| Definitions
Childhood sexual abuse can be defined as any exposure
to sexual acts imposed on children who inherently
lack the emotional, maturational, and cognitive
development to understand or to consent to such
acts. These acts do not always involve sexual intercourse
or physical force; rather, they involve manipulation
and trickery. Authority and power enable the perpetrator
to coerce the child into compliance. Characteristics
and motivations of perpetrators of childhood sexual
abuse vary: some may act out sexually to exert dominance
over another individual; others may initiate the
abuse for their own sexual gratification (5, 6).
Although specific legal definitions may vary among
states, there is widespread agreement that abusive
sexual contact can include breast and genital fondling,
oral and anal sex, and vaginal intercourse. Definitions
have been expanded to include noncontact events
such as coercion to watch sexual acts or posing
in child pornography (7).
Prevalence
The prevalence of childhood sexual abuse in the
United States is unknown. Because of the shame and
stigma associated with abuse, many victims never
disclose such experiences. Incest was once thought
to be so rare that its occurrence was inconsequential.
However, in the past 25 years there has been increased
recognition that incest and other forms of childhood
sexual abuse occur with alarming frequency (8).
Researchers have found that victims come from all
cultural, racial, and economic groups (9).
Current estimates of incest and other childhood
sexual abuse range from 12% to 40% depending on
settings and population. Most studies have found
that among women, approximately 20% - or 1 in 5
- have experienced childhood sexual abuse (9). Consistent
with this range, studies have revealed that:
Among girls who had sex before they were 13 years
old, 22% reported that first sex was nonvoluntary
(10).
Twelve percent of girls in grades 9 through 12 reported
they had been sexually abused; 7% of girls in grades
5 through 8 also reported sexual abuse. Of all the
girls who experienced sexual abuse, 65% reported
the abuse occurred more than once, 57% reported
the abuser was a family member, and 53% reported
the abuse occurred at home (11).
Approximately 40% of the women surveyed in a primary
care setting had experienced some form of childhood
sexual contact; of those, 1 in 6 had been raped
as a child (12).
A national telephone survey on violence against
women conducted by the National Institute of Justice
and the Centers for Disease Control and Prevention
found that 18% of 8,000 women surveyed had experienced
a completed or attempted rape at some time in their
lives. Of this number, 22% were younger than 12
years and 32% were between 12 and 17 years old when
they were first raped (9).
Common Symptoms in Adult Survivors of Childhood
Sexual Abuse:
- Physical Presentations
- Chronic pelvic pain
- Gastrointestinal symptoms/distress
- Musculoskeletal complaints
- Obesity, eating disorders
- Insomnia, sleep disorders
- Pseudocyesis
- Sexual dysfunction
- Asthma, respiratory ailments
- Addiction
- Chronic headache
- Chronic back pain
- Psychologic and Behavioral Presentations
- Depression and anxiety
- Posttraumatic stress disorder symptoms
- Dissociative states
- Repeated self-injury
- Suicide attempts
- Lying, stealing, truancy, running away
- Poor contraceptive practices
- Compulsive sexual behaviors
- Sexual dysfunction
- Somatizing disorders
- Eating disorders
- Poor adherence to medical recommendations
- Intolerance of or constant search for intimacy
- Expectation of early death
Although there is no single syndrome that is universally
present in adult survivors of childhood sexual abuse,
there is an extensive body of research that documents
adverse short- and long-term effects of such abuse.
To appropriately treat and manage survivors of CSA,
it is useful to understand that survivors' symptoms
or behavioral sequelae often represent coping strategies
employed in response to abnormal, traumatic events.
These coping mechanisms are used for protection
during the abuse or later to guard against feelings
of overwhelming helplessness and terror. Although
some of these coping strategies may eventually lead
to health problems, if symptoms are evaluated outside
their original context, survivors may be misdiagnosed
or mislabeled (5).
In addition to the psychologic distress that may
potentiate survivors' symptoms, there is evidence
that abuse may result in biophysical changes. For
example, one study found that, after controlling
for history of psychiatric disturbance, adult survivors
had lowered thresholds for pain (13). It also has
been suggested that chronic or traumatic stimulation
(especially in the pelvic or abdominal region) heightens
sensitivity, resulting in persistent pain such as
abdominal and pelvic pain or other bowel symptoms
(14, 15).
Although responses to sexual abuse vary, there is
remarkable consistency in mental health symptoms,
especially depression and anxiety. These mental
health symptoms may be found alone or more often
in tandem with physical and behavioral symptoms.
More extreme symptoms are associated with abuse
onset at an early age, extended or frequent abuse,
incest by a parent, or use of force (4). Responses
may be mitigated by such factors as inherent resiliency
or supportive responses from individuals who are
important to the victim (4). Even without therapeutic
intervention, some survivors maintain the outward
appearance of being unaffected by their abuse. Most,
however, experience pervasive and deleterious consequences
(4).
The primary aftereffects of childhood sexual abuse
have been divided into seven distinct, but overlapping
categories (16):
- Emotional reactions
- Symptoms of posttraumatic stress disorder (PTSD)
- Self-perceptions
- Physical and biomedical effects
- Sexual effects
- Interpersonal effects
- Social functioning
Responses can be greatly variable and idiosyncratic
within the seven categories. Also, survivors may
fluctuate between being highly symptomatic and relatively
symptom free. Health care providers should be aware
that such variability is normal.
References
McCauley J, Kern DE, Kolodner K, Schroeder AF,
DeChant HK, Ryden J, et al. Clinical characteristics
of women with a history of childhood abuse: unhealed
wounds. JAMA 1997;277:1362-1368
Koss MP, Koss PG, Woodruff WJ. Deleterious effects
of criminal victimization on women's health and
medical utilization. Arch Intern Med 1991;151:342-347
Drossman DA, Leserman J, Nachman G, Li ZM, Gluck
H, Toomey TC, et al. Sexual and physical abuse
in women with functional or organic gastrointestinal
disorders. Ann Intern Med 1990;113:828-833
American Medical Association. Diagnostic and treatment
guidelines on mental health effects of family
violence. Chicago: AMA, 1995
Hendricks-Matthews M. Long-term consequences of
childhood sexual abuse. In: Rosenfeld J, Alley
N, Acheson LS, Admire JB, eds. Women's health
in primary care. Baltimore: Williams & Wilkins,
1997:267-276
Britton H, Hansen K. Sexual abuse. Clin Obstet
Gynecol 1997;40:226-240
Maltz W. Adult survivors of incest: how to help
them overcome the trauma. Med Aspects Hum Sex
1990;24:42-47
Hendricks-Matthews MK. Caring for victims of childhood
sexual abuse. J Fam Pract 1992;35:501-502
Tjaden P, Thoennes N. Prevalence, incidence, and
consequences of violence against women: findings
from the National Violence Against Women Survey.
Research in Brief. Washington, DC: U.S. Dept of
Justice, Office of Justice Programs, November
1998, NCJ 172837
Moore KA, Driscoll A. Partners, predators, peers,
protectors: males and teen pregnancy. New data
analysis of the 1995 National Survey of Family
Growth. In: Not just for girls: the roles of boys
and men in teen pregnancy. Washington, DC: The
National Campaign to Prevent Teen Pregnancy, 1997:
7-12
Schoen C, Davis K, Collins KS, Greenberg L, Des
Roches C, Abrams M. The Commonwealth Fund survey
of the health of adolescent girls. New York: The
Commonwealth Fund, 1997
Walker EA, Torkelson N, Katon WJ, Koss MP. The
prevalence rate of sexual trauma in a primary
care clinic. J Am Board Fam Pract 1993;6:465-471
Scarinci IC, McDonald-Haile J, Bradley LA, Richter
JE. Altered pain perception and psychosocial features
among women with gastrointestinal disorders and
history of abuse: a preliminary model. Am J Med
1994:97:108-118
Cervero F, Janig W. Visceral nociceptors: a new
world order? Trends Neurosci 1992;15:374-378
Drossman DA. Physical and sexual abuse and gastrointestinal
illness: what is the link? Am J Med 1994;97:105-107
Courtois CA. Adult survivors of sexual abuse.
Prim Care 1993;20:433-446
Return to The
American Academy of Experts in Traumatic Stress
Homepage |
