Childhood Sexual Abuse (CSA) – the most Heart breaking scenario

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Childhood Sexual Abuse (CSA) is not uncommon. In fact it is rife.

A national survey involving both men and women revealed that one third of women and one sixth of men report a history of CSA(1). This estimate is somewhat elevated when compared to other estimates, but is not too far removed from other estimates either. For example a global meta-analysis of CSA prevalence found that between 164 – 197 (as high as 20%) in every thousand girls, and between 66-88 (as high as 9%) in every thousand boys report having endured abuse (2).

It is worth repeating this for the sake of emphasis: a third of women, a fifth of men, and more than that who may have suffered neglect; these are the people that make up our communities and congregations and workplaces. Everyday you meet with people who have gone through these sorts of relational trauma.

The impact can be devastating. It can impact on virtually all areas of functioning:

It can impact on all sectors of the Heart: Shame, betrayal, hopelessness, emotional deregulation that leads to a sense of not knowing who you are.

It can impact on the Mind: Concentration and memory difficulties, increased vigilance, dissociation (to the point of not knowing who or where you are), flashbacks during the night or during sleep, and an inability to recall important aspects of the event.

It can impact on the Body: Increased startle response, sleep disturbance, physical reactivity including sweaty skin, racing heart rate, and hyperventilation. Victims not only have to endure negative physical symptoms, but may be at risk developing a range of medical problems. Exposure to catastrophic events appears as though it may be a risk factor for a variety of cardiovascular, gastrointestinal, endocrinological, musculoskeletal systems (3)

It can impact on mood: Anxiety, mood lability (literally this means ‘prone to slip‘), a feeling of numbness or inability to enjoy positive feelings like love. Increased risk for development of comorbid psychiatric problems such as Major Depression.

It can impact on Behaviour: avoidance of people and places that act as reminders, increased risk for self harm and addictions, increased risk of suicide, avoidance of talking about feelings.

It can impact on Relationships: Feelings of estrangement from others. This sense of estrangement leads to isolation which increases the risk of re-victimisation.

It is important to emphasise that many people can and do recover. If you have been the victim of relational abuse, you can predict the rate at which you recover by assessing: Dose, support and coping.

Dose, is another word for severity. We can think of it in terms of intensity and frequency and duration. The dose can be determined by the nature of the abuse. If someone has been raped, has endured this many times across a long time span by multiple offenders who remain close by (such as a relative in which case the sufferer has endured incest) then the nature of the trauma is such that it is a deep injury and recovery will be very slow. In this regard the dose is high (intensity, frequency and duration are all elevated).

If the dose is low, then the frequency, intensity and duration would all be lower and the prognosis will be more favourable. In such cases someone may have had isolated experiences of physical abuse that weren’t severe, the offender was removed and it did not happen again.

The second area that might help you predict the rate of recovery is support. If there is poor connection with the person the victim discloses the trauma to, then the victim may suffer even more. For example, if the response to the discloser involves either blaming and / or disbelieving then this will lead to increased likelihood that the victim will have ongoing difficulties.

Conversely if the victim discloses promptly and there is a positive and constructive response then the prognosis is much more favourable.

If we have been hurt or abused, our task is to turn towards our Heart. Our Heart contains all experiences that fall under the titles of Connection (shame, self esteem etc), Identity (all the labels we give ourselves) and control (hopelessness and despair). For many of us, we turn away from these areas. To some extent this is understandable because if we do acknowledge shame, betrayal and low self esteem it is likely that we will experience painful emotion. So we avoid the feelings by turning away from our Heart and all that is in it.

However, we know that fleeing from these experiences won’t help. Using alcohol, self harm, or perhaps even just refusing to talk about it will only mean that we fail to address and undo the damage CSA caused us. Some people may have suggested to you that you should just ‘move forward’ and put it in the past. But we can’t move forward with a heavy Heart.

Instead, we need to move back to move forward. To face what has happened, we need to face what is on our own Hearts (the shame, the betrayal, the feelings). If we do this in connection and safety with someone we trust, then we put ourselves in the best position to recover.


1. Najman, J. M., Dunne, M. P., Purdie, D. M., Boyle, F. M. & Coxeter, P. D. (2005).  Sexual abuse in childhood and sexual dysfunction in adulthood: An Australian population based study. Archives of Sexual Behaviour, 34, 517-526.

2. Stoltenborgh, M., van Ijzendoorn, M.H., Euser, E. M. & Bakermans-Kranenburg, M. J. (2011). A Global Perspective on child sexual abuse: Meta-Analysis of prevalence around the world. Child Maltreatment, 16(2), 79-101.

3. Friedman, M.J. & McEwen, B. (2004). PTSD, health and allostatic load? In P.P Schnurr & B.L. Green (Eds.), Trauma and health” Physical health consequences of exposure to extreme stress (pp 157-188). Washington, DC: American Psychological Association.

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