Consequences

 
 

The consequences of sexual assault are complex and difficult to document. Victim studies reveal the difficulties experienced by people who have been sexually assaulted compared to their non-assaulted counterparts. However, most of these studies do not allow these difficulties to be attributed to the sexual assault alone.1,2

  • Sexual assault in childhood or adulthood impacts not only the victim, but also the victim’s family and friends as well as society as a whole. In this regard, sexual assault is a public health problem that concerns everyone.
  • Sexual assault has numerous potential consequences that can last a lifetime and span generations, with serious adverse effects on health, education, employment, crime, and the economic well-being of individuals, families, communities and societies.2

Consequences of child sexual abuse

  • There does not appear to be a specific pattern of consequences from sexual abuse experienced in childhood. In fact, the sequelae, or after-effects, of childhood sexual abuse vary from one child to the next.1,3
  • Victims of child sexual abuse can face immediate psychological consequences as well as chronic effects that can impact their adjustment throughout their development.4,5,6

Immediate psychological consequences of child sexual abuse include:

  • Shock
  • Fear
  • Anxiety, nervousness
  • Guilt
  • Symptoms of post-traumatic stress disorder
  • Denial
  • Confusion
  • Withdrawal, isolation
  • Grief
 
 

Sexual abuse that occurs during a child’s development can have adverse effects on certain developmental processes, such as emotional regulation, cognitive style, and coping mechanisms, and thus entail long-term consequences.7

  • Sexual abuse in childhood is known to be a major risk factor in the development of long-term psychological and social adjustment problems that can carry over into adulthood and affect married life and parenthood.1,2,3
  • The most common effects of sexual abuse in children are symptoms of post-traumatic stress disorder, psychological distress and inappropriate sexual behaviour.1,7
  • Roughly one third of sexually abused children do not display symptoms deemed problematic (i.e. symptoms that have reached the clinical threshold).1,3 There may be various reasons for this, including:1,3
    • These children experienced less severe sexual abuse.
    • These children have protective factors that help them cope better with the trauma of the abuse.
    • These children may exhibit no symptoms during assessment, but have latent sequelae that might manifest later.
  • Depending on their age, victims of child sexual abuse are also at greater risk of experiencing the following consequences:
     
    Consequences of sexual abuse exhibited in childhood1,3,7
    Neurobiological changes Depressive symptoms
    Developmental delays Anxiety, fear, distrust of others
    Anger, aggression Maladjustment in school
    Sexual behaviour problems Social isolation behaviour
    Symptoms of post-traumatic stress disorder Somatic problems (e.g. enuresis)
    Behaviour problems Dissociative symptoms 
    Low self-esteem  
     
    Consequences of sexual abuse exhibited in adolescence1,3,7
    Neurobiological changes Delinquency
    Depressive symptoms Homelessness, running away from home
    Anxiety, fear, distrust of others Alcohol and drug use
    Symptoms of post-traumatic stress disorder Gang involvement
    Self-mutilation and self-destructive behaviour High-risk sexual behaviour
    Low self-esteem and poor body image Teen pregnancy
    Suicidal thoughts or attempted suicide Early sexual initiation
    Eating disorders (anorexia, bulimia) Sexually transmitted and blood-borne infections (STBBI)
    Social isolation behaviour Multiple sexual partners
    Strained relationships with family Lack of emotional commitment in romantic relationships
    Behaviour problems Sexual revictimization and offences
      Dating victimization and abuse

Post-traumatic stress disorder

Post-traumatic stress disorder (PTSD) is a reactive disorder that can develop following a traumatic event and be diagnosed by a physician. A traumatic event is an experience that involves a threat and/or harm to a person’s physical and/or psychological integrity. The person’s immediate response to the event must involve intense fear, helplessness or horror.

The symptoms of PTSD can be grouped into three main categories:

  1. Re-experiencing symptoms: the person relives the trauma over and over through flashbacks or nightmares.
  2. Avoidance: the person avoids ― purposely or not — thoughts, feelings or situations that are reminders of the traumatic experience. Avoidance symptoms include dissociation, difficulty remembering the event or emotional numbness.
  3. Hyperarousal: the person is always on the alert and hypervigilant, even when there is no danger. Hyperarousal symptoms may include insomnia.
In children, PTSD symptoms can manifest in several ways, including:8
  • Distress at exposure to reminders of the abuse
  • Re-enactment of the trauma through play
  • Feeling that the trauma is happening again
  • Recurrent flashbacks or memories
  • Nightmares
  • Specific fears
  • Persistent recounting of the traumatic event
  • Diminished interest in activities
  • Avoidance of reminders of the trauma
  • Problems with concentration

For more information on post-traumatic stress disorder, visit the Info-trauma website.

Factors influencing the development of adverse outcomes in children

  • Research has identified several factors that influence the development of adverse outcomes in sexually abused children and provide a better understanding of the range of difficulties these children experience. These factors can be grouped into four categories:1,3
     
     

    Many experts believe that parental support is the single most important factor in helping sexually abused children adjust following the abuse and in reducing the risk of their developing symptoms, regardless of the characteristics of the abuse experienced. Parental support includes, in particular, believing the child and taking action following the disclosure of abuse.3

    1. Characteristics of the sexual abuse experienced +

      Type of abuse, frequency, duration, age when abused, relationship to perpetrator.

    2. Personal characteristics of the victim+

      Gender, personality, personal skills, coping strategies.

    3. Characteristics of the family+

      Other stressful events experienced by the family, quality of parent-child relationship, family functioning.

    4. Sources of support+

      Maternal and family support, reaction of friends to disclosure of the abuse, support resources (peers, significant adults).

Consequences of childhood sexual abuse exhibited in adulthood

  • Some people who were sexually abused during childhood have few sequelae once they reach adulthood. However, many studies have shown that childhood sexual abuse can have a wide range of consequences that carry into adulthood and across multiple spheres of functioning.9,10
  • Not only can childhood sexual abuse have lasting effects throughout adulthood, but the effects can take new forms in adulthood, affecting marital and parental life as well.
Possible adverse effects of childhood sexual abuse exhibited in adulthood5,10,11,12,13,14,15,16
Sexual and physical health
  • Somatic problems
  • Risky lifestyles (e.g. smoking, alcohol and drug use)
  • Poorer physical health
  • Poorer perception of physical health
  • More frequent visits to the physician
  • Occupational disability
  • Chronic diseases
  • Chronic pain
  • High-risk sexual behaviour (unprotected sex, multiple partners, etc.)
  • Gynecological and perinatal complications
  • Sexual problems (e.g. painful intercourse, vaginismus in women)
  • Greater risk of contracting HIV and STBBIs
Psychological
  • Mental health problems (depression, personality disorders, psychotic disorders, panic disorder, etc.)
  • Psychological distress
  • Dissociation
  • Symptoms of post-traumatic stress disorder
  • Anxiety
  • Self-mutilation
  • Suicidal thoughts, attempted or completed suicide
  • Drug and alcohol abuse
Relational and marital
  • Less trusting of others
  • Commitment issues
  • Greater family and personal conflict
  • Isolation
  • Fear of intimacy
  • Marital dissatisfaction
  • Less stable relationships with partners
  • Marital conflict
  • Spousal violence
Parental*
  • Permissive parenting practices
  • Parenting stress
  • Parentification of children
  • Troubled parent-child relationships
Perinatal period
  • Early motherhood
  • Renewed symptoms of post-traumatic stress disorder (during pregnancy, delivery, nursing)
  • Premature births
  • Post-partum depression

*Studies focused on mothers who were sexually abused in childhood.

Child sexual abuse and mental health outcomes

Child sexual abuse has often been associated with a higher risk of mental health problems in adulthood. A study of a cohort of sexually abused children followed for over 40 years found that women who were sexually abused in childhood were more than seven times more likely to have received a diagnosis of post-traumatic stress disorder, nearly nine times more likely to have a substance abuse disorder (drugs or alcohol) and nearly 8.5 times more likely to have received a diagnosis of borderline personality disorder than non-abused women.17

Consequences of adult sexual assault

 
 

Studies show that between 17% and 65% of women who were sexually assaulted in adulthood exhibit symptoms of post-traumatic stress disorder (PTSD).18

  • Sexual assault in adulthood can have an immediate and direct negative impact, such as injury, physical trauma or death. It can also lead indirectly to a variety of effects on physical and mental health and well-being.2
  • Most sexual assaults occurring in adulthood happen once and take place at a time of life when the victim’s identity and personality have been shaped. Adult sexual assault is therefore more likely to produce a smaller range of sequelae than child sexual abuse.9
  • Sexual assault victims are more likely to experience post-traumatic stress disorder symptoms, even years after the assault took place, than non-assaulted adults.19,20

Post-traumatic stress disorder

Post-traumatic stress disorder (PTSD) is a reactive disorder that can develop following a traumatic event and be diagnosed by a physician. A traumatic event is an experience that involves a threat and/or harm to a person’s physical and/or psychological integrity. The person’s immediate response to the event must involve intense fear, helplessness or horror.

The symptoms of PTSD can be grouped into three main categories:

  1. Re-experiencing symptoms: the person relives the trauma over and over through flashbacks or nightmares.
  2. Avoidance: the person avoids — purposely or not — thoughts, feelings or situations that are reminders of the traumatic experience. Avoidance symptoms include dissociation, difficulty remembering the event or emotional numbness.
  3. Hyperarousal: the person is always on the alert and hypervigilant, even when there is no danger. Hyperarousal symptoms may include insomnia.

For more information on post-traumatic stress disorder, visit the Info-trauma website.

  • Adult victims of sexual assault are at higher risk of experiencing the following negative outcomes:
Possible adverse effects of adult sexual assault18,19,20
Physical and sexual health
  • Somatic problems (e.g. migraines, nausea, fatigue)
  • Food issues, diminished appetite
  • High-risk sexual behaviour (unprotected sex, multiple partners, etc.)
  • Greater use of health care services
  • Gynecological and menstrual pain (women)
  • Sexual dysfunction
  • Higher risk of contracting HIV and STBBIs (between 4% and 30% of victims contract an STBBI after being sexually assaulted)
  • Revictimization
Psychological
  • Fear, anxiety, social anxiety disorder
  • Psychological distress and severe depression
  • Symptoms of post-traumatic stress disorder
  • Self-mutilation
  • Suicidal thoughts, suicide attempts
  • Drug and alcohol abuse
Relational and social
  • Less trusting of others
  • Isolation
  • Fear of intimacy

Factors influencing the range of adverse effects experienced by adult sexual assault victims

The adverse psychological effects of adult sexual assault vary from one person to the next and are influenced by a range of factors.

The characteristics of the sexual assault, the characteristics of the victim (age, gender, personality), the circumstances under which the assault is disclosed to family and friends, post-assault help seeking and sociocultural norms help shape the way in which the sexual assault affects the victim’s subsequent adjustment and well-being.18

 
 

Male victims of adult sexual assault report higher rates of sexual dysfunction than female victims and are also more confused and conflicted about their sexual orientation.19

  • Even if men are at less risk of sexual assault than women, several studies have found that they report just as many adverse effects as female victims — even more according to some studies — and the adverse effects are just as significant.19,20.
     

Societal consequences of sexual assault

  • Sexual assault has consequences not only for the victim, but also for society as a whole through the associated social and economic costs.
    • Social costs correspond to all of the non-monetary consequences of criminal acts, including the consequences for the perpetrator and the victim and their families and friends as well as those affecting society as a whole. The societal consequences of sexual assault, like other types of crime, can include, in particular, diminished quality of life for society and increased feelings of insecurity among individuals, especially women, who are more likely to be the victims of sexual assault.
    • Economic costs are costs directly attributable to sexual assaults. They can be borne either by society or by the victims themselves. The economic costs of sexual assault are tangible and include judicial services, social services, education, health, employment and personal costs.

      For example, the economic costs associated with sexual assault include:
      • Police services
      • Criminal prosecution
      • Correctional system and enforcement of legislation
      • Lost wages (victims and their loved ones)
      • Health care
      • Lost productivity (victims and their loved ones)
      • Victim support services (e.g. community organizations)
      • Victim compensation programs
      • etc.
  • The cost estimate of child sexual abuse in Canada exceeds $3 billion annually in terms of health care, social services, education and justice.21.
  • The economic costs of violence against Canadian women, including sexual assault, total at least $4.2 billion each year (1995 estimate), for social services, education, criminal justice, labour, employment, and health and medical care.22
  • Cost-specific data show the heavy economic toll that sexual assault exacts on society (the cost estimates below come from U.S. studies, as the equivalent data are not available for Canada):
    • Adult sexual assault is the costliest crime against people in the United States, at an estimated cost to victims and society of $127 billion each year according to 1996 data.23
    • In 2008, the cost estimate per sexual assault (rape) in the United States was approximately $151 423.24
    • The expected lifetime income loss from sexual victimization in adolescence is $241 600.25
 
 

Références

  1. Baril, K. and Tourigny, M. (2009). La violence sexuelle envers les enfants. In M.E. Clément and S. Dufour, eds., La violence à l’égard des enfants en milieu familial (pp. 145-160). Anjou: Éditions CEC. (Available in French only)
  2. World Health Organization (WHO), London School of Hygiene and Tropical Medicine. (2010). Preventing intimate partner and sexual violence against women. Taking action and generating evidence. Geneva: World Health Organization.
  3. Hébert, M. (2011). Les profils et l’évaluation des enfants victimes d’agression sexuelle. In M. Hébert, M. Cyr, and M. Tourigny, eds., L’agression sexuelle envers les enfants Tome 1 (pp. 149-204). Québec: Presses de l’Université du Québec. (Available in French only)
  4. From the “Sexual Violence: Consequences” section of the Centers for Disease Control and Prevention website: www.cdc.gov/ViolencePrevention/sexualviolence/.
  5. Polucci, E.O, Genuis, M.L. and Violato, C. (2001). A meta-analysis of the published research on the effects of child sexual abuse. Journal of Psychology, 135(1): 17-36.
  6. Putnam, F.W. (2003). Ten-year research update review: child sexual abuse. Journal of the American Academy of Child Adolescent Psychiatry, 42(3): 269-278.
  7. Wolfe, V.V. (2007). Child sexual abuse. In E.J. Mash and R.A. Barkley, eds., Assessment of Childhood Disorders (4th ed.) (pp. 685-748), New York: Guilford Press.
  8. Berthiaume, C., Bériault, M. and Turgeon, L. (2006). L’état de stress post-traumatique chez les enfants : manifestations et traitement. In S. Guay and A. Marchand, eds., Les troubles liés aux événements traumatiques : Dépistage, évaluation et traitements (pp. 139-150), Montréal: Presses de l’Université de Montréal. (Available in French only)
  9. Cyr, M. and Payer, M. (2011). Les interventions curatives auprès des adultes ayant été victimes d’agression sexuelle pendant leur enfance. In M. Hébert, M. Cyr, and M. Tourigny, eds., L’agression sexuelle envers les enfants Tome 1 (pp. 303-332). Québec: Presses de l’Université du Québec. (Available in French only)
  10. Thibodeau, C. and Lavoie, F. (2012). Influence d’une agression sexuelle vécue pendant l’enfance sur la santé physique à l’âge adulte. In M. Hébert, M. Cyr, and M. Tourigny, eds., L’agression sexuelle envers les enfants Tome 2 (pp. 225-258). Québec: Presses de l’Université du Québec. (Available in French only)
  11. DiLillo, D. and Damashek, A. (2003). Parenting characteristics of women reporting a history of childhood sexual abuse, Child Maltreatment, 8(4): 319-333.
  12. Dube, S.R., Anda, R.F., Whitfield, C.L., Brown, D.W., Felitti, V.J., Dong, M. and Giles, W.H. (2005). Long-term consequences of childhood sexual abuse by gender of victim. American Journal of Preventive Medicine, 28(5): 430-438.
  13. Fergusson, D.M, Boden, J.M. and Horwood, L.J. (2008). Exposure to childhood sexual and physical abuse and adjustment in early adulthood. Child Abuse & Neglect, 32: 607-619.
  14. Neumann, D., Houskamp, B., Pollock, V. and Briere, J. (1996). The long-term sequelae of childhood sexual abuse in women: a meta-analytic review. Child Maltreatment, 1: 6–16.
  15. Jewkes, R., Sen, P. and Garcia-Moreno, C (2002). Sexual violence. In E.G. Krug, L.L. Dahlberg, J.A. Mercy, A. Zwi and R. Lozano-Ascencio, eds., World report on violence and health (pp. 147-181). Geneva: World Health Organization.
  16. Liang, B., Williams, L.M. and Siegel, J.A. (2006). Relational outcomes of childhood sexual trauma in female survivors: a longitudinal study, Journal of Interpersonal Violence, 21(1): 21-47.
  17. Cutajar, M.C., Mullen, P.E., Ogloff, J.P., Thomas, S., Wells, D. and Spataro, J. (2010). Psychopathology in a large cohort of sexually abused children followed up to 43 years. Child Abuse & Neglect, 34(11): 813-822.
  18. Campbell, R., Dworkin, E. and Cabral, G. (2009). An ecological model of the impact of sexual assault on women’s mental health. Trauma, Violence, & Abuse, 10(3): 225-246.
  19. Peterson, Z.D., Voller, E.K., Polusny, M.A. and Murdoch, M. (2011). Prevalence and consequences of adult sexual assault of men: Review of empirical findings and state of the literature. Clinical Psychology Review, 31: 1-24.
  20. Elliott, D.M., Mok, D.S. and Briere, J. (2004). Adult sexual assault: Prevalence, symptomatology, and sex differences in the general population. Journal of Traumatic Stress, 17(3): 203-211.
  21. Hankivsky, O. and Draker, D.A. (2003). The economic costs of child sexual abuse in Canada. A preliminary analysis. Journal of Health and Social Policy, 17(2): 1-33.
  22. Greaves, L., Hankivsky, O. and Kingston-Riechers, J. (1995). Selected estimates of the costs of violence against women. London: Centre for Research on Violence Against Women and Children.
  23. National Institute of Justice. (1996). The extent and costs of crime victimization: A new look. Washington, DC: U.S. Department of Justice. Downloaded from: www.ncjrs.gov/pdffiles/costcrim.pdf.
  24. DeLisi, M. (2010). Murder by numbers: Monetary costs imposed by a sample of homicide offenders. The Journal of Forensic Psychiatry & Psychology, 21: 501-513.
  25. MacMillan, R. (2000). Adolescent victimization and income deficits in adulthood: Rethinking the costs of criminal violence from a life-course perspective, Criminology, 38: 553-588.