Long Term Consequences

Child sexual abuse results in both short-term and long-term medical, emotional, psychological, spiritual, and behavioral consequences to child victims. Decades of research have shown that victims experience a wide range of negative effects which may last many years or even for the rest of their lives, depending on factors specific to the abuse, the abuser, and the victim. Because sexual abuse is so invasive and impactful, the sense of self is radically altered. The potential for harmful effects embraces an all-inclusive list of problems that human beings can suffer: negative emotions, problem and addictive behaviors, self-destructive tendencies, physical illness, mental illness, unhealthy relationships, education and employment difficulties, lost potential, lost hopes, and lost dreams. 

Because child sexual abuse impacts all areas of a child's emotional and psychological development, it predicts adult dysfunction. Browne and Finkelhor's classic study (1986) reported the most common long-term symptoms of sexual abuse as:

• Depression
• Self-destructive behavior 
• Anxiety
• Isolation and stigma 
• Lowered Self-Esteem
• Inability to Trust
• Substance abuse 
• Sexual problems

Neumann, Houskamp, Pollack, and Briere (1996) classified the most commonly reported symptoms into five categories:

• Affective - Included anger, anxiety, and depression
• Behaviors - Included revictimization, self-mutilation, sexual problems, substance abuse, and suicidal ideation and attempts
• Relational and identity - Interpersonal problems, poor self-concept
• Psychological - dissociation, obsessions and compulsions, somatization , Traumatic stress response
• General

Effects can be categorized into the following areas:   

• Emotional and Psychological 
• Cognitive Distortions 
• Behaviors 
• Relationships 
• PTSD 
• Dissociation 
• Health Effects 
• Addictions 
• Sexuality 
• Effect on Brain Development and Brain Chemistry. (See also Brain Effects.)

Long-term consequences to male victims differ from those of female victims.

A child does not have the ability to assign blame or responsibility for the behaviors of others, and, therefore, when bad things happen, tends to hold himself responsible. A pervasive sense of guilt and shame develops, and children are not apt to talk about the sexual abuse for years. Sexual abuse affects the total personality, self-concept, personal identity, and self-esteem. It profoundly alters the development of attitudes toward self, sexuality, and trusting relationships during the critical early years of development.

Stock (2002) investigated long-term symptoms of childhood sexual abuse and evaluated published literature. Long-term symptoms showed consistency among studies. The top three symptoms listed by professionals who worked with sexual abuse survivors were:

1. Depression 
2. Low self-esteem 
3. Trust difficulties

The top three symptoms mentioned by survivors themselves were:

1. Guilt and shame
2. Trust difficulties 
3. Low self-esteem

Child sexual abuse affects each individual differently based on a number of factors. Barker-Collo and Read (2003) reviewed models that attempt to explain these differences. Characteristics of the abuse and contextual factors are linked to immediate and prolonged reactions in victims.The following factors interact with each other:

• Younger age at time of abuse
• Severity of abuse
• Presence of other abuse and neglect
• Relationship to the perpetrator 
• Response to disclosure
• Support during the crisis
• Involvement of authorities
• Attachment

More severe consequences are predicted if the victim:

• Was closely related to the perpetrator
• Was involved with authorities
• Negative initial response to disclosure
• Poor attachment to adult caregiver(s)   

The symptoms that a child victim or adult survivor experience are strongly affected by a number of interacting factors. Attachment has a significant impact on a victim's ability to cope and the level of distress experienced. Insecure attachment is a risk factor for emotional and psychological consequences. Secure attachment predicts fewer effects of abuse. When victims blame themselves for the abuse, consequences are also more serious.