SUMMARY PAPER



Consequences of Sexual Abuse: The Adolescent Repercussions


by Wantan A. Student


Human Development 1500
Tom Day
15 December 1998

Abstract
Sexual abuse is a confusing, frightening, and frequently devastating experience for a child. They are robbed of, at the very least, their innocence and security. Sadly, as these children become adolescents, this experience also affects their self-image, happiness, ability to cope, mental state, and desire to live.
Psychiatric studies frequently address the consequences of sexual abuse, and three have been selected for this paper.
The first study addresses adolescents who developed mental health problems following sexual abuse, and examines the gender differences among them. These adolescents were closely paired with a control group of adolescents who had not experienced any sexual abuse.
The second study is a longitudinal study of victims of sexual abuse, and focuses on the follow-up study that took place 5 years after the children received initial treatment for sexual abuse. Predetermined potential predictors were evaluated in relation to changes in the adolescents.
The third study examines adolescents admitted to psychiatric facilities with serious suicidal behavior, and assesses whether a history of physical and/or sexual abuse would increase the likelihood of this behavior. It also explores the degree of severity of sexual abuse and the adolescents' use of coping techniques.
Finally, I will review my findings, compare the three studies, and draw my conclusions. I
hope to gain insight into the struggles that plague young victims of sexual abuse.
First Study:

Sex Abuse and Gender Differences

Garnefski, Nadia, M.Sc. and Rene F.W. Diekstra, Ph.D. (1997). Child Sexual Abuse and Emotional and Behavioral Problems in Adolescence: Gender Differences. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 323-329.

The objective of this cross-sectional, self-report study was to compare sexually abused (SA) adolescent boys and girls with non-sexually abused (NSA) adolescent boys and girls and determine the occurrence of mental health problems and collect data concerning these problems.
The authors began with a sample of 15,245 adolescents from 212 randomly selected schools in the Netherlands. They took a subset of 1,490 Dutch students, aged 12-19 years. At least one incident of sexual abuse was reported by 745 students. Using the original population, the authors matched each SA student with a NSA student. The matching guidelines were age and sex.
Between October 1992 and January 1993, each selected student filled out a self-report questionnaire during school hours under teacher supervision. There was a question assessing previous sexual abuse, the independent variable. Ten behavioral and emotional problem areas were condensed into four problem categories that served as dependent variables: (1) aggressive/criminal behavior, (2) addiction-risk behaviors, (3) suicidality, and (4) emotional problems.
The findings revealed that, in comparison to their NSA counterparts (compared by gender), SA girls were 2.5 times as likely to have emotional problems or aggressive/criminal behavior, 2.3 times as likely to have addiction-risk behavior, and 4.8 times as likely to have suicidal thoughts or behavior. SA Boys, when compared to NSA boys, were 5.9 times as likely to have emotional problems, 1.7 times as likely to have aggressive/criminal behavior, 1.6 times as likely to have addiction-risk behavior, and 10.8 times as likely to have suicidal thoughts or behavior. In addition, 65.3% of SA boys reported problems in two or more categories, compared to 37.9% of girls.
Second Study:

Five Years After Child Sexual Abuse


Tebbutt, Jennifer, B.Sc., M.P.H., Heather Swanston, B.Sc., R. Kim Oates, M.D., M.P.H, and Brian I. O'Toole, B.Sc., Ph.D., M.P.H. (1997). Five Years After Child Sexual Abuse: Persisting Dysfunction and Problems of Prediction. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 330-339.

This longitudinal interview study's assessed sexually abused children five years after they were sexually abused. Changes in behavior, depression, and self-esteem (dependent variables) were evaluated, and possible predictors of these changes (independent variables) were examined.
Sexually abused children who attended the Child Protection Units at two Sydney, Australia metropolitan hospitals were recruited between 1988 and 1990. They were 62 girls and 22 boys, ages 5 to 15, and all were free from serious developmental delays. Five years later, the follow-up research was conducted (parents of 16 children either declined the follow-up or were not available).
Children and parents were interviewed separately by either Jennifer Tebbutt or Heather Swanston. Almost all of the two-hour interviews (92%) took place in the homes of the interviewees. Factors that might potentially affect depression, self-esteem, and behavior (such as family functioning, contact with the abuser, abuse prior to intake, and treatment) were examined.
Concerning depression and self-esteem, the variables associated with change were age, negative life events, and further contact with the abuser. Older sexually abused children were more prone to high depression and low self-esteem at the follow-up. Any contact at all with the abuser and negative life events produced the same results. Treatment appeared to have no effect on depression or self-esteem. Increased behavior problems were predicted by recent life events and poor family functioning at intake. Children who were sad, depressed, or suffering from low self-esteem at the time of abuse were likely to have ongoing problems in these areas.
Third Study:

Child Abuse and Suicidal Behavior

Cohen, Yifat, Anthony Spirito, Cheryl Sterling, Deidre Donaldson, Ronald Seifer, Barry Plummer, Ruscinda Avila, and Kathy Ferrer. (1996). Physical and Sexual Abuse and their Relation to Psychiatric Disorder and Suicidal Behavior among Adolescents who are Psychiatrically Hospitalized. Journal of Child Psychology and Psychiatry and Applied Disciplines, 37, 989-993.

This study's objective was to determine if subjects with a history of physical and/or sexual abuse (independent variable) had a higher rate of suicidal behavior (dependent variable), and if the severity of sexual abuse was related to the severity of psychiatric problems (dependent variable).
Thirty-two male adolescents and 72 female adolescents who had been admitted to an inpatient psychiatric facility in the United States participated in the study. Participants were admitted for serious psychiatric disturbances (e.g. suicidality, depression) and ranged in age from 12 to 18 years. It was determined if the participants had been victims of sexual abuse, physical abuse, or both. Twelve males and 25 females had not been victims of abuse.
Data was collected from participants and their parents on diagnosis, hopelessness, depression, self-concept, coping, and overall behavior. All but the diagnosis were obtained by self-report. Diagnosis was performed by inpatient team through observation and interview.
The study showed that abuse history was not a risk factor, in this group, for suicidal behavior. It was speculated that all participants were reacting to negative life experiences, regardless of abuse, which may have created a ceiling effect. However, severe sexual abuse, or a history of both sexual and physical abuse, was a predictor for use of more negative coping strategies. Because of the unequal numbers of males and females, this study did not account for gender differences. Consequently, the authors acknowledge that while their study didn't show higher suicide rates for sexually abused girls, that finding contradicts other studies.


General Summary & Synthesis:

The most apparent conclusion I can draw from the above studies is that sexual abuse creates a host of problems for its victims. All three studies relied largely on self-report methods from the adolescents themselves, which might create doubt when considering the adolescent personal fable (the extreme highs and lows of this stage might cause the participants to exaggerate their struggles). However, Garnefski & Diekstra's study that showed the greatest consequences of abuse was the same study that compared the sexually abused participants to non-sexually abused students living primarily non-traumatic lives (even if they were exaggerating, they reported far fewer problems than the abused adolescents).
The common threads for all abused children in all three studies seemed to be depression, low self-esteem, and suicidal behavior. The longitudinal study conducted by Tebbutt et al. found that depression and low self-esteem persisted after 5 years, particularly in children that were older when the abuse occurred (suicidal behavior was not evaluated). Cohen et al. speculated that suicidal behavior is not a problem unique to sexual abuse, but rather a result of negative life experiences. This does not, however, make it any less significant in the life of an abused adolescent.
I have always been aware that sexual abuse has a negative effect on its victims, but I always assumed the repercussions were primarily associated with interpersonal relationships. These studies have definitely shown I was wrong, or at least not entirely right!
References

Garnefski, Nadia, M.Sc. and Rene F.W. Diekstra, Ph.D. (1997). Child Sexual Abuse and Emotional and Behavioral Problems in Adolescence: Gender Differences. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 323-329.

Tebbutt, Jennifer, B.Sc., M.P.H., Heather Swanston, B.Sc., R. Kim Oates, M.D., M.P.H, and Brian I. O'Toole, B.Sc., Ph.D., M.P.H. (1997). Five Years After Child Sexual Abuse: Persisting Dysfunction and Problems of Prediction. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 330-339.

Cohen, Yifat, Anthony Spirito, Cheryl Sterling, Deidre Donaldson, Ronald Seifer, Barry Plummer, Ruscinda Avila, and Kathy Ferrer. (1996). Physical and Sexual Abuse and their Relation to Psychiatric Disorder and Suicidal Behavior among Adolescents who are Psychiatrically Hospitalized. Journal of Child Psychology and Psychiatry and Applied Disciplines, 37, 989-993.