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The Elephant in the Room: Childhood Sexual Abuse

Throughout my career, I've worked with all types of victims of childhood sexual abuse - those who disclosed as it was happening, children who disclosed years later, adults who have disclosed for the first time decades later, parents coping with the guilt of knowing their child was abused under their own roof, children perpetrating on other children, and the parents of the children perpetrating... you name it. It's more common than people realize.. yet it still carries a heavy taboo and a cloud of shame and guilt around it.

First thing is first. If you have experience with CSA in your own life in some way, take a deep breath before reading this page. Whether you've disclosed or never disclosed, whatever age you are (or were), know that you were ONLY a child and you deserved none of it.

What is CSA?

Child sexual abuse (CSA) is more common than spoken about. Around 1 in 9 girls and 1 in 53 boys have experienced CSA in some form. 9 out of 10 children who experienced CSA are related to their abuser, and the setting is often in their home or the home of the abuser.

CSA an occur in many forms and is not limited to touching. At times, this can be adults or older children exposing younger children to pornography, or alternatively filming them.

Frequently 'grooming' initially occurs, which means that the child is offered special gifts, treatment, bribes, treats, affection or outings. An adult chooses a child, recruits them which means engaging them in activities to build their trust and affection. Finally, the abuser ensures that the child can keep the secret, and begins to manipulate them into believing they have chosen to be abused.

Signs of CSA

  • A bad feeling in your gut that something is not right, something is wrong or that CSA is happening. If you have this intuition feeling, DO NOT RATIONALIZE IT AWAY

  • Physical concerns such as frequent UTIs, genital pain, bleeding, bruising -- this may look like spots on the sheets that the child cannot explain

  • Unexplained knowledge or talk about advanced sexual topics

  • Secret keeping

  • The child acting out or exhibiting anger or fear when away from primary caregivers

  • Sudden regression such as bedwetting

  • Inappropriate, unexplained sexualized behaviors not appropriate to age

  • Isolation

  • Avoidance of baths, bathrooms or other situations in which clothing may be removed

  • Poor hygiene

  • Changes in eating or sleeping

  • Changes in fear, anger, mood, personality, or self-esteem

  • Frequent stomachaches

  • "Hearing voices" or "seeing things" at night

  • Self harm or suicidal talk

  • Frequent nightmares

  • Negative expressions, lack of joy and lack of interest in usual activities

  • Seems more distracted and distant than usual

  • Artwork containing disturbing or sexual images

  • Self-hatred toward body

  • Use of stuffed animals or toys to mimic sexual acts

  • Drug/alcohol use

  • Running away from home

Long Term Impacts

I frequently explain to patients that when we are born, our brains are not prepared for experiences of violation and betrayal such as CSA -- which is one of the ultimate forms of violation of a human life. That being said, our brains become unsure of how to process this information. Hence, signs noted above may become noticeable.

For those who have kept their secret, they may offer experience guilt (was it my fault? did I enjoy it? did I ask for it? why didn't I tell anyone?) and shame (what's wrong with me?). In cases of being related to the abuser, it becomes even more murky. It can be difficult and confusing when we had good times with a relative and they took advantage of us. Some of the major things that may occur after abuse include:

  • Eating Disorders and body issues (anorexia, bulimia, binge eating)

  • High levels of suicidal ideation and suicide attempts

  • Self harm

  • More frequent pain such as pelvic pain, stomach issues, headaches or trouble swallowing

  • Chronic anxiety and panic attacks

  • Amnesia about childhood (also called dissociation)

  • Difficulty with intimacy (lack of enjoyment, avoidance of sex, fearing sex, erectile dysfunction)

  • Fear of being hurt by romantic partners or friends

  • Avoidance of pelvic exams or medical examinations

If you are a parent who may have survived CSA, it is also important to note that you may have intrusive images or fears of abusing your own child. You may feel guilty, or avoid contacting, hugging or being near your child. This is a common reaction to CSA. Do not hesitate to seek therapy services, it can make a world of difference! I promise there is hope.


Therapy can be extremely beneficial for people who've experienced CSA, and each therapist carries their own approach. Personally, I've seen amazing things come from EMDR -- but that is not to take away from other modalities such as Trauma Focused Cognitive Behavioral Therapy.

Sometimes, people do benefit from medication. Everyone has a different reaction, and everyone has a different preference as far as treatment. For PTSD, we have a ton of options to reduce feeling on edge, scared, nervous, paranoid/hypervigilant and to reduce nightmares and flashbacks (which can be crippling).

With CSA often comes anxiety and depression. Most of the very young children I've seen with suicidal gestures, attempts or thoughts had been sexually abused. While it is uncomfortable to think about, suicidal thoughts can arise as young as age 4. If you are worried about suicidal thoughts for your child, here are some red flags of suicidal behavior to watch out for in children. There are medications that can help to reduce the anxious, depressive and/or suicidal symptoms that may result from CSA. Relief is possible.


A Parent's Guide to CSA

Books for Parents about CSA

List of resources for survivors

Sexual Assault Hotline

Professional Organizations that provide support and information about CSA

Resources for Adult survivors of CSA

Resources for Parents who's child experienced CSA

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