Emotional and Psychological

Several of the most common long-term symptoms of sexual abuse, outlined by Browne and Finkelhor in their classic study (1986), are emotional or psychological in nature. These include depression and anxiety. All symptoms are linked and impact one another, and emotions contribute to self-destructive behaviors and relationship difficulties.  Neumann, Houskamp, Pollack, and Briere's (1996) categories of long-term symptoms include emotional and psychological groupings. Anger, anxiety, and depression are included in the emotional category. dissociation, traumatic stress, somatic symptoms, and obsessions and compulsions are included in the psychological category.  

Emotional Consequences of Childhood Sexual Abuse

• Anger - Victims are angry at the perpetrator, themselves, non-abusive caregivers (mothers), and other non-supportive people. This anger is often referred to as rage and often the rage is directed towards men. Stock (2002) reports that 50% - 60% of abused women report high levels of anger. This anger does not appear to reduce significantly when child sexual abuse victims become adults.
• Anxiety - Anxiety is a common symptom following trauma of any kind. Anxiety attacks occur frequently in sexual abuse survivors. Herman (1984) referred to this anxiety as "chronic severe anxiety."
• Depression - Child sexual abuse victims are four times more likely to be depressed than non-abused individuals. Studies show that depression occurs in up to 100% of survivors of sexual abuse.
• Fear - Fear is most often reported by survivors as fear of men. Fear of intimacy also contributes to relationship difficulties.
• Isolation and loneliness - Many sexual abuse survivors fear being alone or being without a close relationship. This contributes to involvement in unhealthy or dangerous relationships as adults. Alienation and avoidance are terms which also refer to this problem area in adult survivors. Survivors often feel different from others and feel stigmatized because of their abuse. Researchers often use the terms loneliness, social isolation, and poor social adjustment interchangeably as they reflect similar behaviors in survivors. Studies show that isolation and loneliness occurs in up to 100& of survivors of sexual abuse.
• Low self-esteem - This is also referred to as low self-confidence or an inability to view positive characteristics in the self. Low self-esteem is usually accompanied by feelings of worthlessness and inferiority. This result of abuse contributes to a range of other difficulties that survivors experience, such as relationship problems and shame. Studies have shown that as many as 92% of survivors have self-esteem issues.     
• Guilt and shame - The difference between guilt and shame can be stated in this way: Guilt is feeling bad about something you have done while shame is feeling that you are bad. Victims of child sexual abuse feel both, believing that they are responsible for doing something bad and that they themselves are bad. Victims often report an experience of feeling like "damaged goods." They blame themselves for the abuse and feel guilt and shame related to it. Sometimes the offender had told them that they are responsible for the abuse, and that something they did initiated the sexual activity. Victims are usually required by the offender, through threat and coercion, to maintain the secret, and they feel shame in holding the secret and not telling the mother or another responsible adult about the abuse. When non-violent touch is involved, victims respond sexually to the touch are are often ashamed and confused by this natural physiological occurrence. Stock (2002) reports that frequency rates range to 88% of victims experiencing guilt and shame about the abuse. 
• Inability to trust - Because of violation of trust and betrayal issues, particularly if the perpetrator was a known, trusted adult or family member, the ability to trust others is negatively affected. The closer the relationship and more authority and responsibility the perpetrator had in the victim's life, the greater the loss in ability to trust. This symptom contributes to adult relationship problems and isolation and loneliness in adulthood. 
• Inability to identify and express emotions - Victims feel an intense array of emotions but are often too young or immature to identify these. Often emotions that are expressed are invalidated by the perpetrator. Victims learn to avoid or suppress emotional responses. They often dissociate, not experiencing emotions as they arise because they are not aware or present in the experience. Confusion regarding emotional response is common in adult survivors. They may misinterpret and mislabel emotions and then respond inappropriately. This interferes with social interactions and is a barrier to establishing intimate relationships.
• Inability to tolerate stress - A traumatic event is a stressful event. Stress hormones and neurochemicals are released into the body at the point of acute stress. If the individual experiences chronic stress, dysfunction occurs in the regulatory processes governing the physical response to stress. Depletion of  neurochemicals occurs, and other abnormal brain processes occur, including reduction in size in the hippocampus. (See brain effects.) The person experiences a reduced capacity to deal with stress. A state of chronic anxiety has contributed to the inability to deal with additional stress.

Psychological Consequences of Childhood Sexual Abuse

• PTSD or Posttraumatic Stress Disorder - PTSD is a constellation of symptoms that includes some of those listed above, such as anxiety, fear, and anger. PTSD results from an individual experiencing trauma and having neither adequate coping skills nor the opportunity to adequately process feelings associated with the trauma. Not all victims of trauma develop PTSD, and factors such as resilience contribute to their adjustment following the trauma. Studies report a range of up to 100% of survivors developing PTSD.
• Dissociation - Many sexual abuse victims dissociate. Although their bodies are present during the abuse, they have escaped to a different place in their minds. This coping skill is adaptive at the point of abuse. However, if individuals continue to dissociate in adulthood, they minimize awareness to their present lives. This has a negative impact on function and relationships. Dissociation is a common symptom in victims who have PTSD. It is also related to increased somatic symptoms in child and adult survivors. Reduced awareness may contribute to the inability to relate a physical symptom to a present emotion.
• Dissociative Personality Disorder - Sometimes when a victim dissociates during abuse, she develops another identity to cope with and survive the trauma of the abuse. 
• Borderline personality disorder - Individuals who are diagnosed with this disorder usually report significant abuse in childhood. They are invalidated by adult caregivers, being told that what they feel is not what they feel, what they saw is not what they saw, what they experienced is not what they experienced. Dissociation is a common symptom of this disorder. Individuals with borderline personality disorder have unstable moods, high levels of anger, disturbed and chaotic relationships, feelings of emptiness, poor self-image, impulsivity, and self-destructive behaviors. Self-harm, suicidal ideation and attempts, and substance abuse issues are common. This disorder affects almost all areas of a person's life and is difficult to treat.   
• Self-harm or self-injury - This is often referred to as parasuicidal behavior. It is self-injury inflicted, not in an attempt to kill oneself, but as a coping strategy. Many individuals report that self-harm is a self-soothing behavior and reduces feelings of stress. Examples of self-harm are: cutting, burning wiht cigarettes, self-biting, scratching, stabbing, and self-poisoning. Although self-harm is not done in an attempt to suicide, it often accidentally results in suicide. For example, someone who frequently cuts the wrists, arms, legs, or abdomen may cut deeper than intended and create a lethal injury. Self-harm is a common behavior associated with borderline personality disorder and is frequently seen in both male and female adult sexual abuse survivors.
• Eating disorders - Eating disorders result in individuals having a compulsion to eat or not to eat. An eating disordered person may also have a body dysmorphic disorder, viewing their body in a distorted manner and not seeing it as it is in reality. Viewing themselves as fat, they attempt to get thin. The most common eating disorders are anorexia nervosa, bulimia nervosa, and binge eating disorder. All three are asssociated with significant health problems and can result in death. Someone with anorexia has a very low body weight and fears gaining weight or getting fat. It is believed that anorexia is related to a desire for coontrol in the person's life. Someone with anorexia lierally starves herself to death. Bulimia involves cycles of binging and purging in which the person eats large quantities of foor and then vomits. Laxatives, fasting, over-exercise, and enemas are also used in an attempt to rid themselves of the excess calories. This addictive process is associated with other compulsive behaviors such as substance abuse. Binge eating is often called compulsive overeating. Unlike bulimics, binge-eaters do not purge to rid themselves of the food. They often eat in secret, similar to other addictions, hiding food, stuffing themselves, and feeling guilty. This eating disorder is sometimes known as emotional eating as the person is using food as a coping mechanism to deal with stress, anxiety, or anger.   
• Major Depressive Disorder - Depression is commonly demonstrated by symptoms of sadness and reduced interest in activities. It affects the body, altering brain chemistry, and affects the person's ability to function in all areas of life. This includes: eating, sleeping, sexual activity, family, school or employment, and social life. Survivors with this disorder may be sad, anxious, restless, and feel worthless, helpless, and hopeless. They may have difficulty concentrating and making decisions. They may consider suicide as an option or develop a plan to kill themselves. Energy is reduced, and depressed individuals feel slowed down and tired. They may also have other symptoms such as: headaches, digestive disorders, and chronic pain. Young children can develop this disorder after sexual abuse. Victims often report thoughts of suicide. 
• Bi-Polar Disorder - This disorder is a combination of a depressed disorder and a manic disorder. The person cycles between these two moods or poles. When depressed, the person exhibits symptoms discussed under depression. When manic, the person has an extremely elevated mood, energy, unusual thought processes, and impulsivity. They may have racing thoughts, need little sleep, be grandiose, irritable, angry, and delusional. They may be hyperactive or impulsive in a variety of ways and engage in significant risk-taking, such as sexual promiscuity, gambling, and shopping binges. Bi-polar disorder may include pschotic episodes in which the person loses touch with reality. 
• Anxiety disorders such as generalized anxiety, Panic Disorder, obsessive compulsive disorder, phobias, and social anxiety disorder - Anxiety disorders and fear-based disorders which result in distressing levels of anxiety can result from trauma. With generalized anxiety, the person has a persistent, free-floating anxiety that is not focused on a particular person, event, or situation. These individuals are caught in a recurrent stress cycle and may develop headaches, heart palpitations, and other symptoms. These symptoms inhibit normal daily function. When a person has a panic attack, she experiences a sense of terror and fear and is confused, has difficulty breathing, dizzy, and possibly nauseus. These bouts of anxiety are not predictable and may occur in any life situation. Individuals then develop a fear of another panic attack which inhibits engagement in normal life activities. Obsessive-compulsive disorders are characterized by obsessions, distressing thoughts that repeat themselves and often make no sense, and compulsions, a sense of feeling forced to act on the obsession, to do it in order to reduce the anxiety. Examples include repeatedly checking the door to see if it is unlocked, counting rituals, and compulsive organizing. Phobias are irrational fears of certain objects or situations and avoiding these objects or situations to reduce the anxiety related to them. The person may know that the fear is not rational. Social anxiety disorders create intense fear in the person when in public social situations. This disorder can prevent a person from establishing social relationships and be a barrier to intimate adult relationships.  
• Psychosis and paranoia - Psychotic behavior and paranoia may accompany depression, bipolar disorder, and other psychiatric diagnoses. Psychosis indicates that the person is not in touch with reality. He may have visual, auditory, or tactile hallucinations, delusional beliefs, and disordered thought processes. Paranoia is a type of thought disorder characterized by intense fear and anxiety and is often irrational and delusional. Schizophrenia, bipolar disorder, severe clinical depression, severe stress, and sleep deprivation can result in psychosis.    
• Somatic disorders - This is also known as somatization disorder or Briquet's disorder, a psychiatric diagnosis for persons who persistently complain of physical problems for which medical professionals can find no organic cause. Somatic complaints are common among sexual abuse survivors. This is thought to be directly associated with the traumatic abuse. The body was violated, and the survivor is aware of physical function, and does not usually relate physical problems to stress events. Instead, she interprets the physical symptom as medical in nature. Another line of thinking regarding somatic disorders has to do with body memory. The cognitive memory of abuse is often suppressed and may not be accessible. However, the memory may be encoded in the body and triggered by certain experiences. Other somatic disorders include: conversion disorder, hypochondriasis, body dysmorphic disorder, and pain disorder.