Victims typically do not disclose their abuse out of embarrassment along with fear that they will not be believed or will be blamed for what happened to them. In addition, perpetrators usually demand secrecy and often control their victims through the use of bribes or threats (Paine & Hanson, 2002). Victims have been found to accommodate the abuse psychologically by using coping mechanisms such as denial, minimization, and dissociation regarding the abuse itself or its damaging effects (Coons, Bowman, Pellow, & Schneider, 1989; Summit, 1983).
Studies have consistently demonstrated that CSA is associated with a broad range of behavioral, psychological and physical problems that persist into adulthood. Psychological sequelae include anxiety, depression, PTSD, self-destructive behavior, dissociation, substance abuse, sexual maladjustment, and a tendency towards revictimization in subsequent relationships (Browne, & Finkelhor, 1986; Roesler & McKenzie, 1994).
Because CSA is an experience rather than a disorder, it is difficult to predict how any single individual will respond. Research indicates that long-term effects of CSA range from the child being asymptomatic to showing evidence of severe distress (Kendall-Tackett, Williams, & Finkelhor, 1993). No single factor has been found to explain individual variations in outcome following CSA. Some abused children remain asymptomatic, some outcomes are delayed until later stages of development, and some outcomes may only be expressed with cumulative trauma (Putnam, 2003).
Factors that have been found to influence outcome can be viewed as falling into three broad categories: (1) individual factors (e.g., attributions, coping strategies employed); (2) abuse-related characteristics (e.g., age at the time of abuse, use of force, multiple versus single assault, penetration, proximity to perpetrator); and (3) interactions with others (e.g., responses to disclosure, quality of attachment relationships) (see Barker-Collo & Read, 2003, for a review). Numerous studies have found evidence of a dose-response relationship with more severe abuse being associated with worse outcomes (e.g., Felitti et al., 1998; Kendler et al., 2000; Mullen, Martin, Anderson, Romans, & Herbison, 1993).