Childhood Sexual Abuse: A Mental Health Issue

Author: Canadian Mental Health Association, BC Division

Our experiences in childhood play a big part in shaping our health and well-being throughout our lives. Sexual abuse in childhood can leave scars that can last for a long time. But many cases are never reported.

Some people feel very scared about reporting abuse. They may feel embarrassed, guilty or ashamed. Some people blame themselves or believe that they deserved to be abused. Others report abuse, but they aren’t taken seriously or believed. Sexual abuse is a crime. It can have a large impact on health and well-being.

What is it?

Sexual abuse is any sexual contact between a child and an adult, or using a child for sexual purposes. It's often done by someone the child knows and trusts. In BC, a child is anyone under the age of 19.¹ Sexual exploitation is another form of child sexual abuse. It happens when a child is talked into or forced into sex acts in exchange for things like money, drugs, food or shelter.²

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Who does it affect?

It’s estimated that one in three girls and one in six boys are sexually abused in North America.³ The exact number is hard to determine because many cases are not reported to authorities.⁴ Of adults who receive mental health services, it’s thought that as many as 50% of women and 25% of men have experienced childhood sexual abuse.⁵

Children living with a mental illness, learning disability or physical disability are more than twice as likely to report childhood sexual abuse as their peers. These health problems may also make it harder to identify mental health problems, like post-traumatic stress disorder, that are linked to the abuse.⁶

While childhood sexual abuse can happen in any community, factors like poverty, homelessness, loss and racism can increase the risk. In BC, youth who are homeless are much more likely to have experienced sexual abuse.^7,8

If you believe a child is being abused

Call 911 if you believe a child is in immediate danger. Call 911 if a crime has been committed against a child, is being committed against a child, or will likely be committed against a child.

In BC, the law says that anyone who suspects a child is being abused or neglected must report it to a child welfare worker with the local Ministry of Children and Family Development office or Delegated Aboriginal Child and Family Services Agency. You can find local contact information in the blue pages of your phone book or online at www.mcf.gov.bc.ca. If the office is closed or you don’t know who to call, call the Helpline for Children at 310-1234 (no area code is needed). It’s available 24 hours a day and you don’t have to give your own name.²⁹

Recognizing men

It’s thought that about one in six boys or young men are survivors* of sexual abuse. But men are much less likely than women to be recognized as victims of sexual abuse, much less likely to be taken seriously and much less likely to receive treatment. Male survivors of childhood sexual abuse are also often viewed as less vulnerable than women, and mental health professionals may be less likely to ask men or recognize sexual abuse.⁹

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How does childhood sexual abuse affect adult well-being?

Childhood sexual abuse can have a wide range of effects in adulthood. Some adult survivors experience few mental health problems, while others experience many mental health problems. Abuse is a kind of trauma. Trauma is a situation that’s shocking, intense and distressing. The effects of trauma include a complicated mix of factors, such as:

The amount of any kind of trauma you previously experienced
The severity of the trauma
How close you were to the person who abused you
How long the abuse lasted
How people you trusted reacted to the abuse, if you told them—did they believe you and support you or dismiss you?¹⁰

Here are some of the ways that experiences of childhood sexual abuse can affect well-being:

Trust—Abuse may impair your sense that the world is a safe place and impair your ability to trust others. This may be particularly difficult if you had a close relationship with the abuser.¹¹
Self-esteem—You may blame yourself for the abuse, even though it isn’t your fault. You may have a hard time feeling good about yourself or hopeful about your future.¹²
Coping with stress—You may have a lot of negative feelings, which may make it hard to cope with everyday stress.¹²
Impulsivity—Impulsivity means acting on urges before thinking through the consequences, which can lead to risky activities.¹²
Anger—You may have a hard time controlling your anger.¹²
Dissociation—With dissociation, your mind “separates” itself from painful events to protect itself. You may have a hard time remembering what happened, feel like the world around you isn’t real or feel like you aren’t connected to your body. It’s a common reaction to pain and fear.¹³
Self-harm—You may harm yourself, but not intend to end your life. It may be a way to cope with difficult thoughts or feelings.¹⁴

These are common reactions to trauma. But they can lead to problems when they affect the way you live your life. It’s important to get help if you are having a hard time coping with past trauma.

Other problems linked to childhood sexual abuse include:

Mental illness—Experiencing childhood sexual abuse does not mean that you will develop a mental illness, but it is one of many risk factors. People who experience childhood sexual abuse may have a higher risk of experiencing anxiety disorders (such as post-traumatic stress disorder),¹⁵ depression,¹⁶ eating disorders,¹⁶ dissociative disorders¹⁷ and personality disorders.¹⁸
Substance use problems—Survivors of childhood sexual abuse are at greater risk of developing problems with alcohol and other drugs^19,20,21 and may be more likely to start using substances at a younger age.^22,23,24,25 There may also be a link between your response to childhood sexual abuse (such as depression, low self-esteem or post-traumatic stress disorder) and the risk of experiencing problems with substances.^19,21,26 Substances may be a way to cope with difficult experiences.^19,21

Revictimization

Revictimization means that you experience abuse again at another time in your life. People who experience childhood sexual abuse are two to three times more likely to experience abuse as adults. Childhood abuse may affect the way adults interprets warning signs, understand trust and control in relationships, and expect others to act in relationships.²⁷

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What can I do about it?

It's important to find help as soon as you can. Connecting with others who care about and support you as early as possible can help protect you from the negative impact of childhood sexual abuse and help you heal. Unfortunately, many people feel that talking about childhood sexual abuse is taboo, even though we know it happens and know that it's a crime. Some survivors are cut off from supports like family, friends and community members when they talk about their experiences. This isolation can make it harder to heal and feel well again. If you aren't sure who you can talk to, check out the resources in the next section of this

You can also find help for problems associated with childhood sexual abuse. Treatment for adult survivors may help you:

Overcome troubling thoughts and feelings, like self-blame, guilt or low self-esteem
Overcome unhelpful coping strategies, like self-harm or eating problems
Build healthy skills, like building trust and setting healthy boundaries in relationships

Treatment should also address any other mental health or substance use problems, so it will look different for everyone.

Remember, you may have experienced traumatic events in the past, but people can help now. It is never too late to find help.²⁸

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Where do I go from here?

If you are in danger or believe that someone else is in danger, call 9-1-1.

VictimLinkBC
Call 1-800-563-0808 or text 604-836-6381 for information and referrals for many different services, including victim services, counselling services, housing resources and government resources. It’s free, confidential and available 24 hours a day. VictimLinkBC is available in over 110 languages. For more information, visit

One in Six
Visit www.1in6.org to learn more about male survivors of childhood sexual abuse and connect with others. You can also find resources for family members, friends and loved ones.

Preventing and Treating Child Maltreatment
This issue of Simon Fraser University’s Children’s Mental Health Research Quarterly discusses child abuse and neglect. Visit www.childhealthpolicy.sfu.ca to learn more, including risk factors, prevention strategies and effective treatments.

Crisis lines aren’t only for people in crisis. You can call for information on local services or if you just need someone to talk to. If you are in distress, call 310-6789 (do not add 604, 778 or 250 before the number) 24 hours a day to connect to a BC crisis line, without a wait or busy signal. The crisis lines linked in through 310-6789 have received advanced training in mental health issues and services by members of the BC Partners for Mental Health and Addictions Information.

In this fact sheet, we use the term "survivor" to describe anyone who has experienced abuse because it's the term used most often in research. People who experience sexual abuse can and do survive and thrive.²⁸

About the author

cmha bc logo

The Canadian Mental Health Association promotes the mental health of all and supports the resilience and recovery of people experiencing a mental illness through public education, community-based research, advocacy, and direct services. Visit www.cmha.bc.ca.

Footnotes:

Dial-A-Law. (2010, March). Reporting Suspected Child Abuse [fact sheet]. Vancouver, BC: Canadian Bar Association, BC Branch. www.cba.org/bc/public_media/family/156.aspx.
BC Ministry of Children and Family Development. (2007). BC Handbook for Action on Child Abuse and Neglect (For service providers), Victoria, BC: Author. www.mcf.gov.bc.ca/child_protection/pdf/handbook_action_child_abuse.pdf.
Hirakata, P. (2009). Narratives of Dissociation: Insights into the Treatment of Dissociation in Individuals Who Were Sexually Abused as Children. Journal of Trauma and Dissociation, 10, 297-314.
Beattie, K. Family violence against children and youth. In AuCoin, K. (Ed). (2005). Family Violence in Canada: A Statistical Profile 2005. Ottawa, ON: Canadian Centre for Justice Statistics, Statistics Canada. www.statcan.gc.ca/pub/85-224-x/85-224-x2005000-eng.pdf.
Cavanagh, M, Read, J. and New, B. (2004). Sexual abuse inquiry and response: A New Zealand training programme. New Zealand Journal of Psychology, 33(3), 137-144.
Smith, S., Stewart, D., Peled, M. et al. (2009). A Picture of Health: Highlights from the 2008 BC Adolescent Health Survey. Vancouver, BC: McCreary Centre Society.
Smith, S., Saewyc, E., Albert, M. et al. (2007). Against the Odds: A profile of marginalized and street-involved youth in BC. Vancouver, BC: McCreary Centre Society.
Lynne, J. and Farley, M. (2008). Prostitution of Indigenous Women: Sex Inequality and the Colonization of Canada's First Nations Women. Vancouver Rape Relief and Women's Shelter. www.rapereliefshelter.bc.ca/learn/resources/prostitution-indigenous-women-sex-inequality-and-colonization-canadas-first-nations-.
Fisher, A., Goodwin, R. and Patton, M. (2009, March). Men & Healing: Theory, Research, and Practice in Working with Male Survivors of Childhood Sexual Abuse: A Guidebook. Ottawa, ON: The Men’s Project. www.themensproject.ca/files/uploads/stfnetw_tmp2-files/menandhealingfinal.pdf.
O’Leary, P., Coohey, C. and Easton, S.D. (2010). The effects of severe child sexual abuse and disclosure on mental health during adulthood. Journal of Child Sexual Abuse, 19, 275-289.
Mullen, P.E. and Fleming, J. (1998, Autumn). Long-term Effects of Child Sexual Abuse. Issues in Child Abuse Prevention, 9. http://www.aifs.gov.au/nch/pubs/issues/issues9/issues9.html.
Healthwise. (2009, February 13). Child Abuse and Neglect: What happens [fact sheet]. Victoria, BC: HealthLinkBC. http://www.healthlinkbc.ca/kb/content/special/tm4865.html#tm5164.
Lynch, S.M. et al. (2008). Attending to Dissociation: Assessing Change in Dissociation and Predicting Treatment Outcome. Journal of Trauma and Dissociation, 9(3), 301-319.
Batey, H. et al. (2010). Negative Intrusive Thoughts and Dissociationas Risk Factors for Self-Harm. Suicide and Life-Threatening Behavior, 40(1), 35-49.
Penza, K.M. et al. (2003). Neurobiological effects of childhood abuse: implications for the pathophysiology of depression and anxiety. Archives of Women’s Mental Health, 6, 15-22.
Pearlstein, T. (2002). Eating disorders and comorbidity. Archives of Women’s Mental Health, 4, 67-87.
DSM-IV-TR, p. 521 (dissociative amnesia); DSM-IV-TR, p. 525 (dissociative fugue); DSM-IV-TR, p. 527 (disocciative identity disorder); DSM-IV-TR, p. 531 (depersonalization disorder).
Spataro, J. et al. (2004). Impact of child sexual abuse on mental health: Prospective study in males and females. British Journal of Psychiatry, 184, 416-421.
Stewart, S.H. (1996). Alcohol abuse in individuals exposed to trauma: A critical review. Psychological Bulletin, 120(1), 83-112.
Arellano, C.M. (1996). Child maltreatment and substance use: A review of the literature. Substance Use & Misuse, 31(7), 927-935.
Gutierres, S.E. & Van Puymbroeck, C. (2006). Childhood and adult violence in the lives of women who misuse substances. Aggression and Violent Behaviour, 11, 497-513.
Harrison, P.A., Fulkerson, J.A., & Beebe, T.J. (1997). Multiple substance use among adolescent physical and sexual abuse victims. Child Abuse & Neglect, 21(6), 529-39.
Hawke, J.M., Jainchill, N., & DeLeon, G. (2000). The prevalence of sexual abuse and its impact on the onset of drug use among adolescents in therapeutic community drug treatment. Journal of Child & Adolescent Substance Abuse, 9(3), 35-49.
Dube, S.R., Miller, J.W., Brown, D.W., Giles, W.H., Felitti, V.J., Dong, M., & Anda, R.F. (2006). Adverse childhood experiences and the association with ever using alcohol and initiating alcohol use during adolescence. Journal of Adolescent Health, 38, 444.e1-444.e10.
Waldrop, A.E., Santa Ana, E.J., Saladin, M.E., McRae, A.L., & Brady, K.T. (2007). Differences in early onset alcohol use and heavy drinking among persons with childhood and adulthood trauma. American Journal of Addictions, 16, 439-442.
Cohen, J.A., Mannarino, A.P., Zhitova, A.C. & Capone, M. E. (2003).Treating child abuse-related posttraumatic stress and comorbid substance abuse in adolescents. Child Abuse & Neglect, 27, 1345-65.
Lau, M. and Kristensen, E. (2010). Sexual revictimization in a clinical sample of women reporting childhood sexual abuse. Nordic Journal of Psychiatry, 64(4), 4-10.
National Clearinghouse on Family Violence. (2002). Adult Survivors of Child Sexual Abuse: Overview paper. Ottawa, ON: PHAC. www.phac-aspc.gc.ca/ncfv-cnivf/publications/nfntsxagrsexadult-eng.php.
BC Ministry of Children and Family Development. (2007). BC Handbook for Action on Child Abuse and Neglect (For service providers). Victoria, BC: Author. www.mcf.gov.bc.ca/child_protection/pdf/handbook_action_child_abuse.pdf.

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