Childhood Sexual Abuse

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Although child abuse is probably as old as childhood itself, serious research into child abuse arguably began in 1962 with the publication of Kempe and colleagues' seminal paper, "The Battered Child Syndrome" (Kempe, Silverman, Steele, Droegemuller, and Silver 1962). Not long afterwards, health care professionals began to direct their attention to the specific problem of childhood sexual abuse (Cosentino and Collins 1996). In the past few decades, numerous instances have been documented in detailed case histories, and important research into the causes and consequences of childhood sexual abuse has been initiated.

Numerous extensive reviews have been published that summarize what is presently known about childhood sexual abuse, focusing on the following domains.

  • Short-term effects (Beitchman et al. 1991; Beitchman et al. 1992; Briere and Elliott 1994; Browne and Finkelhor 1986; Finkelhor 1990; Gomes-Schwartz et al. 1990; Green 1993; Kelley 1995; Kendall-Tackett et al. 1993; Trickett and McBride-Chang, 1995).
  • Long-term consequences (Beitchman et al. 1991; Briere 1988; Briere and Elliott 1994; Briere and Runtz 1991; Cahill et al.1991a; Collings 1995; Ferguson 1997; Finkelhor 1987; Gibbons 1996; Glod 1993; Green 1993; Murray 1993; Polusny and Follette 1995; Trickett and McBride-Chang 1995; Wolfe and Birt, 1995).
  • Prevention of abuse (Adler and McCain 1994; Berrick and Barth 1992; MacMillan et al. 1994; Olsen and Widom 1993; Wolfe et al. 1995).
  • Treatment of both survivors and abusers (Cahill et al. 1991b; Cosentino and Collins 1996; Faller 1993; Finkelhor and Berliner 1995; O'Donohue and Elliot 1993).

Consequently, this chapter is not intended to provide a detailed analysis and review of the literature on childhood sexual abuse. Rather, it is meant to serve as a brief overview of, and introduction to, this area of inquiry.


Before delving into the field of childhood sexual abuse, one must first understand what is meant by the term. Indeed, the lack of a standard definition has been a major criticism of the field and controversies abound (Finkelhor 1994a; Gibbons 1996; Gough 1996a; Green 1993). In general, the legal and practical research definitions of child sexual abuse require the following two elements: (1) sexual activities involving a child (sometimes construed as including adolescence), and (2) the existence of an "abuse condition" indicating lack of consensuality (Faller 1993; Finkelhor 1994a). "Sexual activities" refer to behaviors intended for sexual stimulation; such activities need not involve physical contact, however, leading to separate definitions for "contact sexual abuse" and "noncontact sexual abuse." Contact sexual abuse includes both penetrative (e.g., insertion of penis or other object into the vagina or anus) and nonpenetrative (e.g., unwanted touching of genitals) acts. Noncontact sexual abuse refers to activities such as exhibitionism, voyeurism, and child pornography (see Faller 1993 and Finkelhor 1994a for reviews on definitions of childhood sexual abuse).

An abuse condition is said to exist when there is reason to believe that the child either did not, or was incapable of, consenting to sexual activity. Three main conditions can be distinguished: (1) the perpetrator has a large age or maturational advantage over the child; or (2) the perpetrator is in a position of authority or in a caretaking relationship with the child; or (3) activities are carried out against the child's will using force or trickery. As evident from this brief summary, "Childhood Sexual Abuse" covers a wide range of acts and situations, and therefore is open to considerable subjective interpretation.


Increasing attention has been directed toward childhood sexual abuse not only because of the psychosocial sequelae associated with its occurrence, but also because it now appears to be more widespread than previously thought (Adler and McCain 1994). However, accurate estimates of the occurrence of childhood sexual abuse are difficult to obtain because many cases are never reported. Thus, available statistics represent only those cases reported to child protection agencies or to law enforcement, and therefore underestimate the true magnitude of the problem.

There are two official sources of incidence data for cases in the United States: The National Incidence Study of Child Abuse and Neglect (NIS), a federally funded research project; and statistics from state child protection agencies (Finkelhor 1994a). The NIS conducted in 1993 documented over 300,000 cases of sexual abuse among children known to professionals in the course of a year, or a rate of approximately forty-five cases per 10,000 children (Sedlak and Broadhurst 1996). Child protective services data suggest that approximately 140,000 cases of childhood sexual abuse occur annually, or twenty-one cases per 10,000 children (Leventhal 1998). An editorial by Finkelhor (1998) suggested that the incidence may be declining. However, this remains to be substantiated. In general, reports suggest that the rate of childhood sexual abuse has increased substantially over the past decades (Sedlak and Broadhurst 1996).

Retrospective surveys provide a second source of information on the occurrence of childhood sexual abuse. Reported rates depend upon how it is defined and operationalized in any given survey. When childhood sexual abuse has been assessed with a single item that narrowly defines it as rape or sexual intercourse, reported prevalence rates tend to be low (e.g., less than 12 percent). Conversely, when it is defined more broadly (e.g., touching genitalia) and assessed using multiple items, prevalence rates tend to be much higher, but with a wide range. The discrepancies observed in the estimated prevalence of childhood sexual abuse points to the need for increased standardization and the use of better assessment instruments in this research.

Because rates of childhood sexual abuse are substantially greater among females than males (e.g., Cosentino and Collins 1996; Finkelhor et al. 1990; Sedlak and Broadhurst 1996), the majority of this research has focused on women. Surveys suggest that anywhere from 18 percent to 30 percent of college women and 8 percent to 33 percent of male and female high school students report having experienced this abuse at some point in their lives (Ferguson 1997; Finkelhor 1994a; Gibbons 1996; Green 1993; Gorey and Leslie 1997). Among the general adult female population, prevalence rates range from 2 percent to 62 percent (Finkelhor 1987; Finkelhor et al. 1990; Saunders et al. 1992). Rates are even higher within various clinical populations, with 35 percent to 75 percent of female clients reporting a history of some form of sexual abuse during childhood (Gibbons 1996; Wurr and Partridge 1996).

The number of males who have been sexually abused is difficult to estimate because it has been the subject of fewer high-quality studies (Holmes and Slap 1998; Watkins and Bentovim 1992). Nonetheless, a few studies have examined this issue among men and estimate that approximately 3 percent to 16 percent of all men in the United States were sexually abused during childhood (Finkelhor et al. 1990; Gibbons 1996; Holmes and Slap 1998). As is the case for women, rates are higher when studying clinical populations, with estimates ranging from 13 percent to 23 percent (Holmes and Slap 1998; Metcalfe et al. 1990).

In sum, based on the evidence available in the literature, Finkelhor (1994a) estimates that 20 percent of adult women and 5 percent to 10 percent of adult men are survivors of childhood sexual abuse. Similarly, a synthesis of sixteen cross-sectional surveys on the prevalence of it among nonclinical populations reported unadjusted estimates of 22.3 percent for women and 8.5 percent for men (Gorey and Leslie 1997).


Research conducted over the past decade indicates that a wide range of psychological and interpersonal problems are more prevalent among those people who have been sexually abused than among those who have not been sexually abused. Although a definitive casual relationship between such problems and sexual abuse cannot be established using retrospective or cross-sectional research methodologies (Briere 1992a; Plunkett and Oates 1990), the aggregate of consistent findings in this literature has led many investigators and health care providers to conclude that childhood sexual abuse is a major risk factor for a variety of problems, both in the short-term and in later adulthood (Briere and Elliott 1994; Faller 1993). The various problems and symptoms described in the literature can be categorized as follows: (1) posttraumatic stress; (2) cognitive distortions; (3) emotional distress; (4) impaired sense of self; (5) avoidance phenomena; (6) personality disorders; and (7) interpersonal difficulties. In the remainder of this section, each of these categories is defined and illustrated using examples from the research literature.

Posttraumatic stress refers to certain enduring psychological symptoms that occur in reaction to a highly distressing, psychiatric disruptive event. To be diagnosed with posttraumatic stress disorder (PTSD) an individual must experience not only a traumatic event, but also the following problems: (1) frequent re-experiencing of the event through nightmares or intrusive thoughts; (2) a numbing of general responsiveness to, or avoidance of, current events; and (3) persistent symptoms of increased arousal, such as jumpiness, sleep disturbances, or poor concentration (American Psychiatric Association (APA) 1994). In general, researchers have found that children and adults who have been sexually abused are significantly more likely to receive a PTSD diagnosis than their nonabused peers (McLeer et al. 1992; Murray 1993; Rowan and Foy 1993; Saunders et al. 1992; Wolfe and Birt 1995).

Cognitive distortions are negative perceptions and beliefs held with respect to oneself, others, the environment, and the future. In the abused individual, this type of thought process is reflected in his or her tendency to overestimate the amount of danger or adversity in the world and to underestimate his or her worth (Briere and Elliott 1994; Dutton et al. 1994; Janoff-Bulman 1992). Numerous studies document such feelings and perceptions such as helplessness and hopelessness, impaired trust, self-blame, and low self-esteem among children who have been sexually abused (Oates et al. 1985). Moreover, these cognitive distortions often continue on into adolescence and adulthood (Gold 1986; Shapiro and Dominiak 1990).

Emotional distress or pain, which typically manifests itself as depression, anxiety, anger, or all of these, is reported by many survivors of childhood sexual abuse. Depression is the most commonly reported symptom among adults with a history of childhood sexual abuse (Beitchman et al. 1992; Browne and Finkelhor 1986; Cahill et al. 1991a; Polusny and Follette 1995). Greater depressive symptomatology is also found among children who have been abused (Lipovsky et al.1989; Yama et al.1993).

Similarly, elevated anxiety levels have been documented in child victims of sexual abuse and adults who have a history of it (Gomes-Schwartz et al. 1990; Mancini et al. 1995; Yama et al. 1993). Adults with a history of childhood sexual abuse are more likely than their nonabused counterparts to meet the criteria for generalized anxiety disorder, phobias, panic disorder, obsessive compulsive disorder, or all of these (Mancini et al. 1995; Mulder et al. 1998; Saunders et al. 1992).

Another common emotional sequel of childhood sexual abuse is anger; specifically, chronic irritability, unexpected or uncontrollable feelings of anger, difficulties associated with expressing anger, or all of these (Briere and Elliott 1994; Van der Kolk et al. 1994). During childhood and adolescence, anger is most likely to be reflected in behavioral problems such as fighting, bullying, or attacking other children (Chaffin et al. 1997; Garnefski and Diekstra 1997).

Sexual abuse also can damage a child's developing sense of self, with adverse long-term consequences. The development of a sense of self is thought to be one of the earliest developmental tasks of the infant and young child, typically unfolding in the context of early relationships (Alexander 1992). Thus, how a child is treated early in life critically influences his or her growing self-awareness. Childhood sexual abuse can interfere with this process, preventing the child from establishing a strong self image (Cole and Putnam 1992). Without a healthy sense of self, the person is unable to soothe or comfort himself or herself adequately, which may lead to overreactions to stressful or painful situations, and to an increased likelihood of re-victimization (Messman and Long 1996). Indeed, numerous studies have found high rates of sexual re-victimization (e.g., rape, coercive sexual experience) among individuals reporting a history of childhood sexual abuse (Fergusson et al. 1997; Urquiza and Goodlin-Jones 1994; Wyatt et al. 1992)

Avoidance is another major response to having been sexually abused. Avoiding activities among victims may be viewed as attempts to cope with the chronic trauma and dysphoria induced by the abuse. Among the dysfunctional activities associated with efforts to avoid recalling or reliving specific memories are: dissociative phenomena, such as losing time, repression of unpleasant memories, detachment, or body numbing (APA 1994; Cloitre et al. 1997; Mulder et al. 1998; Nash et al. 1993); substance abuse and addiction (Arellano 1996; Briere 1988; Wilsnack et al. 1997); suicide or suicidal ideation (Briere and Runtz 1991; Saunders et al. 1992; Van der Kolk et al. 1991); inappropriate, indiscriminate, and/or compulsive sexual behavior (McClellan et al. 1996; Widom and Kuhns, 1996), (for reviews see Friedrich 1993; Kendall-Tackett et al. 1993; Tharinger 1990); eating disorders (Conners and Morse 1993; Douzinas et al. 1994; Schwartz and Cohn 1996; Wonderlich et al. 1997); and self-mutilation (Briere 1988; Briere and Elliott 1994). Each of these behaviors serve to prevent the individual from experiencing the considerable pain of abuse-specific awareness and thus reduces the distress associated with remembrance. However, avoidance and self-destructive methods of coping with the abuse may ultimately lead to higher levels of symptomatology, lower self-esteem, and greater feelings of guilt and anger (Leitenberg et al. 1992).

Numerous investigations have found a greater rate of borderline personality and dissociative identity (formerly multiple personality disorder) disorders among adult female survivors of chilhood sexual abuse (Green 1993; Polusny and Follette 1995; Silk et al. 1997). Borderline personality disorder includes symptoms of impulsiveness associated with intense anger or suicidal, self-mutilating behavior, and affective instability with depression which are typical sequelae in sexually abused children and in adult survivors of sexual abuse (APA 1994). Childhood trauma, especially continued sexual abuse, is an important etiological factor in many cases of dissociative identity disorder, the most extreme type of dissociative reaction (APA 1994).

Finally, interpersonal difficulties and deficient social functioning often are observed among individuals who have been sexually abused (Briere 1992b; Cloitre et al. 1997). Such difficulties stem from the immediate cognitive and conditioned responses to victimization that extend into the longer term (e.g., distrust of others), as well as the accommodation responses to ongoing abuse (e.g., passivity). Often, victims of childhood sexual abuse know the perpetrator, who might be a family member, clergy, or friend of the family. The abuse is thus a violation and betrayal of both personal and interpersonal (relationship) boundaries. Hence, it is not surprising that many children and adults with a history of childhood sexual abuse are found to be less socially competent, more aggressive, and more socially withdrawn than their nonabused peers (Cloitre et al. 1997; Mannarino et al. 1991; Mullen et al. 1994).

Among adults, interpersonal difficulties are manifested in difficulties in establishing and maintaining relationships (Finkelhor et al. 1989; Liem et al. 1996) and in achieving sexual intimacy (Browne and Finkelhor 1986; Mullen et al. 1994). Children who have been sexually abused are more likely to exhibit increased or precocious sexual behavior, such as kissing and inappropriate genital touching (Cosentino et al. 1995).

The consequences of childhood sexual abuse can be quite severe and harmful. However, it is important to note that an estimated 10 to 28 percent of persons with a history of it report no psychological distress (Briere and Elliott 1994; Kendall-Tackett et al. 1993). This raises the question of why some persons exhibit difficulties while others do not. Research addressing this question has found the following to be important mediators of individual reactions to childhood sexual abuse:

  • Age at onset of abuse. Although further elucidation is needed, the available evidence suggests that postpubertal abuse is associated with greater trauma and more severe adverse sequelae than is prepubertal abuse (Beitchman et al. 1992; Browne and Finkelhor 1986; McClellan et al. 1996; Nash et al. 1993);
  • Gender of the victim. One of the main findings in this area is that male victims appear to show greater disturbances of adult sexual functioning (Beitchman et al. 1992; Dube and Herbert 1988; Garnefski and Diekstra 1997);
  • Relationship to perpetrator. Abuse involving a father or father figure (e.g., stepfather), which accounts for an estimated 25 percent of all cases (Sedlak and Broadhurst 1996), is associated with greater long-term harm (Browne and Finkelhor 1986; Gold 1986);
  • Duration and frequency of abuse. In general, the greater the frequency and duration of abuse, the greater the impact on later psychological and social functioning (Nash et al. 1993);
  • Use of force. The use of force or threat of force is associated with more negative outcomes (Kendall-Tackett et al. 1993);
  • Penetration or invasiveness. Penetrative abuse is generally associated with greater long-term harm than are most other forms of abuse (Kendall-Tackett et al. 1993); and
  • Family characteristics and response to abuse disclosure. Individuals who have been abused are more likely to originate from single-parent families, families with a high level of marital conflict, and families with pathology (e.g., parent is an alcoholic, violence between parents, maternal disbelief, and lack of support); all of which are associated with a poorer outcome and greater levels of distress (Beitchman et al. 1992; Draucker 1996; Green 1996; Romans et al. 1995).


This review has focused exclusively on studies done in the United States. This is important to keep in mind because the nature of abuse varies according to one's cultural belief system (Gough 1996). As a result, attempts to compare societies on the basis of their care of children or the extent of violence in family relations are fraught with problems (Gough 1996b; Levinson 1989). In addition, methodological factors, such as the questions asked and how childhood sexual abuse is defined and measured, hamper the ability to make direct comparisons among the rates across different countries. All that can be surmised, to date, is that it is not a phenomena just of the United States, but is an international problem (Finkelhor 1994b). Finkelhor's synthesis indicates that most countries have rates similar to those found in the United States and that females are abused at a greater rater than males.

Nonetheless, cross-cultural studies can shed new light on the origins and impact of sexual abuse (Leventhal 1998; Runyan 1998). Such investigations may enable us to understand better the relative importance of different factors that influence the occurrence of abuse and teach us about societies that have been successful at protecting children. Intercultural comparative investigations can also help us appreciate the range of sexual behaviors that are, or can be considered "normal," and thereby contribute to a better understanding of abnormality in childhood sexual behavior and adult behaviors toward children.

It is not surprising that definitions of abuse not only vary within a culture, but also between cultures. The meaning of "abuse," especially, depends upon ideas of individual rights and roles and responsibilities between people and groups within society (Gough 1996a). How a child is viewed will influence what is evaluated as abuse. Definitions of child abuse would be quite different, for example, in a feudal state in which children are considered to be their parents' possessions. Cultural expectations about sexual interactions among adolescents and between different age groups will also affect whether particular practices are defined as abuse (Abramson and Pinkerton 1995). Among the Sambia people of the highlands of Papua, New Guinea, for example, all young boys are expected to participate in ritualized fellatio with older boys as part of their initiation into manhood (Abramson and Pinkerton 1995). In essence, the younger boys are forced to submit; thus, this practice fulfills the two main criteria for childhood sexual abuse as defined above (coercive sex with a child or adolescent). Nevertheless, the Sambia consider ritualized fellatio to be critical for survival (they believe that semen is the source of manly strength and that it must be obtained through ingestion).

Definitions of abuse can also be expected to change over time to reflect societal changes. For instance, anecdotal evidence suggests that in Victorian England it was considered acceptable for a nurse or nanny to quiet a male infant by putting his penis in her mouth (Abramson and Pinkerton 1995). Today, this practice would clearly be considered childhood sexual abuse. The recent broadening of definitions of abuse has been accompanied by a greater sensitivity to signs of abuse that fit these changing definitions, and a greater willingness for professionals and others to intervene into the private family lives of others, or beyond the walls of institutional life, and so to offer greater visibility of children's experiences (Gough 1996a).


Perusal of the literature in this domain suggests several avenues for future studies. First and foremost, large-scale, longitudinal investigations of child victims are needed that examine global functioning, abuse-specific functioning, and attributional and coping strategies along with abuse, child, family, and community factors. Such studies could provide information about both the initial effects of sexual abuse and the factors that influence adjustment at later developmental stages and into adulthood. Because not all victims of childhood sexual abuse develop adjustment problems, a better understanding of who is likely to experience such problems is needed.

Second, further research is needed regarding the efficacy of various approaches for the treatment of related problems (see Cosentino and Collins 1996; O'Donohue and Elliot 1993 for reviews). The utility or effectiveness of any particular treatment modality has yet to be demonstrated using a large-scale, randomized study in which treatment outcomes are measured using standardized instruments and untreated control groups. Consequently, treatment decisions often are made by clinicians without empirically tested guidelines.

Third, greater attention needs to be paid to methodological rigor in the conduct of childhood sexual abuse studies (Green 1993; Plunkett and Oates 1990; Trickett and McBride-Change 1995). In particular, investigators need to: (1) define it clearly and consistently; (2) use instruments with documented psychometric properties; (3) use control or comparison groups, when appropriate; and (4) employ large sample sizes whenever this is feasible. Studies of treatment modalities should also conduct multiple follow-up assessments to determine whether intervention effects are sustained over time. Finally, studies are needed that clearly disentangle the effects of sexual abuse from other forms of abuse or maltreatment.


Childhood sexual abuse is a significant and widespread problem in our society, no matter how it is defined. Since it was first brought to the public's attention in the 1960s, a vast amount of research has been conducted in an effort to understand its impact on victims. From the various reviews on the topic, several conclusions can be drawn. First, despite the considerable heterogeneity among sexual abuse victims, as a group, sexually abused children and adolescents tend to display significantly higher levels of symptomatology than their nonabused, nonclinic-referred peers. Second, compared to other clinic-referred children, two problem areas appear to differentiate sexually abused children and adolescents: post-traumatic stress disorder symptomatology and sexuality problems. Third, the type and severity of sequelae experienced by victims depends on the specific characteristics of the abuse situation and the perpetrator. Fourth, research on adult survivors suggest that abuse-related problems tend to persist into adulthood. Indeed, childhood sexual abuse histories are common among several clinical populations, including patients initially diagnosed as depressed or as having a borderline personality disorder.

Taken together, these findings suggest that clinicians and health care providers should screen for sexual abuse among children, adolescents, and adults. For instance, questions about childhood sexual abuse could become part of routine intake procedures. Moreover, it is important that a wide range of service providers are sensitive to, and have staff trained to deal with, issues of childhood sexual abuse when it emerges. Service providers' policy and practice guidelines should explicitly acknowledge the prevalence and impact of it on women, men, and children.

Schools also need to have greater involvement in the prevention and diagnosis of childhood sexual abuse, especially since it generally occurs between the ages of six and twelve (Finkelhor 1994a; Sedlak and Broadhurst 1996). School-based education programs may be a useful vehicle for intervention and prevention. Teachers need to be educated and trained about their role in recognizing and reporting suspected cases.

Finally, further community awareness is needed to help prevent it from occurring. Greater community efforts toward providing treatment services for persons with a history of childhood sexual abuse are needed as are programs targeting potential perpetrators. Society must work together to stamp out this abhorrence and to assist its survivors.

Preparation of this article was supported in part by a training grant from the Maternal and Child Health Bureau, U.S. Department of Health and Human Services (MCJ 9040). The author thanks Steven D. Pinkerton, Ph.D. for his helpful comments on this manuscript.


Abramson, P.R., and S.D. Pinkerton 1995 With pleasure: Thoughts on the Nature of Human Sexuality. New York: Oxford University Press.

Adler, N.A., and J.L. McCain 1994 "Prevention of Child Abuse. Issues for the Mental Health Practitioner." Child and Adolescent Psychiatric Clinics of North America 3(4):679–693.

Alexander, P.C. 1992 "Application of Attachment Theory to the Study of Sexual Abuse." Journal of Consulting and Clinical Psychology 60:185–195.

American Psychiatric Association 1994 Diagnostic and Statistical Manual of Mental Disorders, 4th ed. Washington, D.C.: Author.

Arellano, C.M. 1996 "Child Maltreatment and Substance use: A Review of the Literature." Substance Use and Misuse 31(7):927–935.

Beitchman, J.H., K.J. Zucker, J.E. Hood, G.A. DaCosta, and D. Akman 1991 "A Review of the Short-term Effects of Childhood Sexual Abuse." Child Abuse and Neglect 15:537–556.

——, and E. Cassavia 1992 "A review of the long-term effects of child sexual abuse." Child Abuse and Neglect 16:101–118.

Berrick, J.D., and R.P. Barth 1992 "Child Sexual Abuse Prevention: Research Review and Recommendations." Social Work Research and Abstracts 28(4):6–15.

Briere, J. 1988 "The Long-term Clinical Correlates of Childhood Sexual Victimization." Annals of the New York Academy of Sciences 528:327–334.

——1992a "Methodological Issues in the Study of Sexual Abuse Effects." Journal of Consulting and Clinical Psychology 60:196–203.

——1992b Child Abuse Trauma: Theory and Treatment of the Lasting Effects. Newbury Park, Calif.: Sage Publications.

——, and D.M. Elliott 1994 "Immediate and Long-term Impacts of Child Sexual Abuse." Sexual Abuse of Children 4(2):54–69.

——, and M. Runtz 1991 "The Long-term Effects of Sexual Abuse: A Review and Synthesis." New Directions for Mental Health Services 51:3–13.

Browne, A., and D. Finkelhor 1986 "Impact of Child Sexual Abuse: A Review of the Research." Psychological Bulletin 99(1):66–77.

Cahill, C., S.P. Llewelyn, and C. Pearson 1991a "Long-term effects of Sexual Abuse Which Occurred in Childhood: A Review." British Journal of Clinical Psychology 30(2):117–130.

——1991b "Treatment of sexual abuse which occurred in childhood: A review." British Journal of Clinical Psychology 30(1):1–12.

Chaffin, M., J.N. Wherry, and R. Dykman 1997 "School Age Children's Coping with Sexual Abuse: Abuse Stresses and Symptoms Associated with Four Coping Strategies." Child Abuse and Neglect 21(2):227–240.

Cloitre, M., P. Scarvalone, and J.A. Difede 1997 "Posttraumatic Stress Disorder, Self- and Interpersonal Dysfunction Among Sexually Retraumatized Women." Journal of Traumatic Stress 10(3):437–452.

Cole, P.M., and F.W. Putnam 1992 "Effect of Incest of Self and Social Functioning: A Developmental Psychopathology Perspective." Journal of Consulting and Clinical Psychology 60:174–184.

Collings, S.J. 1995 "The Long-term Effects of Contact and Noncontact Forms of Child Sexual Abuse in a Sample of University Men." Child Abuse and Neglect 19(1):1–6.

Connors, M.E., and W. Morse 1993 "Sexual Abuse and Eating Disorders: A review." International Journal of Eating Disorders 13(1):1–11.

Cosentino, C.E., and M. Collins 1996 "Sexual Abuse of Children: Prevalence, Effects, and Treatment." Annals of the New York Academy of Sciences 789:45–65.

Cosentino, C.E., H.F. Meyer-Bahlburg, J.L. Alpert, S.L. Weinberg, and R. Gaines 1995 "Sexual Behavior Problems and Psychopathology Symptoms in Sexually Abused Girls." Journal of the American Academy of Child and Adolescent Psychiatry 34(8):1033–1042.

Douzinas, N., V. Fornari, B. Goodman, T. and Sitnick 1994 "Eating Disorders and Abuse." Child and Adolescent Psychiatric Clinics of North America 3(4):777–796.

Draucker, C.B. 1996 "Family-of-Origin Variables and Adult Female Survivors of Childhood Sexual Abuse: A review of the Research." Journal of Child Sexual Abuse 5(4):35–63.

Dube, R., and M. Hebert 1988 "Sexual Abuse of Children Under 12 Years of Age: A Review of 511 Cases." Child Abuse and Neglect 12(3):321–330.

Dutton, M.A., K.J. Burghardt, S.G. Perrin, K.R. Chrestman, and P.M. Halle 1994 "Battered Women's Cognitive Schemata." Journal of Traumatic Stress 7(2):237–255.

Faller, K.C. 1993 Child Sexual Abuse: Intervention and Treatment Issues. Washington, D.C.: U.S. Dept. of Health and Human Services, Administration for Children and Families, Administration on Children, Youth, and Families, National Center on Child Abuse and Neglect.

Ferguson, A.G. 1997 "How Good is the Evidence Relating to the Frequency of Childhood Sexual Abuse and the Impact Such Abuse has on the Lives of Adult Survivors?" Public Health 111(6):387–391.

Fergusson, D.M., L.J. Horwood, and M.T. Lynskey 1997 "Childhood Sexual Abuse, Adolescent Sexual Behaviors and Sexual Revictimization." Child Abuse and Neglect 21(8):789–803.

Finkelhor, D. 1987 "The Sexual Abuse of Children: Current Research Reviewed." Psychiatric Annals 17:233–241.

——1990 "Early and Long-term Effects of Child Sexual Abuse: An Update." Professional Psychology 21(5):325–330.

——1994a "Current Information on the Scope and Nature of Child Sexual Abuse." Future of Children 4(2):31–53.

——1994b "The International Epidemiology of Child Sexual Abuse." Child Abuse and Neglect 18(5):409–417.

——1998 "Improving Research, Policy, and Practice to Understand Child Sexual Abuse." Journal of the American Medical Association 280(21):1864–1865.

——, and L. Berliner 1995 "Research on the Treatment of Sexually Abused Children: A Review and Recommendations." Journal of the American Academy of Child and Adolescent Psychiatry 34(11):1408–1423.

Finkelhor, D., G. Hotaling, I.A. Lewis, and C. Smith 1990 "Sexual Abuse in a National Survey of Adult Men and Women: Prevalence, Characteristics, and Risk Factors." Child Abuse and Neglect 14(1):19–28.

——1989 "Sexual Abuse and its Relationship to Later Sexual Satisfaction, Marital Status, Religion, and Attitudes." Journal of Interpersonal Violence 4:279–399.

Friedrich, W.N. 1993 "Sexual Victimization and Sexual Behavior in Children: A Review of Recent Literature." Child Abuse and Neglect 17(1):59–66.

Garnefski, N., R.F. and Diekstra 1997 "Child Sexual Abuse and Emotional and Behavioral Problems in Adolescence: Gender Differences." Journal of the American Academy of Child and Adolescent Psychiatry 36(3):323–329.

Gibbons, J. 1996 "Services for Adults who Have Experienced Child Sexual Assault: Improving Agency Response." Social Science and Medicine 43(12):1755–1763.

Glod, C.A. 1993 "Long-term Consequences of Childhood Physical and Sexual Abuse." Archives of Psychiatric Nursing 7(3):163–173.

Gold, E.R. 1986 "Long-term Effects of Sexual Victimization in Childhood: An Attributional Approach." Journal of Consulting and Clinical Psychology 54:471–471.

Gomes-Schwartz, B., J.M. Horowitz, and A.P. Cardarelli 1990 Child Sexual Abuse: The Initial Effects. Newbury Park, Calif.: Sage Publications.

Gorey, K.M., and D.R. Leslie 1997 "The Prevalence of Child Sexual Abuse: Integrative Review Adjustment for Potential Response and Measurement Biases." Child Abuse and Neglect 21(4):391–398.

Gough, D. 1996a "Defining the Problem: Comment." Child Abuse and Neglect 20(11):993–1002.

——1996b "Child Abuse in Japan." Child Psychology and Psychiatry Review 1:12–18.

Green, A.H. 1993 "Child Sexual Abuse: Immediate and long-term Effects and Intervention." Journal of the American Academy of Child and Adolescent Psychiatry 32(5):890–902.

——1996 "Overview of Child Sexual Abuse." In S. J. Kaplan, ed., Family Violence: A Clinical and Legal Guide. Washington, D.C.: American Psychiatric Press, Inc.

Holmes, W.C., and G.B. Slap 1998 "Sexual Abuse of Boys. Definition, Prevalence, Correlates, Sequelae, and Management." Journal of the American Medical Association 280(21):1855–1862.

Janoff-Bulman, R. 1992 Shattered Assumptions: Towards a new Psychology of Trauma. New York: Free Press.

Kelley, S.J. 1995 "Child Sexual Abuse: Initial Effects." Annual Review of Nursing Research 13:63–85.

Kempe, C.H., F.N. Silverman, B.F. Steele, W. Droegemuller, and A.K. Silver 1962 "The Battered Child Syndrome." Journal of the American Medical Association 187:17–24.

Kendall-Tackett, K.A., L.M. Williams, and D. Finkelhor 1993 "Impact of Sexual Abuse on Children: A Review and Synthesis of Recent Empirical Studies." Psychological Bulletin 113:164–180.

Leitenberg, H., E. Greenwald, and S. Cado 1992 "A Retrospective Study of Long-term Methods of Coping with Having Been Sexually Abused During Childhood." Child Abuse and Neglect 16(3):399–407.

Leventhal, J.M. 1998 "Epidemiology of Sexual Abuse of Children: Old Problems, New Directions." Child Abuse and Neglect 22(6):481–491.

Levinson, D. 1989 Family Violence in Cross Cultural Perspective. Newbury Park, Calif.: Sage.

Liem, J.H., J.G. O'Toole, and J.B. James 1996 "Themes of Power and Betrayal in Sexual Abuse Survivors' Characterizations of Interpersonal Relationships." Journal of Traumatic Stress 9(4):745–761.

Lipovsky, J.A., B.E. Saunders, and S.M. Murphy 1989 "Depression, Anxiety, and Behavior Problems Among Victims of Father-child Sexual Assault and Nonabused Siblings." Journal of Interpersonal Violence 4:452–468.

MacMillan, H.L., J.H. MacMillan, D.R. Offord, L. Griffith, and A. MacMillan 1994 "Primary Prevention of Child Sexual Abuse: A Critical Review: II." Journal of Child Psychology and Psychiatry and Allied Disciplines 35(5):857–876.

Mancini, C., M. Van Ameringen, and H. MacMillan 1995 "Relationship of Childhood Sexual and Physical Abuse to Anxiety Disorders." Journal of Nervous and Mental Disease 183(5):309–314.

Mannarino, A.P., J.A. Cohen, J.A. Smith, and S. Moore-Motily 1991 "Six- and Twelve-month Follow-up of Sexually Abused Girls." Journal of Interpersonal Violence 6:494–511.

McClellan, J., C. McCurry, M. Ronnei, J. Adams, A. Eisner, and M. Storck 1996 "Age of Onset of Sexual Abuse: Relationship to Sexually Inappropriate Behaviors." Journal of the American Academy of Child and Adolescent Psychiatry 35(10):1375–1383.

McLeer, S.V., E. Deblinger, D. Henry, and H. Orvaschel 1992 "Sexually Abused Children at High Risk for Post-traumatic Stress Disorder." Journal of the American Academy of Child and Adolescent Psychiatry 31:875–879.

Messman, T.L., and P.J. Long 1996 "Child Sexual Abuse and its Relationship to Revictimization in Adult Women: A Review." Clinical Psychology Review 16(5):397–420.

Mulder, R.T., A.L. Beautrais, P.R. Joyce, and D.M. Fergusson 1998 "Relationship Between Dissociation, Childhood Sexual Abuse, Childhood Physical Abuse, and Mental Illness in a General Population Sample." American Journal of Psychiatry 155(6):806–811.

Mullen, P.E., J.L. Martin, J.C. Anderson, S.E. Romans, and G.P. Herbison 1994 "The Effect of Child Sexual Abuse on Social, Interpersonal and Sexual Function in Adult life." British Journal of Psychiatry 165(2):35–47.

Murray, J.B. 1993 "Relationship of Childhood Sexual Abuse to Borderline Personality Disorder, Posttraumatic Stress Disorder, and Multiple Personality Disorder." Journal of Psychology 127(6):657–676.

Nash, M.R., O.A. Zivney, and T. Hulsey 1993 "Characteristics of Sexual Abuse Associated with Greater Psychological Impairment Among Children." Child Abuse and Neglect 17(3):401–408.

Oates, R.K., D. Forest, and A. Peacock 1985 "Self-esteem of Abused Children." Child Abuse and Neglect 9:159–163.

O'Donohue, W., A. and Elliot 1993 "Treatment of the Sexually Abused Child: A review." Journal of Clinical Child Psychology 3:218–228.

Olsen, J.L., and C.S. Widom 1993 "Prevention of Child Abuse and Neglect." Applied and Preventive Psychology 2(4):217–229.

Plunkett, A., and R.K. Oates 1990 "Methodological Considerations in Research on Child Sexual Abuse." Pediatric and Perinatal Epidemiology 4(3):351–360.

Polusny, M.A., and V.M. Follette 1995 "Long-term Correlates of Child Sexual Abuse: Theory and Review of the Empirical Literature." Applied and Preventive Psychology 4:143–166.

Romans, S.E., J.L. Martin, J.C. Anderson, M.L. O'Shea, and P.E. Mullen 1995 "Factors that Mediate Between Child Sexual Abuse and Adult Psychological Outcome." Psychological Medicine 25(1):127–142.

Rowan, A.B., and D.W. Foy 1993 "Post-traumatic Stress Disorder in Child Sexual Abuse Survivors: A Literature Review." Journal of Traumatic Stress 6(1):3–20.

Runyan, D.K. 1998 "Prevalence, Risk, Sensitivity, and Specificity: A Commentary on the Epidemiology of Child Sexual Abuse and the Development of a Research Agenda." Child Abuse and Neglect 22(6):493–498.

Saunders, B.E., L.A. Villeponteaux, J.A. Lipovsky, D.G. Kilpatrick, and J.L. Veronen 1992 "Child Sexual Assault as a Risk Factor for Mental Disorders Among Women: A community Survey." Journal of Interpersonal Violence 7:189–204.

Schwartz, M.F., and L. Cohn 1996 Sexual Abuse and Eating Disorders: A Clinical Overview. New York: Brunner/Mazel.

Sedlak, A.J., and D.D. Broadhurst 1996 Third national incidence study of child abuse and neglect. Washington, D.C.: U.S. Dept. of Health and Human Services, Administration for Children and Families, Administration on Children, Youth, and Families, National Center on Child Abuse and Neglect.

Shapiro, S., and G. Dominiak 1990 "Common Psychological Defenses Seen in the Treatment of Sexually Abused Adolescents." American Journal of Psychotherapy 44(1):68–74.

Silk, K.R., J.T. Nigg, D. Esten, and N.E. Lohr 1997 "Severity of Childhood Sexual Abuse, Borderline Symptoms, and Familial Environment." In M.C. Zanarini, ed., Role of Sexual Abuse in the Etiology of Borderline Personality Disorder Washington, D.C.: American Psychiatric Press, Inc.

Tharinger, D. 1990 "Impact of Child Sexual Abuse on Developing Sexuality." Professional Psychology: Research and Practice 21(5):331–337.

Trickett, P.K., and C. McBride-Chang 1995 "The Developmental Impact of Different Forms of Child Abuse and Neglect." Developmental Review 15(3):311–337.

Urquiza, A.J., and B.L. Goodlin-Jones 1994 "Child Sexual Abuse and Adult Revictimization with Women of Color." Violence and Victims 9(3):223–232.

Van der Kolk, B.A., J.C. Perry, and J.L. Herman 1991 "Childhood Origins of Self-destructive Behavior." American Journal of Psychiatry 148(12):1665–1671.

Van der Kolk, B.A., A. Hostetler, N. Herron, and R.E. Fisler 1994 "Trauma and the Development of Borderline Personality Disorder." Psychiatric Clinics of North America 17(4):715–730.

Watkins, B., and A. Bentovim 1992 "The Sexual Abuse of Male Children and Adolescents: A Review of Current Research." Journal of Child Psychology and Psychiatry and Allied Disciplines 33(1):197–248.

Widom, C.S., and J.B. Kuhns 1996 "Childhood Victimization and Subsequent Risk for Promiscuity, Prostitution, and Teenage Pregnancy: A Prospective Study." American Journal of Public Health 86(11):1607–1612.

Wilsnack, S.C., N.D. Vogeltanz, A.D. Klassen, and T.R. Harris 1997 "Childhood Sexual Abuse and Women's Substance Abuse: National survey findings." Journal of Studies on Alcohol 58(3):264–271.

Wolfe, D.A., N.D. Reppucci, and S. Hart 1995 "Child Abuse Prevention: Knowledge and Priorities." Journal of Clinical Child Psychology 24(Suppl):5–22.

Wolfe, V.V., and J.A. Birt 1995 "The Psychological Sequelae of Child Sexual Abuse." Advances in Clinical Child Psychology 17:233–263.

Wonderlich, S.A., T.D. Brewerton, Z. Jocic, B.S. Dansky, and D.W. Abbott 1997 "Relationship of Childhood Sexual Abuse and Eating Disorders." Journal of the American Academy of Child and Adolescent Psychiatry 36(8):1107–1115.

Wurr, C.J., and I.M. Partridge 1996 "The Prevalence of a History of Childhood Sexual Abuse in an Acute Adult Inpatient Population." Child Abuse and Neglect 20(9):867–872.

Wyatt, G.E., D. Guthrie, and C.M. Notgrass 1992 "Differential Effects of Women's Child Sexual Abuse and Subsequent Sexual Revictimization." Journal of Consulting and Clinical Psychology 60(2):167–173.

Yama, M.F., S.L. Tovey, and B.S. Fogas 1993 "Childhood Family Environment and Sexual Abuse as Predictors of Anxiety and Depression in Adult Women." American Journal of Orthopsychiatry 63(1):136–141.

Heather Cecil

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