This paper brings together learning from existing research on the impacts of child sexual abuse. It sets out what is known about impact across all forms of child sexual abuse, unless a particular form and/or context for sexual abuse is stated.
The term ‘children’ in this paper refers to individuals under 18 years of age.
What is child sexual abuse?
The UK Government’s statutory definition of child sexual abuse acknowledges that sexual abuse can occur across a range of forms and contexts. Both children and adults can sexually abuse children, and the abuse can take place in both intra- and extra-familial contexts. Child sexual exploitation is a form of child sexual abuse.
Technology-assisted abuse has many of the same impacts as offline abuse, although children sexually abused online are particularly unlikely to disclose it.
Many people live with the impacts of being sexually abused in childhood. The CSA Centre’s analysis of a number of surveys suggests that at least 15% of girls and 5% of boys are sexually abused before the age of 16.
Why do the impacts of child sexual abuse differ?
Victim-survivors of child sexual abuse can be impacted in a wide range of ways by the abuse, but the nature and extent of impact varies from one individual to the next. Although some key factors – such as the child’s age when the abuse occurred, their relationship to the person harming them, and the abuse’s duration – may influence the impact of child sexual abuse, there is no conclusive agreement about this.
Establishing causality is difficult
The complex relationship between sexual abuse and other aspects of an individual’s life experiences means that, while a particular outcome may be strongly associated with child sexual abuse, it is not usually possible to state that the abuse is the sole cause of that outcome – especially where someone has also experienced other forms of child abuse or neglect. It is common for victim-survivors to experience multiple forms of victimisation in childhood; over half of adults in England and Wales who reported being sexually abused before the age of 16 years also experienced another type of abuse, whether physical abuse, emotional abuse and/or witnessing domestic violence or abuse.
Impacts may occur at different times, and may change over time
Individuals may feel the impacts of child sexual abuse at different points over the course of their lifetime, and the ways they are impacted can change from childhood to adulthood; furthermore, other forms of victimisation as a child and/or an adult can compound the impacts of sexual abuse. Conversely, some adults who were sexually abused as children do not report significant adverse consequences in adulthood, although the evidence on long-term impact is still building. All of this means that victim-survivors themselves are the best experts on how they have been and are being affected, and any attempt to understand how an individual is impacted should begin with them.
Impacts are affected by social inequalities
An understanding of intersectionality – a recognition that people occupy multiple, overlapping identities and social positions – is crucial when thinking about the impacts of child sexual abuse. Intersectionality means that ascribing particular forms of impact to specific groups is complicated, but it is important to recognise differences where they exist.
Cultural context can play an important role in child sexual abuse, including influencing whether and how such abuse is reported and addressed by adults/professionals. Socio-cultural factors, including cultural norms, can create barriers to disclosure for victim-survivors from Black and minority ethnic groups. Social inequalities and discrimination can mean that children from these groups are also less likely to come to authorities’ attention, face additional barriers to accessing statutory services, receive poorer-quality support, and may be more often targeted for exploitation.
Victim-survivors of child sexual abuse may experience specific mental health impacts based on their biological sex, although there is no conclusive agreement on this.
There are high rates of sexual abuse perpetrated against d/Deaf and disabled children as well as barriers to help-seeking for them, which may compound the impact of the abuse.
Homophobia within families and other environments can create a conducive context for sexual abuse and serve to silence children who identify as lesbian, gay, and bisexual, as can stereotypes and stigma directed against transgender and queer/questioning victim-survivors.
Taking an intersectional approach requires recognising that no one individual is identified by a single characteristic; victimisation occurs within the context of these multiple dimensions of someone’s identity and social location.
What is known about impact?
Taking this understanding of variability into consideration, a range of impacts have been documented for victim-survivors of child sexual abuse in childhood and adulthood. The list below is not exhaustive but highlights some of the most strongly evidenced areas of impact in the literature.
Mental health and emotional wellbeing
Adverse impacts on mental health and wellbeing are regularly reported by victim-survivors, during both childhood and adulthood. Victim-survivors may experience anxiety disorders and depression; eating disorders and disturbances, particularly bulimia nervosa; and sleep disruption and insomnia, although sleep disturbance in general is common for all children so care is advised in using this as an indicator of sexual abuse.
As a coping response, victim-survivors may dissociate from the abuse, both while it is occurring and later. This can make it difficult to talk about what happened in the way that professionals and the criminal justice system sometimes require. Disclosing child sexual abuse can be a traumatic process, with both short-term and long-term effects on emotional wellbeing, especially where others have negative reactions to the disclosure. However, victim-survivors have also indicated that delayed disclosure had a detrimental impact on their mental health. Disclosure can lead to intense feelings of shame and guilt, which may contribute to the onset of post-traumatic stress disorder (PTSD).
Many studies have highlighted a link between self-blame and low self-esteem for victim-survivors. These feelings of guilt and shame can have a lasting impact on emotional wellbeing, so that victim-survivors’ feel unworthy, have low self-confidence, distrust the genuineness of others, and fear discovery. Shame also plays a key role in suicidality and suicidal ideation.
In the longer term, victim-survivors of child sexual abuse may be diagnosed with psychiatric disorders such as post-traumatic stress disorder and borderline personality disorder. Importantly, the Independent Inquiry into Child Sexual Abuse (IICSA) noted that there has been a shift in how the links between adverse mental health outcomes and sexual abuse are understood, moving towards an understanding of these as adaptive rather than ‘disordered’ responses.
Impacts on physical and mental health are interconnected, and it is sometimes difficult to separate the two. For example, mental health issues may cause chronic insomnia, which in turn can impact physical health. Self-harming behaviour, which victim-survivors may use to help regulate their emotions and mental health, can also have significant consequences for physical health.
Immediate physical impacts of child sexual abuse may include injuries associated with penetrative abuse and sexually transmitted infections, as well as early-onset puberty for girls. Although it is widely thought that child sexual abuse causes physical injuries or other physical impacts which can be identified through medical examination, this is often not the case; the child’s own account remains the single most important diagnostic feature in identifying sexual abuse.
Longer-term, the impacts of child sexual abuse on victim-survivors’ general physical health can include upper respiratory issues and gastrointestinal conditions such as irritable bowel syndrome. There can also be impacts on gynaecological or reproductive health, including for women a greater fear of childbirth and increased difficulties with delivery and breastfeeding. Victim-survivors may also suffer from chronic illnesses such as arthritis and cardiopulmonary symptoms; and are at higher risk of obesity or high body mass index, particularly for women.
Sex and sexual functioning in adolescence and adulthood
‘Traumatic sexualisation’ – the inappropriate development of sexuality, sexual feelings and attitudes – is commonly considered a specific impact of child sexual abuse. This can affect an individual’s sense of sexual satisfaction, sexual feelings and sexual actions. In addition, impacts on sexual functioning – such as problems with sexual desire and sexual arousal – may become apparent for victim-survivors in adolescence and adulthood. Together, the impacts on sex and sexual functioning can compound adverse impacts on mental and physical health, and on emotional wellbeing.
While sexual abuse is always a violation, sexually abused children can sometimes experience bodily responses often associated with pleasure, leading to a feeling of betrayal by the body. It may also lead them to initiate sexual activity with those abusing them, and/or with other people. This can develop into forms of harmful sexual behaviour in childhood towards adults or other children – but it is important to remember that most sexually abused children do not go on to abuse others, and most children displaying harmful sexual behaviour do not commit sexual offences as adults.
Relationships and parenting
Sexual abuse can affect children’s psychosocial development and attachment across different relationships in both childhood and adulthood. In the long term, sexual abuse in childhood can adversely impact relationship satisfaction, stability and emotional investment. However, some victim-survivors report having an enhanced sense of empathy, which supports the development of fulfilling and connected interpersonal and intimate relationships.
Victim-survivors may experience difficulties with some aspects of parenting. These can include difficulties establishing boundaries between themselves and their children, being overly permissive as parents and/or using physical discipline, struggling with attachment and being critical of their own parenting ability, and – particularly for men – feeling fearful that they will abuse their children. Though there can be adverse impacts on parenting, victim-survivors can also demonstrate protective parenting practices, including confidence in their ability to protect their children from abuse.
Spirituality and religious belief
To date, evidence on the impacts of child sexual abuse on religious belief is limited almost exclusively to Christianity. Some victim-survivors report lower levels of spiritual wellbeing and lower engagement in religious practice following abuse; for children sexually abused within religious institutions, the impact on mental health can be compounded by the religious context. However, faith can act as a protective factor against some of the adverse mental health and wellbeing impacts of sexual abuse, with some adult victim-survivors finding that their faith and spirituality provide psychological and emotional comfort.
Socio-economic and educational impacts
Child sexual abuse can have a negative impact on victim-survivors’ educational attainment, although engagement with education can be used by children as a coping strategy and act as a protective factor in mitigating the mental health impacts of sexual abuse. In adulthood, child sexual abuse can be associated with lower employment rates, incomes and self-reported financial stability. In many cases, it may be that the mental and physical health impacts of child sexual abuse are behind these lower socio-economic outcomes.
Impacts are wider than the individual
Although this paper has focused on the impacts of child sexual abuse on victim-survivors, there are a number of wide-ranging impacts that extend beyond this, including impacts on families. Non-abusing mothers may experience impacts that mirror those of their sexually abused child, and this means that they also need support. Less is known about the impacts on other non-abusing family members including siblings, or on fathers, friends and peers.
There is a social impact, including victim-survivors’ increased use of and involvement with public services such as social services and the criminal justice and healthcare systems. The financial and non-financial costs relating to children who experienced contact sexual abuse in the year ending 31 March 2019 have been estimated to be at least £10.1 billion.
What helps to improve long-term outcomes?
Both individual and social factors can mitigate the impact of sexual abuse on victim-survivors, both at the time and later in life.
Individual factors include attributing blame externally and having internal resources such as coping skills and self-esteem. Education has also been highlighted as a protective factor.
In terms of social factors, secure attachment to caregivers can be key in mitigating the adverse impacts of child sexual abuse. Support from non-abusing parents, particularly mothers, is associated with improved emotional and behavioural outcomes. Having support from family and friends is another key protective factor.
Identifying child sexual abuse early and providing a supportive response can reduce long-term adverse impacts, as can support in adulthood. If responses – by professionals and others – are not supportive, or if the child anticipates that they will not be supportive, this can compound adverse impacts on mental health and emotional wellbeing, including by instilling shame and guilt. Conversely, non-judgemental and trauma-informed responses can improve victim-survivors’ ability and willingness to seek support and disclose further.
Professionals can respond in compassionate and consistent ways to help mediate impacts, including by providing opportunities for children and adults to disclose child sexual abuse, believing disclosures, and recognising and responding to signs of child sexual abuse.
Help for professionals
There are evidence-based resources which give practical guidance and suggestions on creating a safe and supportive space where victim-survivors can explore the impacts of child sexual abuse and receive an appropriate response; these include resources focused on victim-survivors with African and/or Caribbean heritage. The CSA Centre has also published practice guidance on supporting non-abusing parents and carers – a vital element in improving outcomes for victim-survivors of child sexual abuse.