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Child Sexual Abuse
Child sexual abuse is a form of child abuse in which an adult or older adolescent uses a child for sexual stimulation. Forms of child sexual abuse include asking or pressuring a child to engage in sexual activities (regardless of the outcome), indecent exposure (of the genitals, female nipples, etc.) to a child with intent to gratify their own sexual desires or to intimidate or groom the child, physical sexual contact with a child, or using a child to produce child pornography.

Approximately one out of four children suffers from a form of child sexual abuse. Unfortunately, child sexual abuse has short and long term psychological effects and physical effects. Short terms psychological effects include regressive behavior, inappropriate sexual behavior,  lower self-esteem,  sleep disturbances,  anti-social behavior,   and poor performance at school. Long term psychological effects can include depression,   post-traumatic stress disorder   , anxiety, sleep disturbances,   suicide or suicidal thoughts, substance abuse,   teen pregnancy,  self-destructive behaviors, risky sexual behaviors,  propensity to further victimization in adolescences and adulthood,   and mental health in adulthood. Studies also suggest that long term effects extend further into the victims’ relationships with partners and child in their adulthood.

Sexual abuse by a family member is a form of incest, and can result in more serious and long-term psychological trauma, especially in the case of parental incest.

The global prevalence of child sexual abuse has been estimated at 19.7% for females and 7.9% for males, according to a 2009 study published in Clinical Psychology Review that examined 65 studies from 22 countries. Using the available data, the highest prevalence rate of child sexual abuse geographically was found in Africa (34.4%), primarily because of high rates in South Africa; Europe showed the lowest prevalence rate (9.2%); America and Asia had prevalence rates between 10.1% and 23.9%. In the past, other research has concluded similarly that in North America, for example, approximately 15% to 25% of women and 5% to 15% of men were sexually abused when they were children. Most sexual abuse offenders are acquainted with their victims; approximately 30% are relatives of the child, most often brothers, fathers, uncles or cousins; around 60% are other acquaintances such as 'friends' of the family, babysitters, or neighbors; strangers are the offenders in approximately 10% of child sexual abuse cases. Most child sexual abuse is committed by men; studies show that women commit 14% to 40% of offenses reported against boys and 6% of offenses reported against girls. Most offenders who sexually abuse prepubescent children are pedophiles, although some offenders do not meet the clinical diagnosis standards for pedophilia.

Under the law, "child sexual abuse" is an umbrella term describing criminal and civil offenses in which an adult engages in sexual activity with a minor or exploits a minor for the purpose of sexual gratification. The American Psychiatric Association states that "children cannot consent to sexual activity with adults", and condemns any such action by an adult: "An adult who engages in sexual activity with a child is performing a criminal and immoral act which never can be considered normal or socially acceptable behavior."

Psychological Effects
Sexually abused children suffer from more psychological symptoms than children who have not been abused; studies have found symptoms in 51% to 79% of sexually abused children. Child sexual abuse can result in both short-term and long-term psychological effects. These effects and their intensity are dependent of the severity of the abuse, the relationship between the perpetrator and victim, the level of threats or forces used, the duration and frequency of the abuse, and the parental and social support of the victims. The social stigma of child sexual abuse may also compound the psychological harm to children. In addition, many of the following effects are closely linked and related to one another.

Short Term Effects
The initial or short term effects usually influences the early childhood development of the victim. These effects are also indicators for adults that a child has been sexually abused. Bed-wetting, thumb sucking, and doll destruction are all examples regressive behaviors resulting from child sexual abuse. In addition, inappropriate sexual behaviors like sexual interest, inappropriate sexual knowledge, and sexual acting out are also indicators of child sexual abuse. Other short term psychological effects include but not limited to lower self-esteem, sleep disturbances,   anti-social behavior,   and poor performance at school.

Long Term Effects
Many long term effects of child sexual abuse can influence the victims in their adolescence and adulthood years. Most victims commonly experience anxiety, poor self-esteem, anti-social behaviors, and suicide or suicidal thoughts. Moreover, violent behaviors have been reported more frequently in male sexual abuse victims than female victims as a coping mechanism with the stress of the abuse. Furthermore, different kinds of disorders such as somatization, neurosis, eating disorders, attention deficit/hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), and conduct disorder (CD) are commonly diagnosed amongst victims of child sexual abuse.

Dissociation and posttraumatic stress disorder (PTSD)
Child abuse, including sexual abuse, especially chronic abuse starting at early ages, has been found to be related to the development of high levels of dissociative symptoms, which includes amnesia for abuse memories. The level of dissociation has been found to be related to reported overwhelming sexual and physical abuse. When severe sexual abuse (penetration, several perpetrators, lasting more than one year) had occurred, dissociative symptoms were even more prominent.

Besides dissociation, 37-53% of victims of child sexual abuse experience symptoms of PTSD. According to Widom (1999), who wrote "sexual abuse, perhaps more than other forms of childhood trauma, leads to dissociative problems ... these PTSD findings represent only part of the picture of the long-term psychiatric sequelae associated with early childhood victimization ... antisocial personality disorder, alcohol abuse, and other forms of psychopathology." Children may develop symptoms of post-traumatic stress disorder resulting from child sexual abuse, even without actual or threatened injury or violence.

Depression and substance abuse
Depression is amongst the most common effects of child sexual abuse. Research states that 43-67% of victims meet the diagnostic criteria of depression. Combined with high levels of anxiety, substance abuse is a common way to escape and cope with the depression and anxiety.

Sleep disturbances
Recent research studies suggest a relationship between sleep disturbances and child sexual abuse. Sleep quality has been closely linked with depression in adolescents. The relationship between sleep and depression is likely bidirectional. In addition, sleep disturbances such as nightmares and insomnia, are also characteristics of PTSD. However, according to Noll, Trickett, Susman, & Putnam (2006), results establish a clear connection between childhood sexual abuse and sleep problems independent from depression and PTSD. In addition, abuse involving penetration of any kind, longer duration of the abuse, and being threaten by perpetrator are all reported to increase the insomnia symptoms, nightmare frequency, and degrees of distress.

Revictimization
Furthermore, Noll et al. (2006) suggest that sleep disturbances, combined with PTSD and depression, are a significant predictor of revictimization for victims of child sexual abuse. Revictimization is defined as physical or sexual harm inflicted by another person to reenact the initial abuse. Because sleep problems lower the inhibitions and impair cognition, these sleep-induced impairments may further contribute to victimization by increasing risky sexual behaviors. These risky sexual behaviors, including earlier sexual intercourse, higher frequency of sexual encounters with new partners, and decreased use of contraception and STD prevention, have all been reported as outcomes of child sexual abuse. As the result, higher rates of teen pregnancy, sexually transmitted diseases, prostitution, sex trading, and rape or attempted rape have all been linked to these risky behaviors. Research show that victims of child sexual abuse report twice as many subsequent rapes or sexual assaults and 1.6 times as many physical violence incidents (including domestic violence). Revictimization is different than self-harm which is direct harm inflicted by the victims themselves as a way to internalize the trauma. Child sexual abuse victims are reported to have almost four times as many incidences of self-inflicted harm and more than 20% more subsequent, significant life time traumas compared to non-abused victims. Furthermore, being sexually abused was the strongest predictor of self-harm compared with other forms of child maltreatment.

Mental Illness
Another long-term effect is mental illness in adulthood. Victims of child sexual abuse report higher incidence of psychiatric diagnoses occurring over a lifetime: 56% for women and 47% for men compared to non-abused victims: 32% for women and 34% men. Some of the victims suffer from borderline personality disorder (BPD), dissociative identity disorder (DID), and bulimia nervosa. There are many factors associated with mental health; the more severe the abuse is, the more symptoms of mental illness. In addition, victims who have been physically assaulted or have been abused by more than one person also report more mental illness symptoms. Moreover, the younger the victims, the more mental illness symptoms reported.

Parenting
Not only does child sexual abuse affect the victims, studies indicate that partners and children of victims are also influenced by the abuse indirectly. Mothers who are victims of child sexual abuse report less satisfaction and poorer communication in their relationship with their partner and greater negativity with the child. Studies show that poor mental health and depression result in lower maternal confidence and withdrawal from their children. These all have negative effects on their parenting techniques resulting in poor relationships with their children. Furthermore, children of victims of child sexual abuse report more total problems, hyperactivity, conduct problems, peer problems, and emotional problems compared to the children of non-abused mothers.