Childhood Sexual Abuse

Childhood sexual abuse is a major societal problem with long term psychological effects that often carry on into adulthood.  Sexual abuse crosses all socio-economic classes, ages, and affects both genders regardless of race or ethnicity.  It is often believed that sexual abuse occurs with a stranger, hence children are taught “stranger danger” awareness; however, ninety-five percent of sexual abuse happens with someone the child knows and trusts (Finkelhor, Ormrod, Turner, & Hamby, 2005, p. 10). What follows is a discussion of the disclosure of sexual abuse, the incidence rates of sexual abuse, and the long term mental health consequences of sexual abuse.

Children find it difficult to disclose sexual abuse.  Some keep the secret because they are threatened or coerced by the perpetrator, many are too ashamed to disclose, and others cannot find the words to describe what happened to them.  When adult survivors are interviewed “55-69% of adults indicated that they never told anyone about the sexual abuse during childhood” (London, Bruck, & Wright, 2008, p. 31).  Even when the child tells, the perpetrator is rarely reported to authorities. According to Martin and Silverstone (2013), “The data also suggests that in over 95% of cases the CSA is never disclosed to authorities” (para. 1).  Failure to hold perpetrators responsible for their crimes is another layer in CSA that compounds the problem as it allows a perpetrator to potentially rape another child.

When a child discloses sexual abuse there is a risk that the person they are telling will not believe them and even if the person believes the child, often nothing is done to stop the perpetrator or punish the perpetrator, so the child is still not safe.  A study by Jonzon and Lindblad (2005) found there is a link between the “adequacy of response to disclosure . . . as a key factor in adult functioning” (as cited in O’Leary, Coohey, & Easton, 2010, p. 285).  Children who tell about their sexual abuse and are believed, function better as adults.  Is it also damaging to the child when the person they disclose to tells someone else. The betrayal results in “a greater number of mental health symptoms as an adult” (O’Leary, Coohey, & Easton, 2010, p. 282). The disclosure itself can compound the trauma for the child who is placing their trust in a person they believe is going to help them.

It is generally believed that the rates of sexual abuse are declining over recent years with the teaching of prevention programs to school children; however, a study by Collin-Vezina, Helie and Trocme (2010) found that “in Canada, the question concerning the decline of CSA is still open to debate, as conflicting results emerge from the diverse sources of child protection data” (p. 811).  Some of the discrepancy in the numbers has to do with the way CSA is defined as sometimes only physical sexual contact is considered, and exposure to pornography, sexting, and internet luring is ignored.

As well, there is considerable discrepancy in self-reports of CSA compared to the data from police reporting and child protection services “while 1 out of 8 people report having experienced CSA, official incidence estimates center around only 1 per 250 children” (Collin-Vezina, Helie, & Trocme, 2010, p. 2).  Many more adults report being sexually abused as a child than the official data states as not all children come to the attention of child protection services or the police.  This is a significant number to be aware of for those who treat mental health issues as CSA can be at the root of many mental health problems.

Some of the long term effects of CSA that carry on throughout adulthood are mental health issues such as “depression, anxiety disorders, eating disorders, sexual disorders, suicidal behavior, and substance abuse” (Draper, 2007, p. 262).  As well, “the victims of CSA suffered three times the burden of mental health problems compared to members of the general community” (Cutajar et al., 2010, p. 819).  Not only are sexual abuse victims more likely to suffer mental health problems as adults they are more likely to present with multiple mental health issues.

There is a continuum in which some survivors function well for a long time and then experience problems, while others may have a lifetime struggle. There is strong relationship between CSA and attempted suicide, as well as suicide ideation. Post traumatic stress disorder (PTSD) is also common among CSA adult survivors with “86% of  survivors [meeting] . . . criteria for a PTSD diagnosis at some point during their lives” (Wilson, 2009, p. 59). PTSD symptoms can be wearing on an individual as they re-experience the trauma, and have difficulties sleeping. Survivors also experience low self-esteem and poor life coping skills.

The sexual victimization of a child has long term implications in the development of future mental health problems when they reach adulthood.  Disclosure of sexual abuse when a child is supported and believed may contribute to better outcomes for their future mental health; however, the effects of CSA on adult functioning are an important consideration for mental health professionals since the incidence of sexual abuse is so high. It requires careful determination as historical sexual abuse may be the root cause of mental health difficulties and the clinician may miss part of the full client assessment.

References

Collin-Vezina, D., Helie, S., & Trocme, N. (2010). Is child sexual abuse declining in Canada? An analysis of child welfare data. Child Abuse & Neglect: The International Journal34(11), 807-812. doi:10.1016/j.chiabu.2010.05.004

Cutajar, M., Mullen, P., Ogloff, J., Thomas, S., Wells, D., & Spataro, J. (2010). Psychopathology in a large cohort of sexually abused children followed up to 43 years. Child Abuse & Neglect34, 813-822. doi:10.1016/j.chiabu.2010.04.004

Draper, B., Pfaff, J., Pirkis, J., Snowdon, J., Lautenschlager, N., Wilson, I., & Almeida, O. (2008). Long-term effects of childhood abuse on the quality of life and health of older people: results from the Depression and Early Prevention of Suicide in General Practice Project. Journal Of The American Geriatrics Society56(2), 262-271. doi:10.1111/j.1532-5415.2007.01537.x

Finkelhor, D., Ormrod, R., Turner, H., & Hamby, S. (2005). The Victimization of Children and Youth: A Comprehensive, National Survey. Child Maltreatment10(1), 5-25. doi: 10.1177/1077559504271287

London, K., Bruck, M., & Wright, D. (2008). Review of the contemporary literature on how children report sexual abuse to others: Findings, methodological issues, and implications for forensic interviewers. Memory16(1), 29-47. doi:10.1080/09658210701725732

Martin, E., & Silverstone, P. (2013). How much child sexual abuse is “below the surface,” and can we help adults identify it early? Frontiers in Psychiatry4(7). doi:10.3389/fpsyt.2013.00058

O’Leary, P., Coohey, C., & Easton, S. (2010). The effect of severe child sexual abuse and disclosure on mental health during adulthood. Journal Of Child Sexual Abuse19(3), 275-289. doi:10.1080/10538711003781251

Wilson, D. (2010). Health consequences of childhood sexual abuse. Perspectives in Psychiatric Care, 46(1), 56-64. doi:10.1111/j.1744-6163.2009.00238.x