Article details

Title: A Review of the Long-Term Effects of Child Sexual Abuse
Author(s): Joseph H. Beitchman, K. Zucker, J. Hood, G. DaCosta, D. Akman, & E. Cassavia
Affiliation: Child and Family Studies Center, Clarke Institute of Psychiatry, University of Toronto
Citation: Beitchman, J., Zucker, K., Hood, J., DaCosta, G., Akman, D., & Cassavia, E., “A Review of the Long-Term Effects of Child Sexual Abuse,” Child Abuse and Neglect, vol. 16, 1992, pp. 101-118.

Notes

The authors reviewed 32 studies of the long-term effects of child sexual abuse, some of which relied on clinical samples. They wrote:

As usual with clinical samples, a constellation of variables commonly associated with psychopathology, such as family disruption, parental illness, alcoholism, etc. was also found in these clinical populations so that their unique relation to CSA could not easily be determined unless a control group was included. Unfortunately control groups were rarely employed in these studies of clinical cases.

Sexual disturbances or dysfunction among CSA victims was found in several studies, but due to the lack of control groups, the authors wrote that there was no way to determine the extent to which these findings were related to CSA. The findings of two studies suggested similar frequencies of dissatisfaction among people had experienced CSA and those who had not.

The variety of definitions of “sexual disturbance” used by various studies also made it difficult to compare results and to assess the significance of the findings. Thus, the proportion of sexual disturbances that could be attributed to CSA remained unknown.

Cases that yielded higher rates of sexual disturbance tended to be those involving father-daughter incest or penetration (including oral penetration). The degree to which women experienced anxiety or depression as a result of the abuse may have been affected by the presence of coercion and the nature of parental reaction and support.

The review also came to the following general conclusions:

• CSA was linked to later homosexuality, but only weakly.
• There was a significant occurrence of “revictimization” among those who had experienced CSA. That is, having one childhood sexual experience with an adult made it more likely that that person would have another such experience later.
• In the absence of threat or force, the evidence did not support a link between CSA and suicidal tendencies.
• The evidence did not justify the designation of a postsexual abuse syndrome, as had been proposed by another researcher.
• There was insufficient evidence to establish a strong link between CSA and multiple personality disorder, or a link between CSA and borderline personality disorder.

Some of the studies attempted to determine the impact of age of onset of CSA on effects, but the authors wrote that the large number of variables made results ambiguous. Those whose CSA started when they were older tended to have more invasive experiences (e.g., penetration) than those who were younger, and degree of invasiveness had already been linked to degree of harm. People who were younger when their CSA experiences began tended to have a longer duration of experiencing CSA, and duration had also already been linked to the significance of effects.

Younger children were more likely to experience CSA from a father or stepfather than older children, and this relationship of the abuser to the abused had been linked to effects of CSA. The authors concluded, therefore, that there was no evidence that the age of onset was a factor in the long-term effects of CSA.

Additional findings for males were as follows:

• One study found that male victims were more poorly socially adjusted than female victims. However, several other factors needed to be controlled for before definite conclusions could be made.
• Another study found that males were more likely to be victims of force than females.
• A third study showed that male victims experienced more sexual dysfunction than controls did.
• A fourth study showed that male victims of CSA were more likely to be homosexually active in adulthood than males without CSA experiences.
• A fifth study found that male CSA victims were more likely to have sexual identity confusion.
• A sixth study found that adolescent sex offenders were more likely to be victims of CSA than adolescents in general.

The researchers concluded:

In those studies where abuse involving penetration was adequately frequent, the results support an association between invasive sexual abuse and trauma or harm. Where the outcome measure was adjustment, mental health status, or other psychiatric symptoms, the results are suggestive, but not certain.

They also noted that a history of CSA was related to disrupted families (single-parent homes, families with marital conflict, homes with substance abuse or depression in the family), and that supportive and stable families tended to mitigate the negative outcomes for those who experienced CSA.