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Survivors of childhood sexual abuse experience an array of overwhelming and intense feelings. These may include feelings of fear, guilt, and shame. Abusers have been known to tell children that it is the fault of the child that they are abused, shifting the blame away from the abuser, where it belongs, and placing it on the child.
Along with this, abusers may threaten or bribe the child into not speaking up; convincing the child that he or she will never be believed. The reaction of a survivor’s friends and family to the disclosure of the abuse also has the potential to trigger immense feelings of guilt, shame and distrust, particularly if those individuals denied that the abuse was taking place, or chose to ignore it.
While each individual’s experiences and reactions are unique, there are some responses to child sexual abuse that are common to many survivors:
• Low self-esteem or self-hatred
• Guilt, shame and blame
• Sleep disturbances / disorders
• Somatic Concerns
• Dissociative Patterns
Many survivors go through a process where the mind distances itself from the experience because it is too much for the psyche to process at the time. This loss of connection with thoughts, memories, feelings, actions or sense of identity, is a coping mechanism and may affect aspects of a survivor's functioning.
• Lack of trust for anyone
Many survivors were betrayed by the very people they are dependent upon (family, teachers etc.) who cared for them, who insisted they loved them even while abusing them; learning to trust can be extremely difficult under these circumstances.
93% of victims under the age of 18 know their attacker.
Many survivors as adults find themselves in abusive, dangerous situations or relationships.
• Unstable interpersonal relationships
• Difficulties with Sexuality and Intimacy
Many survivors have to deal with the fact that their first sexual encounter was a result of abuse. Such memories may interfere with the survivor's ability to engage in sexual relationships, which may bring about feelings of fright, frustration, or being ashamed.
Adult survivors of childhood sexual abuse often adopt coping mechanisms (or survival strategies) to guard against feelings of terror and helplessness that they may have felt as a child. These past feelings can still have influence over the life and present behavior of an adult survivor. Here are some common coping mechanisms:
• Grieving / Mourning
• Alcohol or drug abuse
• Disordered Eating / Eating Disorders
• Self-injury/suicidal ideation and attempts 
Some additional facts about childhood sexual abuse:
Both men and women are affected by sexual abuse. The prevalence of child sexual abuse is difficult to determine because it is often not reported; experts agree that the incidence is far greater than what is reported to authorities.
1 in 5 girls and 1 in 20 boys is a victim of child sexual abuse. Self-report studies show that 20% of adult females and 5-10% of adult males recall a childhood sexual assault or sexual abuse incident.
Psychological outcomes can be severe for men because men are socialized to believe that they are immune to sexual assault and because societal reactions to these assaults can be more isolating.
Women may have difficulties trusting men leading to problems in work and home life.
Parenting issues may arise for both men and women. Women can experience shame during pregnancy, feeling it is "wrong" to be pregnant.
Woman who were sexually assaulted before the age of 18 [are] twice as likely to report being raped as adults.
Heterosexual male survivors may experience a fear that the assault will make them gay; may feel that they are “less of a man.”
Homosexual male survivors may feel the crime is “punishment” for their sexual orientation; may worry that the assault affected their sexual orientation; may fear they were targeted because they are gay and withdraw from the community; may develop self-loathing related to their sexual orientation.
Anger about the assault, leading to outward- and inward-focused hostility, can occur in both male and female survivors but may look different.
Avoidance of emotions or emotional situations, stemming from the overwhelming feelings that come with surviving a sexual assault, can occur in both male and female survivors. 
In most instances, the survivor never discussed the abuse with others while it was occurring. In fact, many survivors do not remember the abuse until years after it has occurred, and may never be able to clearly recall it. Often, after being triggered by a memory, this individual will need treatment as coping strategies fail. It is imperative that survivors speak with someone, whether it is a friend or counselor, about the abuse and past and current feelings.  In treatment for childhood sexual abuse and PTSD (Post-Traumatic Stress Disorder), strategies are customized to the individual’s needs, preferences and stage of recovery. Among these strategies are:
• Psychological first aid immediately after the event
• Medication that can play a role in reducing symptom intensity
• Avoidance of use of substances
• Psychotherapy in cognitive, psychodynamic, supportive and other modalities. 
 Hall & Hall
 RAINN a
 National Center for Victims of Crime
 RAINN b and Davis & Frawley
 RAINN a
The foregoing material was prepared using materials from the following websites, articles and books including the use of extensive quotations from the sources. A good faith attempt has been made to credit the original sources. Hilltop Cares encourages you to visit these sites and sources for further information.
ACA - Hall & Hall (2011). The Long-Term Effects of Childhood Sexual Abuse: Counseling Implications. http://www.counseling.org/docs/disaster-and-trauma_sexual-abuse/long-term-effects-of-childhood-sexual-abuse.pdf?sfvrsn=2
Davies and Frawley (1994). Treating the Adult Survivor of Childhood Sexual Abuse. New York: Basic Books
NAMI. Post-Traumatic Stress Disorder Fact Sheet.
National Center for Victims of Crime.
www.victimsofcrime.org Child Sexual Abuse Statistics.
a. Adult Survivors of Childhood Sexual Abuse. www.rainn.org https://www.rainn.org/get-info/effects-of-sexual-assault/adult-survivors-of-childhood-sexual-abuse
b. Male Sexual Assault. www.rainn.org https://www.rainn.org/get-information/types-of-sexual-assault/male-sexual-assault