Pennsylvania Coalition to Advance Respect (PCAR) Technical Assistance Bulletin Adult survivors of childhood sexual abuse (ASCSA) Child sexual abuse (CSA) is physical or non-physical contact between an adult or minor and a child which results in sexual stimulation and the gratification of the adult or minor (Pennsylvania Coalition to Advance Respect [PCAR], 2022). Child sexual abuse includes acts of physical touch such as rape or sexual assault. Non-touching behaviors like exposing children to adult sexual activity or sexualized talk are also sexual abuse. (PCAR, 2022). As time passes, children who are sexually abused grow up and become adult survivors. This resource hopes to shed light on the lasting effects of CSA into adulthood and provide ways to support survivors as they navigate life as adult survivors of childhood sexual abuse (ASCSA). The CDC estimates that 91% of childhood sexual abuse is perpetrated by someone the child knows. Children often do not report sexual abuse. Sometimes, this is out of fear or shame. However, not all child abuse happens in the same way. When a child is molested, they may not realize until adulthood that they were the victim of sexual abuse (Helping Survivors of Sexual Abuse & Assault, n.d.). Grooming Grooming is often a tactic deployed when someone intends to abuse a child. Child sexual abuse is often a gradual process, with the perpetrator deliberately testing the child’s boundaries using their familiarity with the youth and/or their own social status and power to take advantage of the child (PCAR, 2022). This process often happens by building the trust of the child and adults responsible for the child’s welfare, such as giving gifts or favors, separating the child from others, creating a norm of secrecy for other activities, and violating boundaries (PCAR, 2022). Grooming, in addition to the abuse, can lead to many effects on survivors during their youth and adulthood. "Experiencing threatening/violent grooming during childhood sexual abuse is a significant predictor of trauma symptom severity for adult survivors." -Grooming Hurts Too: The effects of types of perpetrator grooming on trauma symptoms in adult survivors of child sexual abuse Grooming can happen to whole communities and society as well. Perpetrators often put themselves into positions of power and trust, such as professors, coaches, members of clergy, doctors, volunteers, etc. It can be difficult for people to hold the concept of a person as nice and valued in the community, and the concept that they can cause harm such as sexual abuse, simultaneously. We often think of people as all good or all bad, which is not true for anyone. For more information about victim blaming, check out PCAR’s Victim Blaming and Selective Compassion podcast [https://pacentered.podbean.com/]. Effects of Childhood Sexual Abuse on Adults The effects of sexual abuse can reach into many areas of the survivor’s life. Assessing the effects that occur for each survivor can assist in determining how to support them in their healing journey. Examples of effects of CSA might include: • Physical – direct effects on the body, disordered eating, sleep issues, chronic pain/headaches Survivors showed activity limitations (including difficulty dressing/bathing, difficulty concentrating, remembering or making decisions, and difficulty doing errands alone) at a significantly higher rate than those with no sexual violence history. – The National Intimate Partner and Sexual Violence Survey: 2016/2017 Report on Sexual Violence • Mental/emotional – dissociative states, memory loss, self-injurious behavior, substance abuse, hypervigilance, and other mental health diagnoses such as post-traumatic stress disorder and personality disorders Adult survivors of childhood sexual abuse showed increased risk of psychopathology, including… anxiety, substance abuse, and personality disorders. – Psychopathology in a large cohort of sexually abused children followed up to 43 years • Behavioral – compulsive sexual behaviors or avoidance, low self-esteem, use of unhealthy coping skills (ex. excessive sleeping, substance use, hoarding, impulsive spending, etc.) • Relational – intolerance or overdependence on intimacy, difficulty with trust, continued abuse in relationships • Self-Concept - feelings of shame and a sense of badness; self-blame for the abuse; distrust in their emotions, decision, instincts; self-hatred; feelings of being different than others Flashbacks are a common after effect experienced by survivors of sexual harassment, abuse and assault. Flashbacks are not just memories, but multisensory re-experiences of the abuse. They are often alarming and overwhelming for the survivor. Understanding what flashbacks are and how they occur can help survivors navigate them successfully. Flashbacks can be experienced in many ways, such as: -Visually: explicit images or outlines or shadows -Auditory: sounds, phrases, music -Olfactory: certain smells -Physically: feelings (painful or otherwise) in the body -Emotionally: implicit memory It’s important to remember that flashbacks are often accompanied by intense emotions of fear, shame, guilt, sadness, anger, etc. Flashbacks can happen without warning, in any environment. For example, during intimate times with a partner or ourselves, when watching a movie or show, or while sleeping/dreaming. Grounding techniques can help survivors navigate and recover from a flashback safely. We enjoy the Me Too Movement’s virtual Survivor Sanctuary (me too, 2023) [https://sanctuary.metoomvmt.org/]. Navigating Healthy Relationships and Sexual Intimacy after CSA Navigating relationships as a survivor of childhood sexual assault/abuse can be challenging. Having healthy relationships and sexual intimacy is possible. Here are some ways that survivors can navigate relationships and intimacy in a healthy way (HealthyPlace, 2022). Start fostering a healthy relationship with the body Since CSA survivors tend to disconnect from their body as a way to survive the abuse, some survivors of CSA mention these tools being helpful to start developing a healthy relationship with their body again: • Exercise, trauma sensitive yoga, coloring/drawing, meditation, listening to music • Vagus Nerve Exercises [https://www.verywellmind.com/how-does-stimulating-the-vagus-nerve-improve-mental-health-6740302] • Healthy sexual exploration of their own body Inform partners as best as they can ahead of time This can take some pressure off of having to discuss too much in real time. Giving themselves grace & time No need to rush. Take time to learn more. Healing is not a straight path; there will likely be ups and downs as they move through the journey. Practice communicating their needs Start small, like what they would like to eat for dinner. Over time, communicating needs can grow in frequency and depth of need. Set guidelines/expectations for consent One example might be: “I’d like to spend more intimate time later, but let’s check in in a bit to discuss more.” Change things up as needed Each person’s relationship to another can and should evolve and grow over time. Likewise, it’s important to consider changing terms and negative associations to more positive and accurate phrasing. • Sex is a choice, not an obligation • “I call this having sex, not ‘banging’” The CERTS Model for Healthy Sex requires that these five basic conditions be met: consent, equality, respect, trust, and safety (Maltz, 2002). How to Support an Adult CSA Survivor Regardless of where an adult survivor is on their journey of healing, supportive reactions and responses from the people survivors interact with have the ability to be incredibly helpful and healing. Whether the person is a counselor, friend, advocate, or family member; the following traits can be helpful in supporting adult survivors of child sexual abuse: Supportiveness It’s not always easy to know what to say when someone tells you they’ve been sexually assaulted, especially if they are a friend or family member. For a survivor, disclosing to someone they care about can be very difficult, so we encourage you to be as supportive and non-judgmental as possible. It’s also important to continue to check in with the survivor. Authenticity One does not need to present strong professionalism or a cold front, just being present is the greatest gift to a person that is struggling. Cultural Humility Being aware of our own implicit biases and privilege, and having the willingness to grow our own knowledge about others, can be especially helpful for survivors. Awareness of Strength Hold awareness of the survivor as a strong individual with their own capabilities, knowledge, strengths, and ability to care for themselves and make their own choices. Share knowledge of CSA/trauma with survivors This let’s survivors know in a practical and authentic way that they are not alone. For example, your ASCSA is describing feeling frustrated about their own fertility issues. You share that this is a common physical/medical symptom in survivors of CSA. Utilize your own skills for yourself This might include grounding, taking space when needed, listening to your own needs, and setting boundaries. This allows us to be more fully present and a calm, safer place for survivors to come to. What if an adult is just learning about a childhood victimization? Sometimes, adults do not know that they were victimized during childhood. This could be due to the abuse being normalized, memory repression, being very young at the time of the abuse, or many other reasons. If someone is just learning about their victimization, we want them to know that we believe them and: 1. They are not alone, and they do not have to go through this alone. 2. There are trained and experienced people that can support them. Find a local sexual assault services center for free confidential counseling and options for next steps. 3. There’s no timetable when it comes to recovering from sexual violence. Healing takes time and practice. Try to give the survivor as much grace as you would a child. Resilience We like this explanation from Psychology Today, which describes resilience as “the psychological quality that allows some people to be knocked down by the adversities of life and come back at least as strong as before. Rather than letting difficulties, traumatic events, or failure overcome them and drain their resolve, highly resilient people find a way to change course, emotionally heal, and continue moving toward their goals” (Psychology Today, 2023). Trauma itself does not necessarily make someone less resilient. The American Psychological Association (APA) notes that many factors can contribute to a person’s ability to adapt to adversity, such as: • the ways in which individuals view and engage with the world • the availability and quality of social resources • specific coping strategies (Resilience [apa.org]) Resilience isn’t a finite resource within us. It is more like a muscle we can exercise and grow. Research shows that the resources and skills attributed to resilience can be cultivated and practiced (APA, 2020). Many survivors of childhood sexual abuse are able to lead successful, healthy lives after their trauma experience. The best supported protective factors found in one systemic study were education, interpersonal and emotional competence, control beliefs, active coping, optimism, social attachment, external attribution of blame and by far, social support from the family and wider social environment (Domhardt, 2015). Resources Bunn, T. (2014). Is what you are feeling a flashback? Psychology today. https://www.psychologytoday.com/us/blog/conquer-fear-flying/201408/is-what-you-are-feeling-flashback Cheeseman, G. M. (2021). Stimulating the vagus nerve aids childhood trauma recovery [Blog post]. The Possible Path. https://medium.com/the-possible-path/stimulating-the-vagus-nerve-aids-childhood-trauma-recovery-3d5adbd3a4a1 Jean-Philippe, M. (2021). Bruce Perry explains to Oprah the impact of childhood neglect. Oprah Daily. https://www.oprahdaily.com/entertainment/books/a36213501/oprah-bruce-perry-quotes-what-happened-to-you/ National Association of Adult Survivors of Child Abuse. (n.d.). National Association of Adult Survivors of Child Abuse [Website]. http://www.naasca.org/ RAINN. (2022). Redefining resilience: A learning series for child sexual abuse survivors [Webpage]. https://rainn.org/redefining-resilience-series/ RAINN. (2023). Flashbacks [Webpage]. https://www.rainn.org/articles/flashbacks The Morris Center. (n.d.). Adult survivors of child abuse [Webpage]. The Morris Center. https://www.ascasupport.org/ References American Psychological Association. (2020). Building your resilience [Webpage]. https://www.apa.org/topics/resilience/building-your-resilience Basile, K. C., Smith, S. G., Kresnow, M., Khatiwada, R. W., & Leemis, R. W. (2022). The National Intimate Partner and Sexual Violence Survey: 2016/2017 report on sexual violence. Centers for Disease Control and Prevention. https://www.cdc.gov/violenceprevention/pdf/nisvs/nisvsReportonSexualViolence.pdf?ACSTrackingID=DM83944 Domhardt, M., Munzer, A., Fegert, J. M., & Goldbeck, L. (2015). Resilience in survivors of child sexual abuse: A systematic review of the literature. Trauma, Violence, & Abuse, 16(4), 476-493. https://doi.org/10.1177/1524838014557288 Healthysex.com. (2023). The CERTS Model for Health Sex [Webpage]. https://healthysex.com/library-items/the-certs-model-for-healthy-sex/ Helping Survivors of Sexual Abuse & Assault. (n.d.). Long-term effects of child sexual abuse and molestation [Webpage]. https://helpingsurvivors.org/child-sexual-abuse/long-term-effects/ Maltz, W. (2002). The CERTS Model of Healthy Sex [Webpage]. HealthyPlace. https://www.healthyplace.com/sex/good-sex/the-certs-model-of-healthy-sex Me too. (2023). Survivor’s sanctuary [Webpage]. Me too. International. https://sanctuary.metoomvmt.org/ PCAR. (Producer). (2023, March 1). Victim blaming and selective compassion [Audio podcast episode]. In PA Centered. https://pacentered.podbean.com/ Pennsylvania Coalition to Advance Respect. (2022). About sexual violence: Children [Webpage]. https://pcar.org/about-sexual-violence/children Psychology Today. (2023). Resilience [Webpage]. Psychology Today. https://www.psychologytoday.com/us/basics/resilience Resource Sharing Project. (2023). Building resilience: Conversations with and about adult survivors of child sexual abuse [Webinar]. https://resourcesharingproject.org/resources/building-resilience-conversations-with-and-about-adult-survivors-of-child-sexual-abuse/ Survivor’s Network. (2019). Flashbacks. https://survivorsnetwork.org.uk/resource/flashbacks Tracy, N. (2019). Common symptoms in adult survivors of childhood sexual abuse. HealthyPlace. https://www.healthyplace.com/abuse/articles/symptoms-adult-survivors-childhood-sexual-abuse A Special Thank You to our Reviewers Erika B. Brosig, LCSW Chief Operating Officer Victim Services, Inc. Joanna Dragan, MA Supervisor of Sexual Violence Services SPHS CARE Center STTARS Program Ana Gomez, MSW Direct Services Supervisor Safe Monroe © 2023 Pennsylvania Coalition to Advance Respect. A division of Respect Together. www.pcar.org