Common Symptoms in Adult Survivors of Childhood Sexual Abuse

Common Symptoms in Adult Survivors of Childhood Sexual Abuse:

• Physical Presentations
• Chronic pelvic pain
• Gastrointestinal symptoms/distress
• Musculoskeletal complaints
• Obesity, eating disorders
• Insomnia, sleep disorders
• Pseudocyesis
• Sexual dysfunction
• Asthma, respiratory ailments
• Addiction
• Chronic headache
• Chronic back pain
• Psychologic and Behavioral Presentations
• Depression and anxiety
• Posttraumatic stress disorder symptoms
• Dissociative states
• Repeated self-injury
• Suicide attempts
• Lying, stealing, truancy, running away
• Poor contraceptive practices
• Compulsive sexual behaviors
• Sexual dysfunction
• Somatizing disorders
• Eating disorders
• Poor adherence to medical recommendations
• Intolerance of or constant search for intimacy
• Expectation of early death

Although 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. 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. These coping mechanisms are used for protection during the abuse or later to guard against feelings of overwhelming helplessness and terror. 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).

In addition to the psychologic distress that may potentiate survivors' symptoms, there is evidence that abuse may result in biophysical changes. For example, one study found that, after controlling for history of psychiatric disturbance, adult survivors had lowered thresholds for pain (13). 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).

Although responses to sexual abuse vary, there is remarkable consistency in mental health symptoms, especially depression and anxiety. These mental health symptoms may be found alone or more often in tandem with physical and behavioral symptoms. More extreme symptoms are associated with abuse onset at an early age, extended or frequent abuse, incest by a parent, or use of force (4). Responses may be mitigated by such factors as inherent resiliency or supportive responses from individuals who are important to the victim (4). Even without therapeutic intervention, some survivors maintain the outward appearance of being unaffected by their abuse. Most, however, experience pervasive and deleterious consequences (4).

The primary aftereffects of childhood sexual abuse have been divided into seven distinct, but overlapping categories (16):

• Emotional reactions
• Symptoms of posttraumatic stress disorder (PTSD)
• Self-perceptions
• Physical and biomedical effects
• Sexual effects
• Interpersonal effects
• Social functioning

Responses can be greatly variable and idiosyncratic within the seven categories. Also, survivors may fluctuate between being highly symptomatic and relatively symptom free. Health care providers should be aware that such variability is normal.

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