Difficulty in Adulthood in Individuals that were Sexually-Abused as Children Introduction to Sexual Abuse in Children

Sexually-abused children commonly develop problems that persist into adulthood. Child sexual abuse has come to be regarded as a cause of mental health problems in adult life. The influences of child sexual abuse on interpersonal, social and sexual functioning in adult life has only recently attracted attention. Research into child sexual abuse was initiated by the self-disclosures of adults who publicly admitted to their abuse as children. These victims, predominantly women, often attributed personal difficulties to their sexual abuse as children.

Early research into the effects of child sexual abuse frequently employed groups of adult psychiatric patients (Jones, 1974), which further reinforced the emergence of an adult-focused psychiatric discourse about child sexual abuse. The manner in which child sexual abuse has been brought to the public's eye and the nature of the advocacy movement which placed child sexual abuse firmly on the social agenda provided an almost exclusive emphasis on female victims and incestuous abuse. Research into sexual abuse of boys is much less prevalent, where the majority of abuse is not incestuous (Guidry, 1995; Sageman, 2003).

Risk Factors for Childhood Sexual Abuse

Child sexual abuse is not a random phenomenon in the population. Sexual abuse occurs more frequently in children from socially-deprived and disorganized family backgrounds (Messman-Moore & Long, 2003). Marital dysfunction such as parental separation and domestic violence is associated with higher risk of child sexual abuse, and involves within-family and outside-family abusers (Fergusson, Horwood, & Lynskey, 1996; Fergusson, Lynskey, & Horwood, 1996)

Similarly, there are increased risks of abuse with a stepparent in the family, and when family breakdown results in institutional or foster care

. Poor parent-child relationships are associated with increased risk of child sexual abuse, though it is not always easy to separate the impact of abuse on intimate family relationships from the influence of poor attachments on vulnerability to abuse (Fergusson, Horwood et al., 1996; Fergusson, Lynskey et al., 1996). There is also a considerable overlap between physical, emotional and sexual abuse, and children who are subject to one form of abuse are significantly more likely to suffer other forms of abuse

(Coffey, Leitenberg, Henning, Turner, & Bennett, 1996)

Consequences of Childhood Sexual Abuse

A history of child sexual abuse has been found to be associated with problems with sexual adjustment in adult life (Coverdale & Turbott, 2000). Foa et al. (Foa & Street, 2001) reported reduced sexual esteem in both men and women who had reported child sexual abuse. Furthermore, women who reported child sexual abuse involving intercourse were significantly less likely to find their adult sexual relationships very satisfactory.

On the basis of clinical observations, it has been suggested that women exposed to child sexual abuse may in early adult life respond by heightened anxiety about sexual contact with avoidance of relationships, or a promiscuity type in which the victim devalues herself and her sexuality. What constitutes promiscuity tends to be a highly subjective evaluation, and women with a history of child sexual abuse are more ready to respond judgmentally about their prior sexual behavior by labeling it promiscuous than would non-abused woman with a similar range of sexual experiences. This reflects not changed sexual behavior, but changed attitudes to one's own sexuality.

Sexually-abused children not only face an assault on their developing sense of their sexual identity, but a blow to their construction of the world as a safe enough environment and their developing sense of others as trustworthy. In those abused by someone with whom they had a close relationship, the impact is likely to be all the more profound. A history of child sexual abuse is reported to be associated in adult life with insecure and disorganized attachments (Colman & Widom, 2004). Increased rates of relationship breakdown have also been reported in those exposed to child sexual abuse (Roberts, O'Connor, Dunn, & Golding, 2004).

Muram et al. (Muram, 1993) found that their subjects reporting child sexual abuse were more likely to report a general instability in their close relationships. Though those with histories of child sexual abuse were just as likely as controls to be currently in a close relationship, they were more likely in the past to have experienced divorce or separation. When asked about the level of satisfaction with their current relationship, those with abuse histories expressed significantly lower levels of satisfaction, with the level of current satisfaction being lowest for intercourse victims.

The experience of child sexual abuse at a vulnerable moment in the child's development of trust in others may predispose one to a specific deficit in forming...

The attribution of a lack of concern and a tendency to be intrusive and overcontrolling to their partners may be a product of these partners' actual attitudes and behavior, or could reflect primarily the expectations, interpretations and projections directed at the partner by these women with histories of child sexual abuse. Conversely, those who have been abused may be more prone to enter relationships with emotionally-detached and domineering partners because their lowered self-esteem and reduced initiative limits their choices, or from some neurotic compulsion to repeat.
There have been numerous studies examining the association between a history of child sexual abuse and mental health problems in adult life that have employed clinical samples, convenience samples, and random community samples. There is now an established body of knowledge clearly linking a history of child sexual abuse with higher rates in adult life of depressive symptoms, anxiety symptoms, substance abuse disorders, eating disorders and post-traumatic stress disorders (Arias, 2004; Goodwin & Stein, 2004; C.F. Johnson, 2004; Messman-Moore & Long, 2003; Raphael, Chandler, & Ciccone, 2004; Roberts et al., 2004). A more controversial literature links multiple personality disorder with child sexual abuse (J. G. Johnson, Cohen, Brown, Smailes, & Bernstein, 1999; J.G. Johnson et al., 2001; Soloff, Lynch, & Kelly, 2002).

The long-term effects of child sexual abuse will also be modified by the individual's experience subsequent to the abuse. Romans et al. (Romans, Martin, & Mullen, 1996) demonstrated that long-term problems following child sexual abuse were significantly lower in those who had supportive and confiding relationships with their mothers and in those who, as adolescents, experienced some success at school, in sporting events, or with peers. The nature of this success (academic, social or sporting), is probably less important than the accompanying strengthening of self-esteem and enhancement of opportunities for effective social interactions with peers.

The relationship between the potential damage inflicted on elements in the child's development and subsequent mitigating factors is complex. For example, the observation that those victims of child sexual abuse who manage to establish and maintain stable marital relationships are protected against some of the potentially adverse outcomes of child sexual abuse (Cole & Putnam, 1992) may reflect, in part, the mitigating and healing influence of effective intimacy. However, equally, the association may be a product of the ability of those, who have for other reasons avoided the worst effects of child sexual abuse, to enter and sustain intimate relationships.

Terr et al. (Terr, 1991) suggested that child sexual abuse interacts with family background to produce disruption of the child's developing self-esteem and sense of mastery of the world. It is these deficits, in turn, that increases the likelihood of psychological problems in later life. This model of developmental deficits leading to social and personal vulnerabilities in adult life, which in their turn create an increased risk of mental health problems, can usefully be expanded.

Those with histories of child sexual abuse, particularly of the more physically-intrusive types, have an increased risk of social, interpersonal and sexual problems in adult life. This association may play a role in mediating at least some of the far better known associations between child sexual abuse and mental health problems.

Greater vulnerability to depression is found in women who lack an intimate and confiding relationship (Hulme & Agrawal, 2004; Kraaij & de Wilde, 2001; Penza, Heim, & Nemeroff, 2003). Depression is also associated with lowered self-esteem and a sense of hopelessness about one's ability to influence one's life (Brodsky et al., 2001; Weiss, Longhurst, & Mazure, 1999). Thus, the social, interpersonal and sexual problems associated with a history of child sexual abuse may themselves provide fertile ground for the development of mental health problems, particularly in the area of depressive disorders.

A plausible hypothesis can be advanced that the developmental disruption engendered by child sexual abuse in the victims' sense of self-esteem, sense of agency, sense of the world as a safe enough environment, in their capacity for entering trusting intimate relationships and, finally, in their developing sexuality, leads in adult life to an increased risk of low self-esteem, social and economic failure, social insecurity and isolation, difficulties with intimacy and sexual problems.

Prevention of Sexual Abuse in Children

The ideal response to child sexual abuse would be primary prevention strategies aimed at eliminating, or at least reducing, the sexual abuse of children (Gibson & Leitenberg, 2000). Secondary and tertiary preventive strategies should be aimed at ameliorating the damage inflicted by abuse, and reducing the subsequent reverberations of that damage.…