The Impact of Child Sexual Abuse: Long-Term Effects
Some research has found that around one-third of children may not show any negative effects of CSA straight away (Kendall-Tackett et al., 1993; Mannarino & Cohen, 1986). This does not necessarily mean, however, that these children are not affected by the abuse, or that they do not experience problems later on. Several interpretations of these “symptom-free” victims have been proposed. For example, Kuyken (1995) suggests that the measures used to detect symptoms in these cases were perhaps not sensitive enough, whereas other authors have posited that these victims may be in a state of shock or denial. The shock/denial hypothesis gave rise to the investigation of “sleeper effects,” which has led to findings of serious emotional, behavioural and social problems for some of these children later on in life (Mannarino, Cohen, Smith, & Moore-Motily, 1991; Saunders, Kilpatrick, Hansen, Resnick, & Walker, 1999; Widom, 1999).
It has further been suggested that individuals who continue to show few or no symptoms, may have experienced: shorter periods of abuse, less severe abuse, abuse without penetration, violence or force, abuse by a person other than a “father figure,” and had the reactive support of their family (Finkelhor, 1990; Ketring & Feinauer, 1999; also see Kuyken, 1995). In fact, much of the variation in symptoms found in CSA survivors has been attributed to these variables. Webster (2001) links the degree of trauma experienced to three specific variables: the amount of actual or implied violence/fear associated with the sexual abuse, the parents’ reactions to disclosure of the abuse and the actions taken thereafter, and the age of the child when the assault occurs. Webster further expands on these three variables with the support of many other authors. For example, in determining the level of fear/violence associated with the abuse, issues of trust, control, obligation and level of emotional connectedness to the perpetrator are all considered; along with the degree of physical invasiveness (especially penetration), pain and violence connected with the act (Bennett, Hughes, & Luke, 2000; Browne & Finkelhor, 1986; Callahan, et al., 2003; Cohen & Mannarino, 2000; Collings, 1995; Mannarino & Cohen, 1996; Russell, 1986).
Family reaction (for example, issues concerning belief and blame), support (for example, counselling) and follow-up (for example, protection of the child from the perpetrator, legal proceedings), also contribute to how the child will cope and recover (or worsen) following disclosure (Kazdin & Weisz, 1998; Saywitz, Mannarino, Berliner, & Cohen, 2000). Lastly, the age (developmental status) of the child when the abuse begins, and the length of time the abuse continues for, also contribute to the degree of trauma experienced by the victim (Tremblay, Herbert, & Piche, 1999). While effects of CSA vary markedly among victims and no single “syndrome” has been identified, the above three variables are somewhat helpful in terms of treating cases of CSA. Of course, the most important component of working with survivors of CSA is their unique understanding and experience of the event/s and intervention/therapy is best approached from within the individual’s own framework and network of supports.
Lastly, several studies have produced findings that suggest that some female CSA victims suffer several long-term negative physiological changes as they get older (Altemus, Cloitre, & Dhabhar, 2003; DeBellis, Burke, Trickett, & Putnam, 1996; DeBellis, Lefter, Trickett, & Putnam, 1994). Not only are CSA females likely to physically “develop” earlier (generating increased male attention), but specific hormonal and neuroendocrine changes have also been evidenced. DeBellis, Chrousos, Dorn, Burke, Helmers, Kling, Trickett, & Putnam (1994) found that a group of 8-15 year old CSA girls had significantly elevated epinephrine, norepinephrine and dopamine levels (catecholamines typically secreted in response to stress) when compared with non-abused girls.
Other studies (DeBellis et al., 1994b, 1996) have found elevated levels of adrenocorticotrophic hormone (ACTH) and cortisol in 7-15 year old girls. Heim, Newport, Miller, & Nemeroff (2000, 2002) found that women who had been sexually abused as children had significantly higher levels of ACTH and cortisol than women who had not been abused (whether they suffered depression or not), and that women who had been sexually abused and suffered depression had significantly higher levels than any other group. Further, stress hormone levels where not found to differ significantly between non-sexually abused depressed and non-depressed women. This study concluded that depression alone does not show the same, significant physiological “stress effect” that CSA does, but that the interaction of depression and CSA can significantly compound stress levels.