By Hani Hamdan
Introduction:
The exposure of sexual abuse is one of the most devastating experiences that anyone could go through and especially if the victim is underage. These kinds of events can destroy the victim’s life, affecting their mental health and how they see the world forever. So, in this research, as an attempt to understand the effects of sexual abuse and the best ways to deal with it, I am going to explore it from three aspects: neuroscience, psychology, and the methods of prevention and intervention.
The aspect of neuroscience:
First, we have a study that presents a neurobiological trajectory of pathogenesis for the consequences of child sexual abuse (CSA) through reviewing 154 papers from 1995 to 2015. The study examines the effects of CSA across three domains:
– Neurobiological impact: The study found that CSA alters the brain structures and functions, including a reduction in the volumes of four key brain regions (hippocampus, prefrontal cortex, corpus callosum, and cerebellum), in addition to abnormalities found in the superior temporal gyrus and cerebellar vermis. These changes impact the brain’s ability to regulate emotions, process memory, execute functions, and respond to stress efficiently.
– Neurochemical and hormonal disruptions: In this area, the study concludes that CSA is linked to dysregulation of serotonin and dopamine systems associated with mood disorders and aggressive behavior, and modifications in the hypothalamic-pituitary-adrenal axis function leading to cortisol hyposecretion in adulthood following CSA, and also heightened stress sensitivity due to early trauma.
– Cognitive and memory effects: Survivors of CSA showed that they may suffer from deficits in memory functions, attention, and problems in social cognition. Additionally, an increased risk of dissociative amnesia and a delay in recalling trauma appeared in the victims of CSA, and the emotional and learning processing may be impaired by changes in brain plasticity induced by extreme stress.
Second, we have a study that explores the structural changes in the brain in individuals with a CSA history through reviewing a series of neuroimaging and neurobiological studies. The study comes out with critical key findings saying that people with a history of CSA have a different brain structure due to changes in the cortical and subcortical regions:
1- Cortical changes:
– Prefrontal cortex: Reduction in the flow and volume of blood, specifically in the medial and dorsolateral regions (linked to impaired decision-making and emotional regulation).
– Temporal lobe: CSA survivors show an increase in the activity of this region, in specific people with PTSD (suggesting heightened emotional sensitivity).
– Occipital lobe: A reduction in gray matter volume in the visual cortex among CSA survivors (particularly when abuse occurs before the age of 12).
– Corpus callosum: The volume of this area is reduced, especially in females CSA survivors (potentially affecting inter-hemispheric communication).
2- Subcortical changes:
– Hippocampus: It’s found to be smaller in CSA survivors, especially on the left side (linked to memory deficits and emotional dysregulation).
– Amygdala: No consistent volume changes were found, but functional differences may exist.
– Cerebellum: Altered blood flow and activity (possibly influencing motor and emotional regulation).
– Insular cortex: Increased activation in CSA survivors who don’t suffer from PTSD (maybe linked to fear anticipation).
– HPA axis dysfunction: A relation between CSA and dysregulation of stress hormones was found (contributing to depression and anxiety).
And because females are more vulnerable to sexual abuse, our third study investigates how sexual abuse affects the adolescent female brain structure, focusing on three key areas (prefrontal cortex, amygdala, and hippocampus), and this is done by comparing two groups: sexually abused SA and healthy control HC female adolescents. Showing that the SA group had larger right and left hippocampus, and right amygdala volumes (related to threat detection and emotional processing), and a reduction in cortical thickness in the right inferior frontal gyrus in the prefrontal cortex region (associated with impulsivity and dysregulation).
At last, let’s investigate how men with a history of sexual abuse can change their long-term functions, so for this purpose, we have a study that tested 29 men, 16 with CSA history (9 of them diagnosed with PTSD, and 7 are not), and 13 control participants. The study looked at the differences in the men with a CSA history in three brain networks:
1) Default mode network: The group with CSA history and PTSD showed increased connectivity in the medial prefrontal cortex (mPFC) in comparison with the group without PTSD, and the group without PTSD showed less connectivity between the posterior cingulate cortex and mPFC than the control group.
2) Salience network: both CSA groups appeared to have reduced connectivity of striatal-thalamic circuits compared to controls.
3) Limbic Network: The control group had stronger connectivity between the amygdala and mPFC, which is absent in the CSA group (with or without PTSD).
Thus, we can conclude that sexual abuse has detrimental neurobiological and structural effects on the child and adolescent brain, affecting their mental and cognitive abilities, and reducing their psychological well-being.
The aspect of psychology:
The first study gives a comprehensive review exploring the global prevalence, risk factors, and cultural dimension of CSA, and it says that the rates of CSA are nearly 11.8% globally, showing higher rates in females, and emphasizing that reporting is inconsistent worldwide due to cultural norms, stigma, and lack of standardized definitions. Moving to the risk factors, the study divides them into three sectors:
– Sociodemographic: Generally, CSA rates are higher in females than in males, and this is due to underreporting in males. It shows that the younger the victim is, the worse the outcomes are, and African American children and poor children are more vulnerable.
– Abuse characteristics: the penetrative abuse leads to more severe psychological outcomes, and abuse by close relatives causes greater distress.
Family dynamics: the mental health of parents and their caregiving quality can influence the risk. Additionally, self-blame in children can lead to more suffering.
Now, the cultural dimension offers some consideration saying that. First, the cultural beliefs can shape the definitions, reporting, and response to CSA. Second, in some regions, practices like child marriage and genital mutilation are culturally sanctioned. Third, different cultures have protective practices, including gender separation, virginity norms, and harsh penalties for abuse.
The second study is an umbrella review that consists of 19 meta-analyses covering 559 primary studies and over 4 million participants, which examines the long-term effects of CSA, and what it says is that CSA has a broad impact in the long-term, causing psychiatric conditions, including PTSD, depression, anxiety, borderline personality disorder, schizophrenia, and conversion disorder. On the psychological level, the study shows that CSA can lead the victim to suicide attempts, the misuse of substances, reinforcing sexual revictimization, seeking sex work, and committing self-harm.
Thirdly, we have a study that explores how mothers with a CSA history influence the psychology and mental health of their children who have been through CSA. The first thing this study shows is that mothers with a CSA history reported higher psychological distress, PTSD symptoms, and dissociation following their child’s CSA disclosure, and their children appeared to have a more internalizing attitude (anxiety, depression, withdrawal), and an externalizing attitude (aggression, delinquency), and symptoms of dissociation compared to children of mothers without CSA history. The maternal distress and dissociation mediated the relationships between maternal CSA and all children’s outcomes, and the maternal symptoms of PTSD specifically mediated internalizing attitudes of their children.
So, all of the above can give us a broad perspective of the psychology of CSA from different angles, and give us a deeper understanding of it, leading us to the methods for how we can prevent and intervene in these cases.
Prevention and intervention:
The first study in this section makes the case for prevention approaches that parents can follow to reduce the risk of CSA for their children. To achieve this goal, the authors propose a dual pathway approach, where parents play a protective role both directly (through supervision, monitoring, and involvement) and indirectly (by fostering children’s self-esteem, competence, and emotional security). The authors divide the parental protector role into two main methods:
1. External barrier: The active supervision and involvement of parents decreases the potential risk of offenders, and this is because offenders tend to exploit unsupervised access and caregivers’ absence.
2. Victim resistance: Because children with emotional insecurity or poor caregiver relationships are more vulnerable, the authors argue that supportive parenting enhances children’s ability to resist, respond to, and disclose abuse.
The study concludes with final recommendations, which suggest that teaching parents to recognize grooming behavior and how to establish healthy boundaries, as well as encouraging a warm and accepting environment for their children, along with strong emotional support, also focuses on disadvantaged populations through community services and media campaigns. Finally, the evaluation emphasizes outcomes by measuring changes in parental knowledge, behavior, and child safety indicators, as well as assessing CSA risk reduction through long-term follow-up plans.
Pivoting to the second study, which is a systematic review that identifies the main CSA prevention methods and tests how effective they are, pointing toward the gaps found in these studies. . Starting with the types of these methods and how effective they are:
1- The school-based educational programs teach children concepts like body safety, what is considered appropriate and inappropriate touch, and how children should seek help.
2- Some of these studies tried innovative methods such as storybooks, games, videos, and peer education to test if they are different from traditional methods.
3- From all these studies, just one was an evaluation for an initiative led by the government.
4- One of the studies was in Kenya, where they taught children self-defense, and showed a nearly 62% reduction in sexual assault incidents.
Moving to the effectiveness rates, most of the studies measured increased knowledge and self-efficacy, and just one study showed an actual reduction in CSA incidence. A few of which used validated tools or conducted long-term follow-ups, and zero valuations of population-level or NGO-led interventions were found.
The key gaps identified in this study were:
1- Lack of population-level or government-led initiatives.
2- Limitation in the coverage of certain geographic areas (especially in developing countries)
3- Absence of culturally adapted methods.
4- Scarcity of peer-reviewed journal publications for rigorous evaluations.
Finally, the study recommends solving the identified gaps by these steps: one is that methods of prevention should be beyond the school to reach children who don’t attend school, two is focusing on public health approaches, integrating CSA prevention into broader child protection frameworks, three is directed towards governments and NGOs in order to invest more culturally adapted, scalable interventions, and four addressing more rigorous and longitudinal evaluations so the real world impact is assessed.
The third study discusses resilience in survivors of CSA. In this study, the most supported factors linked to resilience are:
– School safety: The schools with a low stress environment were associated with resilient outcomes.
– Interpersonal and emotional competence: Understanding and managing emotions, and knowing how to regulate emotions, were found to be protective against suicidal ideation and suicidal attempts.
– Active coping strategies: The problem-focused coping approach (teaching children to identify specific issues causing distress and working towards solving these problems was found to be linked to adaptive functioning on academic, behavioral, and social levels, unlike the avoidant coping, which was found to cause greater sexual anxieties.
– Social attachment: Secure and higher emotional attachment was found to be protective against the negative effects of CSA.
– Community and family support: Positive parenting and living in a stable family, in addition to care from peers and the surrounding community, were critical factors in resilience with CSA cases.
Based on the above, the study gives some clinical recommendations suggesting using psychoeducation and cognitive strategies tailored to developmental stages, enhancing the social support system, and considering trauma-focused cognitive behavioral therapy as a promising intervention.
Conclusion:
In this research, we discussed the biological basis of sexual assault in children and adolescents, and how it changes the structure and function of the victim’s brain. Secondly, we examined the psychological consequences of CSA, discovering its long-lasting effects on the mental health of the victim. In the final part, we explored methods of prevention and intervention, enabling us to understand how to address this phenomenon in the most effective ways.
Resources:
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