Much research suggests that child sexual abuse can be a severely traumatizing and emo­tionally damaging experience, with long-term negative consequences for many of the victims (Miner et al., 2006; Putman, 2009; Zwickl & Merriman, 2011). Clinical contact with adult survivors of child sexual abuse often reveals memories of a childhood filled with distress and confusion. Survivors speak of their loss of childhood innocence, the contamination and interruption of normal sexual development, and a profound sense of betrayal by a relative, family friend, priest or clergyperson, or community leader.

A number of factors influence the severity of a child victim’s response to sexual abuse. The longer the molestation goes on, the worse the prognosis is for recovery from the

trauma of the abuse (Brown et al., 2008; McLean & Gallop, 2003). Feelings of powerless­ness and betrayal may be especially pronounced when physical force is used to perpetrate an act of child sexual abuse or when the victim has a close relationship to the offender. These two factors—physical force and victim-offender relationship—probably correlate most strongly with subsequent negative consequences for survivors of child sexual abuse (Brown et al., 2008; Hanson et al., 2001). Other factors known to influence how a child responds to sexual abuse include the age of the victim and perpetrator at the onset of the abuse, the victim’s feelings of responsibility for the situation, and the number of per­petrators (Brown et al., 2008). The younger the child, the greater the discrepancy in age between victim and perpetrator, the stronger the feelings of responsibility, and the higher the number of perpetrators, the greater the severity of a child’s response to sexual abuse.

Many victims of child sexual abuse have difficulty forming intimate adult relationships (Rumstein-McKean & Hunsley, 2001; Vandeusen & Carr, 2003). When relationships are established, they often lack emotional and sexual fulfillment (Feiring et al., 2009; Kris – tensen & Lau, 2011). For both sexes, a strong link exists between sexual abuse in childhood and sexual difficulties in adulthood (Camuso & Rellini, 2010; Zwickl & Merriman, 2011; Staples et al., 2011). Other common symptoms of sexual abuse survivors include low self­esteem, guilt, shame, a self-image of "badness" and low expectations for future happiness, depression, alienation, a lack of trust in others, revulsion at being touched, drug and alcohol abuse, obesity, elevated suicide rates, a predisposition to being repeatedly victimized in a variety of ways, and long-term medical problems, such as chronic pelvic pain and gastroin­testinal disorders (Balsam et al., 2011; Putman, 2009; Reese-Weber & Smith, 2011).

Posttraumatic stress disorder, a common occurrence in adult women who have expe­rienced rape, is also prevalent among many females who are sexually abused in childhood. About half of all victims of sexual abuse meet the criteria specified for PTSD (Frazier et al., 2009). Symptoms of PTSD in children include nightmares; psychic numbing (diminished responsiveness to the outside world); lack of interest in previously enjoyed activities; avoid­ing thoughts, feelings, or activities that produce memories of the abuse; irrational fears of being left by caregivers; excessive daydreaming; forgetfulness; and memory deficits (Frazier et al., 2009; Putman, 2009). Finally, studies reveal that adult survivors of child sexual abuse often exhibit detrimental parenting practices, such as the use of inconsistent or harsh disci­pline and inadequate supervision of their children (Martsolf & Draucker, 2008).

A variety of treatment approaches have emerged to help survivors of child sexual abuse resolve issues regarding these experiences and their emotional aftermath (Put­nam, 2003; McPherson et al., 2012; Vandeusen & Carr, 2003). These treatment strat­egies range from individual therapy to group and couple-oriented approaches. Most metropolitan areas in the United States also have self-help support organizations for survivors of sexual abuse. (If you want more information about how to seek professional therapeutic assistance, we suggest reviewing the guidelines in Chapter 14.)