Adult Survivors of Child Sexual Abuse: Risks to Love, Marriage, and Parenthood

Abuse survivors may be understandably concerned or anxious about entering intimate relationships, especially marriage and parenthood. Psychotherapy can be a powerful tool to address our fears.

What Are Some Common Risks?

Childhood sexual abuse violated our development, our autonomy, and our bodies-or at a minimum our privacy and our personal space. We have been, in the most painfully literal way, objectified-turned into objects that seemed to exist only for the gratification of others’ desires, disregarding our own subjectivity and worth. Many of the risks for survivors are related to a disintegration of a sense of self, with integrity and boundaries.

No survivor can be predicted to have any particular mental health problem. On the other hand, certain problems often have a history of abuse behind them:

• Depression
• Anxiety disorders
• Post traumatic stress symptoms, including flashbacks, nightmares, and “hypervigilance”
• Chronic pain, whether or not traceable to a physical cause or injury
• Personality disorders
• Eating disorders
• Suicide and suicidal gestures

We also often manifest certain attitudes and behaviors:

• Confusion, shame, and overcompensation around sexual identity and desire
• Patterns of “difficult” responses to situations and relationships
• Emotional numbness and detachment; mood swings and personality shifts
• Inability to trust, compounded by difficulty in judging trustworthiness
• “Freezing” in response to threats, including neutral situations that invoke past abuse
• Self harm and compulsive risk-taking, including reckless sex
• Abuse of intoxicants or prescribed drugs, often severe

Handicapped at the Starting Gate?

Damage to survivors’ selfhood complicates entering, sustaining, and negotiating intimacy. Some maladaptive behaviors may be triggered or exacerbated by the stress of relationships and parenthood. Pregnancy and childbirth inherently pose a risk for depression, a risk that can be heightened for survivors going through the normal course of gynecological exams and the exposed and traumatic process of childbirth. The parental instinct to protect children may mesh with survivors’ hypervigilance, creating an additional layer of exhaustion for the already demanding task of parenting. Trust issues may make forming and sustaining relationships difficult, or may lead to a series of relationships based on dominance, abuse, and control. Flashbacks and dissociative freezing may interfere with sexual relations, even in a generally positive and supportive partnership.

Where in the World Can I Be Safe?

Child sexual abuse is often accompanied by some failure of the family. Even the most loving and supportive of families may be inadequate to deal with the aftermath of abuse that occurs outside the home, or at the hands of a trusted friend. When abuse occurs within the family, the denial and enabling that often compound it can make the family of origin a treacherous place. Survivors may have no sense of the family as a place of safety and security, and no faith in our ability to create a secure and safe home for our children.

As parents, we may even mistrust our own natural and healthy responses to our children’s needs for physical affection. The risk to children is less that abuse-surviving parents will be abusively intimate and more that we will be cold and/or uncomfortably ambivalent about proper affection and intimacy.

The Good News

Faced with the unbearable, we responded with emergency measures to cope-measures that are most often not sustainable and in the long run may be harmful. Still, nothing in this area is all black and white. Instead of being chronically mistrustful or misplacing our trust, some of us develop better-than-normal accuracy in gauging others’ intentions and character. Whether we endured, escaped, or both-whether we reported abuse early, later, or have yet to disclose it-amidst the wreckage of “normal” development, we found strength, resilience and inventiveness that kept us alive and functioning. Now is the time to apply those qualities in a constructive way to reclaiming the stolen pieces of ourselves. We can correct our first stumbling steps toward preserving our personhood in peer support groups, in psychotherapy, and with luck and effort, within intimate, loving relationships with partners and children.

Psychotherapy’s knowledge of and ability to treat the effects of child sexual abuse has grown tremendously. Therapy for survivors is deeply informed both by what research and clinical outcomes reveal and by what survivors teach therapists about what works for us and what does not. Adult survivors can enter therapy confident-or able to soon gain the confidence-that while many difficulties and risks are known, none of them are predetermined; and means are available to deal with most survivors’ issues and anxieties. Survivors’ groups can also help with support, strategies, and reality checks.

Survivors of child sexual abuse have been profoundly betrayed. It is no surprise that the effects of abuse can be deep and lasting. Difficult as it may be to believe, there is a world of genuine love out there waiting to welcome survivors: to hear our stories, honor our struggles, respect our personhood, and be worthy of our trust. We deserve that human legacy of love; we have the power to carry it forward to another generation. Psychotherapy can be the critical step we need to take toward unlocking that power.