The Long Term Effects of Child Sexual Abuse Essay Example for Free

The Long Term Effects of Child Sexual Abuse Essay Abstract Childhood sexual abuse is a serious concern that has been associated with long term effects amongst survivors. Using secondary data, this qualitative piece of research explores the long term effects of child sexual abuse in later adult life. The purpose for this study is to create awareness to professionals that sexual abuse effects continue long after the abuse stops thus, sufficient knowledge on the characteristics of the abuse. The long term effects focuses on three developmental domains; emotional social and behavioural. The emotional aspect looks at depression, feelings of guilt and anxiety. The social aspect focuses on relationships and intimacy, and the behavioural aspect will discuss issues self-destructive behaviours. Results from the research highlight that the long term effects are not consistent across the three domains. Thus, child sexual abuse is viewed as a risk factor, as opposed to an actual cause to the effects. Nevertheless, knowledge on the long term effects is imperative, to provide appropriate support and services. Research recommendations are discussed. Acknowledgments The writing of this dissertation has been one of my biggest challenges thus far; as emotional as it was, I am pleased that I decided to follow through with my chosen topic. I have learnt so much in the process, both academically and personally. This dissertation would not have been possible without the support and guidance of several individuals. First and foremost, I would like to give thanks to God for providing me with the strength and courage to undergo such a huge challenge. I would like to say a special thank you to my beloved family and friends who have given me their support and understanding over the past five months. I am really grateful to be blessed with such wonderful people, may God bless you all. I would like to express my deepest gratitude to my dissertation tutor, Tricia Ayre. Thank you for your invaluable assistance from the beginning to the end. Your support has meant a lot and kept me on the right tracks. Thanks. Thanks to my manager and colleagues at my final year placement who also showed me a generous amount of support. A great effort has been put into enabling children to disclose their abuse, interventions and laws to protect survivors from such abuse. However, how the abuse effects the survivors has received comparatively little attention, (Nelson and Hampson 2008). Research has documented that survivors are more prone to suffer from physical, social emotional, cognitive and behavioural problems than non survivors, (Piper 2008, Nelson and Hampson 2008, Sanderson 2002). This is vital knowledge; as such effects are likely to have an impact on the survivor’s well-being. The aim of the research is to explore the long term effects of CSA in three developmental domains; Social, Emotional and Behavioural. The three domains are associated with The Framework for the Assessment of Children in Need and their Families, (Department of Health 2012). Each domain plays a vital role in the developmental needs of a child, interruptions in one or more of the domains can lead to a child not meeting their full potential, (Department for Education and Skills 2004). The Framework for the Assessment of Children in Need and their Families, highlights the importance of these specific developmental domains in order for a child to achieve, it is for this reason why I have chosen to explore these areas. The emotional aspect will discuss depression, feelings of guilt and anxiety. The social aspect will focus on relationships and intimacy, and finally the behavioural aspect will discuss issues self-destructive behaviours. CSA can leave survivors with both short and long term effects. This view is supported by Ferguson (1997), ‘as well as the immediate effects of such abuse seen in childhood, findings from research have reported how the impact of CSA can affect the lives of adult survivors. ’ â€Å"Sexual abuse is a traumatic and damaging experience which can affect a child’s capacity for trust, intimacy, mental health and emotional development and ability to achieve both educationally and socially†,( London Child Protection Committee 2005). As a result of the damage caused, it is likely for survivors to come into contact with professionals and services to address issues they may be undergoing. However, not all victims will disclose that they are survivors of CSA due to shame and embarrassment. In some cases, the individuals may not be aware that their present issues are related to their past abuse therefore will not feel the need to make the professional aware. Only 27 per cent of abused women attending general practices disclosed childhood abuse to their doctors, (Mammen and Olsen 1996). Therefore, it is important for professionals to have sufficient knowledge of the long term effects of CSA, as unknowingly may well be working with survivors. Long term effects of CSA can interfere with survivor’s mental health and well being, for these reasons social workers are likely to work with such service users, empowering them to reach their full potential. Thus it is imperative that social workers are aware of and familiar with the symptoms and long term effects associated with childhood sexual abuse, to gain a better understanding of how to support such service users, (Hall and Hall 2011). I have taken an interest in this subject for a number, as whilst undergoing my social work placement in a women’s prison, I worked with offenders with drug and alcohol misuse. A number of women disclosed that as a child, they had experienced a form of sexual abuse as a child. Anecdotally, many of the women used substances to control their emotions or repress the painful memories from their childhood. Research findings from Nesse (1994) states that drugs artificially induces pleasure or blocks normal suffering and are routinely used to block defences; such as pain and anxiety. Substance misuse can lead the individual to experience issues in areas such as social, emotional, and behavioural, (National Institute on Drug Abuse 2004). Without the prisoner disclosing their past abuse, or the professional not being aware of the long term effects caused by CSA, the effects of the abuse can go unnoticed. Consequently issues surrounding their drug misuse are addressed however; the underlying problem of CSA still remains. As a newly qualified social worker, it is important that I am aware of both the short and long term effects of CSA, as there is a likelihood of meeting with survivors in my work environment. Being able to identify the effects, would allow me to develop a more effective way of addressing the service users immediate needs, making sure they are aware of the supportive services available in the community. Therefore conducting this piece of research would have a positive contribution towards my professional development, as I would be equipped with sufficient knowledge and understanding, prior going into practice. Conducting research into this field I believe will also have a positive impact on my personal development, as I am a survivor of CSA. Although it is important for professionals working with survivors to be aware of the effects, it is equally important for the survivors themselves to be aware that the effects can continue long after the abuse stops. Through considerable media attention public awareness on CSA has increased throughout the years, though CSA is not a recent phenomenon. CSA is a social problem that has been of concern during earlier historical periods, (Conte 1994). According to Jeffery (2006), prior to the 1960’s there was very little mention of CSA. CSA and incest was seen as a taboo, (La Fontaine 1988). As this taboo was often shared by the victim, family and professional the problem remained widely unrecognised, (Bentovim et al 2009). In 1908 the Incest Act was established and incest became illegal. However, this era was still seen as ‘The time of silence’, as it was literally impossible to think about disclosing or debating sexual abuse, such acts were not accepted and viewed as forbidden. (Carlsson 2009). The Children Act in 1948 introduced child care departments to be set up in local authorities. Under the 1948 Children Act, it became the duty of a local authority to receive the child into care in cases of abuse or neglect, (Spicker 2007). In the 1940’s there was an interest in CSA by social scientists; large scale studies of sexual practices were conducted, these were known as the Kinsey studies. Findings showed that a number of participants had a sexual experience as a child with an adult, (Jeffery 2006). Even in the light of these and other studies, there remained widespread public and professional denial that CSA took place, Jeffery (2006). However this could be explained, â€Å"Before the 1970’s the justice system was not receptive to CSA: children viewed as presumptively unreliable; hard to prove abuse; general climate of disbelief; little or no training for police or prosecutors on how to investigate, recognize, and prove child abuse†, (Bala 2006). The growth of the woman’s movement was a turning point for CSA; the role of women in society had shifted, women were now encouraged to speak out about their experiences, as supposed to being ashamed and having to suppress feelings. Sanderson (2002) argued that from this exchange of information and the sharing of experiences it became evident that CSA was a common rather than an isolated experience which many women had experienced. In the 1980’s there was an increase in awareness and concern about sexual abuse of children, this was displayed in the increase of reported incidents of child abuse. Professionals were now playing a more active role in protecting children from such abuse; however this was later criticised, as they were seen as acting too quickly in removing children from their parents. In 1987, over 100 children were removed from their families on emergency Place of Safety Orders on the basis of a diagnosis of sexual abuse made by two paediatricians at a hospital in Middlesbrough, (Munro 2007, p. 21). Following the media outcry these events led to a public inquiry, famously known as The Cleveland inquiry. The message from the inquiry was that professionals needed to take a more legalistic approach to collecting evidence, (Munro 2007, p. 21) Two years later, The Children’s Act 1989 was passed, although it was not implemented until 1990. The Children Act 1989 gave every child the right to protection from abuse and exploitation and the right to inquiries to safeguard their welfare, (Batty 2005). The introduction of the Children’s Act, allowed professionals to intervene in cases they suspected a child was likely to suffer from significant harm. From the 1990’s a number of laws and legislations were put in place to prevent and detect cases of CSA, and prosecute abusers. The Protection of Children’s Act was passed in 1999; it aimed to prevent paedophiles from working with Children, (Batty 2005). In 2003, The Sexual Offences Act was passed; it criminalises all sexual activity with a child under the age of 16, (The Crown Prosecution service 2012). In addition to the increase of laws introduced, CSA has triggered a major reaction in the media; as a result CSA has received increasing public attention, (Ferguson 1997). Jeffery (2006) suggested that the increase in reported incidents of CSA over the years is related to a better understanding of the signs and symptoms of abuse and better inter-agency working. Although there has been an increase in the number of reported incidents, CSA is still largely hidden and unreported, so it is difficult to get an accurate picture of the extent of different forms of abuse, (London Child Protection Committee 2005). Pereda et al (2009) reviewed 65 studies from 22 different countries and concluded that the global prevalence of CSA is estimated at 19. 7 per cent for females and 7. 9 per cent for men. The highest prevalence rate of CSA geographically was found in Africa with 34. 4 per cent. This was mainly due to the high rate of abuse in South Africa. South Africa has many migrant workers; due to lack of job opportunities in their vicinity parents left their children alone for weeks to months with relatives or minders, while they travelled to distant places. This exposed the children to all sorts of abuse, especially sexual abuse, (Madu and Peltzer 2000). On the other hand, Europe displayed the lowest prevalence rate with 9. 2 per cent. However, even the lowest prevalence rate includes a large number of victims who need to be taken into account, (Wihbey 2011). Chapter Two 2. 0Methodology This dissertation was conducted to explore and critically examine the current literature on the long term effects of CSA, focusing on three specific domains; social, emotional and behavioural. To begin with, I attended tutorials that primarily focused on how to write and structure a dissertation. With the knowledge gained I was able to compose my first stage proposal form, at this point I identified my dissertation topic, title, rationale and aim. I was then allocated a supervisor; through one to one meetings and emails, I sought advice and guidance on the best approach that suited my dissertation topic. Targets and deadlines were also agreed upon as time management was essential. To aid my literature search I also sought advice from the librarian at the University of West London. All Material used for this dissertation solely relied upon secondary data sources. Data was gathered from the University of West London and The British library. Search engines such as Google and Yahoo were used to search web resources. I initially began by using the phrase ‘Long term effects of CSA’; however the results produced were broad, I decided to narrow my results by searching for the three domains individually, e. g. ‘Behavioural effects of CSA in adulthood’. I then read through the results provided, those that were significant to my research I printed off. Reading the literature thoroughly, I highlighted relevant points, using different colour highlighters for each domain. Findings from this dissertation were presented using qualitative research. As CSA is a sensitive topic, it was important that the approach used suited the content of the dissertation. Qualitative research aims to describe and explain relationships, where quantitative research predicts casual relationships, (Family health international 2011). Presenting the data using qualitative research allowed me to explore the subject in great detail. Family health international (2011) states that qualitative research provides information about the ‘human’ side of an issue; giving the nature of the dissertation I believed this design was the most appropriate. When athering information for the literature review, I primarily focused on literature published in the United Kingdom. However, the research presented was insufficient; I therefore furthered my search to various countries. For this reason, this study will not be based solely in the United Kingdom. The dissertation aimed to reflect both females and males experience of CSA. However, a considerable amount of literature gathered had used female participants. As Jehu (1991 cited in Forensic Psychology Practice 1999) highlighted, in regards to research and treatment literature, male survivors have been neglected. Jehu (1991 cited in Forensic Psychology Practice 1999) further explained, ‘ from a cultural perspective, there appears to be some ‘societal reluctance’ to recognise boys as victims of abuse rather than willing participants in sexual encounters’. As mainly female participants were used, it could be argued that the research is not a representative sample of CSA survivors, this could possibly interfere with the study’s validity. Validity is used to determine whether research measures what it intended to measure and to approximate the truthfulness of the results, (Tariq 2009). It is also possible that the gender specific sample could generate significant bias. As I am a survivor of CSA, it is important to acknowledge that my past experiences are likely to affect how I interpret findings gathered from the research. This could cause possible issues surrounding bias, again affecting the validity of the dissertation. Although material used for this research was based on secondary data sources, if I was to conduct primary research on my chosen topic, a number of ethical issues would have to be taken into consideration, due to the complex and sensitive nature of the subject. Firstly, I would need to ensure that full consent is gained from all participants as this protects the individuals from harm and protects the researchers from having their project deemed invalid or unethical, ( Helping Psychology 2009). It is also important, that I inform participants that they have the right to withdraw from the study at any time. Confidentially is another ethical issue that needs to be implemented when carrying out primary research. ‘The assurance of confidentiality carries with it the implication that non-researchers cannot discover the respondents identity’, (Jamison 2007). In this circumstance, confidentially is necessary as it is possible survivors taking part have not disclosed their abuse. Holmes (2004, p. 120) stated; ensuring that transcripts do not include participant’s names was a way to protect participant’s confidentiality. According to Ghate and Spencer (1995, p. 79), the most important concern when undertaking such research is the after effects of the interview on the survivors, as it may trigger and painful memories. Thus it is essential that researchers carefully balance ethical principles, so that collection of data can occur without harm to participants. Ghate and Spencer (1995, p. 79) suggested that post interviewing would be useful for participants who might have found the interview stressful. Chapter Three 3. 0Literature Review According to Office of the United Nations High Commissioner for Human Rights, (2012) Article 1 the definition of a child is â€Å"every human being below the age of eighteen years unless, under the law applicable to the child, majority is attained earlier. † Sexual abuse can be defined as an umbrella term as existing definitions of childhood sexual abuse are diverse and cover a wide range of factors. Sexual abuse can occur in several forms, these include intercourse, attempted intercourse, oral genital contact, fondling of genitals directly or through clothing, exhibitionism or exposing children to adult sexual activity or pornography, (Putnam 2003). For the purpose of this research, the following definition will be used; ‘CSA is the involvement of a child in sexual activity that he or she does not fully comprehend, is unable to give informed consent or for which the child is not developmentally prepared and cannot give consent,’ (World Health Organisation 1999). . 1Factors contributing to the impact of CSA CSA effects can vary from no apparent effects to very severe ones, such as depression and self-injurious behaviours. The impact CSA can have on an individual can differ according to a multiple of factors. Cited in Piper (2008, Ullman 2003) is in support of this view, he concluded that the degree of impact CSA has on a person varies, studies demonstrated the follow ing influencing factors; age of the child abuse, duration of the abuse, frequency of the abuse, relationship with the offender, severity of the ssault and reactions to disclosure. A number of researchers have established that the age at the onset of abuse is an important factor that can influence the impact of CSA; however researchers share contradicting views in regards to what age the abuse has the most impact on the survivor. Corby (1993 p. 123) supports the view that both the short and long term consequences of sexual abuse are less harmful in the younger children, because of the lack of awareness of the social stigma attached to sexual abuse. Gomes-Schwartz (1990 p. 07) found that their 7 to 13 years age group experienced more adverse reaction than did children in their 4 to 6 years. In contrast, Living Well (2010) suggested earlier onset is linked to greater impact. Baker and Duncan (1985) found that majority of women reporting most perceived ill-effects were abused before the age of 10. Cited in Corby (1993 p. 123, Beitchman et al 1991) raised an important argument; they suggested that age needs to be considered in conjunction with other variables. Studies have found a link between the duration of the abuse and the trauma of CSA. Barriere (2005 cited in Sanderson 2006) reported an ongoing sexual relationship with repeated contacts is generally more traumatic and usually produces more sexual abuse effects than a single contact. Browne and Finkelhor (1986 ) reviewed 11 studies and found that six confirmed the longer the duration of the abuse went on, the more traumatic was the effect on the victim. However, it must be addressed that there are many instances of one –off abuses that can have a traumatic effect on victims; this could be the case if the abuse is linked with violence, (Corby 1993, p. 24). If the abused knows their abuser, it is said that the impact of the abuse is much greater, than being abused by an unfamiliar person. Barriere (2005, cited in Sanderson 2006) supports this view as she states the closer the emotional relationship, the greater the emotional trauma. A reason for the increased trauma could possibly be due to betrayal of trust. CSA can occur in multiple forms, from asking or pres suring a child to engage in sexual activities to behaviour involving penetration. The type of sexual activity the victim is exposed to can influence the impact of the abuse. Groth (1982, p. 129-144. ) has differentiated between the child rapist, who uses force, power, and threats in the sexual abuse, and the abusers who takes the more slow approach and often with considerable affection. The effects on the child will be different. Nevertheless, it is important to stress the effects of any type of sexual abuse can cause considerable damage to the individual, (MacFarlane et al 1986, p. 10). When a child discloses their sexual abuse, it is important to remember the reaction can contribute to how the child will cope from their sexual abuse experience, (Allnock 2010). Conte and Schuerman (1987) found that a supportive response was an important factor in reducing the extent of long term problems following sexual abuse. 3. 2Reasons for limited research Over the past years CSA has received much public attention however, majority of research has focused on the victims as children; comparatively little work has been published on the long term consequences, (Cahill et al 1991). CSA researchers are faced with a number of challenges. The definition of CSA is a reason to why there is lack of research. As there is no universal definition researcher’s definitions can differ, and as a result depending on the definition used in the study findings can vary. The lack of research in the long term effects of CSA is also due to the difficulties in establishing casual connections between the abuse and the later affects years after the abuse. The greater the gap between the abuse event and the later behaviour the less chance there is of casually linking the two because of the existence of more intervening variables†, (Corby, 1993 p107). Effects found in survivors are not always exclusive to the childhood sexual abuse and may reflect other underlying issues, (Sanderson 2002, p. 54). Conducting studies in sensitive areas such as CSA has been proven to be difficult; therefore research in such fields may be limited. Willows (2009, p. 7) found â€Å"People who have experienced abuse in childhood may be understandably reluctant to share their experiences, especially in a research setting†. A study conducted on the ethical issues in research on sensitive topics noted that, participants who had experienced child abuse were more likely to report distress after participating in research, due to remembering the past. However, researchers also found that these participants were more likely to report that participation was helpful, (Decker et al 2011). According to Sanderson (2002, p. 5) another difficulty in assessing the long term effects of childhood sexual abuse, is that through the repression of the trauma, or dissociation, survivors of such abuse may possibly not consciously remember the abuse experience. Therefore findings gathered from research could be effected, interfering with the validly and reliability of the study. Despite the difficulties in undertaking research in the long term con sequences of CSA, a number of authors have made positive contributions to such a high profile topic, (Briere and Elliot 1994, Sanderson 2002, Hall and Hall 2011). Research has documented that CSA survivors are more prone to suffer from social, emotional and behavioural problems than non survivors; difficulties include, however are not limited to, anxiety depression, guilt, difficulty with interpersonal relationships, self-destructive behaviours and lowered self-esteem, (Piper 2008). It is important to be mindful that the effects and degree of such abuse varies from person to person. 3. 3Emotional There have been numerous studies examining the association between a history of CSA and emotional distress, (Sanderson 2002, Beitchman et al 1992, Mullen and Fleming 1999). Emotional effects most commonly experienced by survivors of CSA focus on depression, problems of guilt, low self-esteem and anxiety†, Sanderson (2002 p. 57). Amongst the category of emotional distress, depression has been found to be the most commonly reported symptom among survivors, and empirical findings support this view, (Cahill et al 1991). World Health Organisation (20 12) provides a definition of depression; â€Å"Depression is a common mental disorder that presents with depressed mood, loss of interest or pleasure, feelings of guilt or low self-worth, disturbed sleep or appetite, low energy, and poor concentration†. Hall and Hall (2011) documented that survivors may have difficulty in externalizing the abuse, thus thinking negatively about themselves. Ratican (1992) furthered this view by describing the symptoms of survivors’ depression to feeling down, having suicidal ideation, disturbed sleeping and eating patterns. The onset of depression has been associated with CSA in numerous studies, cited in Briere and Elliott (1994). Lanktree et al (1991) reported that adults with a history of CSA may have as much as four-time greater chance of developing depression than do individuals with no such abuse history. Beitchman et al (1992) agrees that depression is a significant issue to survivors of CSA. Reviewing eight studies they were able to identify six of the eight identified association between CSA and depression. Similarly, Briere and Runtz (1985, cited in Cahill et al 1991) found a positive correlation, in their survey of undergraduate women, those who had been sexually abused as a child reported experiencing more depressive symptoms in the preceding 12 months compared to non-abused participants. Although there is thorough research to support the correlation between CSA and depression, a small percentage of researchers failed to find a significant difference. Herman’s (1981 p. 56) found that the difference between participants from abused backgrounds and those from non-abused backgrounds proved to be statistically non-significant. His study demonstrated that 60 per cent of abused survivors reported depression, in relation to 55 per cent of the control group. In some cases, no connection was found; Fromuth (1986) undertook research and no relationship were found between depression and CSA survivors. However, her sample consisted of women with the average age of 19. 4 years, whereas majority of the other studies involved older participants. This could possibly indicate that the onset of depression is more likely to develop in later adult life. Having analysed my literature, low self-esteem was another long term effect commonly identified in CSA survivors. Robson (1988) defined self-esteem as â€Å"the sense of contentment and self-acceptance that stems from a person’s appraisal of his/her own worth, significance, attractiveness, competence and ability to satisfy aspirations†. Studies have implicated CSA in lowering self-esteem in adults, (Mullen and Fleming 1999, Herman and Hirchman 1981,). Bagley and Ramsay (1986) documented a low self-esteem rate of 19 per cent with participants from a sexual abuse background in comparison to 5 per cent among the control group. Herman and Hirchman (1981 cited in Cahill 1991) study, they found that 60 per cent of abused victims reported ‘predominantly negative self-image’ in relation to 10 per cent of their control group. Further evidence to support lowered self- esteem in sexually abused survivors is displayed in Jehu et al study (1985 cited in Sanderson 2002); using the Battle Self Esteem Questionnaire, they reported that 86 per cent of sexually abused women generated scores indicating low self-esteem. Roman’s et al (1996 cited in Mullen and Fleming 1999) agrees that low self- esteem is a significant issue to survivors of sexual abuse. The study showed a clear relationship between the two factors. From their findings, they noted that the impact of the abuse contributed to participant’s level of self- esteem. Those who reported the more intrusive forms of abuse, such as penetration, experienced lower levels of self-esteem. CSA is, by nature, threatening and disruptive, and may interfere with the survivor’s sense of security; therefore it is likely that victims of such maltreatment are prone to chronic feelings of anxiety, (Briere and Elliot1994). Sedney and Brook (1984) found from their college sample, 59 per cent of those participants who had history of sexual abuse suffered from anxiety and nervousness in contrast with 29 per cent of those who had no history of abuse. Briere and Elliot (1994) conducted further research and found that sexually abused adults became anxious in intimate or close relationships or frightened when interacting with authority figures, due to being exposed to sexual acts throu gh manipulation, coercion or power tactics upon a child who is not developmentally capable of understanding or consenting to such acts, (Walding 2002). It has been shown that survivors of CSA frequently take personal responsibility for the abuse; this often translates into feelings of guilt, (Hall and Hall 2011). MacMillan Dictionary (2012) defines guilt as â€Å"a feeling of being ashamed and sorry because you have done something wrong†. Hall and Hall (2011) went on to report that survivors often blame themselves and internalize negative messages about themselves. Tsai and Wanger (1978) reported the feeling of guilt could be accounted for by three important factors; due to sexual abuse being a secret act, the abused feels such acts is shameful therefore should not be disclosed to others. Secondly if during the abuse, if the abused experiences any physical or sexual pleasure, this causes them to feel guilty. The third factor is that the abused may feel guilty for not stopping the abuser by not disclosing the abuse and in some way ‘allowed’ it to continue. Jehu et al (1985) provides clinical evidence to reflect Tsai and Wanger (1978) theory. In their study 82 per cent of survivors blamed themselves for the abuse; this was mainly down to their feeling of guilt. 3. 4Emotional Discussion Depression, anxiety, low self-esteem and guilt were identified as the emotional long term effects most commonly displayed in CSA survivors. The four effects highlighted are all issues of identity, confidence and self-worth. In addition to sexual abuse, it is likely the survivor may have undergone emotional abuse from the abuser. This can also contribute to the survivor’s lack of identity and confidence, (Campling 1993). Mollon (2005, cited in Sanderson 2006) states ‘an individual’s cohesive sense of self and core identity is like the individual’s ‘psychological clothes’, without which the individual is naked, exposed and vulnerable’. As impaired sense of self can lead to vulnerability, reoccurrence of abuse is possible thus the adult may come into contact with a social worker for example, rape or domestic violence. This would suggest that working with CSA survivors, social workers would not only need to have understanding of their signs and symptoms but the manner in which they are going to work with them. Social workers would need to carefully consider the most appropriate intervention when working with such service users as it is likely, survivors would be vulnerable. It is important for professionals not to impose their own views, but to empower survivors to define and build on their own sense of self, that is not dependent on external definitions, (Sanderson 2006). Depression and anxiety disorders are both mental health issues. This would need to be considered by the professional involved in the context of the intervention, as well as risk and safeguarding concerns. 3. 5Social The long-term effects of CSA may also extend beyond victims themselves to impact survivors’ interpersonal relations with significant individuals in their lives, (Dilillo 2001). Research and clinical observations have long suggested that CSA is associated with both initial and long term alterations in social functioning†, (Briere and Elliot 1994). Hall and Hall (2011) reported that symptoms correlated with childhood sexual abuse may hinder the development and growth of relationships therefore survivors may experience a variety of interpersonal effects. Mullen a nd Fleming (1999) state in circumstances when the survivors shared a close relationship with the abusers there impac t is likely to be more profound. Isolation is a social long term effect that survivors of CSA may suffer from. â€Å"It has been observed that sexually abused children tend to be less socially competent and more socially withdrawn than no abused children†, (Briere and Elliot 1994). This is echoed in Courtois (1979) study, findings showed that 73 per cent of sexually abused survivors expressed feelings of isolation and feelings of being different from others. Lew (1988 p. 54) reported that isolation in some cases was something that was learnt from the survivor’s hildhood experience. As a way of keeping the abuse a secret, isolation was often reinforced by the abuser. The lack of ability to trust in relationships has been identified in literature, and is considered a major and significant problem. Mullen and Fleming (1999) provided an explanation into why this might be the case, they stated fears of trust or establishing interpersonal boundaries could stem from the breach of trust and the exploration of vulnerability experienced in the abuse. From the findings gathered in her research, Alexander (1992) stated that the history of CSA was found to be related to insecure and disorganised attachments in adult life. Sanderson (2002, p63) applied the view that the experience of CSA created a fear of intimacy amongst survivors. As a direct response there is a constant search for numerous transient relationships, in preference to stable and constant relationships. Jehu et al (1985) research reflects the work of Sanderson, 77 per cent of their survivors reported that it was ‘dangerous to get close to anyone because they always betray, exploit or hurt you’. A small amount of research has demonstrated that adult survivors of childhood sexual abuse experience greater parental challenges than mothers with no history of abuse, (Dilillo 2001). Cohen (1995) conducted numerous investigations and found differences between abused and non-abused mothers in relation to their parenting skills. Women who had been abused performed less well on the all seven scales on the Parenting Skills Inventory, particularly in areas that assed role support, communication and role image. Van Scoyk et al (1991) provided an explanation into why previously abused parents lack particular parenting skills. They reported these individuals may possibly have inadequate opportunity to observe and learn from healthy, effective parenting models. However, Coleman and Widom (2004 cited in Brick 2005) disagreed with literature found and stated a history of CSA does not necessarily entail that one will have interpersonal dysfunction. In their study, they found amongst those who were abused about 40 per cent of females and 60 per cent of males were in long term relationships. In addition 90 per cent of participants did not commit infidelity with multiple partners. 3. 6Social Discussion Social workers must strive to establish and maintain the trust and confidence of service users, (General Social Care Council, 2012). Research into the long term social effects has shown that, survivors of CSA could possibly have difficulties in building relationships. Therefore, this could have an impact on the working relationship between the survivor and social worker. Trust is an essential factor in building an effective rapport with service users, (Crowther and Cowen 2011). Given the nature of the trauma, disruptions may arise in the survivor’s sense of safety and ability to trust. For that reason, it is important that social workers are equipped with an understanding of how to build and maintain the trust of survivors, as this may differ from working with service users with no history of abuse. Effective training in this area could possibly avoid issues that may sabotage the working relationship between the social worker and survivor. Therefore, more specialist knowledge would be advantageous. Furthermore, the power dynamics of the relationship may well have an impact on the rapport between the survivor and social worker. Fear of authority could influence the survivor’s perception of social workers. As abusers of CSA are often authority figures who exert their power, survivors may learn to fear authoritative figures, (Croft 2008). The inability to grow and develop healthy relationships for some survivors could possibly raise safeguarding concerns. For example, such effect could perhaps interfere with the attachment between a parent and child, resulting to issues effecting parenting capacity. Dr John Bowlby, founder of the attachment theory believed the earliest bonds between a child and care-giver have a great impact on the child that continues throughout their life, (Cherry 2012). However, due to early experiences in their own childhood, parents may become over-protective in order to protect their child from experiencing the same traumas. Conversely in some cases, this could promote the opposite behaviour and the parent become under-protective as it is difficult to display affection and closeness. In either circumstance the child may experience difficulty in achieving and meeting their full potential, due to impaired or inadequate relationships with the parent. Social workers along with other working professionals have the statutory duty to protect children who are at risk. This is in accordance to section 47 of the Children’s Act 1989, (Northamptonshire Local Safeguarding Children Board 2012). Parenting capacity is one of the three domains for The Framework for assessment of children and families and is essential in securing the best outcomes for the child, (Parker and Bradley 2003, p. 19). Disruptive attachment can cause issues with the child’s emotional warmth, stimulation, guidance, boundaries and stability. 3. 7Behavioural According to Thompson (2012) it is possible that repressed or forgotten abuse may manifest itself in adult life by out-of-control behaviours which can lead to the abuse of self and/or others. According to research evidence, early sexual experiences often have an influence on later sexual behaviour, (Herman 1981, Randolph and Mosack 2006, Wooden 2010). Randolph and Mosack (2006) quoted â€Å"When early sexual experience is abusive, it can exert specific effects on subsequent sexual behaviours†. Findings from their research found that, survivors of CSA engaged in risky sexual behaviour at higher rates than individuals who had not experienced such abuse, (Randolph and Mosack 2006). A number of studies furthered Randolph and Mosack findings and reported that risky sexual behaviour in adults previously abused was exhibited in many forms; having many sexual partners, failing to use condoms during intercourse increasing the risk of sexually transmitted infections and having anal sex, (Batten et al, 2001, Wingood and DiClemente, 1997). Herman (1981, p. 84) research echoed these findings, within her sample of sexually abused survivors 35 per cent of the women had a ‘ repertoire of sexually styled behaviour’, it was found they behaved in such manner for attention and1 affection. Wooden, (2010) provided an explanation as to why some adults with a history of CSA may participate in risky sexual behaviour. He stated that sexual abuse could result in the abused to disregard their own humanity therefore, perform sexual acts in a more promiscuous way. Rape and Sexual abuse centre (2011) provided their account of why survivors take part in such behaviours; they stated that due to survivor’s childhood experience it was possible that they were incapable to separating sex from affection, which then leads to promiscuity or impaired arousal. Thompson (2012) also made a contribution and stated that sexual promiscuity was a way of the survivors taking control of their feelings. In contrast to the above findings, Fromuth (1983) found no significant difference between promiscuous behaviour and the previously abused women who participated in the research. Riley (2011, p. 127) stated that in some cases victims could take the opposite direction and avoid sex entirely. She stated that the abused may often refuse to take part in sexual activity to remain in control of their own body, unlike when they were abused against their will as a child. Krahe et al (1999) found that female survivors of CSA were at risk of suffering from abuse in later life. Moore and Long (2002) suggested that abuse could occur in the form of adult sexual assault, physical abuse or psychological maltreatment. They also stated that a number of factors could increase a woman’s vulnerability towards abuse; learned manipulative behaviour, beliefs and attitudes, low self-esteem and learned helplessness. Survivors of childhood sexual abuse may compulsively attach themselves to unsuitable partners, who frequently resemble their abuser, Sanderson (2002, p62). Russell (1986, p. 2) found that 65 per cent of participants from sexual abuse backgrounds were victims of subsequent or attempted rape, in comparison to 36 per cent of non-abused participants. In addition, her findings also displayed that an average of 43 per cent of women had been subjected to physical violence by husbands or partners compared with 18 per cent of the control group. Bauserman an d Davis (1996 cited in Randolph and Mosack 2006), concluded that the relationship between CSA and adult sexual behaviour may depend on whether the individuals viewed the early sexual experience in a positive or negative way. Research has highlighted another effect of childhood sexual abuse; self-destructive behavior. Van der Kolk et al (1991) quoted â€Å"childhood trauma such as sexual abuse contributes heavily to the initiation of self-destructive behaviour’†. Erdmans and Black (2008) noted the different forms of self-destructive behaviour; self-mutilation, alcohol abuse, eating disorders and in some cases suicide. Wonderlich et al (2001) believed that this behaviour is presented as a result to reduce emotional distress associated with their abuse. Hiebert-Murphy and Woytkiw, (2000) added self-destructive behaviour was a maladaptive coping strategy for managing negative- self direct feelings. The experience of being abused as a child may increase a person’s risk for alcohol-related problems as an adult, (Windom 1993). Scher ;amp; Twaite, (1999, cited in Lee et al 2008) explained survivors may turn to alcohol as a means to block out psychological pain as they dissociate from their traumatic memories. Evidence to support this view can be seen in Langeland and Hartgers (1998) study; they found a significantly higher prevalence of issues surrounding alcohol in abused women than in the non- abused women. A positive correlation was also identified in Peters (1984, cited in Sanderson 2006, P. 126) research, 17 per cent of participants subjected to sexual abuse during their childhood had symptoms of alcohol abuse, compared to 4 per cent of the control group. However, Fleming et al (1998) study displayed conflicting results. There was no relationship found between alcohol intake and a history of CSA. Fleming et al (1998) argued that, the relationship between childhood sexual abuse and the development of adult alcohol problems needed to be researched further, as there is a sufficient amount of evidence to suggest that CSA alone is not a causative factor in the development of alcohol abuse. Eating disorders is another form of self-destructive behaviour. Research indicates a possible relationship between sexual abuse and the development of an eating disorder, (Myers 2005). Nelson and Hampson (2008) suggested a significant number of survivors have issues with food for a variety of reasons; determination to exercise control over their lives, self-hatred, reactions to oral assault, self -comfort in compulsive eating and in extreme cases sometimes the eating disorder is adopted as a wish to die. Johnson et al (2002 cited in Sanci et al 2008), conducted a longitudinal study among 782 participants and found that CSA was a risk factor for eating disorders in early adulthood. Oppenheimer et al (1986) found that women with anorexia and bulimia also reported a high incidence of childhood sexual abuse. Sanci et al (2008) reported discrepant findings, as some studies found that CSA was no more prevalent in females that were not subjected to such abuse. Another form of self-destructive behaviour that could possibly manifest into adulthood as a result of CSA is self injurious behaviour (Briere and Elliot, 1994 and Mundy, 2010) Klonsky and Moyer (2008) defined self injurious behaviour as ‘the causing of intentional, direct damage to one’s body tissue without suicidal intent’. Self injurious behaviour can be displayed in many forms such as cutting, burning or bruising, (Mundy 2010). Briere and Elliot, (1994) reported in their research, that self injurious behaviour is aimed to reduce the psychic tension associated with extremely negative guilt, intense depersonalization and feelings of helplessness. Similar to CSA, self injurious behaviour is often a source of humiliation and shame and grows in secrecy, (Mundy 2010). The pleasure gained from self injurious is not so much the inflicting of physical pain, but the cessation of emotional pain, Mundy 2010). Findings to support the view that individuals from a sexually abused background are likely to conduct self injurious behaviour can found in Gibson and Crenshaw (2010) research, a sample of individuals with self injurious behaviour took part in study and it was found that, 93 per cent of participants reported a history of childhood sexual abuse. The study also identified the more severe, the longer the durati on of the abuse or the more frequent the abuse took place the greater the risk of engaging in self injurious behaviour during their adult life. Briere (1984) also provides findings to support this view; it was found during his community study that 31 per cent of survivors expressed a desire to harm themselves, in comparison to 19 per cent of the non-survivors. 3. 8Behavioural Discussion The long term behavioural effects of CSA can raise safeguarding issues as such behaviours can cause significant harm to the survivor as well as the risk of others. Social work is a profession that works with a wide range of individuals in a number of different situations and settings. Alcohol and Drugs are related to a number of issues involving social services. Goodman (2009, p. ) quoted ‘clients will bring with them multiplicity of concerns; relationship issues, financial problems, housing, risk of offending, health (physical and mental) and behaviour problems. For this reason, it is imperative that CSA knowledge is not limited to social workers in the child protection field. However, it should be extended across the board, as the lon g term effects of CSA can present themselves in different situations. Chapter Four 4. 0Discussion The primary aim of the dissertation was to gain an understanding of the long term effects of CSA in three different domains; social, emotional and behavioural. A review of research suggest that although, there is existing evidence to indicate that survivors of CSA are likely to experience lasting effects in adulthood, findings are inconsistent and further research is required. The inconsistency within the results across all domains, has led me to conclude that CSA is in fact a risk factor, rather than a sole cause of the long term effects. When reviewing the literature, a number of CSA authors were in disagreement of the association between CSA and the long term effects in the different domains. Sharland et al (1996, p. 5) states that evidence supporting the effects of child sexual abuse can not be viewed as reliable as most of the evidence has been anecdotal, or based on unrepresentative or small samples. For this reason, it is not always clear to what extent a given study has identified the unique effects of CSA, (Briere and Elliot 1994). According to Ferguson (1997) ‘a well designed and controlled study following the child victims of CSA into adulthood, would enable the effects of such abuse to be monitored and allow data on possible confounding variables to be collected’. Unfortunately not only will this be expensive but also time consuming, thus as previously discussed in the literature review it is important to note that undertaking research in sensitive topics such as CSA can be difficult, and as a result is likely to be restricted. With respect to the literature, patterns emerged in relation to the period the research was published. Majority of the CSA research was carried out in the late 1980’s and 1990’s. Although up-to-date statistics on the prevalence of CSA were referred to, current studies relating to the effects of CSA were limited. The sudden rise in research can be linked with the increased awareness and concern of CSA at the time. â€Å"†¦ it was not until the 1980’s that the existence of CSA, in particular, fully entered the public consciousness†, (Pence and Wilson 1994). The lack of recent research may lead me to believe that society still views CSA as a taboo and unpalatable. It is also possible to propose that other types of sexual abuse have diverted the attention away from CSA. For example, sexual exploitation has recently received a great deal of public attention. In a recent report Barnardos (2012) stated that, child sexual exploitation has become a major child protection issue for communities across the UK. As a result of the increase of interest in the other forms of sexual abuse, CSA has been overlooked. The leading writers in the subject appear to be John Briere and David Finkelhor. Both authors published their research between the period of 1980 and 1990. I found that whilst gathering literature for my review I commonly came across both authors, also many other authors commonly referred to their work. Briere’s focused his work on all forms of child abuse and how the abuse affects the survivor’s psychosocial functioning as an adult, (Goldstien 1992). Finkelhor is best known for his conceptual and empirical research on child sexual abuse this is reflected in his publications, (Durham 2006). The most common long term effect highlighted in the literature was depression. Research illustrates, of all the long term effects depression is the most frequently reported symptom amongst CSA survivors, (Briere and Elliot 1994, Sanderson 2002, Lanktree et al 1991). A plausible explanation to why depression is reported as the most frequent effect, can be due to the fact survivors are more likely to seek medical help for this effect in comparison to effects such as guilt or self-injurious behaviour. A number of survivors of CSA who visit their doctors are acutely distressed and depressed, (Mammen and Oisen 1996). Chapter Five 5. 0Conclusion/Recommendations The study demonstrates that the relationship between long term effects in the three domains; emotional, social, behavioural and the history of CSA abuse is inclusive. Therefore, the inconsistency of findings suggests that CSA can be viewed as a risk factor as opposed to a cause for the wide range of long term effects amongst survivors of CSA. Despite the increase in research, further research is required to enable a more in-depth understanding of the long term effects with a more representative sample of survivors. As literature gathered mainly focused on female survivors, results cannot be generalised. With the purpose of improving the quality of professional’s intervention as well as relevant strategies being developed to support survivors. Having undertaken secondary research on the long term effects of CSA, I would recommend that social workers and related practitioners not just in the child protection field but across all sectors have more adequate training in identifying survivors of CSA to ensure they can provide the appropriate care, treatment, support, and also more awareness on effectively handling disclosures. The outcome of this could possibly increase the numbers of disclosures made and may also prevent survivors of CSA suffering in silence. Personally and professionally, I have successfully gained a better understanding on the journey a number of individuals may experience as a survivor of CSA. Although as a survivor of such abuse, prior to conducting the research I was conscious of some of the effects present however, was not fully aware of the severity and the significant implications such abuse had on not only the life of the survivor, but also on other significant individuals in their lives. I believe having such knowledge will have a positive impact on both my personal and professional development as a social worker. Before undertaking the research, I was always reluctant to speak about my experience of CSA; I tended to repress my memories as a way of coping with the abuse. However, increasing my awareness on the topic I believe, has given me the confidence to feel comfortable within myself to openly disclose my past. The research has allowed me to understand that in fact, sexual abuse effects continue long after the abuse stops. I am now able to identify that many of my current issues stem from my history of abuse; as a result a sense of self-blame has been removed.