The impact of child sexual abuse

A meta-analysis conducted of 35 studies involving samples of children and adolescents aged between 5 and 18 found a positive association between experiences of maltreatment and the use of avoidance strategies to cope with stressful events. Moreover, these strategies have been associated with suicidal ideations, internalized as well as externalized behavior problems, post-traumatic stress symptoms, and low self- esteem in victims of sexual abuse (Dassylva et.al., 2025)

A systematic meta-review of problems reported by survivors of child sexual abuse found that abuse is associated with many different problems across five primary domains: medical, psychological, sexual, repeated (self-)harm, and other problems. The reported outcomes have been found mostly independent of moderating variables such as frequency of the abuse, relationship to perpetrator and type of control group (Nagtegaal & Boonmann, 2021).

A study of over 1,000 children with both objective court-documented evidence of maltreatment and subjective reports of childhood maltreatment made as adults, found that, even for severe cases of maltreatment identified in court records, psychopathology was less likely when these children, as adults, did not also make subjective reports of maltreatment. Risk of psychopathology increased, however, when children made subjective reports of maltreatment as adults. This research suggests that the impact of childhood sexual assault emerges as a result of subjective experiences, rather than objective experiences of childhood maltreatment (Danese & Spatz Widom, 2020).

An umbrella review synthesising meta-analytical findings on the outcomes of child sexual abuse found evidence for associations between sexual abuse and a wide range of psychiatric diagnoses, as well as negative psychosocial and physical health outcomes in adulthood, with particularly strong evidence existing for links between child sexual abuse and later post-traumatic stress disorder, schizophrenia, and substance misuse (Hailes, Yu, Danese & Fazel, 2019).

In a review of the impacts of institutional child sexual abuse, Blakemore and colleagues (2017) likened institutional abuse to intra-familial sexual abuse, noting similarities in terms of its chronicity, severity and relational aspects, and described impacts as “pervasive, numerous and connected”. These authors noted negative impacts across psychological (e.g. post-traumatic stress symptomology, depression, anxiety), physical (e.g. self-reported quality of health, sleep problems), social (e.g. relationship, parenting and sexual difficulties), educational (e.g. school completion, engagement) and economic (e.g. obtaining and maintaining employment) domains.

Child sexual abuse is associated with a range of detrimental and often inter-related outcomes. While child sexual abuse has been shown to be associated with individually increased risks for public mental health service contacts, offending, subsequent victimisation and deaths by suicide or drug overdose, a study by Papalia and colleagues (2017) has shown that these adverse outcomes also tend to co-occur among survivors. For example, this research showed a three-way interaction between public mental health service contact, criminal history and subsequent victimisation – notably, the presence of a psychiatric history increased the likelihood of co-occurring offending and further victimisation among survivors of child sexual abuse (Papalia, Luebbers, Ogloff, Cutajar & Mullen, 2017).

Short-term impacts

Data from children involved in a US-based panel study found that youth who had experienced sexual abuse had lower grades in school, were more likely to drop out, and had lower levels of education than those who had not experienced sexual abuse. Child sexual abuse was found to have an impact on positive future orientation, which in turn impacted on academic outcomes for these children (Ochoa & Constantin, 2023).

A study of 14-18 year old adolescents in Canada found that while overall, boys had higher levels of self-esteem than girls, the opposite was true among victims of child sexual assault: boy victims had lower self-esteem than girl victims. Among victims of CSA, boys reported lower levels of self-esteem than girls, which in turn was associated with an increased risk of displaying delinquent behaviours (Gauthier-Duchesne, Hebert & Blais, 2021).

A recent longitudinal matched-cohort study has shown that sexual abuse is associated with a 1.27 increased risk of infectious disease diagnoses in children and adolescents (Dargan et al., 2019).

Complex trauma

The experience of sexual abuse during childhood is a key antecedent of complex trauma symptoms. Research has shown that the symptoms of complex trauma most often result from prolonged exposure to multiple forms of interpersonal trauma (including sexual abuse), typically during childhood, by caregivers who are expected to provide a safe, predictable, and secure environment (Courtois & Ford, 2013).

Complex trauma is distinguished by its pervasive effects; it is not only a range of functions which are negatively impacted but also development and functioning of the self (Courtois & Ford, 2013). In contrast to “single incident” trauma (which relates to an unexpected and “out of the blue” event), complex trauma is cumulative and repetitive. When this occurs at critical developmental periods, it compromises psychobiological, social and emotional development (Courtois & Ford, 2013).

Intergenerational trauma and victimisation

A comparison of mother and (young adult) child pairs examined the difference between intergenerational cycle maintainers, breakers, initiators, and a control group. This research supported previous work in revealing a higher risk of child sexual abuse in pairs where the mother experienced child sexual abuse. Additionally, this research found that compared to cycle initiators, maintainers reported greater psychological distress and lower ratings of parent-child attachment. Mothers in cycle maintaining pairs also were exposed to more acts of domestic violence than were those in cycle breaking pairs (Marshall, Fernet, & Langevin, 2022).

Links to mental health and suicide

Chronic exposure to CSA is strongly associated with the development of CPTSD. Given the high prevalence rates of CSA and the relevant high risk of developing PTSD after that experience, there is a need to focus research especially onto young people and adolescents suffering from CSA; gender-specific differences in the link between CSA and PTSD have not been addressed at the meta-analysis level in this age group (Boumpa et.al., 2024).

Concerning gender, sexually abused boys and girls seemed to suffer by PTSD at comparable rates; meta regression analysis confirmed this finding (Boumpa et.al., 2024).

Feiring et al. was found that girls experience higher levels of intrusive thoughts and hyperarousal symptoms compared to boys, but equivalent levels of avoidance symptoms. In addition, in the study conducted by Coohey in children and adolescents aged 11 to 14, it was mentioned that sexually abused boys are more likely to have internalizing behaviors during early adolescence and externalizing during later adolescence, while sexually abused girls tend to have internalizing behaviors during the whole period of adolescence (cited in Boumpa et.al., 2024).

The Australian Child Maltreatment Study (ACMS), the first nationally representative study of child maltreatment rates, found that Australians who experienced child sexual abuse are 2.7 times more likely to have self-harmed, and 2.3 times more likely to have attempted suicide, in the prior 12 months (Lawrence, Hunt, Mathews, et al., 2023).

The ACMS also found that Australians who had experienced child sexual abuse are 1.95 times more likely to develop post-traumatic stress disorder, 1.65 times more likely to develop generalised anxiety disorder, 2.12 times more likely to develop a severe alcohol use disorder, and 1.66 times more likely to develop major depressive disorder than the general Australian population (Scott, Malacova, Mathews, et al., 2023).

A study utilising data from a German-wide sexual abuse helpline found that callers with experiences of female perpetrated and male perpetrated sexual abuse experienced similar severe and long-term mental health consequences from the abuse. While the severity of outcomes was similar, specific mental disorders differed, with callers reporting experiences of female perpetrated sexual abuse more likely to report suicidality, self-injury behaviour, personality disorders, dissociative identity disorders, and alcohol or drug addiction, and callers reporting experiences of male perpetrated sexual abuse more likely to report post-traumatic stress disorder, affective disorders, and anxiety disorders (Gerke, Gfrorer, Mattstedt, Hoffmann, Fegert & Rassenhofer, 2023).

Examination of three conditions directly linked to child abuse and neglect: anxiety disorders, depressive disorders, and suicide and self-inflicted injuries, were estimated to have been responsible for 0.5% of all deaths and 2.2% of the burden of disease and injury in 2015 (AIHW, 2019). More specifically, it was estimated that there would have been 26% less suicide and self-inflicted injuries, 20% less depressive disorders and 27% less anxiety disorders in 2015 if no one in Australia had ever experienced child abuse and neglect during childhood (AIHW, 2019).

Men’s experience of child sexual abuse has been shown to be positively associated with depressive and somatic symptoms as well as hostility into middle and late adulthood (Easton & Kong, 2017).

A study of child sexual abuse, its co-occurrence with other forms of maltreatment, and mental health outcomes among males has shown that having a history of child sexual abuse only, and of child sexual abuse co-occurring with other types of maltreatment, was associated with higher odds for many mental disorders and suicide attempts compared to having a history of child maltreatment without sexual abuse (Turner, Taillieu, Cheung, & Afifi, 2017).

Links to physical health

One in 10 respondents to a 2015 Texas Behavioral Risk Factor Surveillance System survey reported experiencing childhood sexual abuse. Individuals who reported child sexual abuse were more likely to report their general health as poor, and to report 14 or more physical unhealthy days, 14 or more mental unhealthy days, and 14 or more activity limitation days in a month. Health-related quality of life outcomes were poorer among those who had experienced more severe forms of child sexual abuse, including penetrative abuse (Downing, Akinlotan, & Thornhill, 2021).

A study of the prevalence of child sexual abuse and its impact on the health of adults in Saudi Arabia found that participants who reported child sexual abuse had 1.7, 2,2 and 3.8 times the odds of diabetes, coronary heart disease and obesity diagnosis respectively compared to participants with no history of child sexual abuse (Almuneef, 2021).

Links to drug and alcohol misuse

The Australian Child Maltreatment Study found that Australians who experienced child sexual abuse are 2 times more likely to be cannabis dependent (Lawrence, et al., 2023).

Forty-seven articles included in a recent systematic review, covering a range of topics related to child sexual abuse and later substance use issues, found a clearly supported link between child sexual abuse and substance use issues later in life (Fletcher, 2020).

Experience of child sexual abuse has been shown to be associated with heavy drinking, hazardous drinking, and the use of marijuana and other illicit drugs – these associations have also been shown to be only marginally attenuated when controlling for depression and self-reported emotional and mental health (Tonmyr & Shields, 2017).

Links to crime

A study examining the relationship between Adverse Childhood Experiences and criminal behaviours in young adults living in 10 countries found that child sexual abuse among females was the strongest predictor of criminal behaviour in the study. The link was weaker among males than females, which the authors suggested may be explained by the fact that females are more likely than male victims to have experienced more severe and chronic sexual abuse and have a greater likelihood of self-blame than males (Basto-Pereira, Gouveia-Pereira, Pereira et al., 2022).

A later examination of this same longitudinal data-set of 2,759 substantiated CSA cases found that CSA victims were more likely to engage in all types of criminal behaviours including violent, sexual and other offending, and that there were stronger associations between CSA and general and violent offending among females, and between CSA and sexual offending among males. This study also showed that sexual and violent revictimisation subsequent to the index sexual abuse was strongly associated with an increased likelihood of most forms of offending behaviour, for both males and females (Papalia, Ogloff, Cutajar, & Mullen, 2018).

A prospective study examining the effects of child sexual abuse on life-course offending found that victims of sexual abuse were more at risk of offending (non-sexual offences) than were controls, but that so too were their siblings. Only female victims were more likely to offend than their siblings. The authors concluded that family and environmental factors were most important in explaining life-course offending among male sexual abuse victims, while these factors were not sufficient to explain the link between child sexual abuse and offending among females (de Jong & Dennison, 2017).

Revictimisation

In the Australian Longitudinal Study on Women’s Health, women aged 24 to 30 in 2019 who had experienced childhood sexual violence were twice as likely to have experienced recent sexual violence, 59% more likely to have experienced recent domestic violence, and approximately 60% more likely to likely to have experienced recent physical violence, than were women of the same age who did not report sexual violence in childhood (Townsend et al., 2022).

A prospective-longitudinal study of 2,759 Australian children (<17 years old) who experienced contact sexual abuse, followed these children and a matched comparison group to age 35 years on average, and found that child sexual abuse victims experienced significantly higher rates of revictimization, with marked increases in odds for interpersonal revictimization, including sexual and physical assault, threats of violence, and stalking (Papalia, Mann & Ogloff, 2020). Widom, Czaja and Dutton (2008) report the findings of a prospective study of children physically and sexually abused between 1967 and 1971, and a comparison group of non-abused children matched for sex, age race and socioeconomic status. Both groups were followed up and interviewed between 2000 and 2002 (at a mean age of 39.5 years). Those who experienced abuse/neglect in childhood had significantly higher rates of sexual assault/abuse in adulthood (47.7% vs. 28.6%).

References

Almuneef, M. (2021). Long term consequences of child sexual abuse in Saudi Arabia: A report from national study. Child Abuse & Neglect, 116, doi: 10.1016/j.chiabu.2019.03.003

Australian Institute of Health and Welfare (2019). Family, domestic and sexual violence in Australia: continuing the national story. Cat. no. FDV 3. Canberra: AIHW.

Basto-Pereira, M., Gouveia-Pereira, M., Pereira, C.R., Barrett, E.L., Lawler, S., Newton, N., et al. (2022). The global impact of adverse childhood experiences on criminal behavior: A cross-continental study. Child Abuse & Neglect, 124, doi: 10.1016/j.chiabu2021.105459.

Blakemore, T., Herbert, J.L., Arney, F., & Parkinson, S. (2017). The impacts of institutional child sexual abuse: A rapid review of the evidence. Child Abuse & Neglect, 74, 35-48.

Boumpa V, et.al. (2024). Sexual abuse and post-traumatic stress disorder in childhood, adolescence and young adulthood: a systematic review and meta-analysis. European Child and Adolescent Psychiatry, 33(6):1653-1673. doi/10.1007/s00787-022-02015-5

Danese, A., & Spatz Widom, C. (2020). Objective and subjective experiences of child maltreatment and their relationships with psychopathology. Nature Human Behaviour, doi: 10.1038/s41562-020-0880-3

Dargan, S., Daigneault, I., Ovetchkine, P., Jud, A., & Frappier, J. (2019). Associations between child sexual abuse and infectious disease diagnosis. Child Abuse & Neglect, 97, 104142.

Dassylva, O., Amédée L.M., Paradis, A. & Hébert, M. (2025). Coping patterns among sexually abused children: A latent profile analysis. Children and Youth Services, 169, https://doi.org/10.1016/j.childyouth.2024.108083

De Jong, R., & Dennison, S. (2017). Recorded offending among child sexual abuse victims: A 30-year follow up. Child Abuse & Neglect, 72, 75-84.

Downing, N.R., Akinlotan, M., & Thornhill, C.W. (2021). The impact of childhood sexual abuse and adverse childhood experiences on adult health related quality of life. Child Abuse & Neglect, doi: 10.1016/j.chiabu.2021.105181.

Easton, S.D., & Kong, J. (2017). Mental health indicators fifty years later: A population-based study of men with histories of child sexual abuse. Child Abuse & Neglect, 63, 273-283.

Fletcher, K. (2020). A Systematic Review of the Relationship between Child Sexual Abuse and Substance Use Issues. Journal of Child Sexual Abuse, DOI: 10.1080/10538712.2020.1801937

Gauthier-Duchesne, A., Hebert, M., & Blais, M. (2021). Child sexual abuse, self-esteem, and delinquent behaviors during adolescence: The moderating role of gender. Journal of Interpersonal Violence, DOI: 10.1177/08862605211001466.

Gerke, J., Gfrorer, T., Mattstedt, F., Hoffmann, U., Fegert, J.M., & Rassenhofer, M. (2023). Long-term mental health consequences of female versus male perpetrated child sexual abuse. Child Abuse & Neglect, 143, doi: 10.1016/j.chiabu.2023.106240

Hailes, H.P., Yu, R., Danese, A., & Fazel, S. (2019). Long-term outcomes of childhood sexual abuse: An umbrella review. Lancet Psychiatry, 6, 830-839.

Lawrence, D.M., Hunt, A., Mathews, B., Haslam, D.M., Malacova, E., Dunne, M.P., Erskine, H.E., Higgins, D.J., Finkelhor, D., Pacella, R.E., Meinck, F., Thomas, H.J., Scott, J.G (2023). Association between child maltreatment and health risk behaviours and conditions throughout life: The Australian Child Maltreatment Study. Medical Journal of Australia, 218 (6 Suppl), S34-S39.

Marshall, C., Fernet, M., & Langevin, R. (2022). Intergenerational continuity of child sexual abuse: Comparison of mother and emerging adult dyads. Journal of Child Sexual Abuse, DOI: 10.1080/10538712.2022.2147888

Nagtegaal, M.H., & Boonmann, C. (2021). Child sexual abuse and problems reported by survivors of CSA: A meta-review. Journal of Child Sexual Abuse, DOI: 10.1080/10538712.2021.1985673.

Ochoa, M.K., & Constantin, K. (2023). Impacts of child sexual abuse: The mediating role of future orientation on academic outcomes. Child Abuse & Neglect, doi: 10.1016/j.chiabu.2023.106437

Papalia, N.L., Luebbers, S., Ogloff, J.R.P., Cutajar, M., & Mullen, P.E. (2017). The long term co-occurrence of psychiatric illness and behavioural problems following child sexual abuse. Australian & New Zealand Journal of Psychiatry, 51(6), 604-613.

Papalia, N., Mann, E., & Ogloff, J.R.P. (2020). Child sexual abuse and risk of revictimization: Impact of child demographics, sexual abuse characteristics, and psychiatric disorders. Child Maltreatment, DOI: 10.1177/1077559520932665

Papalia, N., Ogloff, J.R.P., Cutajar, M., & Mullen, P.E. (2018). Child sexual abuse and criminal offending: Gender-specific effects and the role of abuse characteristics and other adverse outcomes. Child Maltreatment, 23(4), 399-416.

Scott, J.G., Malacova, E., Mathews. B., Haslam, D.M., Pacella, R., Higgins, D.J., Meinck, F., Dunne, M.P., Finkelhor, D., Erskine, H.E., Lawrence, D.M., & Thomas, H.J. (2023). The association between child maltreatment and mental disorders in the Australian Child Maltreatment Study. Medical Journal of Australia, 218 (6 Suppl), S26-S33.

Tonmyr, L., & Shields, M. (2017). Childhood sexual abuse and substance abuse: A gender paradox? Child Abuse & Neglect, 63, 284-294.

Townsend, N., Loxton, D., Egan, N., Barnes, I., Byrnes, E., & Forder, P. (2022). A life course approach to determining the prevalence of sexual violence in Australia: Findings from the Australian Longitudinal Study on Women’s Health. ANROWS Research Report, Issue 14. Sydney: ANROWS.

Turner, S., Taillieu, T., Cheung, K., & Afifi, T.O. (2017). The relationship between childhood sexual abuse and mental health outcomes among males: Results from a nationally representative United States sample. Child Abuse & Neglect, 66, 64-72.