CHILDHOOD SEXUAL ABUSEadulthood (Briere and Elliott 1994; Faller 1993).
The various problems and symptoms described in
the literature can be categorized as follows: (1)
posttraumatic stress; (2) cognitive distortions; (3)
emotional distress; (4) impaired sense of self; (5)
avoidance phenomena; (6) personality disorders;
and (7) interpersonal difficulties. In the remainder
of this section, each of these categories is defined
and illustrated using examples from the research
literature.
Posttraumatic stress refers to certain endur-
ing psychological symptoms that occur in reaction
to a highly distressing, psychiatric disruptive event.
To be diagnosed with posttraumatic stress disor-
der (PTSD) an individual must experience not
only a traumatic event, but also the following
problems: (1) frequent re-experiencing of the event
through nightmares or intrusive thoughts; (2) a
numbing of general responsiveness to, or avoid-
ance of, current events; and (3) persistent symp-
toms of increased arousal, such as jumpiness, sleep
disturbances, or poor concentration (American
Psychiatric Association (APA) 1994). In general,
researchers have found that children and adults
who have been sexually abused are significantly
more likely to receive a PTSD diagnosis than their
nonabused peers (McLeer et al. 1992; Murray
1993; Rowan and Foy 1993; Saunders et al. 1992;
Wolfe and Birt 1995).
Cognitive distortions are negative perceptions
and beliefs held with respect to oneself, others, the
environment, and the future. In the abused indi-
vidual, this type of thought process is reflected in
his or her tendency to overestimate the amount of
danger or adversity in the world and to underesti-
mate his or her worth (Briere and Elliott 1994;
Dutton et al. 1994; Janoff-Bulman 1992). Numer-
ous studies document such feelings and percep-
tions such as helplessness and hopelessness, im-
paired trust, self-blame, and low self-esteem among
children who have been sexually abused (Oates et
al. 1985). Moreover, these cognitive distortions
often continue on into adolescence and adulthood
(Gold 1986; Shapiro and Dominiak 1990).
Emotional distress or pain, which typically
manifests itself as depression, anxiety, anger, or all
of these, is reported by many survivors of child-
hood sexual abuse. Depression is the most com-
monly reported symptom among adults with a
history of childhood sexual abuse (Beitchman et
al. 1992; Browne and Finkelhor 1986; Cahill et al.
1991a; Polusny and Follette 1995). Greater depres-
sive symptomatology is also found among children
who have been abused (Lipovsky et al.1989; Yama
et al.1993).
Similarly, elevated anxiety levels have been
documented in child victims of sexual abuse and
adults who have a history of it (Gomes-Schwartz et
al. 1990; Mancini et al. 1995; Yama et al. 1993).
Adults with a history of childhood sexual abuse are
more likely than their nonabused counterparts to
meet the criteria for generalized anxiety disorder,
phobias, panic disorder, obsessive compulsive dis-
order, or all of these (Mancini et al. 1995; Mulder
et al. 1998; Saunders et al. 1992).
Another common emotional sequel of child-
hood sexual abuse is anger; specifically, chronic
irritability, unexpected or uncontrollable feelings
of anger, difficulties associated with expressing
anger, or all of these (Briere and Elliott 1994; Van
der Kolk et al. 1994). During childhood and ado-
lescence, anger is most likely to be reflected in
behavioral problems such as fighting, bullying, or
attacking other children (Chaffin et al. 1997;
Garnefski and Diekstra 1997).
Sexual abuse also can damage a child’s devel-
oping sense of self, with adverse long-term conse-
quences. The development of a sense of self is
thought to be one of the earliest developmental
tasks of the infant and young child, typically un-
folding in the context of early relationships (Alex-
ander 1992). Thus, how a child is treated early in
life critically influences his or her growing self-
awareness. Childhood sexual abuse can interfere
with this process, preventing the child from estab-
lishing a strong self image (Cole and Putnam
1992). Without a healthy sense of self, the person
is unable to soothe or comfort himself or herself
adequately, which may lead to overreactions to
stressful or painful situations, and to an increased
likelihood of re-victimization (Messman and Long
1996). Indeed, numerous studies have found high
rates of sexual re-victimization (e.g., rape, coercive
sexual experience) among individuals reporting a
history of childhood sexual abuse (Fergusson et al.
1997; Urquiza and Goodlin-Jones 1994; Wyatt et
al. 1992)
Avoidance is another major response to hav-
ing been sexually abused. Avoiding activities among