The authors investigated the association between sexual abuse in childhood and subsequent incidents of deliberate self-harm in women.
A random community sample of women (N=252) that reported having been sexually abused as children was interviewed and compared to a similarly sized group (N=225) that did not report abuse. The subgroup of women sexually abused as children who reported subsequent incidents of deliberate self-harm was then contrasted with abused women who did not report self-harm.
There was a clear statistical association between sexual abuse in childhood and self-harm that was most marked in those subjected to more intrusive and more frequent abuse. Self-harm was also associated with major interpersonal problems in the subject's family of origin and with becoming involved in further abusive relationships as an adult.
Sexual abuse in childhood is associated with later incidents of deliberate self-harm and may well be an etiologic factor in its development.
For me, it was the paper with the most relevant statistics to prove harm caused by sexual abuse I have seen yet. Indeed, 22 of 23 suicide attempts connected with sexual abuse in childhood, and 12 of them "without force". Having no doubt what forced sex can cause suicide, I was interested in the 12 "non-force" cases. Fortunately, were was a detailed description of these 22 cases. The results: In 8 of the 12 cases there was "sexual abuse after age 15", that means usually rape, and before the occurrence of the suicidal attempts. Remarkably even the one subject without childhood sexual abuse was sexually assaulted as an adult. The remaining four cases include an incest case, a case with pregnancy at 16, and a case with "severe parental conflict".
As the result, only one case may reasonably considered as possibly related with a safe and consensual relation: Age 8-9, ongoing genital intercourse with an asquaintance without force, overdosis at 39, "severe conflict over teenage daughter's sexuality at time of own hysterectomy".
It has often been suggested that being exposed to sexual abuse in childhood may be linked to self-damaging and suicidal behavior in adult life (1-9). However, other reviews on deliberate self-harm and attempted siucide, although mentioning the possible role of childhood sexual abuse, do not provide substancial evidence for this hypothesis (10-12). An etiologic link has also been postulated between sexual abuse in childhood and borderline personality disorder, for which one criterion is recurrent suicidal threads, gestures, or behavior or self-mutilating behavior (6,13,14). Further, eating disorders may also be important in the putative path that links sexual abuse in childhood to incidents of deliberate self-harm (9). There is a need for more empirical data before such hypotheses can be evaluated.
Higher rates of deliberate self-harm among those who reported a history of childhood sexual abuse have been reported for social agency clients (1), female inpatients (15,16), young adult and walk-in emergency clinic patients (6,17,18), and adolescents in a mental health center (7). In addition to these studies that were essentially clinical, cohorts from school and college populations have also been studied (2,3,5,7). Both clinic and school studies of childhood sexual abuse and subsequent deliberate self-harm run the risk of relying on atypical study groups and overestimating the links between the two phenomena. Meehan and collegues (19) found that only 56% of students who had been injured as a result of attempting suicide sought medical care, which underlines the limitations of using clinic data to attempt to understand deliberate self-harm.
Only one random community study, to our knowlegde, has reported a possible association between a history of sexual abuse in childhood and later incidents of deliberate self-harm. Bagley and Ramsey (20) found that suicidal ideas and behavior were linked to a prior history of sexual abuse in a follow-up study of 377 Canadian women.
[review of Beitchman 1992
[...]
[...] Twenty-three women (4.8%) among the 477 interviewed reported a history of deliberate self-harm; 22 of these 23 subjects reported sexual abuse in childhood. (...) It should be noted from these data that 91.3% of the women who were sexually abused as children did not report deliberate self-harm, nor did 99,6% of the nonabused comparison subjects. [...]
An additional 35 women recalled having substancial suicidal ideation at some stage of their lives but said they had not acted on these thoughts. When we excluded from the analysis those women who had actually harmed themselves, a significantly higher proportion of subjects with suicidal ideation (N=26 [74,3%] of 35) than without suicidal ideation (N=205 [48.8%] of 420) also reported sexual abuse in childhood. [...]
The sexually abused women with later incidents of deliberate self-harm differed from the rest of the sexually abused group on a number of variables (table 2). Their abuse was significantly more likely to have involved penetration, been repeated 10 or more times, been perpetrated by a father or stepfather rather than some other relative, acquaintance, or stranger, and involved the use of force. There was no significant difference in age at the time of sexual abuse between the subjects who did and did not inflict self-harm.
Victims of sexual abuse in childhood who later inflicted self-harm had experienced more psychosocial disadvantages in their families of origin. They were more likely than the sexually abused subjects without incidents of deliberate self-harm to report a low care and high control relationship with both father (59.1% versus 32.2%) and their mother (63.3% versus 34.8%). They were more likely to report physical abuse from a parent (27.3% versus 12.2%). Their parents were more likely to have quarreled frequently (50.5% versus 13.4%) and not to have been physically affectionate to each other (59.1% versus 35.3%) [...]
Five variables, two that concerned the sexual abuse itself (frequency and use of force), one abuse-related variable (living away from parents), and two post-abuse variables (cohabitation before age 19 and sexual assault after age 15) made independent contributions to the likelihood that a woman with a history of childhood sexual abuse would harm herself.
Childhood sexual abuse and later incidents of deliberate self-harm are clearly shown to be linked statistically by these data. While only a minority of sexually abused women (8.7%) reported deliberate self-harm, almost all the self-harming women reported a history of sexual abuse in childhood (95.7%, N=22 of 23).