Elsevier

Aggression and Violent Behavior

Volume 5, Issue 3, May–June 2000, Pages 291-328
Aggression and Violent Behavior

Review
The impact of child sexual abuse on adult interpersonal functioning: A review and synthesis of the empirical literature

https://doi.org/10.1016/S1359-1789(99)00010-5Get rights and content

Abstract

The many studies that have examined the long-term impact of child sexual abuse (CSA) on adult functioning have primarily focused on the personal distress of survivors, largely ignoring the impact of CSA on interpersonal relationships. This article reviews empirical findings concerning the interpersonal distress of survivors as expressed in their intimate and sexual relationships. First, current conceptualizations of the relationship between CSA and interpersonal relationships are reviewed, with a focus on the theoretical models that appear to have implications for the long-term interpersonal sequelae associated with CSA. This is followed by a review of the research conducted on intimacy within the area of social psychology and a summary of the empirical findings related to intimacy functioning in CSA survivors. A hypothesized typology of intimacy functioning for survivors is suggested. The effects of CSA on three components of sexuality—sexual dysfunctions, underlying psychological components of sexuality, and sexual orientation—are discussed. Finally, the interpersonal issues believed to be most salient for CSA survivors in the therapeutic setting are discussed, along with implications for the client–therapist relationship. Methodological, assessment, and conceptual issues are discussed throughout. Recommendations for future research and clinical endeavors are suggested.

Section snippets

The relationship between child sexual abuse and interpersonal relationships

The literature on the long-term impact of CSA on adult survivors has used various schemata to categorize CSA sequelae. Most often negative correlates are expressed either as diagnostic disorders (e.g., posttraumatic stress disorder [PTSD], borderline personality disorder [BPD]) or descriptive symptomatic domains that are thought to be indicative of personal distress Jumper 1995, Neumann et al. 1996. However, it appears that diagnostic constructs “may not provide the most valid or useful

Theoretical models of child sexual abuse: addressing the association with adult interpersonal functioning

A variety of theoretical models has been offered to explain survivor responses to CSA. These theories have been more clearly articulated to explain the immediate symptomatic outcome in children and are reviewed elsewhere (Kendall-Tackett et al., 1993). Although variability in symptomatic outcome among survivors would argue against applicability of core-domain theories (e.g., PTSD model, sexualized behavior model, and self-image model), within this group of theories, the PTSD model has garnered

Intimacy

Although the clinical literature suggests that survivors' adult relationships may be characterized by lack of trust and intimacy, there has been only minimal empirical investigation of the nature of partner relationships of survivors (Polusny & Follette, 1995). Lack of research investigating the intimacy functioning of CSA survivors is surprising, considering that childhood abuse represents a severe breech of trust for the child. Because of the severity of childhood sexual abuse, it is logical

Sexuality

One area of interpersonal functioning that has received greater attention in the empirical literature is sexual functioning of survivors Finkelhor et al. 1989, Jehu 1989, Mackey et al. 1991. It is not surprising that many survivors experience postassault sexual dysfunctions (Becker, Skinner, Abel, & Cichon, 1986), given that sexual assault is forced sexual contact, which is the ultimate violation and invasion of a person's body and psyche. Survivors often “view sexual activity not as a means of

Treatment studies3

Much of the literature that addresses issues of interpersonal functioning of CSA survivors consists of self-help books, clinical reports addressing observed effects, and articles that address broad treatment issues or strategies applicable to the treatment of survivors. However, there is a void in the empirical literature in terms of treatment outcome studies. Although much has been written about the issues, processes, and strategies for treatment with survivors, there have been decidedly few

Summary and conclusions

The empirical and clinical literature reviewed in this article identifies many substantive issues that must be considered in future research studies and clinical work with CSA survivors. The long-term impact of CSA, particularly as relates to survivor interpersonal functioning, is much broader than originally conceptualized. As has been discussed, interpersonal functioning involves intimacy issues as well as sexuality. Further, researchers must go beyond the behavioral manifestations of the

Acknowledgements

Resource support for this article was provided by the Marie Wilson Howells Foundation at the University of Arkansas. This endowment, dedicated to mental health research, was invaluable in the completion of this article. We particularly offer our thanks to Laura Pitman, Mollie Mount, and Dan Smith for their helpful comments and suggestions.

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