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.

Keywords: biological embedding; sexual abuse; systematic review; traumatic sexualization.

Figure 1

The CCM model of the risk that CSA confers on psychiatric disorders and sex-specific outcomes. Lower risk is associated with singular or independently occurring mechanisms; higher risk is associated with multiple or co-occurring mechanisms. Single asterisks indicate mixed or moderate evidence for CSA elevating risk; double asterisks indicate strong evidence for CSA elevating risk. Abbreviations: CCM, Compounded Convergence of Mechanisms; CSA, childhood sexual abuse; PTSD, posttraumatic stress disorder; STI, sexually transmitted infection.