Introduction
Every year, millions of children around the world become victims of sexual abuse, which makes this problem one of the highest priorities for the international community. One of the most significant consequences of these episodes is the long-term mental health effects of trauma on victims. The most common symptoms are post-traumatic stress disorder (PTSD), anxiety, depression, self-destructive behavior, impaired social and sexual behavior, substance misuse, and others. Most importantly, these effects may persist into adulthood, which poses a risk to both the victims and those around them. Currently, there are methods for effective treatment and prevention of the development of mental disorders in victims of child sexual abuse. These include trauma focused cognitive behavioral therapy as well as medication support for severe symptoms. In this regard, the most important for health care professionals and caregivers is the timely identification of the fact of sexual abuse and the initiation of adequate therapeutic intervention.
Child Sexual Abuse as an International Public Health Problem
Sexual abuse is a common problem in all countries of the world, which also affects children. Researchers define child sexual abuse as an “activity in which an adult, taking advantage of his or her superiority, uses a minor to provide sexual pleasure, stimulation, or sexual gratification” (Castro et al., 2019, pp. 1-2). Currently, child sexual abuse is one of the most acute health related problems. In particular, this issue is significant in the context of providing public health, as it has “long-term outcomes on survivors’ mental, psychological, physical, and sexual health” (Gewirtz-Meydan & Finkelhor, 2019, p. 1). Girls are three times more likely to be victims of sexual abuse, and the age with the highest risk ranges from 6 to 12 years (Castro et al., 2019, p. 2). The problem of child sexual abuse is international and affects huge populations in different countries every year. Most importantly, this situation impacts the most vulnerable population, with long-term consequences affecting the entire future life of children and society.
The scale of the existing problem is also confirmed by the available statistics. Two large meta-analyses of about 10 million children across six continents report that this problem is relevant for approximately 18-20% of girls and 8% of boys across the world (Knack et al., 2019, p. 181). Other studies report figures of 5-18% depending on geographic and cultural context (Castro et al., 2019, p. 2). However, Gewirtz-Meydan and Finkelhor (2019) also point out that research is currently focusing on accounting for sexual violence against girls, which makes information about boys scarce. It is reported that around 120 million girls in the world are currently victims of sexual violence at some point in their lives (Knack et al., 2019, p. 181). In general, studies show that girls are more likely to be victims of sexual violence than boys. The prevalence of episodes also varies with the age of the victims and the characteristics of the perpetrator. Either way, child sexual abuse is a huge international health problem that is currently far from being resolved.
At the same time, perpetrators of child sexual abuse also have certain features. In particular, it is reported that in 85% of cases, abusers are men from 30 to 40 years old (Castro et al., 2019, p. 2). It is also noteworthy that most of the perpetrators belong to the inner circle of victims of abuse. Gewirtz-Meydan and Finkelhor (2019) report that 41-69% of children are sexually abused “by an immediate or extended family member” (p. 2). Thus, most episodes of child sexual abuse involve people known or close to the child, which will also affect the nature of the mental effects. An important characteristic of an episode of sexual violence is the location. Researchers report that most of these events occur in places familiar to children (Castro et al., 2019). Additionally, researchers identify a high and growing prevalence of peer offenses, which is especially relevant for male victims (Gewirtz-Meydan & Finkelhor, 2019). It is noted that most episodes of peer sexual abuse occur in a school setting (Castro et al., 2019). These aspects can also determine the nature of mental trauma and influence the necessary interventions.
This situation also has less obvious consequences, which are an increase in the number of potential perpetrators. In particular, most male child sexual abusers have been victims of abuse themselves in the past (Castro et al., 2019). However, this fact does not mean that the relatively low involvement of boys in sexual violence would contribute to risk reduction. Women are in fact less likely to become perpetrators in child sexual abuse (Castro et al., 2019; Gewirtz-Meydan & Finkelhor, 2019; Knack et al., 2019). However, the researchers note that potential abusers are more likely to witness or suffer abuse in childhood (Castro et al., 2019). This aspect identifies that the prevalence of this problem has even an indirect effect on the potential increase in the volume of episodes of sexual abuse. The information provided highlights that child sexual abuse is an acute international problem that needs to be addressed. Adequate treatment of victims of abuse, as well as measures to prevent these episodes, is one of the priorities of the world community to ensure the public health of society.
Impact of Child Sexual Abuse on the Mental Health of Victims
The main danger of child sexual abuse for victims and society as a whole is the long-term impact on the mental health of victims. In particular, not only physical, but also psychological traumas are the main consequence of these episodes, which have an effect on the entire life of children. Researchers note that childhood sexual abuse is associated with a wide range of “psychosocial, psychiatric, and physical health outcomes” (Hailes et al., 2019, p. 5). The main mental health effects of traumatic episodes for victims are substances misuse, as well as PTSD (Hailes et al., 2019). However, there are other less common psychological and psychiatric effects. Often a traumatic episode leads to the development of several mental disorders in children at once, which persist throughout life.
Research is identifying an even wider range of potential mental disorders in abuse victims. They include “higher levels of depression, guilt, shame, self-harm, eating disorders, somatic problems, anxiety, dissociative disorders, sexual problems and problems related to interpersonal relationships” (Radmanovic, 2020, p. 350). An additional consequence of child sexual abuse is a violation of the ability to cope with stress and depression. This aspect also increases the chances of developing concomitant mental disorders, as well as adverse effects on physical well-being. The main problem in the treatment of these consequences is that physical damage is easy to detect, while psychological damage can be hidden. Researchers also refer to them as a chronic neurological disease, the consequences of which can last for decades (Radmanovic, 2020). Thus, sexual abuse has a negative impact on the psychological development of children, which forms mental disorders in adulthood.
Among the most common consequences of child sexual abuse are the symptoms of a depressive disorder. Victims often have low self-esteem, negative image of themselves, withdrawal from social relationships, withdrawal from social relationships, feeling of uselessness, as well as suicidal ideas, disturbed eating patterns, and sleeping difficulties. Sometimes these symptoms also lead to the development of physical health problems as a direct consequence of mental disorders, as well as psychosomatic symptoms. Among them are pelvic pain, headache, swallowing difficulty, gastrointestinal problems, as well as unhappiness with the appearance and body, feeling dirty or ugly. Many victims also experience symptoms of chronic anxiety, nervous tension, and panic attacks.
Another significant consequence of child sexual abuse is a disturbance in interpersonal interaction, which also leads to disturbances in sexual behavior. In particular, victims may develop a lack of interest in sex, or experience feelings of shame and anger, as well as emotional distancing during sex. Additionally, victims may experience disturbing thoughts about sex, be involved in inappropriate or compulsive sexual behavior, and impairments in the ability to establish and maintain intimate relationships. Male victims of sexual abuse may also experience erectile dysfunction, decreased sexual desire and premature ejaculation; women, in turn, may experience disturbances of sexual excitement.
In general, the observations of the mental health of victims of child sexual abuse identify the relationship of these episodes with an increased frequency of psychiatric disorders. In particular, among this group, there is more frequent and longer psychiatric treatment in both childhood and adulthood than among people who have not been abused (Radmanovic, 2020). Moreover, abused men have an increased incidence of suicide and a tendency to substance misuse. These correlations identify a strong long-term impact of childhood sexual abuse on male victims.
Sexual abuse also has a significant impact on the ability to socialize in adulthood. Male victims tend to have “high level of conflict with society, tendencies towards criminal behavior, compulsions, anti-social characteristics, mental confusion, anxiety, low self-esteem and moodiness” (Radmanovic, 2020, p. 350). Additionally, they usually show increased aggression and hostility towards other people. Female victims in adulthood are prone to developing passive aggressive disorder, perceptual disturbances, somatic complaints, depression, anxiety, and social avoidance. It is noteworthy that PTSD develops in women victims of child sexual abuse on average twice as often as in men (Radmanovic, 2020, p. 350). Additionally, episodes of sexual abuse can have a negative impact on the development of brain function, leading to worsening psychiatric problems.
Victims of child sexual abuse are prone to self-harm and suicide due to their reduced ability to cope with stress. This aspect further emphasizes the importance of treating the psychiatric and psychological consequences of these episodes in the early stages of symptom development. Alcohol and substance misuse can also develop in victims at an earlier age as a way to cope with stress. It is also important that, as noted, adult victims, especially males, can pose a danger to others. This is not only due to an increased tendency to become abusers, but also an increased hostility and anger towards people. Impaired social interaction is the most common cause of sexual abuse due to the development of distrust and avoidance. Additionally, victims of child sexual abuse are more likely to be abused as adults, as they tend to misinterpret signs of control and trust in relationships due to past traumatic experiences.
As noted earlier, different characteristics of sexual abuse have an impact on the mental effects it has on children. Adams et al. (2018) underlines that these episodes lead to an increased risk of developing “depression, anxiety, and post-traumatic stress disorder (PTSD) in adulthood” (p. 167). Moreover, the development of a particular syndrome is influenced by such features of abuse as onset, age, gender, the relationship between the victim and the abuser, and others (Adams et al., 2018). However, at present, the interaction of these individual features on the formation of a particular mental disorder has not been studied, which makes the problem individual in each case. This aspect conditions the subsequent treatment of negative consequences, which often leads to its insufficient effectiveness.
The most significant negative consequence of childhood sexual abuse is lifelong mental distress. In particular, it is reported that in adulthood abuse victims report the development of substance misuse as well as anxiety disorders against the background of long-term depression and PTSD (Kisely et al., 2018). It is also noteworthy that fewer victims report existing disorders immediately after an episode than they do 12 months after (Kisely et al., 2018, p. 700). In this situation, not only physical but also psychological abuse can cause the development of long-term symptoms of depression. PTSD has the highest likelihood of developing substance misuse in adulthood, which identifies an increased risk for victims of sexual abuse.
Described consequences of child sexual abuse on the mental health of victims identify the long-term impact on victims’ lives. This situation is especially dangerous, as social and psychiatric problems pose a threat to the lives of the victims and those around them. In this regard, it is important to emphasize that the victims are not only clones of self-destructive behavior including suicide, but are also more anti-social and other people due to mistrust and avoidance. In this regard, the application of effective strategies for the treatment and prevention of adverse effects on the mental health of children is a priority for maintaining social security. It is also important that adequate therapy is needed to improve the quality of life of victims of child sexual abuse and increase the chances of a happier adulthood.
Treatment and Prevention Strategies
The basis for effective treatment of the mental consequences of victims of child sexual abuse is the early identification of episodes and screening for developing disorders. Health care providers often do not make adequate observations of the effects of the sexual abuse trauma until the child shows the symptoms of mental disorders (Hanson & Wallis, 2018). As part of the primary healthcare setting, professionals need to conduct routine screening of children for signs of sexual abuse in order to increase the chances of timely involvement of more specialized professionals and to minimize possible negative consequences. Researchers are aware that health care providers in the primary setting may not be skilled enough to identify episodes of abuse (Hanson & Wallis, 2018). Therefore, it is proposed to introduce the practice of asking children at least one question: “Since the last time I saw you, has anything really scary or upsetting happened to you or your family?” (as cited in Hanson & Wallis, 2018, p. 1067). This question can help professionals determine if a child should be referred to additional professionals for more focused screening.
First of all, earlier detection of an episode of abuse allows for earlier treatment of its consequences, which increases the chances of successful therapy. In turn, “the long-term effects of prevention initiatives include minimizing or eliminating many of the personal, social, and financial costs associated with the potential negative repercussions” (Knack et al., 2019, p. 9). Measures for early identification of signs of sexual union are secondary prevention measures, which have a number of advantages. However, health care providers may also perceive other signs of sexual abuse. These include apparent visitation anxiety, refusal to undress or expose one’s body for examining by a professional, and distress at being separated from a caregiver. Parents can notice the presence of nightmares, difficulty sleeping alone, the appearance of phobias, outbursts of anger, irritability and sadness. Additionally, children and caregivers may notice such physical symptoms as fatigue, headaches and abdominal pain; children may also show signs of sexually related behavior that is innappropriate for their age. All of these signs should be considered as possible indicators of sexual abuse experienced by the child and require the attention of specialists.
Not all victims of sexual abuse develop signs of mental impairment, additionally, the symptoms of PTSD for example can be confused with attention deficit hyperactivity. disorder, psychosis, or depression (Hanson & Wallis, 2018). However, if an episode of sexual abuse is identified and the presence of adverse mental health effects, the child should be referred for specialized trauma focused intervention. The most common treatment for these consequences is “cognitive-behavioral therapy with additional common cross-cutting elements (Hanson & Wallis, 2018). Those elements include “psychoeducation about trauma and its impact; affective modulation skills, such as relaxation and controlled breathing; gradual exposure to trauma memories; and cognitive processing” (Hanson & Wallis, 2018, p. 1067). Gradual exposure observed to be most effective in minimizing PTSD symptoms. In other words, the gradual exposure of the victim to the memories of the sexual abuse episode makes it possible to strengthen the cognitive abilities for the processing of emotional trauma. In this regard, it is also important to involve the primary caregiver in the therapy process, which positively affects the results of treatment and increases the chances of recovery.
Trauma-focused cognitive-behavioral therapy is the most effective strategy for the treatment of adverse mental health effects of sexual abuse, not only in childhood but also in adulthood. This approach includes education on coping and relaxation skills, tools for addressing inaccurate thoughts about the abuse, the gradual development of the ability to share the details of the traumatic experience. The involvement of the caregiver in the therapy process allows for more open communication, as well as teaching parenting strategies to manage the child’s behavior that can be a consequence of and exacerbate the trauma caused by sexual abuse. It is also important that various associations, including the American Academy of Child and Adolescent Psychiatry, American Academy of Pediatrics, American Psychological Association and others offer information and interventions for victims of child sexual abuse and their parents.
Psychotherapy may be not effective enough for children and adults with more severe symptoms of mental disorders. There are currently no standard guidelines for medical management of the consequences of child sexual abuse. However, there are recommendations for treating victims who present with symptoms of PTSD (Hanson & Wallis, 2018). The main recommendations suggest the use of selective serotonin reuptake inhibitors (SSRIs) for children and adults. However, SSRIs are evidenced to be more effective in the treatment of adult victims of child sexual abuse. Moreover, they should only be used when there is evidence of low effectiveness of psychotherapy and as part of a comprehensive therapeutic plan for addressing comorbid psychiatric diagnoses. It is noted that at present the effect of medications on the effectiveness of the treatment of PTSD in children is little studied, which requires more focus from professionals in this area (Hanson & Wallis, 2018). However, based on existing data, it can be determined that early screening, together with adequate psychotherapy for PTSD, significantly increases the chances of minimizing the negative mental consequences of child sexual abuse for both children and adults.
Conclusion
Child sexual abuse can have a number of adverse negative effects on the mental health of victims and lead to the development of psychiatric disorders. Victims of abuse often experience symptoms of PTSD, engage in self-destructive behavior, experience difficulties in social and sexual interaction, and more. Most importantly, these symptoms may persist and even worsen into adulthood in the absence of adequate intervention. Often victims of child sexual abuse can pose a danger not only to themselves but also to others. This factor requires health care professionals and caregivers to timely identify the fact of abuse, as well as timely intervention. Recommendations are now in place for the effective treatment of these symptoms in both child and adult victims. Thus, it is critical to introduce a mandatory screening d primary care setting for the earliest identification of sexual abuse and initiation of therapy to minimize possible consequences.
References
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