Consequences of child sexual abuse

An update of this section is due in 2025.

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.^1,2
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.⁶

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.^1,2,7
The most common effects of sexual abuse in children are symptoms of post-traumatic stress disorder, psychological distress and inappropriate sexual behaviour.^1,6
Roughly one third of sexually abused children do not display symptoms deemed problematic (i.e. symptoms that have reached the clinical threshold). There may be various reasons for this, including:^1,2
- 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 childhood^1,2,6:
  - Neurobiological changes
  - Developmental delays
  - Anger, aggression
  - Sexual behaviour problems
  - Symptoms of post-traumatic stress disorder
  - Behaviour problems
  - Low self-esteem
  - Depressive symptoms
  - Anxiety, fear, distrust of others
  - Maladjustment in school
  - Social isolation behaviour
  - Somatic problems (e.g. enuresis)
  - Dissociative symptoms
- Consequences of sexual abuse exhibited in adolescence^1,2,6:
  - Neurobiological changes
  - Depressive symptoms
  - Anxiety, fear, distrust of others
  - Symptoms of post-traumatic stress disorder
  - Self-mutilation and self-destructive behaviour
  - Low self-esteem and poor body image
  - Suicidal thoughts or attempted suicide
  - Eating disorders (anorexia, bulimia)
  - Social isolation behaviour
  - Strained relationships with family
  - Behaviour problems
  - Delinquency
  - Homelessness, running away from home
  - Alcohol and drug use
  - Gang involvement
  - High-risk sexual behaviour
  - Teen pregnancy
  - Early sexual initiation
  - Sexually transmitted and blood-borne infections (STBBI)
  - Multiple sexual partners
  - Lack of emotional commitment in romantic relationships
  - 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:

Re-experiencing symptoms: the person relives the trauma over and over through flashbacks or nightmares.
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.
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:

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.

Berthiaume, C., Bériault, M. et Turgeon, L. (2006). L’état de stress post-traumatique chez les enfants : manifestations et traitement. Dans S. Guay et A. Marchand (Dir). Les troubles liés aux événements traumatiques : Dépistage, évaluation et traitements (pp. 139-150), Montréal: Presses de l’Université de Montréal.

Factors influencing the development of adverse outcomes in children

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.²

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:^1,2
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.^8,9
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 adulthood^4,9-15
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.¹⁶

References

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)
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)
From the “Sexual Violence: Consequences” section of the Centers for Disease Control and Prevention website: www.cdc.gov/ViolencePrevention/sexualviolence/.
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.
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.
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.
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.
Cyr, M. et Payer, M. (2011). Les interventions curatives auprès des adultes ayant été victimes d’agression sexuelle pendant leur enfance. Dans M. Hébert, M. Cyr, et M. Tourigny (dir.), L’agression sexuelle envers les enfants Tome 1 (pp. 303-332). Québec: Presses de l’Université du Québec.
Thibodeau, C. et Lavoie, F. (2012). Influence d’une agression sexuelle vécue pendant l’enfance sur la santé physique à l’âge adulte. Dans M. Hébert, M. Cyr, et M. Tourigny (dir.), L’agression sexuelle envers les enfants Tome 2 (pp. 225-258). Québec: Presses de l’Université du Québec
DiLillo, D. et Damashek, A. (2003). Parenting characteristics of women reporting a history of childhood sexual abuse, Child Maltreatment, 8(4), 319-333.
Dube, S.R., Anda, R.F., Whitfield, C.L., Brown, D.W., Felitti, V.J., Dong, M. et Giles, W.H. (2005). Long-Term consequences of childhood sexual abuse by gender of victim. American Journal of Preventive Medicine, 28(5), 430-438.
Fergusson, D.M, Boden, J.M. et Horwood, L.J. (2008). Exposure to childhood sexual and physical abuse and adjustment in early adulthood. Child Abuse & Neglect, 32, 607-619.
Neumann, D., Houskamp, B., Pollock, V., Briere, J. (1996). The long-term sequelae of childhood sexual abuse in women: a meta-analytic review. Child Maltreatment, 1, 6–16.
Jewkes, R., Sen, P. et Garcia-Moreno, C (2002). La violence sexuelle. Dans E.G. Krug, L.L. Dahlberg, J.A. Mercy, A. Zwi et R. Lozano-Ascencio (Dir.), Rapport mondial sur la violence et la santé (pp.163-201). Genève: Organisation mondiale de la Santé.
Liang, B., Williams, L.M. et Siegel, J.A. (2006). Relational outcomes of childhood sexual trauma in female survivors : A longitudinal study, Journal of Interpersonal Violence, 21(1), 21-47.
Cutajar, M.C., Mullen, P.E., Ogloff, J.P., Thomas, S., Wells, D., Spataro, J. (2010). Psychopathology in a large cohort of sexually abused children followed up to 43-years. Child Abuse & Neglect, 34(11), 813-822.

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