The long-term effects of child sexual abuse
- Determining the association between child sexual abuse and later outcomes
- A range of outcomes
- The impact of child sexual abuse on mental health
- Behavioural aspects of mental health functioning
- Interpersonal outcomes
- Physical health and overall developmental outcomes
- Gender differences in the long-term impacts of child sexual abuse and gaps in understandings of male victims/survivors
- A complex interplay
Physical health and overall developmental outcomes
Research indicates that child sexual abuse may be associated with a range of physical and health risk behaviours as well as adverse health outcomes for survivors of such abuse (Zink, Klesges, Stevens, & Decker, 2009). The evidence suggests that health problems for survivors of child sexual abuse stem from a complex matrix of inter-relationships between behavioural, emotional, social, and cognitive factors (Kendall-Tackett, 2002). Research has found that survivors of child sexual abuse: are sick more often (Felitti, 1991); have surgery more often (Kendall-Tackett, Marshall, & Ness, 2000); and are at an increased risk of having chronic pain syndromes (Kendall-Tackett, 2002). Associations have also been found between child sexual abuse and ischemic heart disease, cancer, chronic lung disease, irritable bowel syndrome, and fibromyalgia (Runyan, Wattam, Ikeda, Hassan, & Ramiro, 2002). Scott et al. (2011) found a set of independent predictors in a 10-country study of multiple childhood adversities and early onset chronic physical conditions. Child sexual abuse was most strongly associated with heart disease, osteoarthritis, chronic spinal (back or neck) pain, and frequent or severe headaches. Female victims of child sexual abuse were also at greater risk of sex related health problems such as unintended and aborted pregnancies (Wyatt et al., 1992).
There is now increasing attention to the association between stress and childhood adversity (including child sexual abuse) on the one hand, and brain development and related dysfunction of the immunological and neuroendocrine responses on the other (Odebrecht et al., 2010). Much of this work is focusing on the hypothalamic-pituitary-adrenal (HPA) stress response, with numerous studies indicating an association between early adversity and atypical development of this system that increases the risk for later psychopathology (McCrory, De Brito, & Viding, 2010). The review of research by McCory et al. also outlined the evidence from neuro-imaging, pointing to "structural and functional brain differences that may underpin the psychological and behavioural problems associated with childhood maltreatment" (p. 1090). In this area too, "there is a need for prospective studies to provide a biological basis for the link between CSA with neuroendocrine and immunological consequences and illness in later life" (Odebrecht et al., 2010, p. 445).