Applied Psychology OPUS

Self-Efficacy in Victims of Child Sexual Abuse

Christie Kim

Studies conducted across decades of research have established that between 9-30% of children in North America experience sexual abuse (Briere & Elliot, 2003; Child Maltreatment 2013; Finkelhor, 1994). With regard to gender, approximately 20-30% of girls and 5-10% of boys experience sexual abuse at least once during childhood (Briere & Elliot, 2003; Finkelhor, 1994). Child sexual abuse (CSA) is understood to be the engagement in any sexual behavior with a child under the age of eighteen who is unable to comprehend or give consent to a sexual act due to one’s age or developmental stage (Finkelhor & Browne, 1985). Forms of sexual abuse include violation of the body by use of force, coercion, or against the will of the child, as well as exposure to sexual media (Finkelhor & Browne, 1985; Foster & Hagedorn, 2014). The traumatic experience of sexual abuse, particularly in childhood and adolescence, is associated with low self-efficacy, defined as the belief in one’s own ability to effectively function and exercise control within a situation (Bandura, 1982; Benight & Bandura, 2004; Finkelhor & Browne, 1985; Lamoureaux, Palmieri, Jackson, & Hobfoll, 2011). Self-efficacy diminishes due to CSA, as victims experience significant decreases in self-esteem, mastery, and agency following the abuse (Cecil & Matson, 2001; Cieslak, Benight, & Caden Lehman, 2008; Foster & Hagedorn, 2014; Finkelhor & Browne, 1985; Hagan & Smail, 1997; Lamoureaux et al., 2011).

Researchers suggest that victims’ lowered sense of self-efficacy largely mediates the relation between CSA and disruptions in a child’s emotional, cognitive, and interpersonal development (Benight & Bandura, 2004; Finkelhor & Browne, 1985; Lamoureaux et al., 2011). In particular, self-efficacy predicts the amount of effort a child is able to put forth in persevering through adverse experiences such as CSA, as well as levels of vulnerability to stress and mental illness, self-motivation, resilience, and the nature of the victim’s decision-making and outlook on  life (Bandura, 1982; Benight & Bandura, 2004; Cieslak et al., 2008). Decreased self-efficacy due to CSA also increases the risk for negative mental health and behavioral outcomes such as posttraumatic stress disorder (PTSD), including symptoms of disasociation, re-victimization, self-devaluation, and maladaptive coping mechanisms, such as self-harm and suicidal ideation (Bagley, Berlitho, & Bertrand, 1995; Benight & Bandura, 2004; Cieslak et al., 2008; Coohey, 2010; Lamoureaux et al., 2011; Lev-Wiesel, 2000; Reese-Weber & Smith, 2011; Stern, Lynch, Oates, O’Toole, & Cooney, 1995). However, these detrimental effects do not develop in all victims of CSA, and the intensity and duration of symptoms vary between individuals (Briere & Elliot, 2003). Still, research suggests that the level of self-efficacy may be predictive of the recovery period for victims. More specifically, self-efficacy is thought to influence important steps of recovery, such as help-seeking behavior, resource utilization, disclosure of abuse, and reporting the offense (Finkelhor & Browne, 1985; Foster & Hagedorn, 2014; Lev-Wiesel, 2000).
There is a multitude of empirical studies that provide support for the relation between CSA and negative psychosocial outcomes, yet few studies focus particularly on the outcomes associated with decreased self-efficacy. Accordingly, the present review seeks to explore how lowered self-efficacy due to child sexual abuse predicts disruption in victims’ affective, cognitive, and interpersonal development.

Negative Affect

Fear and anxiety. The traumatic experience of CSA is detrimental to the emotional state of victims both during and long after the offense (Foster & Hagedorn, 2014). Fear has been identified as the predominant emotion in young victims during experiences of CSA. Descriptive firsthand accounts indicate that children feel a deep sense of helplessness and powerlessness during sexual abuse (Foster & Hagedorn, 2014). Furthermore, fear of the repercussions following disclosing the abuse (e.g., parental rejection or skepticism) was found to predict both a lack of or a delayed disclosure (Foster & Hagedorn, 2014). Negative emotional states in victims of CSA further contributes to anxiety. Compared to those without a history of abuse, CSA is correlated with significantly higher levels of anxiety, including anxious arousal and anxiety disorders, across the lifetime (Bagley et al., 1995; Briere & Elliot, 2003; Swanston et al., 2003).  Lowered self-efficacy due to CSA predicts negative affect, such as fear and anxiety, in victims in both the immediate and delayed aftermath.

Depression and self-blame.The negative emotional experiences of CSA victims is further apparent through increased levels of depression and self-blame.  Following fear, feelings of sadness, inefficacy, worthlessness, and shame were found to be prevalent throughout children’s experiences of CSA (Foster & Hagedorn, 2014). A large number of studies have found that CSA predicts higher rates of self-reported sadness and depression across age groups, as well as despair and hopelessness in young individuals exposed to sexual abuse, as compared to those who did not experience sexual abuse (Bagley et al., 1995; Briere & Elliot, 2003; Cecil & Matson, 2001; Lamoureaux et al., 2011; Stern et al., 1995; Swanston et al., 2003). Along with symptoms of depression, victims of CSA often develop internalizing symptoms such as self-blame (Foster & Hagedorn, 2014; Hagan & Smail, 1997). For example, Cieslak et al. (2008) found that CSA predicts decreased coping self-efficacy, defined as the belief in one’s efficaciousness, particularly in mastering the demands of post-abuse recovery, which then predicted blaming oneself for the abuse. Another study found that, among adults who experienced CSA, roughly half of both male and female victims turned the blame inwards and attributed the fault of the abuse to themselves (Lev-Wiesel, 2000). The perception that the abuse occurred because of a personal inability to prevent it reflects the diminished sense of self-efficacy following CSA.

Self-harm and suicidality. Lowered self-efficacy due to CSA is characterized by a decreased sense of agency, which has been found to be significantly predictive of externalizing mental health symptoms, specifically, self-harm and suicidality (Bagley et al., 1995; Briere & Elliot, 2003; O’Connor, Rasmussen, & Hawton, 2009). Compared to non-abused individuals, adolescent victims of CSA report significantly more frequent self-harm and suicidal behaviors (Bagley et al., 1995), a relation that is particularly strong in girls (Noll, Horowitz, Bonanno, Trickett, & Putnam, 2008). The high frequency of externalizing symptoms among victims of CSA reflects disruption in affect regulation due to low self-efficacy.

Disruptions in Cognitions

Self-esteem. Decreased self-efficacy has been linked with disruptions in cognitive development in child victims of sexual abuse. Self-esteem is a crucial component of self-efficacy as it reflects the valuation of self-worth, and it is often impaired in victims of CSA (Finkelhor & Browne, 1985; Hagan & Smail, 1997). Multiple studies have found that children, adolescents, and young adults who experienced sexual abuse during childhood tend to have significantly lower levels of self-esteem and self-worth than their peers who had no such history (Cecil & Matson, 2001; Larmoureaux et al., 2011; Stern et al., 1995; Swanston et al., 2003). Negative cognitions about the self, including self-blame, self-hatred, guilt, and feeling damaged, are indicative of the depreciated senses of self-esteem as a result of lowered self-efficacy in the aftermath of sexual abuse (Hagan & Smail, 1997; Lev-Wiesel, 2000; Noll et al., 2003; Reese-Weber & Smith, 2011).

Mastery and agency. Decreased self-efficacy as the result of force or coercion during a sexual assault can severely damage a child’s cognitive sense of mastery and agency. Mastery, the belief in personal control over life circumstances, and agency, the perceived capability of self-determination, are significantly lower in victims of CSA (Bandura, 1982; Bandura, Reese, & Adams, 1982; Benight & Bandura, 2004; Finkelhor & Browne, 1985). Self-efficacy is contravened when the abuser exerts total power over the victim, instilling a sense of powerlessness through manipulation, secrecy, and threats of punishment (Finkelhor & Browne, 1985; Hagan & Smail, 1997). Research has found that in comparison to those who did not experience CSA, adolescent females with a history of CSA reported a decreased sense of mastery and control in their lives (Benight & Bandura, 2004; Cecil & Matson, 2001). Lower levels of coping self-efficacy, in particular, reflected women’s diminished belief in their ability to master adaptive skills in the period following the trauma (Cieslak et al., 2008). The overwhelming sense of perceived inability to control life situations is intricately related to further cognitive disruptions in CSA victims.

Dissociation. Across both gender and age groups, those with a history of CSA often exhibit dissociative cognitions as a result of impaired self-efficacy. Habitual dissociation was found in a CSA case study by Hagan and Smail (1997), in which a young female victim mentally disconnected from her body as she felt powerless to escape the pain and feared her resistance would yield punishment. Adult men and women who experienced CSA exhibited higher scores of dissociation compared to those who were not abused (Briere & Elliot, 2003). For women specifically, an earlier age of onset of CSA was significantly related to higher dissociative scores (Groth-Marnat & Michel, 2000). The psychological trauma of CSA predicts a decreased sense of efficaciousness, resulting in a significant increase in dissociative cognition.

The self and body. Lowered self-efficacy is predictive of dysfunctional eating behaviors, most notably those which are linked to dissociation. Mercado, Martínez-Taboas, and Pedrosa (2008) found that females with a history of CSA scored significantly higher on a measure of dysfunctional eating-related cognitions, such as bulimia nervosa, and the related behaviors of bingeing and self-induced vomiting (Swanston et al., 2003). Furthermore, both a history of CSA and the disordered eating were found to be highly correlated with dissociative experiences, as extreme eating serves as a medium for escaping unpleasant or painful feelings (Groth-Marnat & Michel, 2000; Mercado et al., 2008). A loss of control and derealization following CSA are reflected in dysfunctional bulimic behaviors, which include severely restricted eating intake, purging, use of laxatives or diuretics, and extreme exercise (Groth-Marnat & Michel, 2000; Mercado et al., 2008). These disordered cognitions and related behaviors are symptomatic of a traumatic loss of control and agency.

The Interpersonal Context of Child Sexual Abuse

Interpersonal relationships. A history of CSA has been found to predict interpersonal adversity due to decreased effectiveness in relationships. For instance, women who were sexually abused during childhood display significantly less effective interpersonal skills (Kearns & Calhoun, 2014). Research shows that young males and females who report experiences of CSA were more likely to fight with family members, have poor relationships with their mothers, and see their friendships end, compared to those who did not experience abuse (Stern et al., 1995; Swanston et al., 2003). Similarly, Lamoureaux et al. (2011) found that, over time, young female victims of CSA tended to exhibit higher levels of psychological distress and social conflict than non-victims. These young women subsequently reported interpersonal resource loss and greater deficiency in social support (Lamoureux et al., 2011). These findings suggest that low self-efficacy due to CSA has a disruptive influence on the development of interpersonal skills, such as regulating and resolving conflict, reaching compromise, or persisting in long-term relationships (Kearns & Calhoun, 2014; Lamoureux et al., 2011; Stern et al., 1995; Swanston et al., 2003).

Sexual self-efficacy. The disruptive impact of lowered self-efficacy on interpersonal relationships is pervasive throughout victims’ romantic and sexual interactions, as a strong negative relation between sexual abuse in childhood and self-efficacy has been found across numerous studies (Coohey, 2010; Hovesepian, Blais, Manseau, Otis, & Girard, 2010; Noll et al., 2003). Female victims of CSA tend to have lower levels of sexual self-efficacy in comparison to those who did not experience sexual abuse (Kearns & Calhoun, 2014). As a result, research shows that men and women who experience CSA reported having greater concerns regarding sexual interactions, such as sexual distress, dissatisfaction, or unwanted thoughts about sex (Briere & Elliot, 2003). The threat of CSA on victims’ self-efficacy is linked to deficits in control pertaining to sexual relations; diminished sexual self-efficacy, in turn, predicts victims’ ability to voice their desires.
Decreased belief in one’s ability to be effective, especially in regards to sexual relationships, appears to silence the voices of childhood victims. Specifically, adolescent girls who were sexually abused report feeling less able to communicate about their sexuality with their partner (Hovsepian et al., 2010). In addition, women do not always feel capable of either giving or denying genuine consent. These women presented higher sexual permissiveness, which Noll et al. (2003) believes may unintentionally communicate a willingness to engage in a sexual act despite insufficient emotional and sexual maturity. Furthermore, women with multiple experiences of sexual abuse were more likely to report decreased sexual assertiveness skills (Kearns & Calhoun, 2014). The experience of CSA is detrimental to victims’ perceived ability to be efficacious within interpersonal interactions, which puts victims at greater risk for future offenses and risky sex practices.

Safe sex practices. Decreased efficacy following CSA also impacts victims’ safe sex practices and can increase risky sexual behaviors. Adolescent girls in particular report feeling less able to communicate about the method and frequency of their contraception use (Hovsepain et al., 2010). Lamoureaux et al. (2011) also found that the experience of CSA for females had a significantly negative effect on self-efficacy, which further predicted HIV- and sexually-risky behaviors. Additional research indicates that the decreased sense of self-efficacy leads to a lack of confidence in negotiating safe sex. Specifically, victims reported higher fears of condom negotiation and were significantly less likely to use condoms on a consistent basis (Brown et al., 2014; Lamoureaux et al., 2011). These findings also revealed weaker levels of power in victims’ sexual relationships with men, and decreased self-efficacy in refusing unwanted sexual activity (Brown et al., 2014).

Revictimization. Decreased self-efficacy further predicts subsequent re-victimization as victims of CSA may feel incapable of protecting themselves against future unwanted advances or assaults (Finkelhor & Browne, 1985; Reese-Weber & Smith, 2011). Multiple studies have found that both men and women are more than twice as likely to experience both sexual and physical victimization if they have experienced sexual abuse in childhood (Noll et al., 2003; Reese-Weber & Smith, 2011; Swanston et al., 2003). In women specifically, decreased self-efficacy due to CSA was found to have a causal effect in increasing the likelihood of sexual victimization (Kearns & Calhoun, 2010). These findings suggest that decreased self-efficacy predicted by CSA leads to diminished efficacy and dissociative tendencies in risky interpersonal situations.

Conclusion

This exploration of the impact of sexual abuse illuminates the role of perceived self-efficacy in the wellbeing of those who were victimized in childhood, with particular emphasis on disruptive effects on victims’ affect, cognitions, and interpersonal relationships. Decreased sense of self-efficacy due to CSA was found to predict negative affect, which was associated with increased rates of self-harm and suicidality (Bagley et al., 1995; Briere & Elliot, 2003; Swanston et al., 2003). Victims of CSA experienced disruptive cognitions as well, such as dissociation and related behavioral disorders (Benight & Bandura, 2004; Cecil & Matson, 2001; Cieslak et al., 2008; Swanston et al., 2003).  Furthermore, individuals with a history of CSA were found to have ineffective interpersonal skills, which led to greater conflict, risky sexual behaviors and revictimization (Hovsepian et al., 2010; Kearns & Calhoun, 2010; Lamoureaux et al., 2011; Swanston et al., 2003)

Across the studies included in this review, a primary limitation inherent to the subject of CSA is the discrepancy between actual and reported cases of CSA (Finkelhor, 1994). Similarly, while most of the studies operationalized CSA in the same way that it was presented in this review, there remains variation in the exact definition and examples of CSA throughout the literature. Furthermore, the generally limited amount of research focusing explicitly on the construct of self-efficacy called for the inclusion of studies which referenced more narrowed components, such as affect, self-esteem, mastery, and agency, which may imply relations that were not explicitly measured (Bandura, 1982; Benight & Bandura, 2004; Coohey, 2010; Finkelhor & Browne, 1985). In the future, studies should focus specifically on self-efficacy as a dynamic construct, to develop a clear model of the influence of CSA on self-efficacy, understand how self-efficacy disrupts key developmental components that are crucial for recovery, and identify potential risk and protective factors. Finally, male participants were largely underrepresented throughout the literature; therefore, many findings, specifically those regarding interpersonal relationship, may not be generalizable beyond female victims of CSA.

In addition to the emotional implications of such abuse, the strength of perceived self-efficacy may be predictive of victims’ help-seeking, resource utilization, and likelihood of reporting abuse (Finkelhor & Browne, 1985; Foster & Hagedorn, 2014; Lev-Wiesel, 2000). With the understanding that self-efficacy can be developed over time, this review stresses the importance of appropriate therapeutic treatment and interventions for victims of sexual violence (Bandura, 1982; Bandura et al., 1982; Kearns & Calhoun, 2010). Future research should aim to gather samples of greater diversity specifically in gender, race, and culture, and explore the effects of self-efficacy interventions and treatment on victims’ recovery.

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