Childhood sexual abuse (CSA) is shockingly common, pervasively underrecognized. Many suffer in silence, behind a veil of shame, disgust, and hatred, often self-directed, though some have less difficulty. Often, worse than the original abuse is the way family reacted—with disbelief, counteraccusation, and allegiance to the perpetrator, a deep-wounding betrayal. Thankfully, courageous high-profile individuals have opened up publicly about their own experience of abuse, and survivors and professionals have labored for years to bring awareness and change.
CSA is defined by the World Health Organization as “the involvement of a child (person less than 18 years old) in sexual activity that the child does not fully comprehend, cannot give consent, or violates the laws or social taboo of society”. Researchers estimate worldwide rates of CSA for girls to be between 12.7 and 18 percent and for 7.8 percent for boys. Rates in the United States are estimated to be 5 percent and vary in other countries, often being significantly higher. Of course, when people don't disclose history, reported rates are lower than actual frequency..
In the U.S., out of every 20 people you meet, on average one will have experienced CSA. They will not necessarily have post-traumatic stress disorder (PTSD) or any other mental or physical health problems as a result. However, as with other adverse childhood experiences (ACEs), the risk is significantly increased for various problems, including depression, anxiety, post-traumatic stress disorder, psychotic experiences, eating disorders, somatic or conversion problems affecting the body including medically-unexplained symptoms, substance misuse, suicidal thinking and self-defeating behaviors, problems from inappropriate or risky sexual behavior, and relationship difficulties.
Non-disclosure of the experience is uniquely associated with negative outcomes. Study authors note that in addition to delaying access to recovery resources and impeding recovery for people who may be in treatment but not addressing CSA directly, non-disclosure may interfere with law enforcement investigation, leaving abusers uncharged or not convicted; it perpetuates a culture of silence and stigma. Leaving perpetrators unidentified leaves other in harm’s way; sometimes non-disclosure in family systems keeps others who may have also been abused from getting help.
Forcing people to share, however, can also cause harm. Encouraging disclosure in effective and therapeutic ways is essential on the individual, group, and public health level.
Because disclosure of CSA is the first step to recovery, it’s most important to understand factors that encourage or discourage disclosure. To that end, Latiff, Fang, Goh and Tan (2023) conducted a study of the existing literature, identifying 27 quantitative studies over the last two decades to distill out 17 significant predictors of CSA disclosure, organized into 7 categories.
The authors reviewed all relevant studies from approximately the last two decades, coming up with a list of almost 1,000 references. Via systematic review, 27 studies met stringent criteria to be included, with good study design and overlapping quantitative measures for synthesis. Authors found 17 factors out of 88 factors looked at across the studies, some facilitators of and other barriers to disclosure.
The factors are generally consistent across all the studies. At the same time, there were differences from study to study. Some studies had contradictory findings—for instance, in one, age was associated with easier disclosure, in another this was not the case (as reflected in the first category, below). Other studies supported that being in a relationship facilitated disclosure, while others found this was nonsignificant. It’s also likely that factors interact with one another, requiring nuance and generating new questions to study. For people interpreting the findings individually, it’s therefore important to exercise caution.
Faciltating factors and barriers to CSA disclosure
As reported: “Facilitators of disclosure included older age, being female, higher IQ, recent abuse, resistance during abuse, clergy perpetrator, non-offending caregiver support, and acculturation. Barriers to disclosure included intellectual disability, avoidant coping, romantic relationships with the perpetrator, family criminality, domestic violence, adherence to traditional Asian values, and ethnic minority identity.”
Of the 17 factors, some are modifiable and others can’t be changed. You can’t change gender, but tools and trainings can be developed that soften barriers in gender-specific ways. For men, where there are strong social barriers to disclosure, creating a tailored environment that destigmatizes CSA and normalizes discussion helps. Male Survivor, for example, is a non-profit group addressing the needs of male survivors of childhood sexual abuse.
For groups in cultures where CSA is stigmatized and hidden and sexuality is generally off-limits for discussion, the creation of programs providing education and addressing systemic factors may make useful disclosure more likely. Societal norms, moral prohibitions, fears of retaliation and exclusion, and other situational factors can be changed on the macro level. It’s important to craft public health programs for specific communities to respect cultural and religious expectations without perpetuating the cycle of silence.
Psychological factors are also important, an area where intervention can help. One finding, for example, is that survivors who resist abuse are more likely to disclose. The capacity to resist abuse suggests an underlying stronger sense of self and concomitant reduced susceptibility to manipulation. Helping survivors develop self-compassion and providing psychoeducation in a supportive and safe atmosphere increase the likelihood of disclosure and follow-through with care. Another important facilitating factor is having a “supportive non-offending caregiver” present—someone who cares and is safe, providing emotional strength and permission to speak.
For CSA survivors and their families and loved ones, for educators, clinicians, and policymakers, and for the healthcare system in general, understanding factors determining disclosure of CSA is critically important. One of the most important things is sharing relatable information publicly about CSA. Seeking help is effective not only in addressing the direct consequences of CSA but is likely to improve long-term mental and physical health, relationship and sexual satisfaction, and general success and satisfaction in life.
The chronic and endemic nature of CSA has lead to a lack of adequate attention to the problem. Oddly, we get used to terrible things and stop paying attention ("normalization of deviance1"). We get engaged by relatively small things—when there is a tragic accident taking the lives of a handful of people, for instance. But we don’t necessarily perk up our ears when we hear about the same old problems taking place day in and day out for countless millions who walk around carrying an often extremely painful and harmful secret.
Many are resilient and do well whether they directly disclose and seek help or not—while others suffer silently. On average, CSA survivors report that sharing their story helps to relieve shame and allows them to move forward.
References
1. Normalization of Deviance is usually used to refer to how preventable problems are missed in engineering and organizational settings. For example, how in spite of multiple warnings, authorities lauched the spaceshuttle Challenger, which exploded due to a foreseeable failure of a simple o-ring. "Normalization of deviance is a phenomenon demonstrated by the gradual reduction of safety standards to a new normal after a period of absence from negative outcomes, which suggests that the absence of negative outcomes tends to reinforce the behaviors associated with cutting corners, bypassing safety checklists, and ignoring alarms." (Wright et al., 2021)
Mahirah Abdul Latiff, Lue Fang, Deborah A. Goh, Li Jen Tan,
A systematic review of factors associated with disclosure of child sexual abuse, Child Abuse & Neglect, Volume 147, 2024, 106564, ISSN 0145-2134,
https://doi.org/10.1016/j.chiabu.2023.106564
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