The effects of childhood sexual abuse don’t necessarily end when childhood does.
18 November is the United Nations World Day for the Prevention of and Healing from Child Sexual Exploitation, Abuse and Violence. It is a reminder of our responsibility to protect children, listen to survivors and recognise that support may be needed long after abuse has ended.
When we think about childhood sexual abuse, we often focus on the experiences themselves. Less attention is sometimes given to how those experiences can affect someone many years later, including their relationships, emotional wellbeing and sense of themselves.
These effects are not inevitable. Survivors respond in many different ways, and a person’s history does not tell us everything about who they are or what their future will hold. But for those who are struggling, understanding possible connections with earlier experiences can be a helpful place to begin.
Why the past can still matter
Research has found associations between childhood sexual abuse and a range of difficulties in adulthood, including PTSD, depression and anxiety. The strength and quality of the evidence vary, and these associations do not mean that every survivor will experience these difficulties (Hailes et al., 2019).
Childhood is a time when we are developing an understanding of relationships, safety and ourselves. When someone who should offer care or protection causes harm, those experiences can influence what feels safe and what we expect from other people.
Research into childhood trauma more broadly suggests that attachment, social support and whether a person’s experiences are acknowledged may all be relevant to later wellbeing (Maercker, Bernays, et al., 2022).
For someone reading this, the question may be less about a diagnosis and more about everyday life: Why is it so difficult to trust? Why do certain interactions hurt so much? Why do I feel ashamed when I know I did nothing wrong?
These questions deserve care and curiosity.
How difficulties may appear in adult life
For some people, relationships can feel confusing. They may want closeness but find it difficult to feel safe depending on someone. Intimacy may bring discomfort, or setting a boundary may feel difficult even when they know what they need.
Emotions can also become overwhelming. Anger, fear or sadness may arrive quickly and feel hard to settle. Others may feel disconnected from their emotions. Shame and harsh self-criticism can affect how a person sees themselves, even when they can recognise that the abuse was not their fault.
Difficulties with emotional regulation, relationships and a persistent negative view of oneself are features of complex PTSD. This condition also includes PTSD symptoms, such as reliving traumatic experiences, avoiding reminders and feeling under threat (Maercker, Cloitre, et al., 2022).
However, childhood sexual abuse does not automatically lead to complex PTSD. These difficulties can have other causes, and recognising something familiar in this description is not enough to establish a diagnosis.
You do not need to fit a particular diagnosis to deserve support.
Understanding without blaming yourself
Some people have spent years trying to manage these difficulties without recognising how they might relate to earlier experiences. They may have been told they are too sensitive, too angry or too difficult, or have come to believe this about themselves.
A more compassionate starting point is to ask what a response might mean in the context of the person’s life. Being watchful, keeping your distance or putting someone else’s needs first may once have felt necessary. Exploring that possibility is different from assuming that every present-day difficulty comes from childhood.
It also matters what is happening now. Feeling hurt or unsafe in a relationship should not automatically be dismissed as a reaction to the past. Current mistreatment needs to be taken seriously.
Responsibility for abuse always lies with the person who committed it. Neither a child’s behaviour nor their response to abuse makes them responsible for what happened.
There is reason for hope
There is encouraging evidence that psychological treatment can help with trauma-related difficulties.
A systematic review found that established PTSD therapies could also improve some difficulties associated with complex PTSD, including negative self-concept and relationship problems. However, evidence was more limited for some outcomes, particularly emotional regulation, and the studies did not all involve people with a confirmed complex PTSD diagnosis (Karatzias et al., 2019).
In a trial involving women with PTSD related to childhood abuse, a treatment combining emotional and interpersonal skills with trauma processing improved PTSD symptoms and other areas of functioning (Cloitre et al., 2010).
These studies include trauma histories beyond childhood sexual abuse. They offer reasons for hope, rather than a promise that one approach will suit everyone.
Therapy can provide space to understand what is happening, consider what you need and work towards changes that matter to you. This might include responding to emotions with greater confidence, communicating boundaries or developing a less punishing relationship with yourself. The approach should be discussed collaboratively, with attention to your circumstances and preferences.
What beginning support can look like
You do not have to arrive at a first appointment ready to describe everything that happened. You can begin with what is difficult now, what you hope might change and any concerns you have about therapy.
Some effective treatments involve working directly with trauma memories. This should come with a clear explanation of the approach and an opportunity to discuss your questions and choices (Cloitre et al., 2010; Karatzias et al., 2019).
Recovery does not have to mean forgetting, forgiving or feeling differently by a particular deadline. Your goals might be very ordinary and deeply important: feeling more comfortable with someone you trust, being able to say no, or spending less of your day criticising yourself.
A responsibility we share
This awareness day is about prevention as well as healing. Protecting children, listening when someone discloses abuse, holding perpetrators accountable and making support accessible are responsibilities that extend beyond survivors themselves.
If this article feels familiar, you do not need to have all the answers before asking for help. What happened matters. How you are feeling now matters too.
Support can begin with understanding where you are today.
Support is available
If reading this has brought up difficult feelings, you do not have to manage them alone. These Australian services offer support:
Blue Knot Helpline — 1300 657 380 (press 1)
Specialist support for adults affected by childhood trauma and abuse, and those supporting them. Available daily, 9 am–5 pm AEST/AEDT. blueknot.org.au1800RESPECT — 1800 737 732
Counselling and support for people affected by sexual, domestic or family violence. Available 24 hours a day, seven days a week. You can also text 0458 737 732 or access online chat at 1800respect.org.au.Lifeline — 13 11 14
Crisis support if you are feeling overwhelmed or need someone to talk to. Available 24 hours a day, seven days a week.
If you or someone else is in immediate danger, call 000.
References
Cloitre, M., Stovall-McClough, K. C., Nooner, K., Zorbas, P., Cherry, S., Jackson, C. L., Gan, W., & Petkova, E. (2010). Treatment for PTSD related to childhood abuse: A randomized controlled trial. American Journal of Psychiatry, 167(8), 915–924. https://doi.org/10.1176/appi.ajp.2010.09081247
Hailes, H. P., Yu, R., Danese, A., & Fazel, S. (2019). Long-term outcomes of childhood sexual abuse: An umbrella review. The Lancet Psychiatry, 6(10), 830–839. https://doi.org/10.1016/S2215-0366(19)30286-X
Karatzias, T., Murphy, P., Cloitre, M., Bisson, J., Roberts, N., Shevlin, M., Hyland, P., Maercker, A., Ben-Ezra, M., Coventry, P., Mason-Roberts, S., Bradley, A., & Hutton, P. (2019). Psychological interventions for ICD-11 complex PTSD symptoms: Systematic review and meta-analysis. Psychological Medicine, 49(11), 1761–1775. https://doi.org/10.1017/S0033291719000436
Maercker, A., Bernays, F., Rohner, S. L., & Thoma, M. V. (2022). A cascade model of complex posttraumatic stress disorder centered on childhood trauma and maltreatment, attachment, and socio-interpersonal factors. Journal of Traumatic Stress, 35(2), 446–460. https://doi.org/10.1002/jts.22756
Maercker, A., Cloitre, M., Bachem, R., Schlumpf, Y. R., Khoury, B., Hitchcock, C., & Bohus, M. (2022). Complex post-traumatic stress disorder. The Lancet, 400(10345), 60–72. https://doi.org/10.1016/S0140-6736(22)00821-2
Awareness-day information: United Nations. (n.d.). World Day for the Prevention of and Healing from Child Sexual Exploitation, Abuse and Violence, 18 November. https://www.un.org/en/observances/child-sexual-exploitation-prevention-and-healing-day