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Impact of Sexual Abuse on Victims

Anna C. Salter, Ph.D.

Effects of Sexual Abuse

Lasting psychological injury . . . is not very common. (Brunold, 1964, p. 8) Brunold,

Effects of Sexual Abuse

Relatively minor effect on adult adjustment. (Gagnon, 1965, p. 177)

Effects of Sexual Abuse

Diminishes the subjects chance of psychosis and allows better adjustment to the external world. (Rascovsky & Rascovsky, 1950, p. 45) Rascovsky,

Effects of Sexual Abuse

May be either a positive, healthy experience of, at worse, neutral and dull. (DeMott, 1980) DeMott,

Children Not Severely Damaged by Incest with a Parent



Setting Fires Vandalism Disrupting Other Children Stealing Aggression Against Girls

Sexually Abusing Boys  Exhibitionism  Fearing Calamity  Suicidal Ideation  Manipulative and Smooth (Yorukoglu & Kemph, 1966)

Impact of Child Sexual Abuse


10 Retrospective Studies
Revealed abuse to anyone as children 1/3 Cases reported to authorities 10% - 18% (London et al., 2005)

Percentage of Sexual Abuse Reported to Authorties

6 to 12% (Elliott, 1993; Russell, 1984; Saunders et al., 1992; Smith et al., 2000)

Delayed Disclosure of Childhood Rape

N = 388

W/in 24 hours > 5 years Never before survey

18% 47% 47% 28% 28%

(Smith et al., 2000)

Delayed Disclosure
N = 156 < One Week < One Year

24% 21% 17%

Five Years Never

39% (Sauzier, 1989)

Percent Who Never Disclosed

22% 28% 31% 33% 46%

Bottoms et al., 2007 Smith et al., 2000 Arata, 1998 Arata, Finkelhor et al., 1990 Ussher & Dewberry, 1995

39% Never told anyone as children (OLeary et al., 2010)

Progressive Disclosure

Elliott & Briere 1994

N = 118 External evidence of abuse Perpetrator confession Witness Pornographic pictures

Elliott & Briere 1994

Many children initially disclosed only fondling Later penetration

Partial Disclosure

21 studies of children with gonorrhea gradual disclosure common (Lyon, in press)

(Elliott and Briere, 1994)

When Did Child Rarely Disclose

Natural Parent Never Later Immediately 55% 30% 17%

Short Vs. Long Delays


Long 5% 48%

Strangers Related to Victim

22% 22% 24% 24%

(Smith et al., 2000)

Children Who Deny

Less likely to disclose the closer the relationship (DiPetro et al., 1997; Smith et al., 2000)

Family Members as Perps

Lower rates or Longer delays (Goodman(Goodman-Brown, et al., 2003; Hershkowitz et al., 2005; Sjoberg & Lindblad, 2002; Lindblad, Smith et al., 2000)


Adolescents abused for the first time as adolescents more likely to disclose than younger children Disclose first to another adolescent (Olafson & Lederman, 2006)

Whom They Told

Mother Best Friend No one

21% 21% 23% 28% (Smith et al., 2000)

Whom They Told Mattered

Children who disclosed to someone other than mother Poorer mental health (Ruggiero et al., 2000)

Response of Mother
Mothers who believed and supported Children had fewer mental health problems (Browne & Finkelhor, 1986; Luster & Small, 1997; Merrill et al., 2001)

Response of Listener
If person disclosed to tells someone else without permission Children have more mental health problems (Gold, 1986; OLeary, 2010)

Cases where offender confessed 24.5% recanted fully or partially (Malloy, Lyon, Quas, & Forman, 2005) Quas,

Predictors Lack of maternal support Abuse by male caretaker

Impact of Disclosure
Adolescents and children who disclosed Greater psychological distress Than those who didnt (Feiring et al., 2002; OLeary et al., 2010)

Impact of Disclosure
Adolescents who disclosed Felt less supported Perceived others reactions as negative Blamed selves for abuse (Feiring et al., 2002)

Discussion of Abuse
Those who discussed abuse Not just disclosed Within one year of abuse Better mental health (OLeary et al., 2010)

Fantastic Elements in Disclosures

Gold Standard Perpetrator Confessed Medical Evidence Consistent Persuasive evidence, e.g. Eyewitness (Dalenberg, 1996) Dalenberg,

Fantastic Elements in Disclosures

Severe Abuse Perpetrator Family Member Force or Threat Repeated Molestation Intercourse or Oral-Genital Oral(Dalenberg, 1996) Dalenberg,

Fantastic Elements in Disclosures

Accounts with Fantastic Elements Severe Gold Standard (52) 15% Nonsevere Gold Standard (8) 2% Nonsevere Questionable (90) 0% Severe Questionable (52) 4% (Dalenberg, 1996) Dalenberg,

Cognitive Distortions of Sadistic Offenders

This child is bad, evil, sick or perverted. She deserves it.

Cognitive Distortions of Sadists

I think young girls and boys are meant to be sex slaves or sex playthings for adults. (Sex offender letter to another pedophile -in reality, a federal marshal in a sting operation.)

Type of Offender
Emotional Visibility? Emotional Invisibility? Where Does Safety Lie?

Sequelae of Sexual Abuse

PTSD  Depression  Anxiety Disorders  Dissociation  Sexual Problems  Re-Victimization Re Affective Flashbacks

PostPost-Traumatic Stress Disorder

Intrusive Symptoms Avoidant Symptoms Arousal Symptoms

Intrusive Symptoms
Intrusive Memories Affective Flashbacks Physical Responses to Triggers Nightmares



Smell of aftershave Footsteps on the stairs Alone in the room with a male Bathroom Dental appointments

Avoidant Symptoms
Refusal to talk or think about abuse Avoidance of reminders Numbing PostPost-traumatic decline


Arousal Symptoms

HyperHyper-startle Lack of concentration Irritability Difficulty sleeping

Correlates of PTSD in Rape Victims

Life Threat Physical Injury Completed Rape 8.5 x (Kilpatrick et al., 1989)

Characteristics of Assault
% 29 58 69 79


Rape Alone Rape/Physical Injury Rape/Life Threat Rape/Injury/Life Threat

(Kilpatrick et al., 1989)

PTSD in Adults Exposed to Violence as Adults

Risk of severe PTSD higher if also sexual abuse after 12 Risk of depression higher if also sexual abuse before 12 (Schoedl et al., 2010)

Sequelae of Sexual Abuse

PTSD  Depression  Anxiety Disorders  Dissociation  Sexual Problems  Re-Victimization Re Affective Flashbacks

Home Grown Solutions to Chronic Pain

Drug Addiction - Prostitution  Alcoholism  Cutting  Suicidality  Crisis addiction

Types of Coping
Avoidant Most common Related to severity of abuse Practical in short-term shortBad outcomes in the long-term long-

Active Coping
Proactive coping  Behavioral changes  Cognitive reframing  Support-seeking Support Self-acceptance Self

Decreased symptoms (Phanicbrat & Townshend, 2010)

Affective Sequelae

Affective Flashbacks Secondary to Cognitions Internalizing Sex Offender Thinking Errors TraumaTrauma-Based World View

Secondary to Current Realities

Implicit Versus Explicit Denial

Contact with Offender

Court appearances  Supervised visitation  Apology sessions  Unsupervised visitation  Reunification

Blame is Not the Only Issue

Powerlessness Loss of agency Loss of faith in ability to control fate External locus of control View of world as malignant

Affective Sequelae

Affective Flashbacks Secondary to Cognitions Internalizing Sex Offender Thinking Errors TraumaTrauma-Based World View

Secondary to Current Realities

Nontraumatized Beliefs

I have a guardian angel that looks after me. Everything happens for a reason. Things turn out for the best.

Positive Illusions

Matlin & Stang. Stang. The Pollyanna Principle. 1978 Summarized over 1000 studies

NonNon-Traumatized Beliefs
Above average Things will work out Underestimate chances of negative events Overestimate chances of positive events Overestimate personal efficacy



Rated Selves More Positively than Peer of Same Sex and Age 87% (Taylor, Lerner et al., Submitted for Publication)

Ones Strengths

Important Rare

Ones Failings

Unimportant Common (Campbell, 1986; Marks, 1984)

Time is on Our Side

Poor Performance Remember as Better 20 Minutes Later (Greenwald, 1980)

Not Recent Phenomena

One month Rated mood each day compared to Own typical mood Almost everybody Typically happier than they typically are (Johnson, 1938)

Lifetime Probabilities of Experiencing Trauma


Fire Car wreck w/ injury Robbery Loved one die from homicide, suicide or accident 30 Some sort 69 (Norris, 1992)

% 10 23 25

TraumaTrauma-Based World View

Shattered Assumptions Belief in Personal Invulnerability Belief the World is Meaningful Belief in Personal Efficacy (Janoff(Janoff-Bulman, 1992)

FallFall-Out from Chowchilla Kidnapping

Massive interferences with Optimism & Trust (Terr, 1985) Terr,

FallFall-Out from Chowchilla Kidnapping

Age 9 Russians ruining ozone layer Everybody killed World end in 2000 Live in Mountains: Towns Not Safe

Age 10

FallFall-Out from Chowchilla Kidnapping

23 of 25 Afraid of the Future

TraumaTrauma-Based World View

Shattered Assumptions Belief in Personal Invulnerability Belief the World is Meaningful Belief in Personal Efficacy (Janoff(Janoff-Bulman, 1992)

World View and Sexual Abuse

When you get old, you die. I have grandparents who are sixty or sixty-nine sixtyand I dont think they are ready to die. But I sometimes think I am going to die sooner than other people I dont know why I think this. I think bad people will hurt me. I may be killed instead of dying. (Terr, 1990 p. 31) Terr,

Worse Outcome
Intrusiveness Injury Physical Violence (E.g., Banyard et al., 2004; Collings, 1995; Collings, OLeary, 2010)

Worse Outcome
Parent (Kendall(Kendall-Tackett, 1993)

Worse Outcome
More severe More frequent and longer lasting

(Banyard et al., 2004; Boudewyn & Liem, 1995) Liem,

Worse Outcome
Multiple abusers

(Briere & Runtz, 1988; OLeary et al., 2010) Runtz,

Sequelae of Sexual Abuse

ReRe-Victimization  PTSD  Depression  Anxiety Disorders  Dissociation  Sexual Problems  Affective Flashbacks


College is Risky
Some sort of sexual victimization 50% Attempted or completed rape 25% (Fisher et al., 2000; Koss et al., 1987)

Risk Recognition
Women abused as children 1) Less likely to recognize risky situations 2) Perceived fewer situations to be high risk 3) Stayed in risky situations longer (Soler-Baillo et al., 2005; Yeater et Soleral.,2010; )

Impact of Rape Myths

Women who accept rape myths Believed they were less vulnerable to rape & Viewed rape-related info as less relevant to rapethem (Bohner & Lampridis, 2004) Lampridis,


Internal My fault External Perpetrator fault Familys fault

Cost of Attributions
Internal Shame, guilt Withdraws from others Negative mental health outcomes Depression; suicidality, low self-esteem; selfinterpersonal problems; PTSD (Zinzow, 2010; Weiner Graham, 1999; Feiring et al., 2002)

Cost of Attributions
Perpetrator Blame Generally better outcomes (Feiring et al., 2002; Hoagwood, 1990; LevHoagwood, LevWiesel, 2000) But Anger, outrage, unjust world Helplessness

What Causes Internal Versus External Attributions?

More severe abuse (Duration, type, frequency) More physical force or coercion

internal external

(Chaffin et al., 1997; Hunter, et al., 1992; Wyatt & Newcomb, 1990; Zinzow et al., 2010)

Role of Age
Self Blame External Blame Older age of onset Younger age of onset (Zinzow et al., 2010)

Peer Abuse
More self blame Less family blame (Zinzow et al., 2010)