Trafford Strategic Safeguarding Partnership

Impact of child sexual abuse

The Centre for expertise on child sexual abuse (CSA Centre) undertakes original research and practice improvement activities, and seeks to translate academic evidence into helpful, practical knowledge.

We recognise that the issue of child sexual abuse receives limited attention in current social work education and training, and are working closely with organisations such as Community Care Inform and a number of local authorities to improve professional development in this area.

This practice briefing provides a brief overview of some key issues that practitioners may want to consider when thinking about the impact of child sexual abuse. It includes references to research which may help social workers improve their understanding and practice.

* The terms practitioner and professional are used interchangeably throughout this paper

Contents

1. Assessing the impact of child sexual abuse

2. Impact on the individual

  • Male and female victims and survivors

3. Impact on others

  • Non-abusing parent(s)/carer(s)
  • Non-abused, non-offending siblings
  • ‘Whole-family approach’

4. The practitioner’s role

1. Assessing the impact of child sexual abuse

Assessing the impact of child sexual abuse (CSA) is both complex and challenging. This is partly because CSA is frequently perpetrated in the context of other abuses and adverse environmental factors (such as parental separation, financial problems and parental substance misuse), so that confidently identifying which experience relates to which symptom is inherently problematic.

Additionally, victims and survivors of CSA are not a homogeneous group; the impact of CSA on victims and survivors can vary greatly between individuals, and between groups of people (such as male and female victims).

It is worth noting that not all victims of CSA will go on to experience long-term effects in their adult life, although a CSA survivor who has not experienced difficulties to date may still do so at some point in the future.

For the many victims and survivors of CSA who do experience adverse outcomes, the recent review and synthesis of research by the Independent Inquiry into Child Sexual Abuse (IICSA) comprehensively highlights the impact of CSA on the individual, across the life course and through the full spectrum of their personal relationships (family, intimate and professional).

For every individual victim and survivor, there is a set of individual circumstances and contexts which need to be considered: it is their experiences and stories we should ultimately listen to.

Nevertheless there is an abundance of research in the field, spanning many decades, where common effects have been recorded and reported by victims and survivors of CSA. The next section will provide an overview of some of the most commonly shared outcomes.

Contributory factors

Many factors influence the level of impact experienced by victims and survivors of CSA, including the family context (supportive, caring and trusting versus unsupportive, neglectful and chaotic2) and the response received upon disclosure or the discovery of abuse.

The severity of the abuse is also likely to influence the long-term effects of CSA felt by victims and survivors, although it is important to recognise that CSA should never be thought of as mild or non-traumatic. Severity in this regard is ‘complexly influenced by a number of other factors’ including:

  • the type of abuse (contact, non-contact/penetrative, non-penetrative etc);
  • the victim’s relationship to the perpetrator;
  • the victim’s age when the abuse started;
  • the duration of the abuse (the time between its starting and ending);
  • the level of force and coercion used;
  • the frequency of the abuse.

The closeness of the relationship of the person responsible for the abuse to the victim often influences other factors, such as the age the abuse starts, the level of threat and violence used and the duration of the abuse. For example, the sexual abuse perpetrated by a biological father against his daughter is usually associated with less physical force, takes place over a longer time period, and generally starts much earlier in the victim’s life (Trickett et al., 1997, cited in Putman, 2003).

Other factors, unrelated to severity, can be equally traumatic and have consequences just as long-lasting. For example:

  • Online, non-contact sexual abuse, such as the production (including self-production) of indecent images, is frequently viewed as less significant or severe as contact sexual abuse; however, the permanency of the indecent images, the blurred boundaries of consent (in the case of peer-on-peer abuse), the associated guilt and the constant threat of exposure and vulnerability to further exploitation may add a further dimension to the abuse’s psychological impact.

2. Impact on the individual

One of the most recognisablemodels in relation to the impact of CSA is Finkelhor and Browne’s (1986). It suggests that victims and survivors are likely to experience four outcomes:

  1. traumatic sexualisation (the inappropriate development of sexuality, knowledge, feeling and attitudes to sex);
  2. betrayal (related to the harm caused by the perpetrator’s position of trust in relation to the child);
  3. powerlessness (related to the child’s will being frequently contravened);
  4. stigmatisation (related to the shame and/or guilt associated with CSA).

This model is applicable across all types of CSA, including child sexual exploitation, institutional sexual abuse as well as online, non-contact sexual abuse – which has been found to be as impactful on victims and survivors as ‘offline-only’ CSA. However, the intensity of the relationships and the context in which the abuse takes place can mean that intra-familial CSA has the most harmful impact under the model.

CSA is also associated with other adverse effects over the life course, including:

  • physical health problems, (irritable bowel syndrome, gynaecological symptoms, headaches, backaches, heart disease and obesity);
  • mental health difficulties (which may present themselves as internalising behaviours);
  • alcohol abuse and substance misuse (which may present themselves as externalising behaviours);
  • relationship difficulties (across the spectrum, including intimate relations, family networks and professional relationships);
  • sexual abuse revictimisation (in which being victim to CSA increases the risk of adulthood victimisation)

Consequential impacts on other areas of a person’s life may include homelessness, low educational attainment and higher likelihood of unemployment.

It should again be stressed that assessing the impact of CSA is not a simple process, and the effects of abuse may not be apparent at any particular life-stage. Individual victims and survivors vary in regard to when and how, if at all, past trauma manifests itself. Furthermore, individuals express their trauma or distress in response to CSA in different ways. These include various non-verbal actions including externalising behaviours (substance misuse, offending and ‘risky’ sexual behaviour) and internalising behaviours (self-harm, depression and other PTSD symptoms). Such maladaptive coping mechanisms should be considered as a form of communication, a way of telling the outside world that something is wrong. When we come across these behaviours we should consider whether trauma of any kind, including sexual abuse, has occurred.

Although research shows that some specific impacts of CSA are more likely to be observed in certain groups than in others, we must bear in mind the pervasive impact of CSA across all aspects of a person’s life and throughout the life course – and must not subscribe to stereotypical symptoms of CSA – if we are to reduce the risk of misinterpreting possible indicators of current or past CSA. This point is illustrated below with regard to the impacts of CSA on male and female victims and survivors.

Male and female victims and survivors.

It is important to note that men and women are vulnerable to experiencing broadly the same adverse effects2; however, males are more likely to experience difficulties related to sexuality, gender identity and expressions of masculinity. Furthermore, ‘cycle of abuse’ stereotypes can put males at increased risk of believing that their personal experience of CSA will potentially lead them to display harmful sexual behaviour themselves. Not only is this belief largely unsupported in research, with other factors such as experience of physical abuse being much stronger indicators, it also silences many men from disclosing their experiences of abuse because they fear being considered a risk to children.

However, individuals’ reactions to CSA may be influenced by their age, ethnicity, cultural and family background in addition to their gender.This is a crucial point, as the behaviours a person presents with directly influence the response they receive, from their family or carers but also, importantly, from professionals.

Case study one

Olivia is five years old. Recently she has started to display overtly sexualised behaviour in school, touching herself under her clothes. It is also reported by the classroom teaching assistant (TA) that she explicitly comments on and tries to touch boys’ private parts during playtimes. The TA feels that Olivia’s comments and actions demonstrate an inappropriate level of sexual knowledge for her age.

Reflection Point::

Based on the above information, what would be the most likely course of action taken and why?

 

Case study two

Dylan has just turned 15 years old. His school has reported concerns for Dylan over the past few years, owing to a deterioration in his behaviour and frequent aggressive outbursts. The school has previously tried to engage Dylan’s family but reports that his home life appears chaotic, which has stopped any meaningful work taking place. Before the summer break, Dylan stole a teacher’s handbag and purse; when caught and confronted, he threatened the staff member. More recently, the school reports that Dylan is displaying overtly sexually harmful behaviour towards both female staff members and pupils. The school feels that it can no longer cope with his behaviour.

Reflection Point::

Based on the above information, what would be the most likely course of action taken and why?

 

It is likely that Olivia would receive a referral to social care regarding concerns of potential CSA. In relation to Dylan, it is unlikely that he would be considered a potential victim of CSA. It is more likely that he would receive either a criminal justice response or an intervention to reduce the risk he poses (sexually or criminally). It may even be possible that Dylan does not meet the threshold for social care intervention.

Both case studies highlight similar externalised behaviours which are recognised as possibly indicating CSA. When considering Dylan’s circumstances, we perhaps view him as less vulnerable owing to his age and gender, even though there are multiple indicators that he is being or has been harmed.

The case studies show that, rather than relying solely on the obvious indicators of CSA, it is incumbent upon us as practitioners to pick up on non-verbal indicators such as displays of harmful sexual behaviour.

 

3. Impact on others

The trauma that CSA can cause affects not only the individual: those close to them often experience the repercussions too. The literature relating to this aspect of CSA – the bulk of which focuses on the non-abusing parent, and predominantly non-abusing mothers – is less well-established, but closely reflects the potential outcomes faced by victims and survivors.

There are significant gaps in our knowledge regarding the impact of CSA on the individual’s other relationships, including those with intimate partners, non-abusing fathers, other caregivers and siblings. Further research in this area will contribute to the overall support and recovery of all those who are affected by CSA.

As is the case with the victims and survicors of CSA themselves,, it difficult to confidently state how a particular outcome experienced by those close to them relates to a specific cause. Additionally, not all non-abusing mothers or close relations will experience the effects listed below.

Non-abusing parent(s)/carer(s)

The significance of the relationship between a victim or survivor of CSA and their non-abusing parent(s) or carer(s) – both before and after abuse or disclosure – cannot be overstated. A positive relationship to a primary carer and a ‘happy’ home environment can build resilience in the first instance, and the response of the non-abusing parent(s) following the discovery of abuse is critical for both the child’s self-perception and their subsequent recovery. On discovery or disclosure (including non-verbal) of CSA, the role of the non-abusing parent(s) is twofold: to manage the effects on the child, and to manage their own distress. Potential impacts of CSA on non-abusing parent(s) include:

  • relationship difficulties (difficulties with trusting other adults, changes in the parent-child relationship);
  • internalising impacts (self-blame, emotional distress, bereavement and loss);
  • socio-economic impacts (difficulties at work, difficulties in family and social life)
  • secondary or vicarious trauma (emotional distress and trauma symptoms owing to the proximity of the abuse)

It should also be borne in mind that, at the time when the victim’s emotional wellbeing and mental health may be compromised, the parent or carer may experience difficulties in these areas too. This is where professional interventions and reassurances can really support families navigating their way through these challenging times.

Non-abused, non-offending siblings

There is a paucity of published research into the impact of CSA on ‘non-abused, non-offending siblings, but this is an important area to consider when thinking about the impact of CSA. A recent academic review (2016) highlighted the need for further research in relation to siblings of victims and survivors of CSA.

From the limited literature available, it would appear that siblings can experience similar outcomes to the victim or survivor with regard to internalising and externalising behaviours, they may also experience feelings of ‘guilt, anger and confusion’ as well as being affected by the emotional distress and turmoil experienced by other non-offending/ non-abused household members.

‘Whole-family approach’

From the limited research to date, it appears that the effects of CSA are frequently felt by close family members. These effects may mirror those felt by the individual who has been abused, including trauma symptoms.

Professional support and interventions at this point may be key to the recovery of the victim or survivor. Following the discovery or disclosure of CSA, practitioners should adopt a ‘whole-family approach’, supporting the adults in the family home to create as supportive and reassuring a home environment as possible. This may include signposting to relevant services  for other family members too.

Without support and guidance, family members often find their internal resources depleted. This can add to the strain and tensions in the home, further exacerbating the support needs of the victim or survivor of abuse, and reducing their potential to recover from the abuse (cited in 2 – page 143 – as ‘933 Breckenridge and Flax (2016) op.cit. Jobe-Sheilds et al (2016).

4. The practitioner’s role

Practitioners’ work with victims and survivors of CSA (including suspected victims and survivors) can, if carried out in an informed manner, have a direct positive impact on their recovery. Practitioners’ actions and the support they offer may influence an individual’s entire life course.

Detailed consideration of the practitioner’s role is outside this briefing’s remit, but as practitioners we can educate ourselves further regarding the impact of CSA – by reading more widely, attending additional training, signing up to the CSA Centre’s mailing list, or watching YouTube videos by credible organisations or experts in this area (including experts by experience). Even small changes in our thinking and practice can make a significant difference – for example, acknowledging that:

  • CSA has diverse effects on individuals (prompting both internalising and externalising behaviours);
  • gender, age, cultural and ethnic backgrounds may influence how individuals communicate their distress and trauma – if we do not recognise this, we may miss whole swathes of individuals who have been sexually abused;
  • some trauma-related behaviours (including sexually harmful and sexual risky behaviour) should, in the first instance, be considered as potential adaptive responses to trauma and/or CSA;
  • CSA impacts on all household members;
  • adopting a whole-family approach is vital if supporting the recovery of the young person who has been abused is the principle reason for your intervention.

Practice principles - the survivor’s voice

As emphasised through this briefing, the impact of CSA will be different for every victim and survivor and those close to them. With this in mind, it is appropriate to end this practice briefing with the ‘survivor’s voice’. The nine practice principles below have been adapted from survivor-led research in Canada, and are applicable to all areas of frontline practice.

  • Respect – CSA can often leave individuals feeling ‘diminished as human beings’, so respect should form the basis of working relationships.
  • Taking time – taking time, as far as possible, and valuing the time spent with survivors can foster an environment of safety and care.
  • Rapport – focusing on building rapport as an objective in itself may increase an individual’s sense of safety and facilitate open communication.
  • Sharing information – being clear about the different purposes and remits of the sessions and meetings, and the professionals encountered at them, is vital to ensure that survivors know what to expect and are prepared.
  • Sharing control – one of the features of CSA is the loss of control, so sharing control and giving up control can support the developing relationship and recovery.
  • Respecting boundaries – this is linked to previous principles, but emphasising the need to respect both physical boundaries and boundaries regarding the topics discussed.
  • Mutual learning – being aware that both the practitioner and the survivor are learning about one another, and aware of the individual nature of CSA for this particular person.
  • Understanding non-linear healing – recognising that recovery from CSA is not a linear process, and so it is normal and to be expected for a survivor’s response to vary from day to day, week to week or year to year.
  • Demonstrating an understanding of CSA – being explicitly clear that practitioners and organisations are aware of CSA and can either provide support directly or signpost to a relevant service. (This can be achieved verbally and/or via posters and other visible media; male-specific advertising may also be necessary.)