The existing literature on the long-term sequelae of child sexual
abuse is reviewed. The evidence suggests that sexual abuse is an
important problem with serious long-term sequelae; but the specific
effects of sexual abuse, independent of force, threat of force, or
such family variables as parental psychopathology, are still to be
clarified. Adult women with a history of childhood sexual abuse show
greater evidence of sexual disturbance or dysfunction, homosexual
experiences in adolescence or adulthood, depression, and are more
likely than nonabused women to be revictimized. Anxiety, fear, and
suicidal ideas and behavior have also been associated with a history
of childhood sexual abuse but force and threat of force may be a
necessary concomitant. As yet, there is insufficient evidence to
confirm a relation between a history of childhood sexual abuse and a
postsexual abuse syndrome and multiple or borderline personality
disorder. Male victims of child sexual abuse show disturbed adult
sexual functioning. The relation between age of onset of abuse and
outcome is still equivocal. Greater long-term harm is associated with
abuse involving a father or stepfather and abuse involving
penetration. Longer duration is associated with greater impact, and
the use of force or threat of force is associated with greater
harm.
Beitchman and collegues, in a review of the long-term effects of sexual abuse, were sceptical about a clear association between sexual abuse in childhood and later suicidality. They stated that overall, the evidence does not support a link between suicidality and childhood sexual abuse in the absence of force or thread of force. They critizised the study of Bagley and Ramsey and suggested that the childhood sexual abuse experiences of the sample, which was a subset of an earlier multistage survey of the suicidal backgrounds of a given population, may not have been representative of the general population. They also stated that two studies, by Sedney and Brooks (2) and Peters (21), found no relationship between a history of sexual abuse in childhood and suicidality. However, there were methodological problems with both of these studies as well. The Sedney and Brooks study (2), with only 51 women in the sexual abuse and comparison groups, may have had a problem of inadequate statistical power. Suicide attempts were more common among women in the group that reported childhood sexual abuse than among women in the group that reported no abuse (16% versus 6%); with a larger study, this difference could well have become statistically significant. Although Peters found no increase in suicide attempts for those with a history of clinical depression, she did not report on nondepressed abused women (21). Self-harm is found in diagnostic groups other than the clinically depressed. Peters herself expressed some reservations about the representativeness of her sample because of the high attition rate (51%) between the two study phases.