Child Sexual Abuse as a Unique Risk Factor for the Development of Psychopathology: The Compounded Convergence of Mechanisms

Abstract

Meta-analytic, population cohort, prospective, and clinical studies provide systematic evidence that child sexual abuse accounts for unique variation in several deleterious outcomes. There is strong evidence for psychiatric disorders, including posttraumatic stress disorder and mood, anxiety, and substance use disorders, and mixed evidence for personality disorders. Evaluation of sex-specific outcomes shows strong evidence for teenage childbearing, sexual revictimization, and sexual dysfunction and mixed evidence for heightened sexual behaviors and sexual offending. This review further demonstrates not only that survivors suffer the noxious impact of traumatic sexualization but that additional transdiagnostic mechanisms, including the biological embedding of stress, emotion dysregulation, avoidance, and insecure attachment, converge to compound risk for deleterious outcomes. A road map to enhance the rigor of future research is outlined, and specific recommendations for evidence-based policy making to boost prevention efforts and increase access to treatment are discussed. Expected final online publication date for the Annual Review of Clinical Psychology, Volume 17 is May 2021. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

Childhood Sexual Abuse and Exposure to Peer Bullying Victimization

“…This study found that CSA-exposed females were more likely to experience cyberbullying and combined cyber/in-person bullying compared to females with no CSA-exposure. This is somewhat unsurprising given prior research has found that maltreated females have a higher propensity to create high-risk social networking profiles (i.e., oversharing, provocative profile picture, references to drug or alcohol use, and use of profanity) (Noll et al, 2013), which may be more common among those with CSA-exposure due to the unique effect of CSA on traumatic sexualization and insecure attachment (Noll, 2021). These high-risk profiles combined with lower cognitive abilities (Noll et al, 2013) and reduced social skills (Noll, 2021) might make these females particularly vulnerable to cyberbullying by peers where social media savviness is considered a social currency, particularly among adolescent girls (Geyer, 2009).…”

“…An estimated 15% of females and 8% of males have experienced childhood sexual abuse (CSA) worldwide (Barth et al, 2013). CSA is uniquely associated with reduced psychosocial, psychiatric, and physical wellbeing (Hailes et al, 2019; Noll, 2021) and increased rates of exposure to additional forms of victimization (Lacelle et al, 2012; Lereya et al, 2015). To date, few studies have examined how CSA victimization is associated with bullying victimization by peers.…”

Trauma Chronicity and the Long-Term Needs of Childhood Sexual Trauma Survivors

“…We also did not assess other types of traumas that co-occur with CST or in addition to CST events. However, prior work has found CST to have more robust [24,43,71,99] or unique relationships to AAOs [15,25,100] compared to other types of traumas (e.g., physical abuse, psychological abuse, and neglect). Furthermore, there may be physical and/or psychological elements of CST experiences which contribute to the observed effects.…”

Linking Salience Signaling With Early Adversity and Affective Distress in Individuals at Clinical High Risk for Psychosis: Results From an Event-Related fMRI Study

“…Childhood trauma exposure represents a promising area of inquiry in this context. Early-life adversity is among the most potent risk factors for affective and psychotic disorders 46 , 47 and impacts multiple aspects of salience processing, including the signaling of signed 48 , 49 and unsigned PEs 50 and the ability to learn from previously rewarded outcomes. 51 Importantly, the amygdala and insula are among the structures most commonly implicated in studies of trauma-related brain changes.…”