Effects of CSA

    The effects of child sexual abuse vary greatly depending on a number of different factors including the number of perpetrators, the nature of the relationship with the perpetrator, age of the victim, as well as the duration and severity of the abuse. Some survivors appear relatively unharmed and function well, but many survivors are affected in multiple ways. 5

Relevance to primary care providers

“The onus is on health professionals to increase their knowledge about the health effects of childhood sexual abuse and to create safe health care environments. To do otherwise breaches the ethical obligation to ‘do no harm’.” 12

  • Since 10-20% of men and 25% of women are survivors of childhood sexual abuse, health professionals in all specialties encounter survivors every day. 12
  • The mental health symptoms associated with childhood sexual abuse are significantly more likely to present in medical settings than in mental health settings. 14
  • Female survivors utilize the healthcare system more often and experience more medical interventions, such as surgery, than non-abused women. 15 16
  • Invasive tests or procedures may cause memories or unresolved anxieties to re-surface.
  • When these memories or overwhelming feelings emerge they are often caused by triggers, or certain aspects of treatment can cause recall (flashbacks or vague body memories) of past abuse. 2 13
  • Many aspects of healthcare can cause the survivor to re-experience the powerlessness and depersonalization reminiscent of previous abuse.6
  • Some survivors are fearful of seeking health care because it involves being touched, often in ways that are invasive or confining and remind them of past abuse. Many survivors avoid routine and preventive services, such as Pap smear testing, clinical breast examination, mammograms, and preventive dental care. 6
  • It is important for primary care providers to remember to refer these patients to therapists or counselors.

Survivors may experience:

  • Interpersonal problems, such as sexual dysfunction, difficulty with intimacy, parenting problems, or social isolation.
  • Sexual compulsivity, victim–perpetrator cycle, and poor academic performance 7
  • Chronic pelvic pain, chronic headaches, abdominal pain, sleeping problems, severe PMS, gastrointestinal and respiratory disorders 8
  • Patterns of self-abuse, such as alcohol or drug abuse/dependence, eating disorders, self-injuries, and suicide attempts 58 60
  • Fear of losing control, concerns with trust and safety, and ambivalence about the body 2
  • PTSD, depression, panic attacks, personality and dissociative disorders 9 10 11
  • Somatic complaints without organic cause, such as chest pain, throat pain, respiratory symptoms, musculoskeletal, and neurological symptoms 55 61
  • Survivors usually present with a generally higher level of stress than other patients and can have an astounding list of symptoms. 52

Consider a history of childhood sexual abuse with these medical diagnoses

  • Chronic Pain Syndrome 8 53
  • Chronic Pelvic Pain 54
  • Fibromyalgia 65
  • Irritable Bowel Syndrome 56
  • Headaches
  • Extreme obesity 57

Psychiatric diagnoses and symptoms more common among survivors

  • Depression
  • Anxiety
  • PTSD 59 52
  • Eating disorders in adolescence 58
  • Substance dependence/abuse 68 69 74
  • Dissociation 21 23 24 and dissociative identity disorder 52 70 For more about dissociation click here .
  • Somatization disorder 68 69
  • Borderline personality disorder 52 66 67

Being aware of the unique challenges that face CSA survivors and being comfortable addressing these issues has the potential to improve the quality of care for all women and men.