CHILDHOOD SEXUAL ABUSEvictims may be viewed as attempts to cope with the
chronic trauma and dysphoria induced by the
abuse. Among the dysfunctional activities associat-
ed with efforts to avoid recalling or reliving specif-
ic memories are: dissociative phenomena, such as
losing time, repression of unpleasant memories,
detachment, or body numbing (APA 1994; Cloitre
et al. 1997; Mulder et al. 1998; Nash et al. 1993);
substance abuse and addiction (Arellano 1996;
Briere 1988; Wilsnack et al. 1997); suicide or suici-
dal ideation (Briere and Runtz 1991; Saunders et
al. 1992; Van der Kolk et al. 1991); inappropriate,
indiscriminate, and/or compulsive sexual behav-
ior (McClellan et al. 1996; Widom and Kuhns,
1996), (for reviews see Friedrich 1993; Kendall-
Tackett et al. 1993; Tharinger 1990); eating disor-
ders (Conners and Morse 1993; Douzinas et al.
1994; Schwartz and Cohn 1996; Wonderlich et al.
1997); and self-mutilation (Briere 1988; Briere and
Elliott 1994). Each of these behaviors serve to
prevent the individual from experiencing the con-
siderable pain of abuse-specific awareness and
thus reduces the distress associated with remem-
brance. However, avoidance and self-destructive
methods of coping with the abuse may ultimately
lead to higher levels of symptomatology, lower
self-esteem, and greater feelings of guilt and anger
(Leitenberg et al. 1992).
Numerous investigations have found a greater
rate of borderline personality and dissociative iden-
tity (formerly multiple personality disorder) disor-
ders among adult female survivors of chilhood
sexual abuse (Green 1993; Polusny and Follette
1995; Silk et al. 1997). Borderline personality dis-
order includes symptoms of impulsiveness associ-
ated with intense anger or suicidal, self-mutilating
behavior, and affective instability with depression
which are typical sequelae in sexually abused child-
ren and in adult survivors of sexual abuse (APA
1994). Childhood trauma, especially continued
sexual abuse, is an important etiological factor in
many cases of dissociative identity disorder, the
most extreme type of dissociative reaction (APA 1994).
Finally, interpersonal difficulties and deficient
social functioning often are observed among indi-
viduals who have been sexually abused (Briere
1992b; Cloitre et al. 1997). Such difficulties stem
from the immediate cognitive and conditioned
responses to victimization that extend into the
longer term (e.g., distrust of others), as well as the
accommodation responses to ongoing abuse (e.g.,
passivity). Often, victims of childhood sexual abuse
know the perpetrator, who might be a family
member, clergy, or friend of the family. The abuse
is thus a violation and betrayal of both personal
and interpersonal (relationship) boundaries. Hence,
it is not surprising that many children and adults
with a history of childhood sexual abuse are found
to be less socially competent, more aggressive, and
more socially withdrawn than their nonabused
peers (Cloitre et al. 1997; Mannarino et al. 1991;
Mullen et al. 1994).Among adults, interpersonal difficulties are
manifested in difficulties in establishing and main-
taining relationships (Finkelhor et al. 1989; Liem
et al. 1996) and in achieving sexual intimacy
(Browne and Finkelhor 1986; Mullen et al. 1994).
Children who have been sexually abused are more
likely to exhibit increased or precocious sexual
behavior, such as kissing and inappropriate genital
touching (Cosentino et al. 1995).The consequences of childhood sexual abuse
can be quite severe and harmful. However, it is
important to note that an estimated 10 to 28
percent of persons with a history of it report no
psychological distress (Briere and Elliott 1994;
Kendall-Tackett et al. 1993). This raises the ques-
tion of why some persons exhibit difficulties while
others do not. Research addressing this question
has found the following to be important mediators
of individual reactions to childhood sexual abuse:- Age at onset of abuse. Although further
elucidation is needed, the available evi-
dence suggests that postpubertal abuse
is associated with greater trauma and
more severe adverse sequelae than is
prepubertal abuse (Beitchman et al. 1992;
Browne and Finkelhor 1986; McClellan et
al. 1996; Nash et al. 1993); - Gender of the victim. One of the main
findings in this area is that male victims
appear to show greater disturbances of
adult sexual functioning (Beitchman et al.
1992; Dube and Herbert 1988; Garnefski
and Diekstra 1997); - Relationship to perpetrator. Abuse involving
a father or father figure (e.g., stepfather),
which accounts for an estimated 25 per-
cent of all cases (Sedlak and Broadhurst