In conclusion, it is evidenced from the above discussion that CSA is a complex and perplexing phenomenon. Whilst definition and methodological issues present problems in the research and clinical arenas, most professionals in the field agree that CSA is a highly destructive and problematic experience for the majority of survivors. Lack of clarity surrounding a specific definition, and massive underreporting of cases has lead to prevalence statistics presenting, at best, “bare minimum” figures. Issues concerning survivor memory, co-occurrence of other problems in childhood upbringing (such as child abuse, poverty, family violence, and drug and alcohol abuse) and co-morbidity of other mental illness, all contribute to the problem of attributing “causal” inference.

While increases in the standard of “research-level precision” of future studies will hopefully culminate in clearer findings, variation in the actual acts of CSA, and individual differences in response to trauma will no doubt continue to confound the issue. While statistics and categorisation remains important in psychology, the individual therapist encountering a survivor/victim in the treatment setting is best to take the approach of educating themselves as much as possible in the issues surrounding CSA and its treatment. Further, it is imperative to remember that the experience of CSA is different for every victim, and to always proceed at a pace that is comfortable for the individual client.

Author: Vikki Rowe is a graduate of AIPC’s Diploma of Professional Counselling and currently studying a Masters of Clinical Psychology course at the Australian Catholic University.

References:

  • Altemus, M., Cloitre, M., & Dhabhar, F.S. (2003). Enhanced cellular immune response in women with PTSD related to childhood abuse. American Journal of Psychiatry, 160(9), 1705-1707.
  • Bagley, C. & Ramsay, R. (1986). Sexual abuse in childhood: Psychological outcomes and implications for social work practice. Journal of Social Work and Human Sexuality, 4, 33-47.
  • Banning, A. (1989). Mother-son incest: Confronting a prejudice. Child Abuse and Neglect, 13, 563-570.
  • Barnett, O.W., Miller-Perrin, C.L. & Perrin, R.D. (1997). Family violence across the lifespan. Thousand Oaks: Sage Publications.
  • Bauserman, R., & Rind, B. (1997). Psychological correlates of male child and adolescent sexual experiences with adults: A review of the nonclinical literature. Archives of Sexual Behavior, 26, 105-141.
  • Beitchman, J.H., Zucker, K.J., Hood, J.E., DaCosta, G.A., & Akman, D. (1991). A review of the short-term effects of child sexual abuse. Child Abuse & Neglect, 15, 537-556.
  • Beitchman, J.H., Zucker, K.J., Hood, J.E., DaCosta, G.A., Akman, D. & Cassavia, E. (1992). A review of the long-term effects of child sexual abuse. Child Abuse and Neglect, 16, 101-118.
  • Bennett, S.E., Hughes, H.M., & Luke, D.A. (2000). Heterogeneity in patterns of child sexual abuse, family functioning, and long-term adjustment. Journal of Interpersonal Violence, 15, 134-157.
  • Boney-McCoy, S., & Finkelhor, D. (1998). Psychopathology associated with sexual abuse: A reply to Nash, Neimeyer, Hulsey, and Lambert (1998). Journal Consulting and Clinical Psychology, 66, 572-573.
  • Briere, J., & Runtz, M. (1988). Symptomatology associated with childhood sexual victimization in a nonclinical adult sample. Child Abuse & Neglect, 12, 51-59.
  • Briggs, F. (1986). Child sexual abuse. Confronting the problem. Australia: Pitman Publishing.
  • Brown, G.R. & Anderson, B. (1991). Psychiatric morbidity in adult inpatients with childhood histories of sexual and physical abuse. American Journal of Psychiatry, 148, 55-61.
  • Browne, A., & Finkelhor, D. (1986). Impact of sexual abuse: A review of the research. Psychological Bulletin, 99, 66—77.
  • Browning, C.R. (2002). Trauma or transition: A life-course perspective on the link between childhood sexual experiences and men’s adult well-being. Social Science Research, 31(4), 473-510.
  • Bryant, S.L., & Range, L.M. (1997). Type and severity of child abuse and college students’ lifetime suicidality. Child Abuse & Neglect, 21, 1169-1176.
  • Burkett, L.P. (1991). Parenting behaviours of women who were sexually abused as children in their families of origin. Family Process, 30, 421-434.
  • Callahan, K.L. Price, J.L. & Hilsenroth, M.J. (2003). Psychological assessment of adult survivors of childhood sexual abuse within a naturalistic clinical sample. Journal of Personality Assessment, 80(2), 173-184.
  • Cohen, J.A., & Mannarino, A.P. (2000). Predictors of treatment outcomes in sexually abused children. Child Abuse and Neglect, 24, 983-994.
  • Collings, S. (1995). The long-term effects of contact and noncontact forms of child sexual abuse in a sample of university men. Child Abuse & Neglect, 19, 1-6.
  • Corbett, R.P.Jr., Harris, K.M. (1995). A review of research for practitioners. Federal Probation, 59(3), 69-76.
  • Corby, B. (2000). Child abuse: Towards a knowledge base (2nd ed). UK: Open University Press.
  • Crittendon, P.M. (1992). Children’s strategies for coping with adverse home environments. International Journal of Child Abuse and Neglect, 16, 329-343.
  • Davidson, J.R.T., Hughes, D.C., George, L.K., & Blazer, D.G. (1996). The association of sexual assault and attempted suicide within the community. Archives of General Psychiatry, 53, 550-555.
  • DeBellis, M.D., Burke, L., Trickett, T.K., & Putnam, F.W. (1996). Antinuclear antibodies and thyroid function in sexually abused girls. Journal of Traumatic Stress, 9, 369-378.
  • DeBellis, M.D., Chrousos, G.P., Dorn, L.D., Burke, L., Helmers, K., Kling, M.A., Trickett, P.K., & Putnam, F.W. (1994a). Hypothalamic-pituitary-adrenal axis dysregulation in sexually abused girls. Journal of Clinical Endocrinology and Metabolism, 78, 249-255.
  • DeBellis, M.D., Lefter, L., Trickett, T.K., & Putnam, F.W. (1994b). Urinary catecholamine excretion in sexually abused girls. Journal of the American Academy of Child and Adolescent Psychiatry, 33, 320-327.
  • Deblinger, E., Steer, R.A., & Lippmann, J. (1999). Two year follow-up study of cognitive behavioral therapy for sexually abused children suffering from post-traumatic stress symptoms. Child Abuse and Neglect, 23, 1371-1378.
  • Edwards, V.J., Holden, G.W., Felitti, V.J., & Anda, R.F. (2003). Relationship between multiple forms of childhood maltreatment and adult mental health in community respondents: Results from the Adverse Childhood Experiences study. American Journal of Psychiatry, 160(8), 1453-1460.
  • Etherington, K. (1995). Adult male survivors of childhood sexual abuse. Counselling Psychology Quarterly, 8(3), 233-241.
  • Esman, A. H. (1994). “Sexual abuse,” pathogenesis, and enlightened scepticism. American Journal of Psychiatry, 151, 1101-1103.
  • Finkelhor, D. (1984). Child sexual abuse: Theory and research. New York: Free Press.
  • Finkelhor, D. (1990). Early and long-term effects of child sexual abuse: An update. Professional Psychology: Research and Practice, 21, 325-330.
  • Finkelhor, D., & Browne, A. (1985). The traumatic impact of child sexual abuse: A conceptualization. American Journal of Orthopsychiatry, 55, 530-541.
  • Flisher, A.J., Kramer, R.A., Hoven, C.W., Greenwald, S., Alegria, M., Bird, H.R., Canino, G., Connell, R., & Moore, R. E. (1997). Psychological characteristics of physically abused children and adolescents. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 123-131.
  • Friedrich, W.N. (1996). Clinical considerations of empirical treatment studies of abused children. Child Maltreatment, 1, 343-347.
  • Friedrich, W.N., Bielke, R., & Uriquiza, A. (1987). Children from sexually abusive families: A behavioral comparison. Journal of Interpersonal Violence, 2, 391-402.
  • Fromuth, M.E. (1986). The relationship of childhood sexual abuse with later psychological and sexual adjustment in a sample of college women. Child Abuse and Neglect, 10, 5-15.
  • Garnefski, N., & Diekstra, R.F.W. (1997). Child sexual abuse and emotional and behavioral problems in adolescent: Gender differences. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 323-329.
  • Gutierrez, P.M., Thakkar, R.R. & Kuczen, C. (2000). Exploration of the relationship between physical and/or sexual abuse, attitudes about life and death, and suicidal ideation in young women. Death Studies, 24(8), 675-688.
  • Heim, C., Newport, D.J., Miller, A.H., & Nemeroff, C.B. (2000). Pituitary-adrenal and autonomic responses to stress in women after sexual and physical abuse in childhood. Journal of the American Medical Association, 284, 592-597.
  • Heim, C., Newport, D.J., Miller, A.H., & Nemeroff, C.B. (2002). Dr Heim and colleagues reply. American Journal of Psychiatry, 159(1), 157-158
  • Herrera, V.M., & McCloskey, L.A. (2003). Sexual abuse, family violence, and female delinquency: Findings from a longitudinal study. Violence & Victims, 18(3), 319-334.
  • Ingram, T.L. (1985). Sexual abuse in the family of origin and unresolved issues: A Gestalt/systems treatment approach for couples. Family Therapy, 12, 175-183.
  • Jumper, S.A. (1995). A meta-analysis of the relationship of child sexual abuse to adult psychological symptoms. Child Abuse and Neglect, 19, 715-728.
  • Kazdin, A.E., & Weisz, J.R. (1998). Identifying and developing empirically supported child and adolescent treatments. Journal of Consulting and Clinical Psychology, 66, 19-36.
  • Kendall-Tackett, K.A., Williams, L.M., & Finkelhor, D. (1993). Impact of sexual abuse on children: A review and synthesis of recent empirical studies. Psychological Bulletin, 113, 164-180.
  • Kendler, K.S., Thornton, L.M., Gilman, S.E., & Kessler, R.C. (2000). Childhood sexual abuse and adult psychiatric substance use disorders in women: An epidemiological and Cotwin control analysis. Archives of General Psychiatry, 57(10), 953-959.
  • Ketring, S. A., & Feinauer, L. L. (1999). Perpetrator-victim relationship: long-term effects of sexual abuse for men and women. American Journal of Family Therapy, 27(2), 109-120.
  • Kiser, L. J., Ackerman, B.J., Brown, E., Edwards, N.B, McColgan, E., Pugh, R., & Pruitt, D.B. (1988). Post-traumatic stress disorder in young children: A reaction to purported sexual abuse. Journal of the American Academy of Child and Adolescent Psychiatry, 27, 645-649.
  • Kolko, D.J., Moser, J.T. & Weldy, S.R. (1988). Behavioral/emotional indicators of sexual abuse in psychiatric inpatients: A controlled comparison with physical abuse. Child Abuse and Neglect, 12, 529-541.
  • Kuyken, W. (1995). The Psychological Sequelae of childhood sexual abuse: A review of the literature and implications for treatment. Clinical Psychology and Psychotherapy, 2(2), 108-121.
  • Lang, S.S. (1997). Childhood sexual abuse affects relationships in adulthood. Human Ecology, 25(2), p3.
  • Mannarino, A.P., & Cohen, J.A. (1986). A clinical-demographic study of sexually abused children. Child Abuse and Neglect, 10, 17-23.
  • Mannarino, A.P., & Cohen, J.A. (1996). A follow-up study of factors that mediate the development of psychological symptomatology in sexually abused girls. Child Maltreatment, 1, 246-260.
  • Mannarino, A.P., & Cohen, J.A., Smith, J.A., & Moore-Motily, S. (1991). Six- and twelve-month follow-up of sexually abused girls. Journal of Interpersonal Violence, 6, 494-511.
  • Matthews, K.A., (1990). Influences of natural menopause on psychological characteristic and symptoms of middle-aged healthy women. Journal of Consulting and Clinical Psychology, 58, 345-351.
  • McLeer, S.V., Deblinger, E., Henry. D., & Orvaschel, H. (1992). Sexually abused children at high risk for post-traumatic stress disorder. Journal of the American Academy of Child and Adolescent Psychiatry. 31. 875-879.
  • McMillan, C., Zuravin, S., & Rideout, G. (1995). Perceived benefit from child sexual abuse. Journal of Consulting and Clinical Psychology, 63, 1037-1043.
  • Murphy, S.M., Kilpatrick, D.G., Amick-McMullen, A., Veronen, L.J., Paduhovich. J., Best, C.L., Villeponteaux, L.A., & Saunders, B.E. (1988). Current psychological functioning of child sexual abuse survivors. Journal of Interpersonal Violence 3, 55-79.
  • Nash, M.R., Hulsey, T.L., Sexton, M.C., Harralson, T.L. & Lambert, W. (1993). Long-term sequelae of childhood sexual abuse: Perceived family environment, psychopathology, and dissociation. Journal of Consulting and Clinical Psychology, 61, 276-283.
  • Nash, M. R., Neimeyer, R. A., Hulsey, T. L., & Lambert, W. (1998). Psychopathology associated with sexual abuse: The importance of complementary designs and common ground. Journal of Consulting and Clinical Psychology, 66, 568-571.
  • Peters, D. K., & Range, L. M. (1995). Childhood sexual abuse and current suicidality in college women and men. Child Abuse & Neglect, 19, 335-341.
  • Pribor, E. F., & Dinwiddie, S. H. (1992). Psychiatric correlates of incest in childhood. American Journal of Psychiatry, 149, 52-56.
  • Rathus, S., Nevid, J. & Fichner-Rathus, L. (2005). Human sexuality in a world of diversity. (6th ed). Boston: Pearson.
  • Rind, B., & Tromovitch, P. (1997). A meta-analytic review of findings from national samples on psychological correlates of child sexual abuse. Journal of Sex
  • Research, 34(3), 237-255.
  • Rind, B., Tromovitch, P., & Bauserman, R. (1998). A meta-analytic examination of assumed properties of child sexual abuse using college samples. Psychological Bulletin, 124, 22-53.
  • Ross, C.A., Norton, G.R., & Wozney, K. (1989). Multiple personality disorder: An analysis of 236 cases. Canadian Journal of Psychiatry, 34, 413-418.
  • Russell, S.E.H. (1986). The secret trauma: Incest in the lives of girls and women. New York: Basic Books.
  • Saunders, B.E., Kilpatrick, D.G., Hansen, R.F., Resnick, H.S., & Walker, M.E. (1999). Prevalence, case characteristics, and long-term psychological correlates of child rape among women: A national survey. Child Maltreatment, 4, 187-200.
  • Saywitz, K.J., Mannarino, A.P., Berliner, L., & Cohen, J.A. (2000). Treatment for sexually abused children. American Psychologist, 55(9), 1040-1049.
  • Shapiro, J.P., Leifer, M., Martone, M.W. & Kassem, L. (1990). Multi-method assessment of depression in sexually abused girls. Journal of Personality Assessment, 55, 234-248.
  • Stepakoff, S. (1998). Effects of sexual victimization on suicidal ideation and behavior in U.S. college women. Suicide and Life-Threatening Behavior, 28, 107-126.
  • Tharinger, D. (1990). Impact of sexual abuse on developing sexuality. Professional Psychology: Research and Practice, 21, 331-337.
  • Tremblay, C., Herbert, M., & Piche, C. (1999). Coping strategies and social support as mediators of consequences in child sexual abuse victims. Child Abuse and Neglect, 25, 929-945.
  • Turner, S. (1993). Talking about sexual abuse: the value of short-term groups for women survivors. Journal of Group Psychotherapy, Psychodrama & Sociometry, 46(3), 110-121
  • Van der Kolk, B.A., Perry, J.C. & Herman, J.L. (1991). Childhood origins of self-destructive behaviour. American Journal of Psychiatry, 148, 1665-1671.
  • Wagner, B.M. (1997). Family risk factors for child and adolescent suicidal behavior. Psychological Bulletin, 121, 246-298.
  • Watkins, B., & Bentovim, A. (1992). The sexual abuse of male children and adolescents: A review of current research. Journal of Child Psychiatry, 33, 197-248.
  • Webster, R.E. (2001). Symptoms and long-term outcomes for children who have been sexually assaulted. Psychology in the Schools, 38(6), 533-547.
  • Widom, C.S. (1995). Victims of childhood sexual abuse: Later criminal consequences. Washington, DC: National Institute of Justice.
  • Widom, C.S. (1999). Posttraumatic stress disorder in abused and neglected children grown up. American Journal of Orthopsychiatry, 56, 1223-1229.
  • Winfield, I., George, L.K., Swartz, M., & Blazer, D.G. (1990). Sexual assault and psychiatric disorders among a community sample of women. American Journal of Psychiatry, 147, 335-341.
  • Wolfe, V., Gentile, C., & Wolfe, D.A. (1989). The impact of sexual abuse on children: A PTSD formulation. Behavior Therapy, 20, 215-228.