Child Sexual Abuse: Consequences and Implications

Gail Hornor, RNC, MS, PNP

Disclosures

J Pediatr Health Care. 2010;24(6):358-364. 

In This Article

Psychiatric Disorders

Child sexual abuse has been linked with a variety of psychiatric disorders in childhood and continuing into adulthood. Martin, Bergen, and Richardson (2004) report that the incidence of psychiatric diagnoses occurring over a lifetime is 56% for women and 47% for men who have disclosed a history of child sexual abuse. However, when no history of child sexual abuse is reported, the rates of psychiatric disorders are much lower, at 32% for women and 34% for men. Depression, suicidal ideation, substance abuse, and PTSD appear to be associated with sexual abuse and will be discussed more completely. However, other psychiatric disorders also have been linked to sexual abuse such as borderline personality disorder, dissociative identity disorder, and bulimia nervosa (Putman, 2003). The development of pain disorders has also been found to be related to child sexual abuse (Sapp, 2005).

Post-traumatic Stress Disorder

Sexual abuse can result in the emergence of PTSD. PTSD can affect the pre-adolescent, adolescent, and adult victim of sexual abuse. The American Psychiatric Association's 1994 Diagnostic and Statistical Manual (DSM–IV) lists diagnostic criteria for PTSD. The criteria include exposure to a traumatic event (sexual abuse) in which the person witnessed or experienced an event that involved actual or threatened death or serious injury to self or others with the individual's response involving intense fear, helplessness, horror, or, in children, disorganized or agitated behavior. Hornor (2005) states that PTSD also involves the persistent re-experience of the traumatic event by recurrent and intrusive recollections of the event, repetitive play expressing a theme of the trauma, repetitive dreams of the event or frightening dreams without recognizable content, flashbacks of the traumatic event or acting or feeling as if the traumatic event was recurring, and/or intense psychological distress or physiologic reactions at exposure to cues to the trauma. Persistent avoidance of stimuli associated with the trauma and numbing of responsiveness also may be exhibited. PTSD also can be associated with persistent symptoms of increased arousal such as difficulty staying or falling asleep, anger outbursts or irritability, difficulty concentrating, or hypervigilance. Clearly, PTSD can result in behaviors that are detrimental to the individual's life. Symptoms of PTSD may not develop immediately following sexual abuse; rather, symptoms may become apparent months or even years following sexual abuse. Certain developmental milestones also can trigger emergence or re-emergence of PTSD symptoms such as initiation of sexual activity or the birth of a child. Cohen, Deblinger, Mannarino, and Steer (2004) suggest that trauma-focused cognitive behavioral therapy can be utilized successfully by clinicians to assist victims of sexual abuse, especially those exhibiting symptoms of PTSD.

Depression

Depression can be present in pre-adolescent children, adolescents, and adults who have been sexually abuse (Mullers & Downing, 2008). Numerous studies have linked major depression and dysthymia with sexual abuse (Paolucci et al., 2001). Both boys and girls who have been sexually abused are at increased risk for the development of depression, and this risk continues into adulthood (Dube et al., 2005). Putnam (2008) suggests that a history of sexual abuse may change the clinical presentation of major depression with reversal of neuro-vegetative signs such as increased appetite, weight gain, and hypersomnia when compared with depressed individuals without a history of sexual abuse. A history of sexual abuse has been associated with earlier onset of depressive episodes and an altered response to standard treatments for depression. The type of sexual abuse (touching vs. non-touching; penetration vs. non-penetration) and relationship to the perpetrator (closer relative vs. non-related) appears to affect the development and severity of depression (Trickett, Noll, Reiffman, & Putnam, 2001). However, Chapman and colleagues (2004) found emotional abuse to pose the greatest risk for the development of depression in childhood and/or adulthood, greater than sexual or physical abuse. PNPs should explore the possibility of sexual abuse as well as other forms of child abuse when a child or adolescent presents with depression.

Suicide

A history of sexual abuse places the individual at increased risk of suicide throughout the life span—childhood, adolescence, and adulthood (Dube et al., 2001). Sapp and Vandeven (2005) state that adolescent boys (grades 8 through 10) who have been sexually abused are at significantly increased risk of suicide, and are at even greater risk than girls who have been sexually abused. Any child or adolescent who expresses suicidal ideation or a suicide attempt must be assessed for all psychosocial risk factors, including sexual abuse.

Substance Abuse

Cigarette smoking usually is initiated in adolescence. The relationship between adult cigarette smoking and childhood sexual abuse was explored by Nichols and Harlow (2004) by conducting a retrospective study on 722 women aged 36 to 45 years. Nearly half (41%) of participants were identified as smokers, with a mean and median age of beginning smoking at age 16 years. Physical abuse was reported by 17% of the participants, and 6% reported sexual abuse. Findings included a 3.5-fold increased risk of smoking in women who gave a history of both physical and sexual abuse and a two-fold increase in women who gave a history of sexual abuse only. Sapp and Vandeven (2005) state that smoking may be initiated during adolescence to help the individual cope with the trauma of the abuse and that continued adult smoking is complicated by nicotine addiction and adult stressors.

Numerous studies have linked child sexual abuse and illicit drug use (Bensley et al., 2000, Dube et al., 2003). Child sexual abuse can produce feelings of helplessness, chaos, and impermanence in children and adolescents, and illicit drug use may serve as a way to escape or dissociate from these feelings (Dube et al., 2003). Sexual abuse, along with other forms of abuse and neglect, has been linked with drug initiation from early adolescence into adulthood and the problems with drug use, drug addiction, and parenteral drug use. Both men and women with a history of child sexual abuse demonstrate an increased risk of alcohol problems and marrying an alcoholic (Dube et al., 2003).

Alcohol use in adolescence is higher among teens who have been sexually abused. Sexual abuse, as well as other forms of child abuse or neglect, should be considered when an individual presents with a substance abuse problem.

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