Child abuse affects millions of children worldwide . Four types of abuse are commonly mentioned: physical, sexual, emotional and neglect. All of them are the cause of great physical and/or psychological discomfort. In general, child sexual abuse is a serious public health problem that interferes with the development of the victim who suffers it, causing short- and long-term repercussions in the entire biopsychosocial sphere of the person.

Child sexual abuse

Child sexual abuse refers to the set of behaviours of a sexual nature established between two persons, one of them being a minor, so that a situation of inequality occurs, for reasons of age or power , and in which the minor is used for the sexual stimulation of the other person (López, 1997). Abusive behaviors include physical contact (genital, anal or oral), or involve the use of the minor as an object of the aggressor’s sexual stimulation (exhibitionism or voyeurism) or of third parties (Madansky, 1996).

Prevalence rates are around 13-15%. These rates are higher for girls, although the impact is equally detrimental to both sexes. The age of greatest vulnerability has been found to be between 7 and 13 years of age, with 70-90 per cent of cases being committed by middle-aged males, often relatives or acquaintances of the victim.

Bonding and attachment styles

The development and quality of early relationships are important aspects in the socio-emotional, personality and mental health development of people. In this sense, attachment is defined as the biological bond that is established between the infant and the primary caregiver(s), who is seen as a secure base from which the child can explore the environment and return when he or she perceives that some danger exists (Bowlby 1969/1982).

These links allow children to develop internal working models from which they create expectations about the possibility of receiving support and how to achieve it. They influence individual emotions, expectations and adult relationships and help individuals to cope with stressful situations.

There are 4 types of attachment styles : the secure attachment and the insecure attachment, within which we find the avoidant, the anxious-ambivalent and the disorganized-disoriented.

Secure attachment occurs when the primary caregiver responds to the child’s distress in a consistent manner, promoting trust in the relationship. On the other hand, avoidant attachment develops when the distress is ignored or there is persistent rejection.

The anxious style develops when caregivers respond to the infant’s distress inconsistently, the child has difficulty trusting the caregiver’s availability to meet the infant’s needs, and high levels of anxiety.

Finally, the disorganized-disoriented style, the baby shows disorganized and/or disoriented behaviors in the presence of the mother.

The family environment that parents create around their children in the first years may favour or hinder their future social relations. When secure attachments are established they favour children becoming more socially competent. Attachment provides emotional security for an adequate development of personality, self-esteem and in the later emotional regulation.

Impact of sexual abuse on attachment

The impact of sexual abuse on attachment is established in childhood and remains stable until adulthood .

Children exposed to parental violence often have unmet basic needs and their caregivers are less available, implying a higher prevalence of unsafe attachment compared to children growing up in a suitable family environment. When those responsible for the abuse are the parents themselves, 80% of the cases, the capacity to establish intimate and trusting relationships are more damaged , since the person who should protect and care for them is the one who is damaged.

Unsafe attachment styles in adults are associated with different psychological and health problems (substance use, alcohol abuse, criminal behaviour, affective and anxiety disorders, low self-esteem, etc.).

However, victims of sexual abuse also present difficulties at the social level, including sexual and marital problems in adulthood, behavioural problems and at the somatic level (general chronic pain, gastrointestinal and eating disorders, sleep disorders and difficulties in attention, memory and concentration).

Author: Tamara Garrido, Psychologist.