Socioeconomic status 

The possible influence of child sexual abuse on adult social and economic functioning has not received the attention it perhaps deserves. The well documented difficulties that sexually abused children experience in the school situation with academic performance and behaviour (Tong et al. 1987; Cohen and Mannarino 1988; Einbender and Friederch 1989) might be expected to negatively influence later educational attainments, and impair the development of the skills and discipline necessary to sustain effective work roles. 

Bagley and Ramsey (1986) noted that those with histories of child sexual abuse tended to have lower status economic roles. A random community sample found women reporting child sexual abuse were more likely to have work histories that placed them in the lowest socioeconomic status categories. (Mullen et al 1994). They were also more likely to have partners whose occupations fell into the lowest socioeconomic groups. This did not simply reflect women with histories of child sexual abuse coming from lower socioeconomic status homes (which they did) but was also a product of a significant decline in socioeconomic status among those reporting child sexual abuse from their family of origin. 

This relative decline in socioeconomic status was most marked for women reporting the more severely physically intrusive forms of abuse involving penetration. This latter group had an odds ratio of over four for such a decline, even following a logistic regression that took into account the confounding influences of family background, social disadvantage and concurrent physical and emotional abuse. 

Interestingly, this decline in socioeconomic status could not be accounted for by simple educational failure, nor was the decline to be explained by a reduced participation in the workforce, or preference for part-time work. The explanation for abused women being in less well paid and prestigious jobs could be that they underestimated their value and sought occupations below their capacities (a failure of self-esteem), or that they were less adept at translating training and opportunity into effective function in the work sphere (a failure of agency). The increased frequency with which those reporting child sexual abuse entered partnerships with men from lower social classes compounded the tendency to decline in socioeconomic status. 

This greater chance of a drop in socioeconomic status relative to family of origin is a crude measure of social and economic failure, and suggests a wide ranging disruption of function that is particularly marked in those reporting the more severe abuse experiences. 

Sexuality and sexual adjustment 

A history of child sexual abuse has been found to be associated with problems with sexual adjustment in adult life (Herman 1981; Finkelhor 1979). Finkelhor (1984) described what he termed reduced sexual esteem in both men and women who had reported child sexual abuse. In a subsequent study, Finkelhor et al. (1989) found that women who reported child sexual abuse involving intercourse were significantly less likely to find their adult sexual relationships very satisfactory. 

An attempt to replicate these findings found no relationship between histories of child sexual abuse and sexual self-esteem, whether in male or female subjects (Fromuth 1986), although there was a suggestion that sexually abused women experienced a wider range of sexual activity and were more sexually active than the non-abused. Greenwald et al. (1990), in a questionnaire study, also failed to establish any significant increase in sexual dissatisfaction or sexual dysfunction in their women reporting child sexual abuse, although they only used a broad definition of abuse and did not analyse their data regarding those reporting penetrative abuse. They concluded that the ‘majority of existing evidence seems to suggest that adult sexual functioning is not significantly impaired in community samples of former female victims of childhood sexual abuse who are not seeking treatment’. 

In a study of a random community sample of 2,250 New Zealand women with a questionnaire and an interview phase, data was gathered on sexual histories including levels of sexual satisfaction and experienced sexual problems (Mullen et al 1994). The average age at which consensual intercourse first occurred, and the frequency of consensual intercourse with peers prior to reaching the age of 16 years, did not differ between controls and those reporting child sexual abuse. When, however, only those reporting child sexual abuse involving penetration were considered, they were significantly more likely to report consensual intercourse with peers prior to 16 years of age. 

The controls and those reporting child sexual abuse were equally likely to have been sexually active in the six months prior to interview, but child sexual abuse victims expressed significantly greater dissatisfaction with the frequency of intercourse, interestingly being more likely to complain of infrequency or an unwelcome frequency. Those with histories of child sexual abuse were nearly twice as likely to report current sexual problems (28 per cent compared with 47 per cent) and for women whose abuse involved penetration, nearly 70 per cent complained of current sexual problems. 

The general level of satisfaction with their sex lives was markedly reduced in those with histories of child sexual abuse compared to controls, an unadjusted odds ratio of 9.4 for overall dissatisfaction with their sex lives that rose to over 12 for abuse involving intercourse. Employing similar questions to those used by Finkelhor (1984) to quantify sexual self-esteem, it was found that significantly more child sexual abuse victims believed their attitudes and feelings about sex caused problems or disrupted their satisfaction in sexual relationships. 

The unease about their own sexuality was most common in those whose reported abuse had involved penetration. There was also a significant increase in the frequency with which the victims complained of what they perceived as negative and disruptive attitudes in their partners that caused sexual difficulties. Fleming et al. (in press) in a community sample of Australian women found that child sexual abuse involving penetration was a significant predictor of sexual problems in adult life, even after taking the family and social backgrounds of the victims into account. 

In the study by Mullen et al. (1994), there was also evidence for an association between a history of child sexual abuse and an earlier age of entering the first cohabitation and an earlier age at first pregnancy. This precocious involvement in an attempt at a permanent union and starting a family was particularly marked for those who had been victims of abuse involving penetration. This association could reflect a search for love and affection away from the inadequate home environment that so often accompanies the more severe forms of child sexual abuse. Sadly, in those who had been victims of the more intrusive forms of child sexual abuse, their attempts to establish relationships and families were likely to founder. 

There is also evidence that women who report child sexual abuse are at greater risk during adolescence of sexually transmitted diseases, teenage pregnancy, multiple sexual partnerships, and sexual revictimisation (Gorcey et al. 1986; Nagy et al. 1995; Russell 1986; Spring and Friedrich 1992; Fergusson et al. 1997). In an Australian study, Fleming et al. (in press) found that child sexual abuse, in particular abuse involving penetration, was associated with increased risks of being raped as an adult and of being the victim of domestic violence. 

These findings support the hypothesis that the exposure of children to the sexual advances and acts of adults places the victim at risk of later sexual problems. The more extreme and persistent forms of abuse produce greater disruption of the child’s developing sexuality. The age at which the abuse occurs might be expected to influence the extent of the long-term damage, and child sexual abuse occurring during the pre-pubertal stages of development is perhaps particularly likely to be traumatic. Currently, there are no adequate data on this relationship between age at abuse and subsequent sexual problems. 

On the basis of clinical observations, it has been suggested that women exposed to child sexual abuse may in early adult life respond by heightened anxiety about sexual contact (with avoidance of relationships), or a paradoxical promiscuity (in which the victim devalues herself and her sexuality). What constitutes promiscuity tends to be a highly subjective evaluation, and women with a history of child sexual abuse are more ready to respond judgmentally about their prior sexual behaviour by labelling it promiscuous than would non-abused woman with a similar range of sexual experiences. This reflects not changed sexual behaviour, but changed attitudes to one’s own sexuality. 

However, there is evidence that in those whose abuse has been particularly gross (in terms of physical intrusiveness, frequency, duration or closeness of relationship to abuser), there is an increased risk of precocious sexual activity with its attendant risks of teenage pregnancy and social ostracism. It would be surprising if the traumatic introduction to sexual activity constituted by child sexual abuse did not place the child’s sexual development in some degree of jeopardy. Studies such as those of Fromuth (1986) and Greenwald et al. (1990) that did not detect any negative long-term effects of child sexual abuse on adult sexuality probably had samples lacking a sufficient number of those exposed to more seriously intrusive abuse and, by their methods of analysis, the damage inflicted by the more severe forms of abuse was diluted with results from subjects reporting inherently less traumatic abuse experiences.

Women in a random community sample who had reported child sexual abuse were asked what problems they attributed to this abuse. They volunteered sexual problems in nearly 20 per cent of cases, and less than 3 per cent added a belief that they had behaved in an unduly promiscuous manner as adolescents in consequence of the abuse (Mullen et al. 1994). Over 50 per cent of the victims of incestuous abuse in this sample regarded the child sexual abuse as having affected their sexual adjustment as adults. This contrasts with only 5 per cent who attributed mental health problems in adult life to their histories of child sexual abuse. 

Similarly, in an Australian study (full reference needed), 17 per cent of those who reported child sexual abuse, when asked whether the abuse had had any long-term effects, reported they believed it had damaged their sexual lives. These self-evaluations certainly underestimate the actual impact of child sexual abuse on the levels of psychopathology, but emphasise the extent to which child sexual abuse is regarded by victims as disrupting subsequent sexual development. 

The sexual problems reported so frequently in those subjected to child sexual abuse, particularly of the more chronic and physically intrusive types, may be conceptualised in terms of the disruption of the developing child’s construction of sexuality and the nature of sexual activity. Child sexual abuse may well create for some victims a construction of sexual intimacy contaminated by exploitation and coercion. The lack of mutuality and benevolence implicit in a child being used as the object of an adult’s sexual acts is a disastrous introduction to the possibility of loving sexual relationships. That experiences of sexual abuse, particularly when repeated or when involving a breach of what should be a caring and protecting relationship, leave no residual damage seems an inherently unlikely proposition.

Long-term Effects of Child Sexual Abuse 
by Paul E. Mullen and Jillian Fleming
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