61 20th annual crime prevention guide TABLE 1 Correlates of childhood sexual abuse and measures of health and function: A selected list of findings from research studies In females, a history of childhood sexual abuse or a range of childhood traumas including sexual abuse is correlated with: • adult onset of 14 mood, anxiety, and substance use disorders • higher rates of childhood mental disorders, personality disorders, anxiety disorders, and major affective disorders, but not schizophrenia • diagnosis of Borderline Personality Disorder continued... ...Handbook on Sensitive Practice continued In males, a history of childhood sexual abuse is correlated with: • anxiety, low self-esteem, guilt and shame, depression, post-traumatic stress disorder, withdrawal and isolation, flashbacks, dissociative identity disorder, emotional numbing, anger and aggressiveness, hypervigilance, passivity and an anxious need to please others • adult onset of five mood, anxiety, and substance use disorders • substance abuse, self-injury, suicide, depression, rage, strained relationships, problems with self- concept and identity, and a discomfort with sex • increased risk of HIV • anxiety and confusion about sexual identity and sexual orientation • increased risk of “acting out” aggressively • contact with criminal justice system Some of the common problems experienced by childhood sexual abuse survivors are summarized in Table 6 using David Finkelhor and Angela Browne’s conceptualization of the traumagenic dynamics of childhood sexual abuse. These dynamics describe the impact that abuse-related behaviours, events, and experiences can have on their victims. Characteristic • Rewarding a child for sexual behaviour may heighten the salience of sexual issues for him or her • Receiving attention and affection for sex can affect a survivor’s ability to achieve a healthy sense of love and belonging • Sexual parts of the child may be fetishized • Abuse may impart misconceptions about sexuality (e.g., sexual identity, sexual orientation, sexual behaviour, and sexual morality) • Sexual activities may become conditioned to negative emotions and memories, creating an aversion to sex or intimacy TABLE 6 Traumagenic dynamics of childhood sexual abuse Traumatic Sexualization • Avoidance of all things sexual • Preoccupation with sexual matters or compulsive sexual behaviours • Precocious sexual activity Aggressive sexual behaviours • Promiscuity • Prostitution (making use of or working in the sex trade) • Sexual dysfunctions (e.g., lack of desire, difficulty with sexual arousal, inability to experience orgasm, and avoidance of sexual intimacy) Dynamics Possible Manifestations • Childhood sexual abuse manipulates a child’s vulnerability, violates the expectation that others will provide care and protection, and may interfere with the ability to trust • The child’s autonomy and wellbeing are disregarded, which may affect the sense of self • Deep-seated guilt and shame develop because children believe something bad about them caused the abuse • Profound sense of grief over lost innocence or the “perfect” or “normal” family; depression • Extreme anxiety or fear, which engenders a sense of dependency Betrayal • Overdependence or clinginess • Vulnerability to subsequent abuse and exploitation • Failure to accurately judge the trustworthiness or motives of others, leading to subsequent abuse and exploitation and/or inability to protect one’s own children from abuse • Social withdrawal, isolation, and/or avoidance of intimate relationships • Chronic relationship difficulties • “Acting out” behaviours (e.g., aggression, delinquency, risk-taking, etc.) Traumagenic Dynamics of Childhood Sexual Abuse