Research Proposal on "Psychological Sequelae of Childhood Sexual Abuse"

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There is a large body of literature that has grown in recent years on the impact of sexual abuse. These studies refer to the wide range of different types and kinds of effects that are experienced by the victims. These are usually divided into short to medium term responses as well as to the more lasting affects of the various types of sexual abuse. It should also be noted at the outset that responses to sexual abuse vary according to the individual's psychological makeup and other social and environmental factors. For instance, some children are less affected by the same type of experience than others. However, in this chapter, while allowance will be made for individual variations and fluctuation in the response to abuse, the more typical and general responses will be focused on.

The immediate impact of sexual abuse is often categorized in terms of trauma, depression, anxiety, sleep and eating disturbances, and cognitions such as self-blame and feeling damaged (O'Donohue & Geer, 1992, p. 100). This can have a wide range of concomitant and related sequelae; for example, responses such as physical aggression, sexual aggression, substance abuse, and suicidal behavior. Longer term affects of early sexual abuse can be seen in the relationship to disorders such as PTSD or Post- traumatic stress disorder. This is an aspect that will be explored in detail in this chapter. Other affects or sequelae will also be explored. These include eating disorders such as Anorexia Nervosa and Bulimia, as well as obesity.

In other words, the results or the effects of childhood sexual obesity can manifest themselves across a wide range of disorders and symptoms, which all have a devastating and of psychologically debilitating affects on the individual well after the sexual abuse has terminated.

As one study on this subject points out, an analysis of the findings of various studies on psychological sequelae of this form of abuse "... provide evidence confirming the link between CSA and subsequent negative short- and long-term effects on development, and support the multifaceted model of traumatization rather than a specific sexual abuse syndrome of CSA" (Johnson 2008). This means that understanding the results and the aftermath of childhoods sexual abuse necessitates taking account of a complex and often interrelated set of symptoms and affects.

The above view also refers to the particular way in which many people who have been abused often refuse to acknowledge the psychological trauma the have experienced. This sublimation or denial of the experience is in many cases the precursor to other symptoms and disorders such as dissociation and the secondary results of trauma, such as the inability to have open and healthy sexual and social relationships with others. The following is a statement by a subject named Evelyn who is forty one years of age. Her description of her experiences provides an illuminating insight into the insidious long-term psychological effects of this form of abuse.

It happened so long ago, I wonder if what I remember is real. I have never told anyone the secret that I have carried deep within me. I do not want to believe it is true. Yet, every day I live is another day that I deny what was done to me. It is another day that I feel I deny a part of myself. I have had such a growing need to tell someone. I do not want the secret to die with me (Duncan, 2004, p. 8).

In this particular case the women was repeatedly abused and violated as a child and this had a devastating affect on her life. A common result of this abuse, which was also experienced by this person, was a loss of self-esteem and sense of self-worth; which also caused her to doubt herself and her own integrity. This is turn had a detrimental affect on the choices and on the relationships she made in her life.

Sexual as well as social relationships can be adversely affected by the experience of childhood sexual abuse. The trauma associated with this abuse can negatively impact the trust between social friends and between marriage partners, and also often has an adverse affect on communication within the relationship. It can also make physical intimacy problematic.

Among the sequelae of sexual abuse in children the most immediate affects are usually a feeling of loss of control and powerless, shame and guilt which can lead to a loss of a sense of security (Barker). This in turn often leads to a range of emotional problems and more long-term sequelae; such as secondary and related problems with regard to sexual maladjustment and interpersonal relationships. Among the other sequelae are depression, an inability to experience pleasure, low self-esteem, as well as dissociative symptoms, self-destructive behavior and eating disorders. The following sections will deal with a number of the central psychological sequelae that result from childhood sexual abuse.

Trauma and depression

It goes without saying that sexual abuse is a very harrowing and traumatic experience for the child. However, what are of concern are the effects that the aftermath of such traumatic experience can have on the individual child; which can profoundly influence the child's life and health. The literature is replete with studies about the way that severe trauma as a result of sexual abuse can lead to a wide range of negative outcomes. For example, research shows that children who are abused often have difficulty in regulating their emotions. As a result they may also not be able to form secure relationships and be unable to develop a secure and cohesive sense of self (Sanderson, 2006, p. 170).

The difficulty that abused children have in expressing their emotions can lead to various forms of disassociation and related psychological problems. In other words, their emotions can become blunted and they may become unemotionally responsive. (Sanderson, 2006, p. 170) This in turn may lead to periods of inner anxiety and stress which may culminate in depression.

Depression is often noted in children who have experienced long periods of sexual abuse. This may in some cases lead to suicide attempts. In one study on this subject it was found that "... The rate of lifetime depression among childhood rape survivors was 52% compared to 27% among nonvictims "(Yuan, Koss, and Stone).

There are numerous studies that indicate a positive correlation between sexual abuse in the child and depression with the after- effects extending into later life - although a number of studies add the caveat that this correlation was confined to more severe abuse where there was penetration or attempted penetration (Cheasty M, Clare a. And Collins C., 1998). As one article stresses, studies show that "...children who are abused and neglected are at increased risk of becoming depressed adults,..." (Abused Children Face Depression Risk as Adults)

An insightful study by Arne Cornelius Boudewyn and Joan Huser Liem entitled Childhood sexual abuse as a precursor to depression and self-destructive behavior in adulthood (1995), makes the important point that the duration of sexual abuse is strongly correlated to the severity and the extent of the depression that is experienced by the child and later the adult. "The more frequent and severe the sexual abuse and the longer its duration, the more depression and self-destructiveness reported in adulthood" (Boudewyn and Liem, 1995). In brief, what many other studies and research articles point out is the view that CSA… READ MORE