The manner in which the long-term effects of child sexual abuse have come to be conceptualised reflects, in no small measure, the very particular circumstances that surrounded the revelation of child sexual abuse as an all too common event in the lives of our children. The first phase of modern research into child sexual abuse was not triggered by observations on child victims, but by the self-disclosures of adults who had the courage to publicly give witness to their abuse as children. These early self-revealed victims, exclusively women, had often been the victims of incestuous abuse of the grossest kind, and plausibly attributed many of their current personal difficulties to their sexual abuse as children. This contrasts with the emergence of child abuse as a public health and research issue that has been driven by the observations of professionals caring for abused children.
The way child sexual abuse was placed on the public and health agendas put a stronger emphasis on the adult consequences of abuse than on the immediate implications for an abused child. It also emphasised the psychiatric implications of abuse because self-declared victims tended to focus on these, and these revelations often occurred in a broadly therapeutic context with mental health professionals. Early research into the effects of child sexual abuse frequently employed groups of adult psychiatric patients (Carmen et al. 1984; Mills et al. 1984; Bryer et al. 1987; Jacobson and Richardson 1987; Craine et al. 1988; Oppenheimer et al. 1985) which further reinforced the emergence of an adult-focused psychiatric discourse about child sexual abuse. It should also be noted that the manner in which child sexual abuse was rediscovered (for it had been well recognised in the 19th century) and the nature of the advocacy movement which placed child sexual abuse firmly on the social agenda also provided an almost exclusive emphasis on female victims and incestuous abuse. The implications remain largely unexplored of the abuse of boys (which for abuse of the most intrusive kinds involving penetration rivals in frequency that of girls), and of the fact that the majority of abuse is not incestuous.