The long-term effects of child sexual abuse

CFCA Paper No. 11 – January 2013

A complex interplay

There is now some clear evidence of the links between child sexual abuse and a number of adverse outcomes for many children in adolescence and adulthood. These links remain even after taking other factors into account, including other forms of abuse and adversities in childhood. The physical health and behavioural difficulties observable in survivors of child sexual abuse reflect emotional distress and mental health problems related to various vulnerabilities, including later atypical stress responses.

Like other forms of abuse and childhood adversity, there is a complex interplay between many aspects of the child's life and circumstances. These include children's individual characteristics and make-up, their caregiving experiences and family and social support, as well as the various aspects of their school, community and society that protect or put them at risk (Banyard et al., 2001; Canton-Cortes & Canton, 2010; Roche, Runtz, & Hunter, 1999; Shapiro, Kaplow, Amaya-Jackson, & Dodge, 2012; Walsh et al., 2010). For example, research has identified the importance of family support and stability and positive parental relationships as important factors in how children respond to child sexual abuse in the short and long term (Andrews, Corey, Slade, Issakidis, & Swanston, 2004; Fergusson & Horwood, 2001; Lynskey & Fergusson, 1997). Peer and partner relationships in adolescence and early adulthood have also been implicated as playing a potentially protective role in the development of psychopathology. Low affiliations with delinquent peers for example, have been associated with less risk of later adjustment difficulties (Lynskey & Fergusson, 1997). There is also evidence of inter-generational effects from parents who were abused, mediated through anxiety and mental health problems and parenting stresses (Roberts et al., 2004).

The complexity of these inter-relationships has significant implications for the policy and practical therapeutic responses to child sexual abuse. Increasingly, a trauma response is being tried and the results are looking promising, but await replication in more rigorous studies. As Green et al. (2010) pointed out, the way "factors" work together (whether they are additive, for example), "has important implications for intervention because it means that prevention or amelioration of only a single CA [childhood adversity] in youths exposed to many CAs is unlikely to have important preventive effects" (p. 121). As Odebrecht et al. (2010) pointed out, it is now increasingly possible to explore the biological basis and psycho-biological markers underpinning the links between child sexual abuse and the longer-term psychological, behavioural, and physical neuroendocrine and immunological consequences. There is also a need for long-term prospective research of this type to do so. Walsh et al. (2010) also pointed to the need for "longitudinal designs that establish the temporal sequencing of CSA, coping, and psychological functioning … to demonstrate causation within a mediational framework and to better understand how victims cope across the lifespan" (p. 12).