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SampleLiteratureReview.htmlRelationship Between Childhood Sexual Trauma and Adult Sexual Risk Behaviors
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SOSW 3350: Research Methods in Social Work
University of Houston Downtown
Month #, 2022
Relationship Between Childhood Sexual Trauma and Adult Sexual Risk Behaviors
Trauma that takes place in childhood can affect children from their childhood years into
their adult lives (Pos et al., 2016). Childhood traumas can be referred to as adverse childhood
experiences (ACEs), a term used by the Centers for Disease Control and Prevention (CDC, 2019)
to describe any potentially traumatic experiences that children 18 years and younger have
experienced resulting in long-term behavioral, mental health, and/or medical problems. ACEs
fall into three categories, abuse (physical, sexual, and emotional), neglect (physical and
emotional), and household challenges (parental separation or divorce, substance use, etc.) (CDC,
2019). In addition, ACEs are extremely prevalent whereas many children experience more than one ACE at a time, and they pose a risk of low life potential, risky behaviors, chronic health
conditions, and early death (Pos et al., 2016).
As previously stated, one category under the umbrella of ACEs is abuse. One specific
form of abuse, sexual abuse, was experienced by an average of 60,000 male and female children in 2017 according to the Administration for Children and Families and the U.S. Department of
Health and Human Services (2019). It is important to keep in mind, however, that the actual
number of childhood sexual abuse or trauma occurances is far greater than what is reported on
the grounds that child victims are often hesitant to tell anyone what has occurred, and the legal
process can be difficult (Pos et al., 2016). Given that, in national samples only 30% of child sexual abuse cases have been reported to the authorities by women and 15% by men (Senn et al.,
2006).
One of the major risks that affects childhood sexual abuse victims into their adult lives
according to Walsh et al. (2014), is risky sexual behavior. Among these risky sexual behaviors
include having unprotected sex, having multiple sexual partners, a greater risk of prostitution, an
increased risk of sexually transmitted infections (STIs) and sexually transmitted diseases (STDs),
and sexual aggression (Walsh et al., 2014). Additional high-risk sexual behavior in adulthood
that is linked to child sexual abuse include, sexual dysfunction, the exchange of sex for drugs,
shelter and money, earlier ages of first consensual intercourse, and sexual revictimization
(Abajobir et al., 2017). The goal of this literature review is to examine existing research, discuss their research methods, and compare their results on the topic to determine and understand the
link between childhood sexual abuse and adult high-risk sexual behavior.
Senn et al. (2006) introduced a unique approach to explain the link between childhood
sexual abuse and adult risky sexual behavior. They hypothesized in their research that childhood
sexual abuse could lead to high-risk sexual behavior in adults through four ways: (1) using drugs
and alcohol to cope with the abuse; (2) mental illness caused by the abuse; (3) riskier social
relationships and (4) poor sexual adjustment (Senn et al., 2006). Each of the four mechanisms
were explored because research linked each of them with childhood sexual abuse, and they also have been associated with risky sexual behavior (Senn et al., 2006). For example, according to
Senn et al. (2006), evidence links depression, drug and alcohol abuse, and partner violence to
both childhood sexual abuse and risky sexual behavior, and based on that principle, the
hypothesis was formed. The Senn et al. (2006) study investigated men and women victims of
sexual abuse as children among patients attending an STD clinic, a factor of great significance since childhood sexual abuse victims contract STDs at a higher rate than the general population.
Patients from the STD clinic that met the eligibility requirements were asked to track important
events in a calendar involving their sexual lives for three months to enable them to answer
survey questions more accurately. The computerized survey allowed the participants to see
questions on the computer screen while also hearing questions aloud over headphones to
measure demographic characteristics, childhood sexual abuse, alcohol use disorders, drug abuse,
the co-occurrence of substance use and intercourse, intimate partner violence, sexual behavior,
and depression (Senn et al., 2006). The results of the Senn et al. (2006) research had four major
findings; (1) childhood sexual abuse rates were significantly high in the population of patients
attending the STD clinic (higher than the national sample rates); (2) the number of childhood
sexual abuse instances reported were similar among both men and women; (3) childhood sexual
abuse was associated with risky behavior that placed participants at risk for an STD; and (4)
childhood sexual abuse increases a person’s likelihood of abusing drugs and alcohol. Moreover,
over one half of all patients that attended the clinic for STD care reported a history of childhood sexual abuse, which was associated with high-risk sexual behavior (Senn et al., 2006).
Sansone et al. (2009) hypothesized that there was a link between childhood sexual abuse
and a variety of sexual behaviors in adulthood. Different from the Senn et al. (2006) study, their
study included randomly recruited insured female participants ranging from 18 to 75 years in age
who attended a specific outpatient medical clinic for routine medical services (Sansone et al., 2009). In addition, 85% of the participants were White, nearly 12% African-American, one
Asian, and one was Native American (Sansone et al., 2009). In regard to education level, the
majority of the participants obtained high school diplomas, but 11% reported that they had a
bachelor’s degree and slightly over 6% had a graduate level degree (Sansone et al., 2009). The
procedure within this particular research study consisted of a four-page booklet of survey
questions to determine the mentioned demographic information, sexual histories, and the
potential exposure to childhood trauma. Sansone et al. (2009) concluded that sexual abuse as a
child was the only childhood-trauma variable to have any correlation with the high-risk sexual
behavior variables, and that there may be demographics such as race and education that make individuals more likely to have experienced both childhood sexual abuse and a history of high
risk sexual behavior in adulthood.
More recent research related to child sexual abuse and high-risk adult sexual behavior
seems to follow the Senn et al. (2006) research. For example, Fix et al. (2019) also observed the
pathways between childhood sexual abuse and high risk sexual behavior, but they focused on the
rates of sexually transmitted infections related to the participants’ gender and race using
population-based longitudinal data. Fix et al. (2019) found that depression signs and symptoms
acted as the mediator of the relationship between sexual abuse as a child and risky sexual
behavior. In addition, gender and race happened to have effects on the link between childhood
sexual abuse and adult risky sexual behavior (Fix et al., 2019). For example, Black women with
a history of childhood sexual abuse were more likely to contract an STI than their White male
and female counterparts (Fix et al., 2019). Another finding from Fix et al. (2019) is that there are many health disparities that may exist between different ethnic/racial backgrounds that possibly
explain why race has an impact on STI rates among child sexual abuse victims.
Limitations
While the studies mentioned propose childhood sexual abuse is directly related to adult
high-risk sexual behavior (Fix et al., 2019; Sansone, et al., 2009; Senn et al., 2006), there are
limitations to the studies. In the first study that was discussed conducted by Senn et al. (2006),
the major limitation is that correlational data does not imply causality. In other words, the
variables measured may have a mutual relationship with variables that were not included in the
study. To give an example, household challenges may lead to childhood sexual abuse, risky
sexual behavior, and even substance use. For the second study examined, potential limitations
include the absence of standardized measures to determine participants’ sexual histories and
childhood trauma, and that some participants could have misjudged having a sexual experience
at an early age with an adult as non-abuse (Sansone et al., 2009). In addition, one limitation from the Fix et al. (2019) study is that it used an existing database, so there were cases in which data
was missing for things such as substance abuse related to risky sexual behavior.
While informative, many previous studies also focus or examine on only one form of
child abuse, such as sexual or physical abuse in relation to adult high-risk sexual behavior.
However, a study conducted by Dube et al. (2003), examined six health problems and their
relationship with all types of ACEs from 2000 back to the 1900s. Among the six relevant health
issues examined was high risk sexual behavior, and they found that high-risk sexual abuse in adulthood is not only linked to childhood sexual abuse but also to the large variety of ACEs that
exist (Dube et al., 2003).
Intervention
There are many interventions that have been developed to reduce sexual risk among adult
childhood sexual abuse survivors. Due to the sensitivity of childhood sexual abuse and sexual
behavior, most interventions aimed toward reducing sexual risk among this population separate men and women, and the intervention methods also differ among gender (Senn et al., 2006).
Separating men and women helps ensure that participants feel comfortable. In addition, it is
important that intervention content differs between men and women because there may be
different variables that mediate the relationship between adult sexual risk and childhood sexual
abuse among men and women (Senn et al., 2006). For example, interventions for women should
focus more on partner violence as the mediator and alcohol use for men (Gilbert et al., 2000). In
addition, research shows that it is important to have trauma-focused intervention groups among
both men and women because it can help participants see how childhood sexual abuse can be a
pathway to substance use for coping with trauma, and it could empower participants by teaching
constructive coping mechanisms (Greenberg, 2001). Also, interventions focused on reducing
sexual risk among childhood sexual abuse survivors could focus on alcohol and drug use as a trigger for high-risk sexual behavior while empowering participants to develop self-efficacy and
problem-solving skills to deal with this trigger (Senn et al., 2006).
According to Roberts (2019), ACEs have similarities with post-traumatic stress disorder
(PTSD), so it is important to interact with clients in a way that decreases stress, promotes safety,
and validates emotions. One way to do that is by implementing trauma-informed care, an
approach to providing care to trauma victims in a way that fully understands how trauma can
affect an individual (“Trauma-informed care”, 2018). Trauma-informed care is based upon five
principles: choice, collaboration, empowerment, safety, and trustworthiness (Keesler & Isham,
2017). By understanding and being aware of trauma, the social worker or clinician can interact with trauma victims in a way that establishes safe environments and avoids re-traumatization
(Keesler & Isham).
Conclusion
Based on the evidence given, many researchers have found that childhood sexual abuse
can lead to adult high-risk sexual behaviors (Fix et al., 2019; Sansone et al., 2009; Senn et al.,
2006). In addition, the research pointed out that childhood sexual abuse can put survivors at risk
for STDs and substance use (Senn et al., 2006). The research also found that among the different
types of childhood trauma, the only form to correlate with high-risk sexual behavior was
childhood sexual abuse (Sansone et al., 2009). Moreover, another finding was that health
disparities exist among different racial and cultural backgrounds that could possibly explain why
race affects STI rates of child sexual abuse survivors (Fix et al., 2019). However, given the
limitations discussed, future research could aim to determine exactly how unique risky sexual
behavior is to childhood sexual abuse because two studies examined had conflicting results. For
instance, as previously stated, Dube et al. (2003) found in their research that risky sexual
behavior is linked to several ACEs, while Sansone et al., (2009) found the exact opposite; that
the only trauma variable in correlation with high-risk sexual behavior was childhood sexual
abuse. Overall, the research presented shows that childhood sexual trauma can lead to risky
sexual behavior. However, to expand the knowledge of this topic, future research could examine
additional variables or mediators that could also lead to risky sexual behavior among childhood sexual abuse survivors, examine high-risk sexual behavior in correlation with the wide range of
ACEs, and examine psychosocial influences that could explain the increased risk of high-risk
sexual behavior among childhood sexual abuse survivors.
References
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