Content Warning: Please be advised, the below article might mention trauma-related topics that include abuse which could be triggering to the reader. If you or someone you love is experiencing abuse, contact theDomestic Violence Hotline at 1-800-799-SAFE (7233). Support is available 24/7. Please also see our Get Help Now page for more immediate resources.
The effects of child abuse and neglect can be serious and detrimental, both short-term and long-term. It can be important to recognize the effects of child abuse and neglect and to report possible mistreatment whenever you see it. People who have been mistreated may also face a greater risk of becoming harmful to others later in life, although many people who were once abused move on to become careful, kind, and productive part of society. If you survived childhood abuse and are still experiencing negative effects, therapy with a licensed mental health professional can be beneficial.
If you or someone you know is witnessing or experiencing any form of abuse, please know that help is available. You can call the National Domestic Violence Hotline anytime at 1-800-799-SAFE (7233).
Content/Trigger Warning: Please be advised, the below article references trauma-related topics that may potentially be triggering.
Effects Of Child Abuse And Neglect: Potential Long-Term Consequences
Long-term consequences of child abuse and neglect can be physical, psychological, and behavioral. The following may occur after mistreatment:
While some long-term effects of child abuse and neglect can occur instantly, such as brain damage from head trauma, other effects may take months or even years to become detectable. Survivors of abuse may face a higher risk for a variety of long-term or future physical health problems, including:
High blood pressure
Survivors of mistreatment and neglect may also be at risk for the effects of stunted or improper brain development. Regions of the brain, including the amygdala, which typically plays a large part in processing emotions, and the hippocampus, which can be critical for learning and memory, can be negatively affected by child abuse and neglect. However, with the help of treatment and intervention, it can be possible to help these areas of the brain recover.
Substance Use Disorders
Children of parents with substance use disorders may face a greater risk of experiencing abuse or neglect. Abuse, in turn, can increase their risk of turning to various substances as coping mechanisms when they grow older.
One long-term study that followed survivors until they reached age 24 found that experiencing physical abuse during the first five years of life can be strongly linked to developing a substance use disorder later in life.
Juvenile Delinquency And Criminal Acts
According to research funded by the National Institute of Justice, those who are neglected or abused as children may be more likely to develop antisocial behaviors, which can include criminal acts and juvenile delinquency, and may choose to associate with others who also display these antisocial tendencies.
Psychological And Behavioral Issues
Experiencing abuse and neglect when you’re young can also be a risk factor for developing psychiatric disorders, such as:
Post-traumatic stress disorder
Anorexia or bulimia
Research on childhood trauma and its effects on the brain suggests that stunted or impaired brain development from abuse may play a part in the potential development of these disorders.
Impaired Cognitive Skills And Executive Functioning
Child abuse and neglect can disrupt brain development, potentially resulting in the impairment of the brain’s executive functions. These functions may include working memory, self-awareness, planning, and problem-solving. This damage can result in:
A higher chance of dropping out of school
These short-term effects can sometimes have a drastic impact on a child’s future.
Direct And Indirect Costs To Society
Abuse and neglect can have far-reaching consequences that often do not stop at the person who is or was abused. Society, as a whole, can be affected by childhood abuse.
In 2015, the Centers for Disease Control found that the total lifetime economic cost of child abuse and neglect generally added up to $428 billion. Direct costs, such as hospitalizations and foster care payments, and indirect costs, such as long-term care, like therapy and medication, factored into this total.
Child Mistreatment And Neglect: Potential Short-Term Consequences
Depending on their age, children who experience abuse and neglect can respond to it in a variety of different ways. Preschool-aged children or toddlers may start bed-wetting and displaying signs of severe anxiety. Elementary school kids might have low grades or very few friends. Some teenagers might experiment with substances or fight with their families, though these aren’t always signs of abuse or neglect.
Depression And Anxiety
Children of any gender or age can experience depression and anxiety as a result of abuse (or unrelated to abuse). Feelings of guilt and anger may also be common, especially among adolescent survivors of abuse.
Altered Sleep Cycles
Those who are abused as children may also experience altered sleep cycles. Nightmares, sleep disturbances, and hypervigilance can contribute to their sleep problems. These symptoms typically occur in preschoolers, but can occur later in life as well, especially if PTSD or anxiety are present.
Regressive behavior can occur when a child regresses to an earlier developmental stage emotionally, socially, or behaviorally. Wanting a bottle or pacifier after they have already been weaned off them may be one example of regressive behavior. Age regression can occur in people of all ages.
Separation Anxiety Disorder
Preschool-aged children may develop separation anxiety disorder as a result of abuse and neglect. Symptoms of this disorder can include constantly shadowing a caretaker around the house, as well as stomachaches and dizziness in anticipation of separation.
People abused as children may develop low self-worth. They may internalize the abuse and believe they caused or deserve it. These feelings of incompetence and shame can carry into adulthood and become long-term effects of child abuse and neglect.
Teenagers may start to engage in unsafe sex or start misusing substances as a result of abuse or neglect from loved ones. They may also start fights in school or bully others.
Possible Signs Of Mistreatment In Children
Many people abused as children feel afraid to tell someone about the situation. This may stem from shame or confusion. It could also occur if the abuser is a parent or trusted adult. That’s why it can be so important to remain aware and alert for signs of child abuse in anyone under your care.
Common red flags of physical abuse, sexual abuse, emotional abuse, and neglect may include:
Sexual behavior or knowledge that is inappropriate for their age
Low attendance in school
You may also notice disturbing behavior from the children’s parents when they are around. This can include verbal abuse, a lack of concern for their children’s well-being, and even physical abuse. While child health experts generally condemn the use of any kind of violence, some people still use corporal punishment to discipline their children.
Types Of Child Abuse
Child abuse can take many forms. Some of them may even occur at the same time. They may include the following:
Physical abuse: Hitting, punching, and choking can be several examples of physical abuse. Anything that puts a child in harm’s way or that is meant to physically injure them is typically considered physical abuse.
Sexual abuse: Sexual abuse generally includes any form of sexual activity with a child.
Emotional abuse: Emotional abuse, such as verbal assault or ignoring a child, can negatively affect self-esteem and emotional well-being.
Neglect: Failing to provide adequate food, shelter, supervision, education, or healthcare is normally considered to be child neglect.
Prevent Child Abuse And Neglect
As a parent, you can work to prevent child abuse and neglect by ensuring that your child is always nurtured and looked after. As a friend or a relative, you can help babysit or look after children in your life and keep an eye out for any of the potential signs of abuse discussed above.
You can also get involved in the local community by developing parenting resources at the local library, asking leaders to create services to meet the needs of different families, and volunteering at child abuse prevention programs.If you believe a child has been abused, please seek help for them immediately. You can contact the child’s doctor, the local police department, or the 24-hour Childhelp National Child Abuse Hotline at 1-800-422-4453. The National Child Abuse Hotline can give you information on support resources, emergency services, and social assistance.
Seeking Professional Help As An Adult Survivor Of Childhood Abuse
If you experienced abuse as a child, it may be beneficial to seek professional help so you can address any long-term effects you may be experiencing. Both in-person and online therapy can be valid options for treatment.
You may feel more comfortable trying online therapy, as you can attend sessions from home at a time that fits your schedule. When discussing vulnerable topics like abuse, it can be helpful to be in a familiar place where you feel safe and comfortable. In addition, you can choose to speak to your therapist via phone call or online chat if a video call feels too intimidating.
Although there isn’t yet much research regarding the efficacy of online therapy for adult survivors of childhood abuse, studies show that, in general, online therapy tends to be just as effective as in-person therapy. Please don’t hesitate to reach out for the help you deserve.
Child abuse and neglect can result in a variety of short-term and long-term consequences. In the short term, some of the effects children may experience can include depression, anxiety, altered sleep cycles, regressive behavior, and low self-esteem. In the long term, those who survived childhood abuse may experience health problems, develop substance use disorders, and live with impaired cognitive skills and executive functioning.
If you believe a child in your life is experiencing abuse, please help them by contacting the Childhelp National Child Abuse Hotline at 1-800-422-4453. Meanwhile, if you are an adult survivor of childhood abuse, you might consider reaching out for help with any long-lasting effects through in-person or online therapy.
While everyone may perceive neglect differently, emotional neglect in childhood generally refers to when a child doesn’t experience emotional security or support from their guardian figures. Our emotions may have been completely ignored or invalidated—purposefully or unconsciously—or we might have been explicitly shamed for expressing our feelings.
Emotional neglect is considered a form of trauma, as it can have long-lasting and profound effects on a person’s emotional and psychological well-being.
— DANIEL RINALDI, MHC
This form of neglect can occur when a caregiver is not present, but when they are present they are emotionally unavailable, if the parent is ill-equipped to handle childhood emotions, or if the parent is purposefully dismissive.
“Emotional neglect is considered a form of trauma, as it can have long-lasting and profound effects on a person’s emotional and psychological well-being,” says therapist Daniel Rinaldi, MHC. He adds that chronic emotional neglect can shape our emotional landscape as adults by affecting our self-esteem and impacting our interpersonal relationships.
Ongoing childhood emotional neglect is a form of child abuse and can lead to lasting trauma. This trauma can make it hard to develop a healthy relationship with others and with ourselves. We might even engage in self-sabotaging behaviors.
Therapy can teach us how to properly identify and label our emotions so that we can deal with them in a healthy way and begin to truly heal.
How Do I Know If I Was Emotionally Neglected as a Child?
Raising children is highly nuanced and inherently difficult; there’s no doubt that our parents or caregivers made mistakes along the way. However, chronic emotional neglect is not the norm, and its ripple effects follow us well into adulthood.
“Emotional neglect can be hard to spot because it is not always visible—even to a professional,” says Aurisha Smolarski, LMFT, founder of Cooperative Coparenting. “It is also hard to spot because it tends to be based less on what a parent does and more on what they don’t do.”
Smolarski says that emotional neglect can be either intentional or unintentional, or even unconscious.
Some parents emotionally neglect their children because they’re uncomfortable with emotions in general and are unsure of how to respond to the complex feelings a child experiences.
Other parents are too overwhelmed with the stress in their own life—including struggles with addiction, work-life balance, child-rearing, and mental health issues. Smolarski also notes that parents who experienced abuse or neglect themselves may be more likely to neglect their own children.
What Are Some Examples of Childhood Emotional Neglect?
Here are some signs of childhood emotional neglect. This isn’t an exhaustive list, but it provides a general idea of what emotional neglect looks like:
Punishment for expressing negative emotions like sadness, frustration, or anger (e.g., being told to go to your room or be quiet)
Lack of shared celebration or joy when experiencing a positive emotion like happiness or excitement (it might even present as zapping the positive emotion with a negative response)
Being told your feelings or experiences aren’t valid or worth further examination (example phrases might include “You’re too sensitive,” “Stop acting like a baby” or “Don’t worry about it.”)
Dismissed or ignored feelings because the parent is focused on themselves or another situation
Withholding or not showing affection, whether it is explicitly requested or not
Failure to intervene or find a solution in situations when a child is under emotional stress
Not acknowledging difficult emotions like grief after losing a pet or embarrassment after being bullied (often because the parent struggles to recognize or process these emotions themselves)
How Does Emotional Neglect in Childhood Affect Us as Adults?
Those of us who were emotionally neglected as children often develop behavior patterns or coping mechanisms. Any of the following might be indicative of emotional neglect in childhood.
Emotional neglect can be either intentional or unintentional, or even unconscious.
Difficulty Expressing and Processing Emotions
Childhood emotional neglect can cause us to avoid emotions all together in adulthood. We may struggle to identify our feelings or find it difficult to process big feelings.
There might also be a general sense of “numbness,” which is ultimately a form of self-protection. Smolarski adds, “They may choose to leave a relationship or situation instead of asking for something they need because that feels safer than the risk of rejection.”
They may withdraw or isolate from social or peer groups because they feel different and because they fear being asked to talk about how they feel.
— AURISHA SMOLARSKI, LMFT
On the other side of the coin, Smolarski says that if we’ve been emotionally neglected as kids, we might end up becoming the “caretaker” or “burden holder” of our friends and family.
Essentially, addressing other people’s emotions and needs allows us to feel worthy, loved, needed, and good enough. This can backfire if we end up focusing so much on others that we fail to prioritize ourselves.
We May Have a Super Hard Time Trusting Other People
Sometimes it feels safer to put up walls so that no one else can get in and potentially hurt us. We’re simply trying to protect ourselves.
So, if we’ve experienced pain in the past we might end relationships the moment we feel threatened or avoid relationships completely.
Vulnerability and opening up to other people may feel scary too which limits the ability to connect with others. “They may withdraw or isolate from social or peer groups because they feel different and because they fear being asked to talk about how they feel,” Smolarski notes.
She adds that some might even self-sabotage their relationships to avoid feeling abandoned, rejected, or neglected. And those who find themselves in close relationships may struggle to access or voice their own emotions, which can negatively impact the relationship.
Our Self-Esteem May Take a Hit
Rinaldi says that chronic childhood neglect can often cause people to have low self-worth. If our self-esteem is low, we might write off our own emotions or even let people walk all over us.
Low self-esteem may also cause struggles with self-compassion and self-love.
We May Try to Cope in Some Not-So-Healthy Ways
In some cases, childhood emotional neglect can present with poor coping techniques as an adult. Bonnie Scott, LPC-S, founder of Mindful Kindness Counseling, says this is often because people who’ve been neglected have trouble trusting their own experience of emotions and needs.
“They may meet those needs in maladaptive ways, like becoming codependent on people who aren’t good for them or showing people-pleasing behaviors to keep people around,” Scott says. They might also rely on drugs or alcohol to get them through a difficult emotion or become addicted to shopping, porn, online usage, risky sex, or food.
How Emotional Neglect Causes Trauma
Rinaldi says that emotional neglect can impact someone’s life—even if it occurs only once or twice—though it is even more profound and complex when there’s a chronic pattern extended over a period of time.
Ongoing Neglect Is Child Abuse
Ongoing emotional neglect is considered a form of child abuse. According to the U.S. Department of Health & Human Services, it’s a traumatic experience that, if severe or continued over a long period of time, can affect a child’s development.1
“Trauma can cause changes in the brain and nervous system that in turn lead to difficulty expressing emotions, lower self-esteem, shame, or guilt,” Smolarski says. “Children suffering from the trauma of neglect can have behavioral issues at home and in school and may struggle to form and maintain relationships in childhood and as adults.”
More severe neglect can lead to substance abuse, the tendency to engage in risky behavior, and long-term mental health issues, such as depression, anxiety, and post-traumatic stress disorder (PTSD).2
If you experienced childhood emotional neglect, know that you’re not alone. So many of us have survived this kind of abuse.
Making the effort to heal this wound is a sign of bravery, and can be done at any age.
— AURISHA SMOLARSKI, LMFT
Fortunately, healing is possible. There’s so much room for personal growth and a pathway to improved self-worth. Trust and emotional intimacy can be learned over time with patience and a strong support system. We can have and deserve fulfilling relationships.
“Remember that there is nothing wrong or bad about you or your emotions,” Smolarski says. “We all have emotions. It’s just that you didn’t have someone to reflect them back to you, to teach you that your emotions are welcome and valid, and to help you regulate them. Making the effort to heal this wound is a sign of bravery, and can be done at any age.”
Therapy Can Help
She adds that this process often requires professional support, such as therapy. Therapy allows us to explore past experiences, process unresolved emotions, and develop healthier coping strategies and communication skills.
In therapy, we can learn how to identify and label emotions accurately, develop self-compassion and self-acceptance, and figure out how to set and maintain healthy boundaries.
“Outside of professional settings, individuals can prioritize their emotional well-being through various self-care activities, such as engaging in activities that bring joy and fulfillment, practicing mindfulness and meditation to cultivate self-awareness, and journaling to express and process emotions,” Smolarski adds.
A quarter of girls and 1 in 13 boys will experience sexual abuse before they are 18 years old, according to CDC estimates.
People who have experienced child sexual abuse (CSA) are more likely to experience disorders such as depression, anxiety and PTSD.
CSA can also have long-term impacts on physical health, with people being more likely to report pain, gastrointestinal symptoms and obesity.
In addition, CSA is linked to negative social effects, such as sexual or relationship problems, and socioeconomic outcomes, such as lower income.
Child sexual abuse (CSA) is an adverse childhood experience (ACE) that has serious long-term consequences for those who have been victimized. The Centers for Disease Control and Prevention (CDC) estimates that 1 in 4 girls and 1 in 13 boys will experience sexualabuse before they are 18. Not only are there psychological consequences to CSA, but longitudinal research has also found that CSA results in negative health, psychosocial, and socioeconomic outcomes for those who have been abused.
The Psychological Consequences of CSA
Many studies have examined the long-term psychological impact of CSA. A recent research review of over four million people found that those who experienced CSA are between two and three times more likely to experience the following disorders compared to adults who were not abused:
It should be noted that many of the psychological consequences of CSA can take years to develop as the abuse is thought to alter brain structure and chemistry during its developmental period. For example, one study found that the average time between the abuse and the onset of depression was 11.5 years, while another studyfound an average of 9.2 years from the time of abuse to the onset of depression and 8 years until the onset of PTSD.
The Physical Consequences of CSA
Numerous studies have also shown that there are long-term impacts to the physical health of those who experienced CSA. Across studies, adults who experienced CSA were 1.35 to 2.12 times more likely to report health problems such as:
As a result of these health problems, adults with a history of CSA use health care more frequently than those without a history of CSA, spending on average 16% more per year. Notably, however, a history of CSA is also associated with lower odds of having health insurance and receiving a general check-up (preventative care) in the past year.
The Psychosocial Impacts of CSA
Researchers have also documented many negative social consequences of CSA including:
Sadly, there is considerable evidence to suggest that those who have experienced CSA are also likely to be revictimized. A recent study involving 12,252 survivors found that 47.5% were sexually victimized again later in life. Similarly, there is also evidence to suggest that the children of women who have been abused are also more likely to be abused themselves, suggesting that the cycle of abuse may continue into the next generation.
The Socioeconomic Consequences of CSA
From an economic perspective, it is estimated the average lifetime cost of child maltreatment (including CSA) per survivor is $830,928. Compared to adults who had not been abused, survivors of CSA were found to:
Earn on average $8,000 less per year
Be less likely to have a bank account, or own stock, a vehicle, or home
Be three times more likely to be out of work due to sickness and disability
Be 14% more likely to be unemployed in general
Be less likely to go to, or graduate from college
Be less likely to have a skilled job
As is clear from the research, CSA significantly negatively impacts all facets of life — not only for those who experience childhood sexual abuse themselves, but also for their loved ones and society at large. Thus, we must all do what we can to prevent sexual abuse before it happens, and provide support and services to those who have already experienced CSA.
Childhood emotional abuse and neglect can result in permanent changes to the developing human brain. These changes in brain structure appear to be significant enough to potentially cause psychological and emotional problems in adulthood, such as psychological disorders and substance misuse.
The National Redress Scheme started on 1 July 2018 and will run for 10 years. You can find information about the Scheme at Nationalredress.gov.auexternal resource or you can call the National Redress Scheme on 1800 737 377 Monday to Friday 8am to 5pm local time.
Finding help and support
The work of this Commission, and particularly the stories of survivors, may bring up many strong feelings and questions. Be assured you are not alone, and that there are many services and support groups available to assist in dealing with these. Some options for advice and support are listed below:
24/7 telephone and online crisis support, information and immediate referral to specialist counselling for anyone in Australia who has experienced or been impacted by sexual assault, or domestic or family violence.
STATES in Australia offer their own range of Counselling & Support (Psychological).
How Abuse Alters Brain Structure
As children grow, their brains undergo periods of rapid development. Negative experiences can disrupt those developmental periods, leading to changes in the brain later on.
Research supports this idea and suggests that the timing and duration of childhood abuse can impact the way it affects those children later in life. Abuse that occurs early in childhood for a prolonged period of time, for example, can lead to particularly negative outcomes.2
Dr. Martin Teicher and his colleagues at McLean Hospital, Harvard Medical School, and Northeastern University studied this relationship between abuse and brain structure by using magnetic resonance imaging (MRI) technology to identify measured changes in brain structure among young adults who had experienced childhood abuse or neglect.3
They found clear differences in nine brain regions between those who had experienced childhood trauma and those who had not. The most obvious changes were in the brain regions that help balance emotions and impulses, as well as self-aware thinking. The study’s results indicate that people who have been through childhood abuse or neglect do have an increased risk of developing mental health issues later on.
Childhood abuse and neglect can have several negative effects on how the brain develops. Some of these are:4
Decreased size of the corpus callosum, which integrates cortical functioning—motor, sensory, and cognitive performances—between the hemispheres
Decreased size of the hippocampus, which is important in learning and memory
Dysfunction at different levels of the hypothalamic-pituitary-adrenal (HPA) axis, which is involved in the stress response
Less volume in the prefrontal cortex, which affects behavior, emotional balance, and perception
Overactivity in the amygdala, which is responsible for processing emotions and determining reactions to potentially stressful or dangerous situations
Reduced volume of the cerebellum, which can affect motor skills and coordination
Press Play for Advice On Healing Childhood Wounds
This episode of The Verywell Mind Podcast, featuring award-winning actress Chrissy Metz, shares how to heal childhood trauma, safeguard your mental health, and how to get comfortable when faced with difficult emotions. Click below to listen now.
Effects on Behavior, Emotions, and Social Function
Because childhood abuse, neglect, and trauma change brain structure and chemical function, maltreatment can also affect the way children behave, regulate emotions, and function socially. These potential effects include:
Being constantly on alert and unable to relax, no matter the situation
Feeling fearful most or all of the time
Finding social situations more challenging
Not hitting developmental milestones in a timely fashion
A tendency to develop a mental health condition
A weakened ability to process positive feedback
These effects can continue to cause issues in adulthood if they’re not addressed. Adults who experienced maltreatment during childhood may have trouble with interpersonal relationships—or they may avoid them altogether.1
This outcome could be related to attachment theory, or the idea that our early relationships with caregivers influence the way we relate to people later on in life. Emotional abuse and neglect don’t allow for a secure attachment to form between a child and caregiver, which causes distress for the child and influences the way they see themselves and others.
Adults who went through childhood emotional abuse or neglect may also experience:1
How childhood abuse or neglect affects children later in life depends on a variety of factors:
How often the abuse occurred
The age the child was during the abuse
Who the abuser was
Whether or not the child had a dependable, loving adult in their life
How long the abuse lasted
If there were any interventions in the abuse
The kind and severity of the abuse
Other individual factors
Through treatment, it is possible to address the effects of childhood emotional abuse and neglect. Treatment in these cases is highly individual since maltreatment can take many forms and each person’s response to it may differ.
Any form of treatment would likely include therapy and, depending on whether or not any other mental health conditions are present, may include medication as well. Some effective forms of therapy are:5
Exposure therapy: Exposure therapy involves interacting with something that typically provokes fear while slowly learning to remain calm. This form of therapy may improve neural connections between several regions in the brain.
Family therapy: Family therapy is a psychological treatment intended to improve relationships within the entire family and create a better, more supportive home environment. This type of treatment may improve HPA axis functioning and lead to a healthier stress response.
Mindfulness-based approaches: Mindfulness-based therapy focuses on helping people develop a sense of awareness of their thoughts and feelings so they can understand them and better regulate them. These approaches may help improve resiliency against stress by benefiting several brain regions and improving neural connections.
Trauma-focused cognitive behavioral therapy (TF-CBT): TF-CBT focuses on helping people learn new coping skills, restructure negative or unhelpful thoughts, regulate their moods, and overcome trauma by crafting a trauma narrative. This form of therapy may help reduce overactivity in the amygdala.
As I have been speaking with a close support-team, I’m starting to sketch out what I’d expect for both BBC/PMSA + Qld Baptist Church/QB to say (“a direct personal response”). As my car accident had been linked with these memories, I’ll be requesting ’under special circumstances’ recordings to be made. I’ll keep you informed …
Finding the right Counsellor may take time, yet when you do it can make needed impact. As I had attended BBC under an OCA award, there may be inclusion of this. Perhaps a seperate ’Apology’ will be needed…
Professor Jill Astbury MAPS, College of Arts, Victoria University
All forms of child sexual abuse (CSA) are a profound violation of the human rights of children. CSA is a crime under Australian law and an extreme transgression of trust, duty of care and power by perpetrators. The rights violations that define CSA are critically connected to the deleterious behavioural and psychological health consequences that ensue. This article examines the long-term effects of CSA on mental health and the determinants of these outcomes, in order to identify opportunities to ameliorate the profound psychological impacts of CSA on the lives of many victims/survivors. The article is based on a literature review commissioned to inform the APS response to the Royal Commission into Institutional Responses to Child Sexual Abuse, which was established in 2013 by the Gillard Government.
Prevalence of child sexual abuse
Rates of CSA are difficult to gauge accurately given the clandestine, sensitive and criminal nature of the sexual abuse to which children are exposed. Perpetrators of CSA are often close to the victim, such as fathers, uncles, teachers, caregivers and other trusted members of the community (Finkelhor, Hammer & Sedlak, 2008). CSA often goes undisclosed and unreported to professionals or adults for many complex reasons, including fear of punishment and retaliation by the perpetrator, as well as the stigma and shame associated with this type of abuse (Priebe & Svedin, 2008).
A global meta-analysis of child sexual abuse prevalence figures found self-reported CSA ranged from 164-197 in every 1,000 girls and 66-88 per 1,000 boys (Stoltenborgh, van Ijzendoorn, Euser, & Bakermans-Kranenburg, 2011). In Australia, Fleming (1997) used a community sample of 710 women randomly selected from the Australian electoral roll and found that 20 per cent of the sample reported experiencing CSA involving contact. Another national survey involving both men and women (Najman, Dunne, Purdie, Boyle, & Coxeter, 2005) reported a higher prevalence of CSA, with more than one third of women and approximately one sixth of men reporting a history of CSA. A more recent study in Victoria (Moore et al., 2010) reported a prevalence rate of 17 per cent for any type of CSA for girls and seven per cent for boys when they took part in the study during adolescence. Both Australian studies involving community samples of women or girls and men or boys indicate that girls are two or more times more likely to experience CSA than boys.
Long-term mental health consequences
A significant body of research has demonstrated that the experience of CSA can exert long-lasting effects on brain development, psychological and social functioning, self-esteem, mental health, personality, sleep, health risk behaviours including substance use, self-harm and life expectancy. CSA often co-occurs with physical and emotional abuse and other negative and stressful childhood experiences that independently predict poor mental and physical health outcomes in adult life.
Nevertheless, the research literature indicates that when other predictors of poor adult mental health are statistically controlled, CSA remains a powerful determinant of psychological disorder in adult life (Kendler et al., 2000). Strong evidence from twin studies indicates that a causal relationship exists between CSA and subsequent mental disorders. Twin studies necessarily control for genetic and family environment factors and a number since 2000 have documented significant associations between CSA, depression, panic disorder, alcohol abuse/dependence, drug abuse/dependence, suicide attempts and completed suicides.
A systematic review and meta-analysis of studies published between 1980 and 2008 (Chen et al., 2010) found that a history of sexual abuse including child sexual abuse was related to significantly increased odds of a lifetime diagnosis of several different psychiatric disorders, including anxiety disorders, depression, eating disorders, posttraumatic stress disorder (PTSD), sleep disorders and suicide. A particularly strong link between CSA and subsequent PTSD has been found.
Although the diagnosis of PTSD may be appropriate for those who have been exposed to relatively circumscribed CSA, Herman (1992) argued more than two decades ago that this diagnosis does not adequately capture the psychological responses of people who are repeatedly traumatised over a long period of time, experience subsequent re-victimisation in adolescence or adult life and typically display multiple symptoms of psychological distress and high levels of psychiatric co-morbidity. For survivors of this kind of CSA, Herman (1992) proposed the expanded diagnostic concept of complex PTSD on the grounds that it was better able to accurately capture the complex psychological sequelae of prolonged, repeated trauma.
Risk of suicide: Australian research
Survivors of CSA face a significantly increased risk of suicide and a higher prevalence of suicide attempts and ideation. An Australian follow-up study (Plunkett et al., 2001) of young people who had experienced CSA compared with those who had not, reported that those with a CSA history had a suicide rate 10.7-13.0 times the national rate. Furthermore, 32 per cent of those sexually abused as children had attempted suicide and 43 per cent had thought about suicide. None of the non-abused participants had completed suicide.
A more recent Australian study confirms and extends this finding. Cutajar and colleagues (2010) conducted a cohort study of 2,759 victims of CSA by linking forensic records from the Victorian Institute of Forensic Medicine between 1964 and 1995 to coronial records up to 44 years later. They found that female sexual abuse victims had 40 times higher risk of suicide and 88 times higher risk of fatal overdose than the rates in the general population. Interestingly these rates were even higher than those for males, in contrast to the usual gender pattern for suicide. The respective rates for males were 14 times and 38 times higher than those in the general population.
Determinants of long-term mental health outcomes
While victims/survivors of CSA face greatly increased risks of poor mental health in adult life, a significant minority do not go on to develop psychological disorders (Saunders, Kilpatrick, Hanson, Resnick, & Walker, 1999). Broadly, two approaches to explaining this finding have informed research: differences in the nature of the abuse that has taken place; and post-abuse factors that positively mediate or intervene in the development of negative long-term mental health outcomes.
Nature of the sexual abuse
The likelihood of experiencing severe, negative mental health outcomes in adult life as the result of CSA is increased by several abuse-specific characteristics. Large scale epidemiological studies have consistently documented that forced penetrative sex, multiple perpetrators, abuse by a relative, and a long duration of CSA (e.g., more than a year) predict more severe psychiatric disturbance and a higher likelihood of being an in-patient in a psychiatric facility in adult life.
More than 20 years ago, Pribor and Dinwiddie (1992) investigated different types of CSA of increasing severity and found that incest victims had a significantly increased lifetime prevalence rate for seven psychological disorders including agoraphobia, alcohol abuse or dependence, depression, panic disorder, PTSD, simple phobia and social phobia. Bulik, Prescott and Kendler (2001) also confirmed that a higher risk for the development of psychiatric and substance use disorders was associated with certain characteristics of the abuse, including attempted or completed intercourse, the use of force or threats and abuse by a relative. More severe and chronic abuse which starts at an early age has also been reported to increase the risk of developing symptoms of dissociation.
Post-abuse mediating factors
Certain factors, both negative and positive, are likely to intervene after CSA has taken place and to mediate adult mental health outcomes.
Coping strategies Specific coping strategies used by survivors can positively or negatively predict long-term psychological outcomes. Overall, positive, constructive coping strategies such as expressing feelings and making efforts to improve the situation are associated with better adjustment (Runtz & Schallow, 1997; Tremblay, Hebert, & Piche, 1999), and negative coping strategies, including engaging in self-destructive or avoidant behaviours, with worse adjustment (Merrill, Thomsen, Sinclair, Gold, & Miller, 2001). However, the coping strategies used by survivors are contingent to some degree on the availability of social or material resources over which children have little or no control.
In addition, the number of negative or maladaptive coping strategies used is predictive of the likelihood of sexual re-victimisation in adulthood (Filipas & Ullman, 2006). This strongly indicates that the link between CSA, negative coping strategies and adverse adult psychological outcomes is strengthened by sexual re-victimisation. Several studies have confirmed this relationship.
Re-victimisation CSA is associated with an increased risk of subsequent violent victimisation including intimate partner violence and sexual violence in adolescence and adulthood (see, for example, Classen, Palesh, & Aggarwal, 2005). Sexual re-victimisation involving rape or other types of sexual abuse/assault poses a potent risk for worse psychological health in adult life. A number of studies have confirmed that women who are sexually re-victimised compared with their non-revictimised counterparts have more severe symptoms of psychological distress in adulthood.
Social support and reaction to disclosure Historically, the role of social support and other societal and cultural factors in determining survivors’ responses to CSA has been under-explored in comparison with the heavy focus on the survivor’s role in responding to sexual trauma. Increased interest in the contribution of social support and other sociocultural factors has prompted increased investigation into the social contextual factors that can mediate adult outcomes following childhood violence, many of which are associated with the reactions to disclosure.
Delay in the disclosure of CSA is linked inevitably with other delays, all of which are harmful to the child. These include delay in putting in place adequate means to protect the child from further victimisation, delay in the child receiving meaningful assistance including necessary psychological and physical health care, and delay in redress and justice for the victim. Without disclosure, negative health outcomes are more likely to proliferate and compound. Conversely, disclosure within one month of sexual assault occurring is associated with a significantly lower risk of subsequent psychosocial difficulties in adult life including lower rates of PTSD and major depressive episodes (Ruggiero et al., 2004).
Yet experiences of disclosure are not uniform and whether they are positive or negative depends on the reactions of the person to whom the CSA is disclosed. Unfortunately, negative reactions to disclosure are common, constitute secondary traumatisation and are associated with poorer adult psychological outcomes (Ullman, 2007). Such reactions include not being believed, being blamed and judged, or punished and not supported, all of which can compound the impact of the original abuse and further increase the risk of psychological distress including increased symptoms of PTSD, particularly when the perpetrator is a relative.
Specific characteristics of disclosure appear to be protective against the development of psychiatric disorders. This finding highlights the importance of social support in concert with effective action by the person in whom the child confides. The degree to which someone is affected is likely to reflect various indicators of the severity of the abuse as well as countervailing protective factors such as the strength of family relationships and the survivor’s self-esteem. One such factor is a warm and supportive relationship with a non-offending parent, which is strongly associated with resilience following CSA and lower levels of abuse-related stress.
Implications for psychological training and practice
The research outlined above shows conclusively that CSA is associated with multiple adverse psychological outcomes, although such outcomes are not inevitable. The identified mediating or intervening factors that increase or decrease the risk of developing psychological disorders as a result of CSA have important implications for psychological training and for the practising psychologists who work with survivors of CSA.
Training on CSA
It is a matter of grave concern that the issue of CSA has been neglected in psychology training. When psychologists lack appropriate knowledge and skills to work with survivors they put both their clients and themselves at risk and can cause unintended harm. Training on CSA is urgently needed in psychology programs to disseminate evidence to students on the protean psychological consequences of CSA as well as the skills necessary to carry out the demanding mental and emotional work of treating survivors. Survivors can have chronic, complex problems in many areas of functioning and psychological disorders can overlap with physical health problems, including pain syndromes and high risk health behaviours such as alcohol, tobacco and drug use. Careful long-term psychological care is often necessary. As survivors may seek help from a range of psychologists, it is important that all psychologists are educated about the magnitude and psychological consequences of CSA.
Apart from acquiring more in-depth knowledge of the emotional effects of CSA and experience in trauma-related interventions, postgraduate courses should prepare practitioners for how exposure to their clients’ traumatic material can traumatise them as well. To remain psychologically healthy while working with survivors of CSA, psychologists need to be able to recognise symptoms of secondary traumatic stress and develop self-care strategies and support systems that will help them to manage the stress related to working with CSA survivors.
Most practising psychologists today who work with survivors have acquired their knowledge and skills ‘on the job’ post-graduation or as a result of their own initiative by attending workshops delivered by specialists in the field. An unknown number of registered psychologists may have no training on CSA and a more systematic continuing education program should be available and accessible so that all psychologists are equipped, at the very least, to ‘do no harm’ to the clients who have experienced CSA.
Implications for psychological practice
Knowing how to facilitate disclosure and take a comprehensive trauma history is an essential first step in developing a treatment plan for survivors of CSA. How a psychologist responds to a client’s disclosure will have an enormous impact on whether a survivor continues or abruptly terminates treatment. Any hint of disbelief, blame or judgment is likely to fracture the client’s fragile hope that she or he will be believed and that it is safe to undertake the painful task of working through the original abuse and its aftermath. If the response to a disclosure is negative it may be years before a survivor is willing to try again, and in the meantime the psychological burden of the abuse and its effects can proliferate. The effort to remain silent and keep the abuse hidden is extremely isolating and cuts off access to potential avenues of psychosocial support.
It would be a mistake for psychologists to assume, for example, that knowing about prolonged exposure therapy for the treatment of PTSD, would, by itself, be sufficient to offer effective treatment to survivors. Beyond the symptoms of traumatic stress associated with CSA, survivors often struggle with many other pressing concerns. These often relate to the deep betrayal of trust by the adult/s with a duty of care towards them as children. This betrayal can prompt persistent negative self-perceptions, difficulties in trusting others and their own judgement, and abiding feelings of shame and intrinsic ‘unloveability’ that contribute to insecure, unsatisfying relationships in adult life. These same issues can impinge on the client-psychologist interaction, making it challenging to establish a robust therapeutic alliance or maintain appropriate boundaries.
CSA does not result in a single disorder such as depression, treatable within the 10 sessions supported under the Better Access to Mental Health Care initiative. The chronicity and complexity of the disorders stemming from CSA require much longer term mental health care. The current system under Medicare is very poorly suited to meeting the mental health care needs of perhaps the most numerous and psychologically vulnerable group in society – CSA survivors.
The Royal Commission has provided a timely opportunity to closely examine the enduring, deleterious and multi-faceted impacts of CSA on survivors, how institutions in which abuse took place failed to intervene and the kind of assistance survivors believe will be most helpful in healing from their traumatic experiences. Psychology has much to contribute to this process and to ensure that the best available psychological evidence is put forward to address the profoundly disturbing phenomenon of child sexual abuse.
Clergy-perpetrated child sexual abuseIn contrast with the large evidence base amassed since the 1980s on the prevalence and health consequences of CSA occurring in the general community, minimal research was published before 2000 on CSA perpetrated by clergy or others working for institutions or organisations, and evidence remains limited in scope.There is an additional theological and spiritual dimension to clergy-perpetrated abuse that sets it apart other forms of CSA, including a spiritual and religious crisis during and after the abuse (Farrell & Taylor, 2000). CSA perpetrated by priests and other members of the clergy has been described as “a unique betrayal” (Guido, 2008) and the “ultimate deception” (Cook, 2005), and the implications of such abuse for victims are eloquently described by McMackin, Keane and Kline (2008):The sexual exploitation of a child by one who has been privileged, even anointed, as a representative of God is a sinister assault on that person’s psychosocial and spiritual well-being. The impact of such a violent betrayal is amplified when the perpetrator is sheltered and supported by a larger religious community. (p.198)Psychological consequences of clergy-perpetrated child sexual abuseClergy-perpetrated sexual abuse of children can catastrophically alter the trajectory of victims’ psychosocial, sexual and spiritual development (Fogler et al., 2008). In the US, investigation into the Catholic Church by the John Jay Research Team repeatedly identified certain psychological effects of clergy CSA in the personal testimony of survivors and family members. These included major symptoms of PTSD with co-occurring substance abuse, affective lability, relational conflicts, and a profound alteration in individual spirituality and religious practices associated with a deep sense of betrayal by the individual perpetrator and the church more broadly (John Jay College, 2004, 2006; McMackin et al., 2008).Some of these negative psychological outcomes are shared with survivors of CSA in the general population but those related to spirituality, religious practices and a sense of betrayal by the church alter the nature of the harm caused by clergy-perpetrated CSA. While a diagnosis of PTSD may be useful as a starting point in understanding and treating survivors of clergy CSA, Farrell and Taylor (2000) contend that “there are qualitative differences in [clergy-perpetrated CSA] symptomatology, which the PTSD diagnosis cannot explain” (p. 28). Such symptoms include self-blame, guilt, psychosexual disturbances, self-destructive behaviours, substance abuse, and re-victimisation. These symptoms are argued to emanate from the theological, spiritual and existential features of clergy CSA. For these reasons, Farrell and Taylor (2000) suggest that a diagnosis of complex PTSD (Herman, 1992) offers a better fit for the symptoms reported by survivors of clergy-perpetrated CSA.Preventing clergy-perpetrated child sexual abuseThe history of denial, cover up and delays in response to disclosures of clergy CSA by churches has been well documented, with their responses to perpetrators evidencing a failure to implement any effective preventative measures. To stop institutional CSA from occurring, it is critical to understand the situational indicators of such abuse so that the opportunities they afford to perpetrators to commit the crime of CSA can be identified.Parkinson and colleagues (2009) identified that having immediate and convenient access to minors were the defining characteristics that facilitated abuse. The evidence also suggests the need for parents and their children to be made much more aware of the grooming tactics used by clergy who perpetrate CSA. The John Jay College study (2006) identified the strategies that allowed the perpetrators to become close to the child they subsequently abused including being friendly with the victims’ families, giving gifts or other enticements such as taking them to sporting events or letting them drive cars, and spending a lot of time with victims.A recurrent theme in Australian victims’ accounts is how their parents’ religious beliefs and trust and reverence for members of the clergy meant that they could not conceive of the possibility that priests could sexually abuse their children and betray their own vows. Yet there is ample evidence that this trust was sadly misplaced and the same caution that would be applied to other members of society needs to be applied to the clergy.Finally, in tandem with a message from churches that there is zero tolerance for CSA, there needs to be a clear and trustworthy process in place, independent of the churches, that encourages children to disclose CSA safely and confidentially. Educational programs in all schools beginning in primary school might be one way of achieving this.Victims of clergy-perpetrated CSA need to be heard with respect and compassion, given meaningful assistance to meet their psychosocial needs, and provided with justice through those who perpetrated the abuse and those who covered it up being held fully accountable. Only then will it be possible for recovery from the immense trauma of clergy CSA and the rebuilding of shattered lives to truly begin.
Parkinson, P., Oates, K. & Jayakody, A. (2009). Study of reported child sexual abuse in the Anglican Church. Submission to the Victorian Inquiry into the handling of child abuse by religious and other organisations.
Plunkett, A., O’Toole B., Swanston, H., Oates, R. K., Shrimpton, S. & Parkinson, P. (2001). Suicide risk following child sexual abuse. Ambulatory Paediatrics, 1 (5), 262-266.
Pribor, E. F. & Dinwiddie, S. H. (1992). Psychiatric correlates of incest in childhood. American Journal of Psychiatry, 149, 52-56.
Priebe, G. & Svedin, C. G. (2008). Child sexual abuse is largely hidden from the adult society: An epidemiological study of adolescents’ disclosures. Child Abuse and Neglect, 32(12), 1095-108.
Ruggiero, K. J., Smith, D. W., Hanson, A., Resnick, H. S., Saunders, B. E., Kilpatrick, D. G., Best, C. L. (2004). Is disclosure of childhood rape associated with mental health outcome? Results from the National Women’s Study. Child Maltreatment, 9, 62-77.
Runtz, M. G. & Schallow, J. R. (1997). Social support and coping strategies as mediators of adult adjustment following childhood maltreatment. Child Abuse and Neglect, 21(2), 211-226.
Saunders, B. E., Kilpatrick, D. G., Hanson, R. F., Resnick, H. S., & Walker, M. E. (1999). Prevalence, case characteristics, and long-term psychological correlates of child rape among women: A national survey. Child Maltreatment, 4,187-200.
Stoltenborgh, M., van Ijzendoorn, M.H., Euser, E. M. & Bakermans-Kranenburg, M. J. (2011). A Global Perspective on child sexual abuse: Meta-Analysis of prevalence around the world. Child Maltreatment, 16(2), 79-101.
Tremblay, C., Hebert, M. & Piche, C. (1999). Coping strategies and social support as mediators of consequences in child sexual abuse victims. Child Abuse and Neglect, 23, 929–945.
Ullman, S. E. (2007). Relationship to perpetrator, disclosure, social reactions, and PTSD symptoms in child sexual abuse survivors. Journal of Child Sexual Abuse, 16(1), 19-36.
Bulik, C. M., Prescott, C. A., & Kendler, K. S. (2001). Features of childhood sexual abuse and the development of psychiatric and substance use disorders. British Journal of Psychiatry, 179, 444-449.
Chen, L. P., Murad, M. H., Paras, M. L., Colberson, K. M., Sattler, A. L., et al. (2010). Sexual abuse and lifetime diagnosis of psychiatric disorders: systematic review and meta-analysis. Mayo Clinic Proceedings, 85(7), 618-629.
Classen, C. C., Palesh, O. G. & Aggarwal, R. (2005). Sexual revictimization: A review of the empirical literature. Trauma, Violence & Abuse, 6(2), 102–129.
Cook, L. J. (2005). The ultimate deception: Childhood sexual abuse in the church. Journal of Psychosocial Nursing and Mental Health Services. 43(10), 18-24.
Cutajar, M. C., Mullen, P. E., Ogloff, J. R. P., Thomas, S. D., Wells, D. L. & Spataro, J. (2010b). Suicide and fatal drug overdose in child sexual abuse victims: A historical cohort study. Medical Journal of Australia, 192(4), 184–187.
Farrell, D. P. & Taylor, M. (2000). Silenced by God: An examination of unique characteristics within sexual abuse by the clergy. Counselling Psychology Review, 15, 22-31.
Filipas, H. H. & Ullman, S. E. (2006). Child sexual abuse, coping responses, self-blame, PTSD, and adult sexual revictimization. Journal of Interpersonal Violence, 21, 652-672.
Finkelhor, D., Hammer, H. & Sedlak, A. J. (2008). Sexually Assaulted Children: National Estimates and Characteristics. National Incidence Studies of Missing, Abducted, Runaway, and Thrownaway Children (NISMART–2) Bulletin. US: Department of Justice.
Fleming, J. (1997). Prevalence of childhood sexual abuse in a community sample of Australian women. Medical Journal of Australia, 166, 65-68.
Fogler, J. M., Shipherd, J.C., Clarke, S., Jensen, J. & Rowe, E. (2008). The impact of clergy-perpetrated sexual abuse: the role of gender, development and posttraumatic stress. Journal of Child Sexual Abuse, 17(3-4), 329-358.
Guido, J. (2008). A unique betrayal: Clergy sexual abuse in the context of the Catholic religious tradition. Journal of Child Sexual abuse,17(3-4), 255-269.
Herman, J. L. (1992). Complex PTSD: A syndrome in survivors of prolonged and repeated trauma. Journal of Traumatic Stress, 5 (3), 377-391.
John Jay College. (2004). The nature and scope of sexual abuse of minors by Catholic priests and deacons in the United States, 1950-2000. Washington, DC: United States Conference of Catholic Bishops.
John Jay College. (2006). The nature and scope of sexual abuse of minors by Catholic priests and deacons in the United States- supplementary data analysis. Washington, DC: United States Conference of Catholic Bishops.
Kendler, K. S., Bulik, C. M., Silberg, J., Hettema, J. M., Myers, J. & Prescott, C.A. (2000) Childhood sexual abuse and adult psychiatric and substance use disorders: An epidemiological and co twin control analysis. Archives of General Psychiatry, 57, 953 -959.
McMackin, R.A., Keane, T. M. & Kline, P.M. (2008). Introduction to special issue on betrayal and recovery: Understanding the trauma of child sexual abuse. Journal of Child Sexual Abuse, 17(3-4), 197-200.
Merrill, L. L., Thomsen, C. J., Sinclair, B. B., Gold, S. R. & Milner, J. S. (2001). Predicting the impact of child sexual abuse on women: The role of abuse severity, parental support and coping strategies. Journal of Consulting Clinical Psychology, 69(6), 992-1006.
Moore, E. E., Romaniuk, H., Olsson, C. A., Jayasinghe, Y., Carlin, J. B. & Patton, G. C. (2010). The prevalence of childhood sexual abuse and adolescent unwanted sexual contact among boys and girls living in Victoria, Australia. Child Abuse and Neglect,34 (5), 379-385.
Najman, J. M., Dunne, M. P., Purdie, D. M., Boyle, F. M. & Coxeter, P. D. (2005). Sexual abuse in childhood and sexual dysfunction in adulthood: An Australian population based study. Archives of Sexual Behaviour, 34, 517-526.
Disclaimer: Published in InPsych on October 2013. The APS aims to ensure that information published in InPsych is current and accurate at the time of publication. Changes after publication may affect the accuracy of this information. Readers are responsible for ascertaining the currency and completeness of information they rely on, which is particularly important for government initiatives, legislation or best-practice principles which are open to amendment. The information provided in InPsych does not replace obtaining appropriate professional and/or legal advice.OCTOBER 2013 | ISSUE INDEX
Bridget Sipera, a teacher at Camden Catholic High School in New Jersey, has been charged with sexually assaulting a male student less than half her age . The two repeatedly had sex over an 18 month period.
Western society tends to view sexual activity among teens as part of the natural process of development. We bombard teens with sexual images. Discouraging sex seems repressive to us.
While we may be protective toward our daughters, some of us actually cheer our sons on. Sex with a teacher is seen as the ultimate fantasy.
But there are serious dangers associated with early sexual activity. And sex between an adult and child is as damaging to boys as it is to girls.
Teens who engage in sex are likely to engage in risky sexual behaviors in adulthood .
They are more likely to have multiple sexual partners, and less likely to use condoms. This increases their chances of contracting a sexually transmitted disease or HIV, and having an unwanted pregnancy.
Ten million of the sexually transmitted diseases newly reported each year are acquired by young people between the ages of 15 and 24 . It bears mention that the brain is not fully developed till age 25.
Early exposure to sexual content can, also, give rise to sexual addiction [4A].
Best estimates are that 3% – 6% of American men suffer from sexual addiction . However, women can fall prey to sexual addiction, too.
Sexual addiction can destroy relationships, compromise finances, and contribute to criminality.
Typically, sexual addiction is characterized by one or more of the following [4B]:
reliance on pornography and/or prostitutes;
an endless succession of meaningless sexual encounters;
use of fetishes in place of human interaction;
sexual sadism or masochism.
Addicts persist in these behaviors despite the negative consequences.
In an attempt to better understand the underlying causes, some psychologists classify sexual addiction into categories . These categories help explain why certain individuals are more susceptible to sexual addiction than others. The categories can overlap.
Biological – Most sexual addiction has a biological component. Where the biological component is predominant, fantasy can supersede or replace relationships altogether. Triggers must be identified and carefully regulated, so that the brain can be retrained to new neural pathways. A sponsor who will hold the addict accountable for lapses can be beneficial.
Psychological – This form of sexual addiction is a reaction to childhood abuse or neglect. As many as 80% of sex addicts may fall into this category. For them, sex has become a maladaptive means of self-soothing. Their underlying psychological pain must be addressed before a healthy self-image can be re-established, more appropriate means of coping substituted, and the addiction overcome.
Trauma-Based – This form of sexual addiction is the direct result of sexual trauma in childhood or adolescence. Trauma drives the repetitive behavior. To heal, the addict must first make the connection between such trauma and his/her acting out. Suppressed feelings surrounding the trauma must be explored and resolved.
Mood Disorder – Sexual addiction can co-exist with anxiety and depression (as well as lead to those). Teens and young adults may use sex as a way of “managing” their mood disorder, and find themselves addicted to the sexual response.
Spiritual – This form of sexual addiction is an attempt to fill an emptiness inside only God can fill. As the philosopher/mathematician/scientist/theologian Blaise Pascal put it, “There is a God-shaped vacuum in the heart of each man which cannot be satisfied by any created thing but only by God the Creator, made known through Jesus Christ.”
That sexual addiction is a challenging and tenacious disorder does not absolve sex addicts of the harm they inflict on others.
 National Center for Biotechnology Information, US National Library of Medicine, National Institutes of Health, PubMed Central, “Understanding and Managing Compulsive Sexual Behaviors” by Timothy Fong MD, November 2006, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2945841/.