These mental health symptoms may be found alone or more often in tandem with physical and behavioral symptoms. Although responses to sexual abuse vary, there is remarkable consistency in mental health symptoms, especially depression and anxiety. It also has been suggested that chronic or traumatic stimulation (especially in the pelvic or abdominal region) heightens sensitivity, resulting in persistent pain such as abdominal and pelvic pain or other bowel symptoms (14, 15). For example, one study found that, after controlling for history of psychiatric disturbance, adult survivors had lowered thresholds for pain (13). In addition to the psychologic distress that may potentiate survivors' symptoms, there is evidence that abuse may result in biophysical changes. Although some of these coping strategies may eventually lead to health problems, if symptoms are evaluated outside their original context, survivors may be misdiagnosed or mislabeled (5). These coping mechanisms are used for protection during the abuse or later to guard against feelings of overwhelming helplessness and terror. To appropriately treat and manage survivors of CSA, it is useful to understand that survivors' symptoms or behavioral sequelae often represent coping strategies employed in response to abnormal, traumatic events. Intolerance of or constant search for intimacyĪlthough there is no single syndrome that is universally present in adult survivors of childhood sexual abuse, there is an extensive body of research that documents adverse short- and long-term effects of such abuse.Poor adherence to medical recommendations.Psychologic and Behavioral Presentations.Common Symptoms in Adult Survivors of Childhood Sexual Abuse: Of this number, 22% were younger than 12 years and 32% were between 12 and 17 years old when they were first raped (9). A national telephone survey on violence against women conducted by the National Institute of Justice and the Centers for Disease Control and Prevention found that 18% of 8,000 women surveyed had experienced a completed or attempted rape at some time in their lives. Approximately 40% of the women surveyed in a primary care setting had experienced some form of childhood sexual contact of those, 1 in 6 had been raped as a child (12). Of all the girls who experienced sexual abuse, 65% reported the abuse occurred more than once, 57% reported the abuser was a family member, and 53% reported the abuse occurred at home (11). Twelve percent of girls in grades 9 through 12 reported they had been sexually abused 7% of girls in grades 5 through 8 also reported sexual abuse. Consistent with this range, studies have revealed that: Among girls who had sex before they were 13 years old, 22% reported that first sex was nonvoluntary (10). Most studies have found that among women, approximately 20% - or 1 in 5 - have experienced childhood sexual abuse (9). Current estimates of incest and other childhood sexual abuse range from 12% to 40% depending on settings and population. Researchers have found that victims come from all cultural, racial, and economic groups (9).

However, in the past 25 years there has been increased recognition that incest and other forms of childhood sexual abuse occur with alarming frequency (8). Incest was once thought to be so rare that its occurrence was inconsequential. Because of the shame and stigma associated with abuse, many victims never disclose such experiences. Prevalence The prevalence of childhood sexual abuse in the United States is unknown. Definitions have been expanded to include noncontact events such as coercion to watch sexual acts or posing in child pornography (7). Although specific legal definitions may vary among states, there is widespread agreement that abusive sexual contact can include breast and genital fondling, oral and anal sex, and vaginal intercourse. Characteristics and motivations of perpetrators of childhood sexual abuse vary: some may act out sexually to exert dominance over another individual others may initiate the abuse for their own sexual gratification (5, 6). Authority and power enable the perpetrator to coerce the child into compliance. These acts do not always involve sexual intercourse or physical force rather, they involve manipulation and trickery. Definitions Childhood sexual abuse can be defined as any exposure to sexual acts imposed on children who inherently lack the emotional, maturational, and cognitive development to understand or to consent to such acts.

Signs of past sexual trauma