to attribute symptoms solely to CSA. Further, the high prevalence of co-occurrence of other family and environmental problems in families of CSA victims (for example, child physical abuse (CPA) and other types of child-maltreatment, family violence, unemployment, poverty and alcoholism/drug problems) has led researchers to be sceptical of attributing victims’ problems to the sexual abuse alone (Nash, Neimeyer, Hulsey, & Lambert, 1998; Widom, 1995).
Despite problems in research design and the absence of a concise definition, much of the research community concur that several effects of CSA appear to be quite apparent. For example, it is widely believed that a victim of CSA has an increased likelihood of experiencing negative physical, psychological, emotional and social problems; while the abuse is occurring, immediately after it ceases, and right through to long-term, even life-long effects (Esman, 1994; McMillan el al., 1995).
Webster (2001) suggests that the specific emotional and behavioural reactions of CSA victims vary markedly based on “genetic predisposition and temperament characteristics, socially taught patterns within the family unit and/or larger cultural group about how to express feelings, as well as the degree of emotional constriction or expressiveness shown by the child.” (p.536). However several studies have still found a number of common problems among CSA victims (see Corby, 2000). Firstly, many children who have been sexually abused show “sexualised conduct” (Beitchman, Zucker, Hood, DaCosta, & Akman, 1991; Edwards et al., 2003; Friedrich, Bielke, & Uriquiza, 1987; Kendall-Tackett, Williams, & Finkelhor, 1993). In fact Friedrich (1996) found age-inappropriate sexualised behaviour to be one of the most predictive consequences of sexual abuse. Further, survivors of CSA frequently become involved in sexual activity at a younger age, are often more “promiscuous,” engage in more “risky” sexual practices, and have a higher likelihood of becoming involved in prostitution (Browning, 2002; Herrera & McCloskey, 2003; Kendler, Thornton, Gilman, & Kessler, 2000).
Female survivors are also more likely to be re-victimised, raped and/or further traumatised (physically and emotionally) – especially by intimate partners (Finkelhor & Browne, 1985; Fromuth, 1986; Russell, 1986). Alternatively, the survivor may become fearful of physical intimacy and adult relationships, and may have serious aversions to sex; these aversions may include feeling guilty, ashamed, or anxious about their sexuality (Tharinger, 1990). Finkelhor and Browne (1985) found that “almost all clinically-based studies show later sexual problems among child sexual abuse victims, particularly among victims of incest” (p.70).
Post-Traumatic Stress Disorder (PTSD) is another problem commonly experienced by victims of CSA (Beichtman et al., 1991; Deblinger, Steer, & Lippmann, 1999; Finkelhor, 1990; Herrera & McCloskey, 2003; Kendall-Tackett et al., 1993; Kiser, Ackerman, Brown, Edwards, McColgan, Pugh, & Pruitt, 1988; Lang, 1997; McLeer, Deblinger, Henry, & Orvashel, 1992; Windom, 1999; Winfield, George, Swartz, & Blazer, 1990). For example, McLeer et al. (1992) found that roughly 50% of their CSA victims met either full or partial PTSD criteria. PTSD in these victims often manifests as: general agitation, sleep problems, hypervigilance, vague and scary nightmares, behavioural disorganisation, repetitive re-play of the abuse using toys or objects, or attempts to re-enact the sexual abuse with peers and/or adults, numbing of emotions, symptoms of dissociation, flashbacks, repressed memories and feelings of isolation, numbness and estrangement from others (Herrera & McCloskey, 2003; also see Webster, 2001).
Finkelhor (1990) however, has challenged the diagnosis of PTSD in Child Sexual Abuse. He posits that PTSD only covers the affective symptoms, (for example, depression and fear) and does not account for problems in the way survivors perceive themselves, their family, or for their sexual problems. Finkelhor argues that reactions to acute stressors (such as rape or war) are more consistent with symptoms for PTSD, and that sexual abuse is more correctly conceived of as a “chronic stressor;” usually occurring over several years and often not involving violence or sudden physical force. Many would disagree with Finkelhor on several accounts. For example, CSA may involve actual or implied physical violence, and several more recent studies (such as Herrera & McCloskey, 2003 and Windom, 1999) have continued to find clinical evidence of PTSD in CSA victims.
Two other symptoms commonly seen in CSA victims and survivors are anxiety and depression (Beitchman, Zucker, Hood, DaCosta, Akman, & Cassavia, 1992; Briere & Runtz, 1988; Edwards et al., 2003; Murphy, Kilpatrick, Amick-McMullen, Veronen, Paduhovich, Best, Villeponteaux, & Saunders, 1988; Shapiro, Leifer, Martone, & Kassem, 1990; Winfield, et al., 1990). Depression associated with CSA is usually seen as a “symptom,” rather than as a “syndrome” (Browne & Finkelhor, 1986). However, other common characteristics of depression, for example, suicide ideation and self-mutilation, are also strongly related to CSA (Briere & Runtz, 1988; Brown & Anderson, 1991; Bryant and Range, 1997; Davidson, Hughes, George, and Blazer, 1996; Gutierrez, Thakkar, & Kuczen, 2000; Peters and Range, 1995; Stepakoff, 1998; Van der Kolk, Perry & Herman, 1991).
In addition to depression and anxiety, sleep problems and panic attacks are also frequently associated with CSA (Bagley and Ramsay, 1986; Kolko, Moser, & Weldy, 1988; Wolfe, Gentile, & Wolfe, 1989). Further, other problems commonly found in CSA victims are: low self-esteem, anger, eating disorders, obsessive compulsive symptoms, tantrums, aggressive, antisocial and self-destructive behaviour, substance abuse, regressive behaviours, multiple personality disorders, withdrawal, guilt, shame, self-blame, powerlessness, helplessness, attention deficit hyperactivity disorder (ADHD), agitation and acting out. Also, victims are more likely to be arrested and have problems with interpersonal relationship and childrearing, and may experience a sense of being fundamentally damaged (Burkett, 1991; Edwards et al., 2003; Etherington, 1995; Finkelhor & Browne, 1985; Herrera & McCloskey, 2003; Kendler et al., 2000; Kolko et al., 1988; Kuyken, 1995; Murphy et al., 1988; Nash, Hulsey, Sexton, Harralson, & Lambert, 1993; Ross, Norton, & Wozney, 1989; Webster, 2001; Widom, 1995). Physical and psychosomatic complaints often include bruises, genital injuries, headaches and stomach aches (see Rathus et al., 2005 and Webster, 2001).
Some children who have experienced CSA have been found to exhibit a cluster of behaviours known as “compulsive compliance” (Crittendon, 1992). Compulsive compliance is characterised by the child being overly compliant to adult requests and even modifying or falsifying feelings and truth to gain (especially parental) approval. These children are very vigilant about how to behave and what to say (based on adult nonverbal cues) and tend to highly structure their lives, even to the point of ritualistic conduct (see Crittendon, 1992 and Webster, 2001).