Exploring the impacts of childhood sexual abuse and related adversities: a multi-study analysis of gendered pathways in disclosure, psychosocial, and psychosexual outcomes

Abstract

Childhood sexual abuse (CSA) is a pervasive and harmful experience with potentially long-term consequences for survivors. This thesis explored the impacts of CSA along with the presence of other adverse childhood experiences (ACE’s), focussing on CSA disclosure, and behavioural, psychosocial, and psychosexual outcomes. Employing a multi-study approach that integrated quantitative and qualitative methodologies, the research investigated gendered pathways and the roles of contextual and interpersonal factors. Each of the three studies addressed distinct but interrelated aspects of CSA’s aftermath, collectively contributing to a nuanced understanding of its complex effects.

The first study examined the relationships between the existence of childhood abuse (CA), as well as CA types specifically—CSA, childhood physical abuse (CPA), and childhood emotional abuse (CEA)—with outcomes including substance use disorder (SUD) patterns and self-directed violence (SDV). Using hierarchical multiple regression, the study identified significant associations between abuse types and maladaptive behavioural outcomes, highlighting the cumulative impact of abuse on risk behaviours. Notably, gender had no significant effect on the outcomes, underscoring shared underlying mechanisms while recognising potentially different contextual manifestations.

The second study explored the pathways linking CA types (i.e., CSA, CPA, and CEA) to sexual shame (SS) through structural equation modelling (SEM). This study investigated the mediating roles of disclosure experiences (DE) and contextual childhood adversities (CCA), as well as the moderating role of gender, to demonstrate how these factors influence psychosexual development. SEM revealed no significant mediating effects for DE, but identified significant mediating effects for CCA in some models. The study also found significant moderating effects for gender on SS in the CSA and CPA models, specifically that female participants were significantly more likely to experience higher levels of SS compared to male participants in these models. The findings emphasised the importance of social and environmental mediators in shaping long-term psychosexual outcomes for CSA survivors.

Building on the findings of these two studies, the third study employed Constructivist Grounded Theory (CGT) to further explore the lived experiences of CSA survivors, focussing on disclosure, recovery, and psychosexual development. Through in-depth semi-structured interviews, the study uncovered diverse trajectories shaped by barriers and incentives to disclosure, revealing the influence of attachment dynamics and societal constructs on the gendered experiences and outcomes of CSA survivors. The findings highlighted the pivotal role of disclosure as both a potential facilitator and barrier to recovery, offering critical insights into the relationship between personal and societal influences.

Synthesising findings across the three studies, this thesis underscores the complexity of CSA’s impact and the critical role of contextual and gendered factors in shaping recovery and developmental trajectories. The research provides valuable insights of how disclosure experiences and contextual adversities influence behavioural and psychosexual outcomes, offering implications for practice and policy. Recommendations include fostering supportive disclosure environments, integrating psychosocial and psychosexual dimensions in intervention frameworks, and addressing gender-specific barriers to recovery. While limitations include the cross-sectional nature of two studies and potential contextual constraints, the findings provide a meaningful contribution to CSA research and support services, paving the way for further exploration into the long-term impacts of CSA.