Living with the aftereffects of childhood sexual abuse
The Vicki Bernadet Foundation has been working comprehensively on child and adolescent sexual abuse (hereinafter, CSA) since its inception in 1997. It carries out prevention and awareness campaigns with the aim of helping to eradicate CSA and to give visibility to this violence, which, despite having a high incidence, remains a taboo subject in many respects.
The only state-level incidence study we have in Spain indicates that 22.5% of women and 15.2% of men have suffered a sexual assault before the age of 18 (López, 1994).
One of the Foundation's areas of intervention is the provision of specialized training aimed at different groups (university students, teachers, workshops with children and adolescents in educational centers, talks to families, participation in the creation of protocols, etc.), with the aim of helping to improve the detection and intervention in cases of CSA.
The organization also offers psychological and legal support to victims of domestic violence and their families. This is perhaps the organization's best-known service and a leading social resource in the region.
Pilar Polo Polo
Over the years, the Foundation has witnessed a significant improvement in the approach to child sexual abuse. Currently, in Catalonia, we have a public network that supports children and adolescents who have experienced sexual abuse, with specialized services such as the Barnahus (Children's House in Iceland). This model, similar to that in Iceland, promotes comprehensive care, where all departments coordinate and attend to the child in the same place, adapted to their developmental stage. There are also the EFE ( Functional Expert Teams ): for addressing child and adolescent sexual violence lasting more than 72 hours and serious abuse within the healthcare system. This network of services, recently deployed in Catalonia and soon to be implemented throughout the rest of Spain, offers hope for the improvement and support of children and adolescents who have experienced child sexual abuse.
Similarly, we believe it is also important to mention the approval of the new Children's Law (Organic Law 8/2021, of June 4, on Comprehensive Protection of Children and Adolescents against Violence), which is designed to guarantee total protection to children and adolescents against any kind of violence, with special attention to sexual, physical, psychological violence and exploitation.
Among its most noteworthy points; this law modifies and considerably extends the statute of limitations for reporting child abuse, promotes specialized training among professionals working with children, promotes mechanisms for reparation and emotional support for victims, encourages the creation of specialized services, includes measures to promote better detection and prevention of violence against children, etc.
All these advances also give hope that sexual abuse in childhood and adolescence will occupy a central place in social policies and agendas, allowing for a better approach to CSA, promoting early detection and better action in a case.
However, many invisible victims remain unable to access these improvements ; these are young people and adults who experienced sexual abuse in their childhood and who are now seeking or needing psychological or legal support. At the Foundation's support service, we receive these adults every day, many of whom continue to grapple with the lasting effects of their abuse. In 2024, we conducted a total of 284 individual therapy sessions with adult victims of sexual abuse.
More frequent sequelae in adults who have suffered a BIA
Child sexual abuse is considered a potentially traumatic event . Its effects can be seen not only during childhood but also in adulthood, regardless of when the abuse occurred, since the symptoms can persist throughout life through manifestations typical of each developmental stage, or even remain asymptomatic and appear much later, long after the abuse (Cantón & Cortés, 2015).
Experiences and responses, as well as the degree of impact, are highly varied, making it difficult to assess the traumatic impact of child sexual abuse on those who have experienced it (Royo, 2007). Studies confirm that the consequences affect all areas of the victim's life, making it impossible to speak of a single syndrome of child sexual abuse (Pereda, 2009).
The most common consequences of childhood abuse are already well-known, and I won't dwell on them here. I will only mention those consequences we commonly find in the adults who consult us, which coincide with studies focused on long-term effects. We typically find a greater likelihood of suffering from depressive disorders, anxiety, complex post-traumatic stress disorder, borderline personality disorder, self-harm, suicidal ideation, and low self-esteem . In the relational sphere, we find greater isolation and social anxiety, difficulties in romantic relationships, challenges in raising children, etc. And in other areas, they also score higher on medically unexplained physical pain, headaches, fibromyalgia, eating disorders, conversion disorders, epileptic seizures, somatic symptoms, etc. They also experience difficulties in the area of sexuality and are at risk of revictimization in adulthood (Pereda, 2010).
When planning a therapeutic approach , we must consider that the prognosis will depend on multiple variables. On the one hand, there are those directly related to the individual (age and developmental stage, available coping strategies, attachment style, support network, etc.). But there are also variables directly related to the abusive situation, such as the relationship with the abuser (the closer the relationship, the worse the prognosis), the type of sexual abuse (penetration being potentially the most traumatic), the age at which the abuse began and its frequency (whether it is a single, acute incident or repeated over time), as well as the family support received at the time of disclosure. Each person and each situation is unique, and although there may be commonalities among abused individuals, each case must be addressed individually.
At the Foundation, around 70% of the cases we treat involve adults living with suffering directly related to sexual abuse they experienced in childhood. The trigger for their distress or the reason they decide to seek our help now can be quite varied. For example, we encounter many people who need therapeutic support when they become parents, a transition often influenced by hypervigilance and fear that the abuser might suffer the same fate as their children, as well as the worry that the abuser may still be in the family and have contact with them. Also, when the child reaches the age the abuser was at the time of the abuse, the mirror effect can bring back many memories. Another time when many adult women come to us is after childbirth, when physical discomfort and memories manifest as intrusive thoughts. These situations often involve dissociation, or in some cases, a defensive semi-forgetting (where the memory remains between consciousness and the unconscious) as a distant recollection. However, with the feeling of bodily invasion and the arrival of motherhood, the memory resurfaces forcefully, generating significant suffering. This reminds us that the body also has a memory (Van der Kolk, 2014), and that unconscious defenses eventually develop cracks through which the memory emerges. This moment is generally one of significant distress and is often accompanied by post-traumatic symptoms.
Other situations that contribute to increased distress in the present, and therefore the demand for therapeutic attention, are related to family changes or shifts, such as when the abuser ages and the need or urgency of caring for them arises, or perhaps the death of that person has occurred, stirring up many feelings, sometimes ambivalent. We also encounter many people who become distressed when the abuser is the parent of their children, and the fear arises that the abuse could be repeated, along with the need and the doubt surrounding breaking the family silence.
Important family gatherings such as Christmas parties, birthdays, etc., where it is known that there will be an encounter with that person, or perhaps conflicts with the family where different positions were taken, often increase the present discomfort (feelings of guilt, misunderstanding, loneliness, etc. appear).
Other life events such as a separation or meeting a new partner, difficulties in the area of sexuality, recurring depressive symptoms, the complaint and the legal process, etc., are also moments that lead the person to a discomfort that needs to be accompanied.
In the case of adults, it is also more common than expected to encounter a lack of understanding from those around them when they disclose abuse. They may be criticized for not having spoken up sooner, or for not knowing what to do now. And they are often told to forget, or not to take any action (what's the point of reporting it now, the abuser is old, etc.). This behavior invalidates their suffering and increases feelings of loneliness and being misunderstood. Group therapy, as a complement to individual therapy, can be a healing space in these cases.
Our experience over these years confirms that there is no single therapeutic process that works for everyone, but rather it is necessary to attend to each case individually, the particularity of the person and their context, accompanying them to find their own solutions.
However, there are certain issues that must be addressed therapeutically in most cases, such as the guilt and shame that often accompany victims. This includes addressing self-esteem, fostering reflective capacity, and promoting a critical understanding of relationships. It also involves reassessing responsibilities and empathizing with the child or adolescent they were at that time, in order to adjust their self-judgment. Finally, it's crucial to offer a different model of relationships, based on respect and understanding.
It is important that adults who have experienced sexual abuse in childhood or adolescence, and who live with the resulting trauma, also receive therapeutic support to improve their quality of life, process the trauma, and rediscover enjoyment in the present. Because what has been experienced cannot be erased, but it can be integrated and lived with in a different way, so that the abuse no longer shapes the present or the future.
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