Relationships and intimacy
The sexual problems linked to child sexual abuse could be an entirely specific effect related to traumatic sexualisation, or could be contributed to by a wider constellation of disruption of interpersonal and intimate relatedness. Child sexual abuse involves a breach of trust or an exploitation of vulnerability, and frequently both.
Sexually abused children not only face an assault on their developing sense of their sexual identity, but a blow to their construction of the world as a safe enough environment and their developing sense of others as trustworthy. In those abused by someone with whom they had a close relationship, the impact is likely to be all the more profound. A history of child sexual abuse is reported to be associated in adult life with insecure and disorganised attachments (Alexander 1993; Briere and Runtz 1988; Jehu 1989). Increased rates of relationship breakdown have also been reported in those exposed to child sexual abuse (Beitchman et al. 1991; Bagley and Ramsey 1986; Mullen et al. 1988).
Mullen et al. (1994) found that their subjects reporting child sexual abuse were more likely to evince a general instability in their close relationships. Though those with histories of child sexual abuse were just as likely as controls to be currently in a close relationship, they were more likely in the past to have experienced divorce or separation. When asked about the level of satisfaction with their current relationship, those with abuse histories expressed significantly lower levels of satisfaction. The level of current satisfaction was lowest for intercourse victims.
Relationship problems were also reflected in the evaluations of the quality of their communication with their partners. Less than half of the victims felt able to confide personal problems to their partner, and nearly a quarter reported no meaningful communication with their partners on a more intimate level, whereas only 6 per cent of controls took an equally negative view of their partners receptivity to their concerns. This perceived gap in communication at a deeper level rose to 36 per cent in those reporting child sexual abuse involving penetration.
In this study, those reporting child sexual abuse were more likely to rate their partners as low on care and concern, and high on intrusive control. Interestingly, the deficiencies perceived in their partners as sources of emotional support by those with histories of child sexual abuse was not generalised to peer relationships where they were just as likely to report they had friends in whom to confide and with whom to share their troubles.
A community study of Australian women found similar results with a history of child sexual abuse adversely affecting the quality of women’s relationships in adult life, and increasing the likelihood of divorce and separation (Fleming, 1997, Fleming et al, in press). Women who reported a history of child sexual abuse were more likely to report their current partner to be uncaring and highly controlling, and to be dissatisfied with the relationship. Child sexual abuse appears to affect a woman’s ability to maintain intimate relationships by interfering with her capacity to develop her sexuality and trust in others. The results of this study also found that women with histories of child sexual abuse who found difficulty in forming satisfying intimate relationships did not, however, report an inability to form close friendships or to receive emotional support from friends.
It is tempting to suggest that the experience of child sexual abuse at a vulnerable moment in the child’s development of trust in others predisposes to a specific deficit in forming and maintaining intimate relationships. The attribution of a lack of concern and a tendency to be intrusive and overcontrolling to their partners could be a product of these partners’ actual attitudes and behaviour, or could reflect primarily the expectations, interpretations and projections directed at the partner by these women with histories of child sexual abuse. Conversely, those who have been abused may be more prone to enter relationships with emotionally detached and domineering partners because their lowered self-esteem and reduced initiative limits their choices, or from some neurotic compulsion to repeat.
Self-esteem encompasses the extent to which individuals feel comfortable with the sense they have of themselves (the self for self) and, to a lesser extent, their accomplishments, and how they believe they are viewed by others (the self for others). Robson (1988) wrote that self-esteem is ‘the sense of contentment and self acceptance that stems from a person’s appraisal of his (or her) own worth, significance, attractiveness, competence and ability to satisfy aspirations’.
A number of studies have implicated child sexual abuse in lowering self esteem in adults (for review, see Beitchman et al. 1992), but the most sophisticated examination of the issue to date is that of Romans et al. (1996). This study showed a clear relationship between poor self-esteem in adulthood and a history of child sexual abuse in those who reported the more intrusive forms of abuse involving penetration. It was, however, those aspects of self-esteem involved with an increased expectation of unpleasant events (pessimism) and a sense of inability to influence external events (fatalism) that were affected, not those involved with a sense of being attractive, having determination, or being able to relate to others.
Long-term impact on mental health
There have been numerous studies examining the association between a history of child sexual abuse and mental health problems in adult life that have employed clinical samples, convenience samples (usually of students), and random community samples. There is now an established body of knowledge clearly linking a history of child sexual abuse with higher rates in adult life of depressive symptoms, anxiety symptoms, substance abuse disorders, eating disorders and post-traumatic stress disorders (Briere and Runtz 1988; Winfield et al. 1990; Bushnell et al. 1992; Mullen et al. 1993; Romans et al. 1995 and 1997; Fergusson et al. 1996; Silverman et al. 1996; Fleming et al. in press). A more controversial literature links multiple personality disorder with child sexual abuse (Bucky and Dallenberg 1992; Spanos 1996).
Space does not allow a full review of the complex relationships between adult psychopathology and child sexual abuse but to illustrate the trajectory followed by such research in recent years, the literature relating a history of child sexual abuse to alcohol abuse in adult life will be briefly considered.