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Do not fill this in! ===Psychological=== Child sexual abuse can result in both short-term and long-term harm, including [[psychopathology]] in later life.<ref name="dinw">{{Cite journal |vauthors=Dinwiddie S, Heath AC, Dunne MP, etal |title=Early sexual abuse and lifetime psychopathology: a co-twin-control study|journal=Psychological Medicine|volume=30 |issue=1 |pages=41β52|date=January 2000|pmid=10722174 |doi=10.1017/S0033291799001373|s2cid=15270464}}</ref><ref name="twin">{{Cite journal |vauthors=Nelson EC, Heath AC, Madden PA, etal |title=Association between self-reported childhood sexual abuse and adverse psychosocial outcomes: results from a twin study|journal=Archives of General Psychiatry|volume=59 |issue=2 |pages=139β145|date=February 2002|pmid=11825135 |doi=10.1001/archpsyc.59.2.139|doi-access=free}}</ref> Indicators and effects include [[Major depressive disorder|depression]],<ref name="Roosa">{{Cite journal|vauthors=Roosa MW, Reinholtz C, Angelini PJ|title=The relation of child sexual abuse and depression in young women: comparisons across four ethnic groups|url=https://archive.org/details/sim_journal-of-abnormal-child-psychology_1999-02_27_1/page/65|journal=Journal of Abnormal Child Psychology|volume=27 |issue=1 |pages=65β76|date=February 1999|pmid=10197407}}</ref><ref name=Widom2007>{{Cite journal|vauthors=Widom CS, DuMont K, Czaja SJ|title=A prospective investigation of major depressive disorder and comorbidity in abused and neglected children grown up|journal=Archives of General Psychiatry|volume=64 |issue=1 |pages=49β56|date=January 2007|pmid=17199054 |doi=10.1001/archpsyc.64.1.49 |doi-access=free}} *{{cite press release |date=January 3, 2007 |title=Child Abuse And Neglect Associated With Increased Risk Of Depression Among Young Adults |website=[[ScienceDaily]] |url=https://www.sciencedaily.com/releases/2007/01/070102092229.htm}}</ref><ref name=Arnow/> [[anxiety]],<ref name="levitan">{{Cite journal|vauthors=Levitan RD, Rector NA, Sheldon T, Goering P|title=Childhood adversities associated with major depression and/or anxiety disorders in a community sample of Ontario: issues of co-morbidity and specificity|journal=Depression and Anxiety|volume=17 |issue=1 |pages=34β42|year=2003|pmid=12577276 |doi=10.1002/da.10077|s2cid=26031006|doi-access=free}}</ref> [[eating disorders]],<ref name=Walsh2011/> poor [[self-esteem]],<ref name=Walsh2011>{{Cite book|last1=Walsh|first1=K.|last2=DiLillo|first2=D.|editor1-last=Paludi|editor1-first=Michael A.|chapter=Child sexual abuse and adolescent sexual assault and revictimization|title=The psychology of teen violence and victimization|volume=1 |publisher=Praeger|location=Santa Barbara, CA|year=2011|pages=203β216|isbn=978-0-313-39375-4}}</ref> [[somatization]],<ref name=Arnow>{{Cite journal|author=Arnow BA|title=Relationships between childhood maltreatment, adult health and psychiatric outcomes, and medical utilization|journal=The Journal of Clinical Psychiatry|volume=65|pages=10β15|year=2004|issue=Suppl 12 |pmid=15315472|url=http://article.psychiatrist.com/?ContentType=START&ID=10000983|access-date=2010-03-16|archive-url=http://arquivo.pt/wayback/20160516194224/http://article.psychiatrist.com/?ContentType=START&ID=10000983|archive-date=2016-05-16}}</ref> [[sleep disorder|sleep disturbances]],<ref>{{Cite journal |author=Noll, J. G. |author2=Trickett, P. K. |author3=Susman, E. J. |author4=Putnam, F. W.|title=Sleep disturbances and childhood sexual abuse|journal=Journal of Pediatric Psychology|volume=31 |issue=5 |pages=469β480|year=2006|doi=10.1093/jpepsy/jsj040|pmid=15958722|doi-access=free}}</ref><ref>{{Cite journal|vauthors=Steine IM, Krystal JH, Nordhus IH, Bjorvatn B, Harvey AG, Eid J, GrΓΈnli J, Milde AM, Pallesen S |title=Insomnia, nightmare frequency, and nightmare distress in victims of sexual abuse: The role of perceived social support and abuse characteristics|journal=Journal of Interpersonal Violence|volume=27|issue=9 |pages=51827β51843|year=2012|doi=10.1177/0886260511430385|pmid=22204947|s2cid=20268989}}</ref> and [[Dissociative identity disorder|dissociative]] and [[anxiety disorder]]s including [[post-traumatic stress disorder]].<ref name="widom">{{Cite journal|author=Widom CS|title=Posttraumatic stress disorder in abused and neglected children grown up|journal=The American Journal of Psychiatry|volume=156 |issue=8 |pages=1223β1229|date=August 1999|pmid=10450264 |url=http://ajp.psychiatryonline.org/cgi/pmidlookup?view=long&pmid=10450264 |doi=10.1176/ajp.156.8.1223|s2cid=7339542 }}</ref><ref name=Treichel>{{Cite journal|url=http://pn.psychiatryonline.org/cgi/content/full/40/15/34-a|archive-url=https://web.archive.org/web/20060303063148/http://pn.psychiatryonline.org/cgi/content/full/40/15/34-a|archive-date=2006-03-03|title=Dissociation Often Precedes PTSD In Sexually Abused Children|first1=Joan|last1=Arehart-Treichel|journal=Psychiatric News|date=2005-08-05|volume=40|page=34|publisher=American Psychiatric Association|issue=15|doi=10.1176/pn.40.15.00400034a}}</ref> While children may exhibit regressive behaviours such as [[thumb sucking]] or [[Nocturnal enuresis|bedwetting]], the strongest indicator of sexual abuse is sexual [[acting out]] and inappropriate sexual knowledge and interest.<ref name=APA2012>[https://web.archive.org/web/20141231094025/http://apa.org/pi/families/resources/understanding-child-abuse.aspx Understanding child sexual abuse: education, prevention, and recovery.] ''[[American Psychological Association]]'' Retrieved 30 October 2012</ref><ref name=Faller>{{Cite book|last=Faller |first=Kathleen Coulborn |title=Child Sexual Abuse: Intervention and Treatment Issues |publisher=Diane Publishing |year=1993 |page=6 |isbn=978-0-7881-1669-8}}</ref> Victims may withdraw from school and social activities<ref name=APA2012/> and exhibit various learning and behavioural problems including [[cruelty to animals]],<ref>{{cite journal |doi=10.2752/089279303786992116 |title=Cruelty to animals in normative, sexually abused, and outpatient psychiatric samples of 6- to 12-year-old children: Relations to maltreatment and exposure to domestic violence |year=2003 |last1=Ascione |first1=Frank R. |last2=Friedrich |first2=William N. |last3=Heath |first3=John |last4=Hayashi |first4=Kentaro |journal=AnthrozoΓΆs|volume=16 |issue=3 |pages=194β212|s2cid=145018287 }}</ref><ref>{{cite book |last=Ascione |first=Frank R. |year=2005 |chapter=Child sexual abuse |chapter-url=https://books.google.com/books?id=DPyAML4cGxcC&pg=PA46 |page=46 |title=Children and Animals: Exploring the Roots of Kindness and Cruelty |publisher=Purdue University Press |isbn=978-1-55753-383-8}}</ref><ref>{{cite journal |doi=10.1016/0145-2134(95)00087-O |pmid=8556438 |title=Clinical characteristics related to severity of sexual abuse: A study of seriously mentally ill youth |url=https://archive.org/details/sim_child-abuse-neglect_1995-10_19_10/page/1245 |year=1995 |last1=McClellan |first1=Jon |last2=Adams |first2=Julie |last3=Douglas |first3=Donna |last4=McCurry |first4=Chris |last5=Storck |first5=Mick |journal=Child Abuse & Neglect |volume=19 |issue=10 |pages=1245β1254}}</ref><ref>{{cite journal |doi=10.1093/jpepsy/11.1.47 |title=Behavior Problems in Sexually Abused Young Children |year=1986 |last1=Friedrich |first1=William N. |last2=Urquiza |first2=Anthony J. |last3=Beilke |first3=Robert L. |journal=Journal of Pediatric Psychology |volume=11 |pages=47β57 |pmid=3958867 |issue=1}}</ref> [[Attention deficit hyperactivity disorder|attention deficit/hyperactivity disorder]] (ADHD), [[conduct disorder]], and [[oppositional defiant disorder]] (ODD).<ref name=Walsh2011/> [[Teenage pregnancy]] and risky sexual behaviors may appear in adolescence.<ref name=Tyler2002>{{Cite journal|author=Tyler, K.A. |title=Social and emotional outcomes of childhood sexual abuse: A review of recent research |journal=Aggression and Violent Behavior |volume=7|issue=6 |pages=567β589 |year=2002 |doi=10.1016/S1359-1789(01)00047-7}}</ref> Child sexual abuse victims report almost four times as many incidences of [[Self-harm|self-inflicted harm]].<ref name=SelfHarm2003>{{Cite journal|author=J. G. Noll |title=Revictimization and self-harm in females who experienced childhood sexual abuse: Results from a prospective study|url=https://archive.org/details/sim_journal-of-interpersonal-violence_2003-12_18_12/page/1452 |journal=Journal of Interpersonal Violence|volume=18|issue=12|pages=1452β1471|year=2003|doi=10.1177/0886260503258035|pmid=14678616|s2cid=38994688|display-authors=etal}}</ref> Sexual assault among teenagers has been shown to lead to an increase in mental health problems, social exclusion and worse school performance.<ref>{{Cite journal |date=2022-09-23 |title=Sexual assault has lasting effects on teenagers' mental health and education |website=National Institute for Health and Care Research |url=https://evidence.nihr.ac.uk/alert/sexual-assault-lasting-effects-teenagers-mental-health-education/ |language=en |doi=10.3310/nihrevidence_53533|s2cid=252516636 }}</ref><ref>{{Cite journal |last1=Clarke |first1=Venetia |last2=Goddard |first2=Andrea |last3=Wellings |first3=Kaye |last4=Hirve |first4=Raeena |last5=Casanovas |first5=Marta |last6=Bewley |first6=Susan |last7=Viner |first7=Russell |last8=Kramer |first8=Tami |last9=Khadr |first9=Sophie |date=2021-08-09 |title=Medium-term health and social outcomes in adolescents following sexual assault: a prospective mixed-methods cohort study |journal=Social Psychiatry and Psychiatric Epidemiology |volume=58 |issue=12 |pages=1777β1793 |language=en |doi=10.1007/s00127-021-02127-4 |pmid=34370051 |pmc=10627884 |s2cid=236953714 |issn=0933-7954|doi-access=free }}</ref> [[File:NIH child sex abuse disorders graph.svg|right|400px|thumb|A study funded by the US [[National Institute of Drug Abuse]] found that "Among more than 1,400 adult females, childhood sexual abuse was associated with increased likelihood of drug dependence, alcohol dependence, and psychiatric disorders. The associations are expressed as [[odds ratio]]s: for example, women who experienced nongenital sexual abuse in childhood were 2.83 times more likely to develop drug dependence as adults than were women who were not abused."<ref name=NIDA17/>]] A well-documented, long-term negative effect is repeated or additional victimization in adolescence and adulthood.<ref name="Messman-Moore">{{Cite journal|doi=10.1177/088626000015005003 |title=Child Sexual Abuse and Revictimization in the Form of Adult Sexual Abuse, Adult Physical Abuse, and Adult Psychological Maltreatment|url=https://archive.org/details/sim_journal-of-interpersonal-violence_2000-05_15_5/page/489 |year=2000|last1=Messman-Moore|first1=T. L.|last2=Long|first2=P. J.|journal=Journal of Interpersonal Violence|volume=15 |pages=489β502|issue=5|s2cid=145761598}}</ref><ref name=Polusny>{{Cite journal|title=Long-term correlates of child sexual abuse: Theory and review of the empirical literature|author1=Melissa A. Polusny|author2=Victoria M. Follette|publisher=Elsevier Ltd.|journal=Applied and Preventive Psychology|volume= 4 |issue= 3|year=1995|pages=143β166|doi=10.1016/s0962-1849(05)80055-1}}</ref> A causal relationship has been found between childhood sexual abuse and various adult psychopathologies, including [[crime]] and [[suicide]],<ref name=Whealin>{{cite web|url=http://www.ptsd.va.gov/public/pages/child-sexual-abuse.asp |archive-url=https://web.archive.org/web/20090730101002/http://www.ptsd.va.gov/public/pages/child-sexual-abuse.asp |archive-date=2009-07-30 |title=Child Sexual Abuse |author=Julia Whealin |publisher=National Center for Post Traumatic Stress Disorder, US Department of Veterans Affairs |date=2007-05-22 }}</ref><ref name="science-freyd">{{Cite journal|vauthors=Freyd JJ, Putnam FW, Lyon TD |title=Psychology. The science of child sexual abuse |journal=Science |volume=308 |issue=5721 |page=501 |date=April 2005 |pmid=15845837 |doi=10.1126/science.1108066|s2cid=70752683 |display-authors=etal}}</ref><ref name="Dozier">{{Cite book |vauthors=Dozier M, Stovall KC, Albus K |year=1999 |chapter=Attachment and Psychopathology in Adulthood |editor1=J. Cassidy |editor2=P. Shaver |title=Handbook of Attachment |pages=497β519 |location=NY |publisher=Guilford Press |isbn=978-1-57230-826-8}}</ref><ref name="Kendall">{{Cite journal|vauthors=Kendall-Tackett KA, Williams LM, Finkelhor D |s2cid=2512368 |title=Impact of sexual abuse on children: a review and synthesis of recent empirical studies |url=https://archive.org/details/sim_psychological-bulletin_1993-01_113_1/page/164 |journal=Psychological Bulletin |volume=113 |issue=1 |pages=164β80 |date=January 1993 |pmid=8426874 |doi=10.1037/0033-2909.113.1.164}} also published in {{Cite book|title=Annual progress in child psychiatry and child development 1994 |first=Margaret E. |last=Hertzig |author2=Ellen A. Farber |year=1994 |publisher=Psychology Press |pages=321β56 |isbn=978-0-87630-744-1}}</ref><ref>{{Cite journal|vauthors=Gauthier L, Stollak G, MessΓ© L, Aronoff J |title=Recall of childhood neglect and physical abuse as differential predictors of current psychological functioning |url=https://archive.org/details/sim_child-abuse-neglect_1996-07_20_7/page/549 |journal=Child Abuse & Neglect |volume=20 |issue=7 |pages=549β59 |date=July 1996 |pmid=8832112 |doi=10.1016/0145-2134(96)00043-9}}</ref><ref name="johnbriere">{{Cite journal |author=Briere J |title=Methodological issues in the study of sexual abuse effects |journal=Journal of Consulting and Clinical Psychology |volume=60 |issue=2 |pages=196β203 |date=April 1992 |pmid=1592948 |doi=10.1037/0022-006X.60.2.196 |url=http://www.johnbriere.com/methodological%20csa%20jccp%201992.pdf |archive-url=https://web.archive.org/web/20080911152635/http://www.johnbriere.com/methodological%20csa%20jccp%201992.pdf |archive-date=2008-09-11 }}</ref> in addition to alcoholism and drug abuse.<ref name=NIDA17>{{Cite journal|title=Childhood Sex Abuse Increases Risk for Drug Dependence in Adult Women |journal=NIDA Notes |publisher=National Institute of Drug Abuse |volume=17 |issue=1 |date=April 2002 |first=Patrick |last=Zickler |doi=10.1151/v17i1CSAIRDDAW |page=5 }}</ref><ref name= Polusny/><ref>{{Cite journal|author=Brown D |title=(Mis) representations of the long-term effects of childhood sexual abuse in the courts |journal=Journal of Child Sexual Abuse |volume=9 |issue=3β4 |pages=79β107 |year=2000 |pmid=17521992 |doi=10.1300/J070v09n03_05|s2cid=20874393 }}</ref> Males who were sexually abused as children more frequently appear in the criminal justice system than in a clinical mental health setting.<ref name=APA2012/> A study comparing middle-aged women who were abused as children with non-abused counterparts found significantly higher health care costs for the former.<ref name=Arnow/><ref name="pmid18204885">{{Cite journal|vauthors=Bonomi AE, Anderson ML, Rivara FP |title=Health care utilization and costs associated with childhood abuse |journal=Journal of General Internal Medicine |volume=23 |issue=3 |pages=294β9 |date=March 2008 |pmid=18204885 |pmc=2359481 |doi=10.1007/s11606-008-0516-1|display-authors=etal}}</ref> Intergenerational effects have been noted, with the children of victims of child sexual abuse exhibiting more conduct problems, peer problems, and emotional problems than their peers.<ref name=Parenting2004>{{cite journal |doi=10.1016/j.chiabu.2003.07.006 |pmid=15159068 |title=The effects of child sexual abuse in later family life; mental health, parenting and adjustment of offspring |url=https://archive.org/details/sim_child-abuse-neglect_2004-05_28_5/page/525 |year=2004 |last1=Roberts |first1=Ron |last2=o'Connor |first2=Tom |last3=Dunn |first3=Judy |last4=Golding |first4=Jean |journal=Child Abuse & Neglect |volume=28 |issue=5 |pages=525β545}}</ref> A specific characteristic pattern of symptoms has not been identified,<ref name="Fergusson">{{Cite book|author1=Fergusson, D.M. |author2=Mullen, P.E. |year=1999 |title=Childhood sexual abuse: An evidence based perspective |url=https://archive.org/details/childhoodsexuala00ferg |location=Thousand Oaks, California |publisher=Sage Publications |isbn=978-0-7619-1136-4}}{{Page needed|date=September 2010}}</ref> and there are several hypotheses about the causality of these associations.<ref name="Roosa"/><ref name="pmid11015813"/><ref>{{Cite journal|vauthors=Briere J, Elliott DM |title=Sexual abuse, family environment, and psychological symptoms: on the validity of statistical control |url=https://archive.org/details/sim_journal-of-consulting-and-clinical-psychology_1993-04_61_2/page/284 |journal=Journal of Consulting and Clinical Psychology |volume=61 |issue=2 |pages=284β8; discussion 289β90 |date=April 1993 |pmid=8473582 |doi=10.1037/0022-006X.61.2.284}}</ref> Studies have found that 51% to 79% of sexually abused children exhibit psychological symptoms.<ref name="Kendall" /><ref>{{Cite journal|doi=10.1177/107906328900200102 |title=The Impact of Child Sexual Abuse On Victims' Adjustment |year=1989 |last1=Caffaro-Rouget |first1=A. |last2=Lang |first2=R. A. |last3=Van Santen |first3=V. |journal=Sexual Abuse: A Journal of Research and Treatment |volume=2 |pages=29β47|s2cid=145389337 }}</ref><ref>{{Cite journal|vauthors=Mannarino AP, Cohen JA |title=A clinical-demographic study of sexually abused children |journal=Child Abuse & Neglect |volume=10 |issue=1 |pages=17β23 |year=1986 |pmid=3955424 |doi=10.1016/0145-2134(86)90027-X}}</ref><ref>{{Cite journal|vauthors=Tong L, Oates K, McDowell M |title=Personality development following sexual abuse |url=https://archive.org/details/sim_child-abuse-neglect_1987_11_3/page/371 |journal=Child Abuse & Neglect |volume=11 |issue=3 |pages=371β83 |year=1987 |pmid=3676894 |doi=10.1016/0145-2134(87)90011-1}}</ref><ref>{{Cite journal|doi=10.1177/088626058700200404 |title=The Effects of Sexual Abuse on Children: A Multidimensional View |year=1987 |last1=Conte |first1=J. R. |last2=Schuerman |first2=J. R. |journal=Journal of Interpersonal Violence |volume=2 |pages=380β390|issue=4|s2cid=143952913 }}</ref> The risk of harm is greater if the abuser is a relative, if the abuse involves intercourse or attempted intercourse, or if threats or force are used.<ref>{{Cite journal|vauthors=Bulik CM, Prescott CA, Kendler KS |title=Features of childhood sexual abuse and the development of psychiatric and substance use disorders |journal=The British Journal of Psychiatry |volume=179 |issue= 5|pages=444β9 |date=November 2001 |pmid=11689403 |doi=10.1192/bjp.179.5.444|doi-access=free }}</ref> The level of harm may also be affected by various factors such as penetration, duration and frequency of abuse, and use of force.<ref name="dinw" /><ref name="twin" /><ref name=Beitchman>{{Cite journal|vauthors=Beitchman JH, Zucker KJ, Hood JE, daCosta GA, Akman D, Cassavia E |title=A review of the long-term effects of child sexual abuse |url=https://archive.org/details/sim_child-abuse-neglect_1992_16_1/page/101 |journal=Child Abuse Negl |volume=16 |issue=1 |pages=101β18 |year=1992 |pmid=1544021 |doi=10.1016/0145-2134(92)90011-F}}</ref><ref name=pmid3704036>{{Cite journal|vauthors=Browne A, Finkelhor D |title=Impact of child sexual abuse: a review of the research |url=https://archive.org/details/sim_psychological-bulletin_1986-01_99_1/page/66 |journal=Psychological Bulletin |volume=99 |issue=1 |pages=66β77 |date=January 1986 |pmid=3704036 |doi=10.1037/0033-2909.99.1.66|hdl=10983/681 }}</ref> The social stigma of child sexual abuse may compound the psychological harm to children,<ref name=pmid3704036/><ref>{{Cite journal|doi=10.1016/S1359-1789(02)00101-5 |title=The 'sexually abused child': Potential mechanisms of adverse influences of such a label |year=2003 |last1=Holguin |first1=G |journal=Aggression and Violent Behavior |volume=8 |pages=645β670|issue=6|last2=Hansen|first2=David J.|url=http://digitalcommons.unl.edu/cgi/viewcontent.cgi?article=1026&context=psychfacpub }}</ref> and adverse outcomes are less likely for abused children who have supportive family environments.<ref>{{Cite journal|vauthors=Romans SE, Martin JL, Anderson JC, O'Shea ML, Mullen PE |title=Factors that mediate between child sexual abuse and adult psychological outcome |url=https://archive.org/details/sim_psychological-medicine_1995-01_25_1/page/127 |journal=Psychological Medicine |volume=25 |issue=1 |pages=127β42 |date=January 1995 |pmid=7792348 |doi=10.1017/S0033291700028154|s2cid=7585679 }}</ref><ref>{{Cite journal|vauthors=Spaccarelli S, Kim S |title=Resilience criteria and factors associated with resilience in sexually abused girls |url=https://archive.org/details/sim_child-abuse-neglect_1995-09_19_9/page/1171 |journal=Child Abuse & Neglect |volume=19 |issue=9 |pages=1171β82 |date=September 1995 |pmid=8528822 |doi=10.1016/0145-2134(95)00077-L}}</ref> ====Posttraumatic stress disorder==== {{Main|Dissociation (psychology)|Posttraumatic stress disorder}} [[Child abuse]], including sexual abuse, especially chronic abuse starting at early ages, has been found to be related to the development of high levels of dissociative symptoms, which includes amnesia for abuse memories.<ref name=chu>{{Cite journal|vauthors=Chu JA, Frey LM, Ganzel BL, Matthews JA |title=Memories of childhood abuse: dissociation, amnesia, and corroboration |journal=The American Journal of Psychiatry |volume=156 |issue=5 |pages=749β55 |date=May 1999 |pmid=10327909 |url=http://ajp.psychiatryonline.org/cgi/pmidlookup?view=long&pmid=10327909 |doi=10.1176/ajp.156.5.749|s2cid=24262943 }}</ref> When severe sexual abuse (penetration, several perpetrators, lasting more than one year) had occurred, dissociative symptoms were even more prominent.<ref name=draijer>{{Cite journal|vauthors=Draijer N, Langeland W |title=Childhood trauma and perceived parental dysfunction in the etiology of dissociative symptoms in psychiatric inpatients |url=https://archive.org/details/sim_american-journal-of-psychiatry_1999-03_156_3/page/379 |journal=The American Journal of Psychiatry |volume=156 |issue=3 |pages=379β85 |date=March 1999 |pmid=10080552 |doi=10.1016/j.biopsych.2003.08.018|s2cid=14670794 }}</ref> Recent research showed that females with high exposure to child sexual abuse (CSA) develop PTSD symptoms that are associated with poor social functioning, which is also supported by prior research studies.<ref>{{cite journal | last1 = McLean | first1 = CP | last2 = Rosenbach | first2 = SB | last3 = Capaldi | first3 = S | last4 = Foa | first4 = EB | year = 2013 | title = Social and academic functioning in adolescents with child sexual abuse-related PTSD | journal = Child Abuse & Neglect | volume = 37 | issue = 9| pages = 675β678 | doi = 10.1016/j.chiabu.2013.03.010 | pmid = 23623621 | pmc = 3740087 }}</ref> The feeling of being "cut-off" from peers and "emotional numbness" are both results of CSA and highly inhibit proper social functioning. Furthermore, PTSD is associated with higher risk of substance abuse as a result of the "self-medication hypothesis" and the "high-risk and susceptibility hypothesis".<ref name="auto">{{cite journal | last1 = Schiff | first1 = M | last2 = Nacasch | first2 = N | last3 = Levit | first3 = S | last4 = Katz | first4 = N | last5 = Foa | first5 = EB | year = 2015 | title = Prolonged exposure for treating PTSD among female methadone patients who were survivors of sexual abuse in Israel | journal = Social Work & Health Care | volume = 54 | issue = 8| pages = 687β707 | doi = 10.1080/00981389.2015.1058311 | pmid = 26399489 | s2cid = 9288531 }}</ref> Besides [[dissociative identity disorder]] (DID), [[posttraumatic stress disorder]] (PTSD), and [[complex post-traumatic stress disorder]] (C-PTSD), child sexual abuse survivors may present [[borderline personality disorder]] (BPD) and eating disorders such as [[bulimia nervosa]].<ref name="Honor2010">{{Cite journal|author=Hornor, G. |title=Child sexual abuse: Consequences and implications |journal=Journal of Pediatric Health Care |volume=24|issue=6 |pages=358β364 |year=2010 |doi=10.1016/j.pedhc.2009.07.003|pmid=20971410}}</ref> ====Research factors==== Because child sexual abuse often occurs alongside other possibly confounding variables, such as poor family environment and physical abuse,<ref>{{Cite journal|vauthors=Mullen PE, Martin JL, Anderson JC, Romans SE, Herbison GP |title=The long-term impact of the physical, emotional, and sexual abuse of children: a community study |url=https://archive.org/details/sim_child-abuse-neglect_1996-01_20_1/page/7 |journal=Child Abuse & Neglect |volume=20 |issue=1 |pages=7β21 |date=January 1996 |pmid=8640429 |doi=10.1016/0145-2134(95)00112-3}}</ref> some scholars argue it is important to control for those variables in studies which measure the effects of sexual abuse.<ref name="twin" /><ref name="pmid11015813">{{Cite journal|vauthors=Kendler KS, Bulik CM, Silberg J, Hettema JM, Myers J, Prescott CA |title=Childhood sexual abuse and adult psychiatric and substance use disorders in women: an epidemiological and cotwin control analysis |journal=Archives of General Psychiatry |volume=57 |issue=10 |pages=953β9 |date=October 2000 |pmid=11015813 |doi=10.1001/archpsyc.57.10.953|doi-access=free }}</ref><ref>{{Cite journal|first1=Harrison G. |last1=Pope |first2=James I. |last2=Hudson |title=Does childhood sexual abuse cause adult psychiatric disorders? Essentials of methodology |journal=Journal of Psychiatry & Law |volume=23 |issue=3 |date=Fall 1995 |pages=363β81|doi=10.1177/009318539502300303 |s2cid=81434466 }}</ref><ref>{{Cite journal|vauthors=Levitt EE, Pinnell CM |title=Some additional light on the childhood sexual abuse-psychopathology axis |url=https://archive.org/details/sim_international-journal-of-clinical-experimental-hypnosis_1995-04_43_2/page/145 |journal=The International Journal of Clinical and Experimental Hypnosis |volume=43 |issue=2 |pages=145β62 |date=April 1995 |pmid=7737760 |doi=10.1080/00207149508409958}}</ref> In a 1998 review of related literature, Martin and Fleming state "The hypothesis advanced in this paper is that, in most cases, the fundamental damage inflicted by child sexual abuse is due to the child's developing capacities for trust, intimacy, agency and sexuality, and that many of the mental health problems of adult life associated with histories of child sexual abuse are second-order effects."<ref>{{Cite journal|vauthors=Fleming J, Mullen PE, Sibthorpe B, Bammer G |title=The long-term impact of childhood sexual abuse in Australian women |url=https://archive.org/details/sim_child-abuse-neglect_1999-02_23_2/page/145 |journal=Child Abuse & Neglect |volume=23 |issue=2 |pages=145β59 |date=February 1999 |pmid=10075184 |doi=10.1016/S0145-2134(98)00118-5}}</ref> Other studies have found an independent association of child sexual abuse with adverse psychological outcomes.<ref name="levitan" /><ref name="twin" /><ref name="pmid11015813"/> Kendler et al. (2000) found that most of the relationship between severe forms of child sexual abuse and adult psychopathology in their sample could not be explained by family discord, because the [[effect size]] of this association decreased only slightly after they controlled for possible confounding variables. Their examination of a small sample of CSA-discordant twins also supported a causal link between child sexual abuse and adult psychopathology; the CSA-exposed subjects had a consistently higher risk for psychopathologic disorders than their CSA non-exposed twins.<ref name="pmid11015813"/> A 1998 [[Rind et al. controversy|meta-analysis by Bruce Rind et al.]] generated controversy by suggesting that child sexual abuse does not always cause pervasive harm, that girls were more likely to be psychologically harmed than boys, that some college students reported such encounters as positive experiences and that the extent of psychological damage depends on whether or not the child described the encounter as "consensual".<ref>{{Cite journal|doi=10.1080/00224499709551891 |title=A meta-analytic review of findings from national samples on psychological correlates of child sexual abuse |url=https://archive.org/details/sim_journal-of-sex-research_1997_34_3/page/237 |year=1997 |last1=Rind |first1=Bruce |last2=Tromovitch |first2=Philip |journal=Journal of Sex Research |volume=34 |pages=237β255|issue=3}}</ref> The study was criticized for flawed methodology and conclusions.<ref name="LC Dallam">{{Cite journal|vauthors=Dallam SJ, Gleaves DH, Cepeda-Benito A, Silberg JL, Kraemer HC, Spiegel D | title=The effects of child sexual abuse: Comment on Rind, Tromovitch, and Bauserman (1998) |url=https://archive.org/details/sim_psychological-bulletin_2001-11_127_6/page/715 |journal=Psychological Bulletin |volume=127 |issue=6 |pages=715β33 |date=November 2001 |pmid=11726068 |doi=10.1037/0033-2909.127.6.715}}</ref><ref>{{Cite book|last1=Oltmanns |first1=Thomas F. |last2=Emery |first2=Robert E. |title=Abnormal Psychology |publisher=Prentice Hall |year=2001 |location=Upper Saddle River, NJ |isbn=978-0-13-187521-0}}{{Page needed|date=September 2010}}</ref> The US Congress condemned the study for its conclusions and for providing material used by pedophile organizations to justify their activities.<ref name="congress">{{cite web|author=US Congress|year=1999|title=Whereas no segment of our society is more critical to the future of human survival than our children|work=106th Congress, Resolution 107|url=http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=106_cong_bills&docid=f:hc107enr.txt.pdf}}</ref> Summary: Please note that all contributions to Christianpedia may be edited, altered, or removed by other contributors. 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