Consequences of child sexual abuse

In brief

• There is no child sexual abuse syndrome. About a third of children and adolescents who have been victims show no symptoms when assessed, and that does not rule out abuse (Kendall-Tackett, Williams and Finkelhor, 1993).
• In adulthood, sexual abuse in childhood is associated with 26 of the 28 outcomes studied, including depression, anxiety, post-traumatic stress disorder, substance use, borderline personality disorder and physical health problems (Hailes et al., 2019).
• The harm is greater when there was penetration, use of force or prolonged abuse, or when the perpetrator was someone close.
• Reactions of disbelief, blame or control in response to disclosure are associated with greater harm. Support from family and from those around the child or adolescent is the best-documented protective factor (Domhardt et al., 2015).

The figures on this page come from meta-analyses, systematic reviews and studies that followed the same people over years. The final section explains how to read them. What studies show about prevention programmes is in Prevention.

In childhood

A review of 45 studies found that children and adolescents who have been victims show more symptoms than those who have not. The most frequent are fears, post-traumatic stress, behavioural problems, sexualised behaviour and low self-esteem, but no symptom appears in the majority. About a third showed no symptoms and some two thirds improved over the following 12 to 18 months. The authors warn that some effects may appear later (Kendall-Tackett, Williams and Finkelhor, 1993).

A meta-analysis of 28 studies with 28,693 participants up to the age of 21 found that sexual abuse is associated with post-traumatic stress disorder with the same strength in males (OR 2.86) and in females (OR 2.38) (Boumpa et al., 2024). Another, of 78 studies with children and adolescents, found psychological harm of medium magnitude, with more depressive and anxiety disorders, greater when there was penetration (Amado, Arce and Herraiz, 2015).

The initial consequences are emotional, cognitive, behavioural, functional and relational. Relationships with other people are among the most affected areas, because the abuse breaks the child’s or adolescent’s trust in those who were meant to care for them (Pereda, 2009).

In adolescence

Among the different types of maltreatment, sexual abuse is the one most strongly associated with suicide attempts in young people: OR 3.41, according to a meta-analysis of 79 studies with 337,185 participants with a mean age of around 16 (Angelakis, Austin and Gooding, 2020). In studies that followed the same people over time, sexual abuse was associated with subsequent suicide attempts (OR 2.43) (Devries et al., 2014).

Adolescence also brings:

• Non-suicidal self-injury, associated with child maltreatment in general (OR 3.42) (Liu et al., 2018).
• Eating disorders with earlier onset and greater severity, in relation to child maltreatment, including sexual abuse (Molendijk et al., 2017).
• Adolescent pregnancy, with a likelihood twice that of those who were not victims (OR 2.21) (Noll, Shenk and Putnam, 2009).
• Sexual risk behaviour, in females and in males (Abajobir et al., 2017).
• School dropout, substance use and further victimisation, observed in girls and adolescent girls followed for 23 years after intrafamilial abuse (Trickett, Noll and Putnam, 2011).

Mental health in adulthood

The umbrella review by Hailes et al. (2019) brought together 19 meta-analyses covering 559 studies and more than four million participants. The strongest psychiatric associations were with conversion disorder (OR 3.3), borderline personality disorder (OR 2.9), anxiety (OR 2.7) and depression (OR 2.7). Only the reviews on post-traumatic stress, schizophrenia and substance use were of high quality (Hailes et al., 2019).

A meta-analysis of 37 studies found an association with anxiety disorders (OR 3.09), depression (OR 2.66), eating disorders (OR 2.72), post-traumatic stress (OR 2.34) and suicide attempts (OR 4.14), stronger when the abuse was rape (Chen et al., 2010).

Two studies that followed people for decades show how the harm persists:

• In New Zealand, a cohort followed from birth to the age of 30 found that, after taking ten family and social factors into account, sexual abuse remained associated with depression, anxiety, suicidal ideation and attempts, alcohol and other drug dependence, and post-traumatic stress. The effect increased with the severity of the abuse (Fergusson, McLeod and Horwood, 2013).
• In Australia, of 2,759 children and adolescents whose abuse was confirmed in a medico-legal examination, 23.3% had contact with public mental health services in the following decades, compared with 7.7% of a comparison group (Cutajar et al., 2010).

Child maltreatment is also associated with more recurrent and persistent depression and with a poorer response to treatment (Nanni, Uher and Danese, 2012).

The body and stress

Abuse and maltreatment in childhood change the body’s response to stress. Studies find a flatter cortisol response to social stress (Bunea, Szentágotai-Tătar and Miu, 2017), more markers of inflammation in adulthood (Baumeister et al., 2016) and changes in brain regions that process threat and regulate emotions (Teicher and Samson, 2016). A study of 51 women found thinning of the area of the cortex that represents genital sensation in those who had been victims of sexual abuse (Heim et al., 2013). Teicher and Samson read these changes as adaptations to a threatening environment and also find them in people who do not develop disorders.

The cumulative wear and tear on the body, known as allostatic load, is one of the mechanisms proposed to explain the relationship between early adversity and illness in adulthood (Danese and McEwen, 2012).

Physical health

Having been a victim of sexual abuse is associated with more diagnoses of functional gastrointestinal disorders (OR 2.43), chronic pelvic pain (OR 2.73), non-epileptic seizures (OR 2.96) and chronic pain (OR 2.20), according to a meta-analysis of 23 studies (Paras et al., 2009). A meta-analysis of 31 studies found poorer general health and more pain in adults who were victims in childhood (Irish, Kobayashi and Delahanty, 2010), and another found that the association of child abuse with adult physical health is comparable in size to its association with mental health (Wegman and Stetler, 2009).

In the Nurses' Health Study II, a US cohort of nurses:

• Forced sexual intercourse in childhood or adolescence was associated with more early cardiovascular events. Much of that association was mediated by preventable factors in adulthood (Rich-Edwards et al., 2012).
• The risk of type 2 diabetes increased with the severity of the sexual abuse and was 69% higher with repeated forced intercourse (Rich-Edwards et al., 2010).

Girls and adolescent girls who had been victims of confirmed sexual abuse had more obesity in early adulthood, 42% compared with 28% (Noll et al., 2007), and more sleep disorders ten years after disclosure (Noll et al., 2006).

The adverse childhood experiences (ACE) study showed that the accumulation of adversities, including sexual abuse, has a graded association with the leading causes of death in adults (Felitti et al., 1998). Two studies measured mortality among those who were victims of sexual abuse:

• In the British 1958 cohort, sexual abuse in childhood was associated with premature death in mid-adulthood, independently of other adversities (HR 2.64) (Rogers, Power and Pinto Pereira, 2021).
• In the Australian cohort of medically confirmed abuse, mortality before the age of 50 was eight times that of the general population, with the largest increase in deaths from external causes (Papalia et al., 2023). These are cases that reached a forensic examination, probably more serious than average.

Relationships and trust

Abuse is often committed by someone the child or adolescent trusts or depends on (Prevalence and statistics). Betrayal trauma theory proposes that this bond aggravates the harm (Freyd, 1996); in a study of adults, traumas committed by people close to them, high-betrayal traumas, were associated with more anxiety, dissociation, depression and physical illness, and low-betrayal traumas did not add risk (Freyd, Klest and Allard, 2005).

In adult life, studies find:

• More anxiety and avoidance in attachment, that is, in the way of relating to people close to them (Pastor-Cerezo and Iborra Cuéllar, 2026).
• More difficulties in intimate relationships and in sexuality (DiLillo, 2001; Pulverman, Kilimnik and Meston, 2018).
• A higher risk of experiencing intimate partner violence (Li, Zhao and Yu, 2019).
• Further sexual assaults: a meta-analysis of 80 studies estimated that 47.9% of those who were victims in childhood experience sexual violence again later in life (Walker et al., 2019). Responsibility for each new assault lies with the person who commits it.

The idea that those who were victims repeat maltreatment with their own children has little support. A meta-analysis of 142 studies found a modest association across generations, which weakens in the better-quality studies (Madigan et al., 2019). In a study of 516 mothers, differences in parenting were explained by other childhood experiences and not by sexual abuse (Zuravin and Fontanella, 1999).

Family, school and community

Abuse also affects the family. Most mothers believe the child or adolescent fully or partly, although many experience ambivalence and significant distress; support from mothers and fathers is consistently associated with better adjustment in their child (Elliott and Carnes, 2001). After disclosure, a considerable proportion of mothers and fathers have psychological and physical problems (Cyr et al., 2016). A review published in Chile found that research mainly studies the mother and the child, and that studies of the whole family, including siblings, are lacking (Latorre, 2023).

At school, child maltreatment is associated with grade repetition, lower marks and problems with peers (Romano et al., 2015). In the New Zealand cohort, the association between sexual abuse and lower educational attainment ceased to be significant once family and social context was taken into account (Boden, Horwood and Fergusson, 2007); context explains part of that relationship.

Stigma and negative reactions from those around them are internalised as shame and self-blame, and make recovery and help-seeking harder (Kennedy and Prock, 2018).

When abuse occurs in an institution

When a school, a church or another trusted institution fails to prevent abuse or responds poorly to it, it adds a harm of its own, known as institutional betrayal (Smith and Freyd, 2014). A review commissioned by the Australian Royal Commission described psychological, physical, social, educational and economic harms, which extend to families and communities, and institutional dynamics that hinder disclosure and protection (Blakemore et al., 2017).

In abuse committed by clergy, there is also spiritual harm. A study of victims from Spain and Chile found mental health similar to that of other victims, but greater harm to religiosity and to belief in God (Pereda et al., 2022). In another study, harm and later personal growth appeared together in the same people (Sicilia, Barrios and Pereda, 2024).

Work, income and costs

Using a US national sample and methods that set bounds on causal effects, child sexual abuse was associated with lower educational attainment and poorer labour market outcomes, in men at least as much as in women (Henkhaus, 2022). In Quebec, a cohort linked to tax records found lower incomes between the ages of 33 and 37, with a larger gap when the abuse was intrafamilial or involved penetration (Bouchard et al., 2023).

The lifetime cost of the child sexual abuse cases confirmed in a single year in the United States was estimated at 9.3 billion 2015 US dollars, some 283,000 dollars for each female child or adolescent victim. The study counted only confirmed cases, so the real burden is greater (Letourneau et al., 2018). There is no published estimate for Chile.

What aggravates and what protects

The consequences are more serious when there was penetration, use of force, frequent or prolonged abuse, several perpetrators, or when the perpetrator was close to the child or adolescent (Kendall-Tackett, Williams and Finkelhor, 1993; Cutajar et al., 2010).

How those around the child or adolescent respond to disclosure has a bearing on what comes after. Reactions of disbelief, blame or control are associated with more symptoms (Ullman, 2003; Dworkin, Brill and Ullman, 2019). Disclosure is a process that unfolds over time and in relationship with other people (Alaggia, Collin-Vézina and Lateef, 2019); what studies say about how long it takes is in Disclosure and reporting.

Between 10% and 53% of those who were victims maintain normal functioning, depending on the study. The best-supported protective factors are support from family and from those around them, education, active coping and attributing blame to the perpetrator rather than to oneself (Domhardt et al., 2015; Marriott, Hamilton-Giachritsis and Harrop, 2014). No longer avoiding what happened, freeing oneself from self-blame and having secure attachment have a positive effect (Cantón-Cortés and Cortés, 2015). In Chile, children and adolescents who completed psychotherapy reported greater well-being and more control over their lives (Capella et al., 2016).

A Foundation survey of 641 adults in the Santiago Metropolitan Region found that the lower well-being of those who were victims was concentrated in the low socioeconomic group: there, they scored on average 1.11 points lower, on a scale of 0 to 10, than those who were not. It is not a probability sample (Murillo et al., 2021).

If you are worried about a child or adolescent, or if you experienced sexual abuse in your childhood, Help (in Spanish) offers guidance and ways to contact us.

How to read these figures

The odds ratio (OR) compares the likelihood of a problem between those who were victims and those who were not. An OR of 1 indicates no difference; one of 2.7 indicates a considerably higher likelihood, close to 2.7 times when the problem is uncommon. The HR, used by studies that follow people over time, is read in the same way.

Almost all studies show association. To get closer to causality, some compare twins of whom only one was a victim. Two of them found more disorders in the twin who was a victim, consistent with an effect of the abuse (Kendler et al., 2000; Nelson et al., 2002), and a third found no differences between twins (Dinwiddie et al., 2000). Part of the risk also comes from the family environment in which the abuse occurs.

Official records and adults’ accounts of their childhood identify partly different people (Baldwin et al., 2019). In one study, the risk of mental health problems was concentrated in those who remembered and recounted the experience (Danese and Widom, 2020).

The figures describe risks in groups of people. They do not predict what will happen to each person who was a victim. What these studies mean by child sexual abuse is explained in Definitions.