The Long Term Harms Experienced by Survivors of Child Sex Abuse

“Daniel,” a survivor of abuse by Father Jerome Ratermann, has found himself on the brink of suicide. “Luke,” a survivor of abuse by Father Arthur Niemeyer, has struggled with alcohol, anxiety, and feelings of unworthiness. In conversations with survivors of child sex abuse by members of the Catholic clergy, Attorney General investigators heard experiences like these over and over again. Survivors spoke of years, and often decades, struggling with challenges including insomnia, anxiety, trust issues, nightmares, suicidal ideation, guilt, addiction, alcoholism, depression, post-traumatic stress disorder (“PTSD”), issues creating and maintaining relationships, and sexual side effects. Their experiences shed light on the road survivors are forced to walk as a result of child sex abuse.

In recent years, work by researchers, scientists, and advocates has demonstrated what survivors have long-known: the consequences of child sex abuse do not end when the abuse ends.^[1] For the survivors, the end of the abuse is often only the beginning of a much longer journey—a search for healing and peace that many struggle to find. Here, we explore the lasting consequences of surviving child sex abuse, and the mental health challenges, substance use disorders, suicide and suicidal ideation, physical health problems, and professional and economic difficulties that many survivors must navigate for years. It is a story too often missed in the coverage of child sex abuse.

Mental Health

Nearly every survivor interviewed by Attorney General investigators reported struggling with some form of mental health challenge in the years after the abuse. Survivors reported a wide variety of such challenges, including insomnia, anxiety, trust issues, nightmares, depression, and PTSD. And for many survivors, the struggle for mental health continued for decades. “Jeffrey,” a survivor of abuse by Father Frank D. Westhoff, fell into a deep depression because he felt he could not tell anyone about what had been done to him. Jeffrey’s experiences of depression continued well into adulthood, and he has spent more than 30 years working to address his mental health.

The experience of Jeffrey, and many more survivors like him, is consistent with the research on the long-term consequences of child sex abuse on mental health. As long ago as 1986, a literature review conducted by Angela Browne and David Finkelhor of the University of New Hampshire found that survivors of sexual abuse experienced a higher rate of anxiety attacks, nightmares, insomnia, feelings of isolation and stigmatization, negative self-concept and self-esteem, negative long-term sexual side-effects, and difficulty developing trusting relationships.^[2] In 1999, a team of scholars led by Dr. Alfred Lange of the University of Amsterdam reached similar conclusions. In reviewing the existing literature, they wrote that “there is abundant evidence that female victims of [child sex] abuse are highly at risk of developing physiological and psychological problems [including]. . . sexual disorders, depression, anxiety disorders, . . . eating disorders, feelings of isolation and stigmatization, deficiencies in self-esteem, anger towards parents . . . sleeping disorders, excessive distrust, borderline personality disorder, dissociative disorders, and psychotic symptoms.”^[3]

More recently, scholars have made significant advances in refining the understanding of the long-term impacts of child sex abuse. For example, in 2019, a team of scholars led by Helen P. Hailes conducted a meta-analysis of 559 studies covering more than 4 million participants to examine the association between child sex abuse and long-term consequences to survivors after they turned 18 years old. The meta-analysis showed that 26 different psychosocial, psychiatric, and physical health outcomes have been “significantly associated with [child sex] abuse.” The strongest associations were between child sex abuse and conversion disorder (a condition that causes physical and sensory problems, such as numbness or blindness), borderline personality disorder, anxiety, and depression. The Hailes team identified a need for further research, however, in order to expand the understanding of the connections between child sex abuse and several other possible long-term outcomes, including bipolar disorder, obsessive compulsive disorder, and homelessness.^[4]

Addiction and Alcoholism

Many child sex abuse survivors also report patterns of alcoholism and addiction that extend years into adulthood. “Richard,” a survivor of Father Thomas Francis Kelly, says that his experience of abuse caused him to become an alcoholic right out of high school. “Adam,” a survivor of abuse by Father John C. Anderson, told Attorney General investigators that he started drinking a lot in the years following the abuse. And “Matthew,” a survivor of abuse by Father Ralph S. Strand, experienced drug addiction during early adulthood.

While the connection between alcohol use, substance use, and child sex abuse is not well understood, there is a growing awareness that a connection exists. In their 2019 meta-analysis, the Hailes team noted that substance misuse was one of the three outcomes for which the highest quality evidence existed as a connection with child sex abuse.^[5] Work by Dr. Cathy Spatz Widom and Dr. Susanne Hiller-Sturmhofel also supports the proposition that “childhood abuse and neglect may increase the risk of alcohol problems” later in life.^[6] Given the gaps that exist in the literature, these researchers emphasize the importance of conducting additional research to clarify this relationship and further refine the understanding of factors that mediate any connection between child sex abuse and later patterns of substance and/or alcohol misuse.

Suicide and Suicidal Ideation

Multiple survivors interviewed by Attorney General investigators reported suicidal ideation and/or suicide attempts. “Rob,” a survivor of Father Walter M. Weerts, has been in therapy for a decade, grappling with “suicide type feelings.” Bob, a survivor of abuse by Father Thomas Considine, first attempted suicide while still in high school, and again in the 1980s. While Bob survived those two attempts, his brother, also a survivor of child sex abuse by a cleric, died by suicide in 1978.

The connections between child sex abuse and suicidality are now well established. As far back as 1986, a wide range of studies already demonstrated a connection between a history of child sex abuse and both self-harm and suicidal ideation.^[7] More recently, a team led by Dr. Megan Spokas of the University of Pennsylvania Department of Psychiatry wrote in 2009 that “[c]hildhood sexual abuse (CSA) correlates with suicide ideation and a history of making a suicide attempt.” Their research also showed that the experiences of male-identifying and female-identifying survivors of child sex abuse differed. “Although women were more likely to endorse a history of CSA, men reporting CSA experienced more hopelessness and suicide ideation, and were more likely to have attempted suicide multiple times and be diagnosed with PTSD and [Borderline Personality Disorder], in comparison to men without a CSA history.” Across all categories, however, the data collected by the Spokas team suggested that “hopelessness was a significant mediator” between child sex abuse and suicide ideation.^[8]

Physical Health

While much of the attention on the long term impacts of child sex abuse focuses on mental health, behavior, and substance use, a growing body of research now suggests that survivors may face long-term physical repercussions as well. In 2010, a team led by Leah Irish published a meta-analytic review of 31 studies in the Journal of Pediatric Psychology, observing that survivors of child sex abuse reported measurably more adverse issues relating to general health, gastrointestinal health, gynecologic or reproductive health, pain, cardiopulmonary symptoms, and obesity than the general population.^[9] In 2016, a research team led by Dr. Tracie O. Afifi of the University of Manitoba published similar results, using data from a Canadian community health survey to estimate that the experience of child sex abuse is linked with increased rates of arthritis, back problems, migraine headaches, cancer, bowel disease, chronic fatigue syndrome, chronic bronchitis/emphysema, chronic obstructive pulmonary disease, and diabetes.^[10] Results like these should alert scholars and policymakers alike that the long-term repercussions of child sex abuse extend beyond mental issues, and affect health and well-being more broadly than has traditionally been recognized.

Economic and Professional Consequences

Survivors interviewed by Attorney General investigators also reported that their history of abuse had interfered with their professional and financial achievement for decades after the abuse ended. “David,” a survivor of abuse by Father Peter D. Kohler, reports that he has “left, quit, or was fired from every job he’s ever had.” Research shows that David is not alone.

In 2010, Columbia University economist Dr. Janet Currie and Dr. Cathy Spatz Widom, now a member of the Graduate Center Faculty at the City University of New York, examined the long-term economic impacts on the survivors of child abuse and neglect. “These new findings,” they concluded, “demonstrate that abused and neglected children experience large and enduring economic consequences.” Using a prospective cohort design study methodology, Dr. Currie and Dr. Spatz Widom were able to measure “a ripple effect from earlier consequences of child maltreatment to long-term consequences for adult functioning, including economic productivity.” Their findings showed that “individuals with histories of abuse and neglect were about 14 percentage points less likely to be employed and significantly less likely to own a bank account, stock, a vehicle, or a home, compared to matched controls  . . . Where participants reported earnings, individuals with documented histories of abuse and/or neglect reported almost $8,000 less per year on average than controls.”^[11]

In 2018, a team led by Johns Hopkins University mental health scholar Dr. Elizabeth J. Letourneau published similar results. Examining the costs associated with sex abuse of female children from a societal perspective, Dr. Letourneau and her team estimated that the cost for female survivors included discounted present values of $14,357 in childhood health care costs, $9,882 in adulthood medical costs, $223,581 in productivity losses, $8,333 in child welfare costs, $2,434 in violence/crime costs (including costs associated with assault, robbery, burglary, and theft), $3,760 in special education costs, and $20,387 in suicide death costs.^[12] These studies demonstrate that the scars left by child sex abuse are not just physical and psychological. Those scars extend further, affecting the careers, finances, and professional achievement of survivors long after the abuse has ended.

Conclusion

Survivors who shared their experiences with Attorney General investigators told of battles for healing that lasted years, and sometimes decades. And while every survivor’s journey is unique, the data and science suggest that as a group, survivors of child sex abuse experience increased rates of mental health challenges, addiction, alcoholism, suicide and suicidal ideation, and physical health problems. Moreover, the long term economic, financial, and professional toll of child sex abuse is significant. Yet far too often survivors are left to cover their own treatment and recovery costs, even as the trauma of their abuse stands in the way of professional achievement.

The experience of survivors, coupled with the science and research, are a call to action. A call that triggers a moral obligation to support the survivors of child sex abuse suffered at the hands of Catholic clergy. The Catholic dioceses and archdiocese in Illinois can, and should, recommit to providing those survivors the ongoing support they need and deserve.

Sources Cited

Afifi, T. O., MacMillan, H. L., Boyle, M., Cheung, K., Taillieu, T., Turner, S., & Sareen, J. (2016). Child abuse and physical health in adulthood. Health reports, 27(3), 10–18.

Browne, A., & Finkelhor, D. (1986). Impact of child sexual abuse: A review of the research. Psychological Bulletin, 99(1), 66–77.

Currie, J., & Widom, C. S. (2010). Long-term consequences of child abuse and neglect on adult economic well-being. Child maltreatment, 15(2), 111–120.

Hailes, H. P., Yu, R., Danese, A., & Fazel, S. (2019). Long-term outcomes of childhood sexual abuse: an umbrella review. The lancet. Psychiatry, 6(10), 830–839.

Irish, L., Kobayashi, I., & Delahanty, D. L. (2010). Long-term physical health consequences of childhood sexual abuse: a meta-analytic review. Journal of pediatric psychology, 35(5), 450–461.

Lange, A., de Beurs, E., Dolan, C., Lachnit, T., Sjollema, S., & Hanewald, G. (1999). Long-term effects of childhood sexual abuse: objective and subjective characteristics of the abuse and psychopathology in later life. The Journal of nervous and mental disease, 187(3), 150–158.

Letourneau, E. J., Brown, D. S., Fang, X., Hassan, A., & Mercy, J. A. (2018). The economic burden of child sexual abuse in the United States. Child abuse & neglect, 79, 413–422.

Widom, C. S., & Hiller-Sturmhöfel, S. (2001). Alcohol abuse as a risk factor for and consequence of child abuse. Alcohol research & health : the journal of the National Institute on Alcohol Abuse and Alcoholism, 25(1), 52–57.

Spokas, M., Wenzel, A., Stirman, S. W., Brown, G. K., & Beck, A. T. (2009). Suicide risk factors and mediators between childhood sexual abuse and suicide ideation among male and female suicide attempters. Journal of traumatic stress, 22(5), 467–470.

1. The studies referenced here each may have limitations, driven by factors such as difficulty in collecting data on commonly stigmatized experiences such as child sex abuse, and the statistical challenges in tracking and untangling consequences of any event to groups over long periods of time. Together, however, the studies confirm the experiences shared by survivors with Attorney General investigators, stressing the need to further explore the still inadequately understood long-term consequences of child sex abuse. 

2. Browne, A., & Finkelhor, D. (1986). Impact of child sexual abuse: A review of the research. Psychological Bulletin, 99(1), 66–77.

3. Lange, A., de Beurs, E., Dolan, C., Lachnit, T., Sjollema, S., & Hanewald, G. (1999). Long-term effects of childhood sexual abuse: objective and subjective characteristics of the abuse and psychopathology in later life. The Journal of nervous and mental disease, 187(3), 150–158.

4. Hailes, H. P., Yu, R., Danese, A., & Fazel, S. (2019). Long-term outcomes of childhood sexual abuse: an umbrella review. The lancet. Psychiatry, 6(10), 830–839.

5. Hailes, H. P., Yu, R., Danese, A., & Fazel, S. (2019). Long-term outcomes of childhood sexual abuse: an umbrella review. The lancet. Psychiatry, 6(10), 830–839.

6. Widom, C. S., & Hiller-Sturmhöfel, S. (2001). Alcohol abuse as a risk factor for and consequence of child abuse. Alcohol research & health : the journal of the National Institute on Alcohol Abuse and Alcoholism, 25(1), 52–57.

7. Browne, A., & Finkelhor, D. (1986). Impact of child sexual abuse: A review of the research. Psychological Bulletin, 99(1), 66–77.

8. Spokas, M., Wenzel, A., Stirman, S. W., Brown, G. K., & Beck, A. T. (2009). Suicide risk factors and mediators between childhood sexual abuse and suicide ideation among male and female suicide attempters. Journal of traumatic stress, 22(5), 467–470.

9. Irish, L., Kobayashi, I., & Delahanty, D. L. (2010). Long-term physical health consequences of childhood sexual abuse: a meta-analytic review. Journal of pediatric psychology, 35(5), 450–461.

10. Afifi, T. O., MacMillan, H. L., Boyle, M., Cheung, K., Taillieu, T., Turner, S., & Sareen, J. (2016). Child abuse and physical health in adulthood. Health reports, 27(3), 10–18.

11. Currie, J., & Widom, C. S. (2010). Long-term consequences of child abuse and neglect on adult economic well-being. Child maltreatment, 15(2), 111–120.

12. Letourneau, E. J., Brown, D. S., Fang, X., Hassan, A., & Mercy, J. A. (2018). The economic burden of child sexual abuse in the United States. Child abuse & neglect, 79, 413–422.