The Immediate and Long-Term Effects of Childhood Sexual Abuse

Abstract

This paper explores the immediate and long-term effects of childhood sexual abuse by reviewing many research studies conducted on both child and adult victims. While each article focuses on a different component of the negative consequences of sexual abuse in children, they all agree that the childhood trauma experienced can have very serious detrimental effects on an individual’s physical and mental health. Specifically, most victims are initially experience symptoms of anxiety, depression, fear, hostility, aggression, and shame. Later in life, these victims tend to suffer from a negative self-image, anxiety, fear of trusting others, substance abuse, and feelings of alienation. Fear of being re-victimized keeps them from functioning normally in society and forming meaningful, healthy relationships. Even while therapy treatment options are available, they are still unable to erase the past. The tone of many of the articles about childhood sexual abuse implies that some kinds of traumatic experiences are severe enough to cause permanent damage.

The Immediate and Long-Term Effects of Childhood Sexual Abuse

Sexual abuse during childhood can be a very traumatic experience that has many unfortunate immediate and long-term effects that hinder an individual’s ability to function. The initial effects most commonly reported by children include feelings of fear, guilt, shame, anger, hostility, aggression, and a lowered sense of self. However, many of these initial effects only increase over time and continue plaguing victims into adulthood. Adults experiencing the long term effects of childhood sexual abuse report high frequencies of anxiety attacks, suicidal ideation, nightmares, depression, and an acute fear of trusting other people. The effects upon the human psyche from such tragic events are recorded and analyzed by a multitude of doctors that examine the range of responses from such invasive and lasting traumatic experiences (Browne & Finkelhor, 1986).

Immediate Reactions in Child Victims

Many studies expand upon these initial emotional responses and reveal the vast array of devastating effects sexual abuse can have on children. Anderson, Bach, and Griffith, (1981) reviewed clinical charts for 155 female adolescent sexual assault victims who received treatment at the Harborview Medical Center in Washington state. 63% of these female victims were suffering from psychosocial complications, such as sleep and eating disturbances, fears and phobias, depression, guilt, shame, and anger.

Comparatively, externalized sequelae, such as having difficulties in school and running away applied to 66% of interfamilial victims and 21% of extrafamilial victims (Anderson et al., 1981). Another study by Friedrich, Urquiza, & Beilke (1986) on 61sexually abused reported similar results. Friedrich et al. reported 46% of their participants scored significantly high on their internalizing scale, which includes fearful, inhibited, depressed, and over-controlled behaviors. In addition, 39% of their participants had significantly high scores on their externalizing scale, which includes aggressive, antisocial, and under-controlled behaviors (Friedrich et al., 1986). Sexual abuse can also have negative effects on social functioning for children including difficulties at school, truancy, running away from home, and early marriages or elopements during teenage years. Incest victims are more likely to run away and elope, seeing it as the only way for them to escape the abuse. In Maricopa County Arizona, 55% of children who were charged with running away, truancy, or listed as missing persons were all incest victims (Browne & Finkelhor, 1986). A study by De Francis (1969) reported 58% of childhood sexual abuse victims expressed feelings of inferiority and a lack of self-worth resulting from their experience.

Childhood sexual abuse also links to symptoms of dissociation, a condition classified by the DSM-IV as a disruption in normally integrated functions of consciousness, memory, identity, and perception of the environment. As stated by Mulder, Beautrais, Joyce, & Fergusson (1998), symptoms of dissociation can range from daydreaming and attention lapses to a pathological failure to integrate thoughts, feelings, and actions.

Dissociation typically occurs as a response to trauma, functioning as a mechanism of defense or providing a means to adapt to pain. If abuse is sustained, the need for the dissociative response becomes greater until eventually it becomes a default mechanism. Once this occurs, an individual’s mental processes become intermittently fragmented. The risk of dissociation is higher during childhood when the mind’s capacity for dissociation is at its highest (Mulder et al., 1998).

Traumatic sexualization occurs when a child’s sexuality developed in an inappropriate and dysfunctional way as a byproduct of sexual abuse. This abuse has ongoing sexual consequences, even after removing the child from the abusive environment. Breire’s (1984) report for the Office of Juvenile Justice and Delinquency found that 27% of the victims 4 to 6 years old scored significantly higher on a sexual behavior scale that included having had sexual relations, open masturbation, excessive sexual curiosity, and frequent exposure of the genitals. In their study, Putte and James (1995) state that survivors of childhood sexual abuse often start behaving very sexually at an earlier age in comparison to their peers. Frequently, they attempt to initiate inappropriate and uninvited sexual behavior with their peers and siblings (Putte & James, 1995). Child victims begin acting out these sexual behaviors because they are confused over the role of sexuality in relationships, with other children and adults.

Treatment

Treatment for children who are victims of sexual abuse often involves therapy. During sessions, children express themselves through play therapy, due to developmental limitations of children, the ability to verbalize or comprehend the wrong done to them must be conducted in more subtle ways, in various stages (Putte & James, 1995).

Abuse reactive play occurs mostly in the beginning phases of therapy and is characterized by the child displaying sexual behavior similar to what occurred during abuse. Reasons for the child’s sexual behavior stem from their perception of the situation. When a child believes that they are in a situation where they are at risk for abuse, they begin displaying sexual behavior (Putte & James, 1995).

This type of therapy is challenging, children often perceive therapists and other caregivers as bad or threatening and are not sure how to act. Based on their previous experiences with adults, children often initiate sexual behavior believing it is inevitable. The development of trust between the victim and therapist is a long and arduous process that can take years. Every step forward must be carefully conducted to prevent the child from reverting to previous stages of mistrust (Putte & James, 1995).

Re-enactment occurs during the middle phases of treatment. This kind of play is evident when a child recreates and re-experiences the abuse they suffered using toys, dolls, and other play props in combination with their own body to depict the details of their sexually abusive experiences. This play type is motivated by the need for the children to express themselves and their need to feel like others approve of them (Putte & James, 1995).

Symbolic sexual play occurs at the end of treatment. During this play, the child behaves sexually in the context of thematic play in an attempt to come to some new understanding of their sexual experiences. The actual concrete events are less important than how the child interprets them. Additionally, any reports that children give about their experience may be subject to drastic changes as they begin to incorporate their sexual experiences with adults and children into their understanding of the larger world. This kind helps children make sense out of their experiences and allows them to try out various representations of themselves with the therapists to get a sense of how the world would react (Putte & James, 1995).

Long Term Impact

While therapy treatments may offer some helpful assistance to victims of childhood sexual abuse, it often does not eliminate traumatic memories or negative feelings associated with them. Many studies reveal that childhood sexual abuse has long-term effects that transition into adulthood. Childhood sexual abuse causes a broad spectrum of adult symptoms and pathological conditions across both Axis I and II of the DSM. These conditions include anxiety, depression, self-destruction, object relations pathology, substance abuse, antisocial personality, borderline personality, psychosis, sexual dysfunction, and somatization (Briere, 1984).

Browne and Finkelhor (1986) state that symptoms of depression are the most commonly reported symptoms by adults molested as children. Briere’s (1984) study about 153 walk-ins to a community health counseling center reported that 51% of the sexual abuse victims and 34% of non-abused clients had a history of suicide attempts. Results of the Briere study reveal that there is an association between childhood sexual abuse and suicide ideation or deliberate attempts at self-harm (Briere, 1984). Symptoms of anxiety and tension are frequently reported by adult victims in addition to substantially higher occurrences of anxiety attacks, nightmares, and difficulties falling asleep.

Other long-term effects for victims of sexual abuse relate to a negative self-image. Victims continue to feel isolated and stigmatized because of childhood experiences. They feel alienated from society because they feel they cannot share their experiences for fear of disapproval. Victims of incest feel feelings of isolation and stigmatization more acutely. In a study by Herman (1981), all victims of father-daughter incest felt branded, marked, or stigmatized by the victimization.

Childhood sexual abuse has a long term negative impact on interpersonal reasoning. Browne and Finkelhor (1986) state that female sexual abuse victims report problems relating to other women and men, have problems with their parents and have difficulties parenting and responding to their own children. Incest victims, in particular, develop negative feelings towards their fathers and mothers (Browne & Finkelhor, 1986). Herman (1981) noticed that the rage of incest victims was primarily directed towards the mother. Incest victims tend to regard all women, including themselves, with contempt (Herman, 1981). Difficulties in parenting results from confusion about closeness and affection, to which the parent assigns sexual meanings based on their abusive childhood. These parents maintain emotional and physical distances from their children.

These problems also affect childhood sexual abuse victims by inhibiting their ability to form romantic relationships. Briere (1984) found that 48% of his clinical subjects had a fear of men. Furthermore, most incest victims never get married out of fear of re-experiencing abuse. The most disturbing aspect of these failed personal relationships is that most female childhood sexual abuse victims are often re-victimized later in life.

A study conducted by the University of New Mexico on 341 sexual assault cases found that 18% of repeated rape victims all incest history (Browne & James, 1986). Consequently, sexual abuse victims attempting meaningful romantic relationships are much more likely to be abused by their husbands. Additionally, after experiencing childhood sexual abuse, it is difficult for many victims to relax and enjoy sexual activity. Some victims react oppositely by developing a compulsive need for sex, believing it is the only way to gain attention and affection.

Conclusion

Childhood sexual abuse causes the abused to face serious mental health problems such as depression, and anxiety that continues causing significant adjustment problems into adulthood. Adults experiencing long-term effects engage in self-destructive behavior to cope with their low self-image problems and damage their personal relationships. Since suffering childhood sexual abuse has severe and comprehensive effects, great care should be taken to prevent these traumatic circumstances. Survivors benefit from play therapies, such as abusive reactive play, re-enactment, and symbolic sexual play. However, most victims have difficulty moving on and these experiences still negatively affect their lives.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

Anderson, S. C., Bach, C. M., & Griffith, S. (1981). Psychosocial sequelae in intrafamilial victims of sexual assault and abuse.

Browne, A., & Finkelhor, D. (1986). Impact Of Child Sexual Abuse: A Review Of The Research. Psychological Bulletin, 99(1), 66-77.

Briere, J. (1984). The Effects of Childhood Sexual Abuse on Later Psychological Functioning: Defining a “Post-sexual-abuse Syndrome. Presented to the Third National Conference on Sexual Victimization of Children, Washington, D.C.

Francis, V. D. (1969). Protecting the Child Victim of Sex Crimes Committed by Adults. American Humane Association, 1, 1-252.

Friedrich, W. N., Urquiza, A. J., & Beilke, R. L. (1986). Behavior Problems In Sexually Abused Young Children. Journal of Pediatric Psychology, 11(1), 47-57.

Herman, J. L. (1981). Father-daughter incest. Cambridge, MA: Harvard University Press.

Mulder, R., Beautrais, A., Joyce, P., & Fergusson, D. (1998). Relationship Between Dissociation, Childhood Sexual Abuse, Childhood Physical Abuse, and Mental Illness in a General Population Sample. American Journal of Psychiatry, 155, 806-811.

Van de Putte, J. S. (1995). A Paradigm For Working With Child Survivors Of Sexual Abuse Who Exhibit Sexualized Behaviors During Play Therapy. International Journal of Play Therapy, 4(1), 27-49.