Trauma-Related Disorders: Sexual Abuse and Psychiatric Comorbidities

  • Cinzia NioluEmail author
  • Giulia Lisi
  • Alberto Siracusano
Part of the Trends in Andrology and Sexual Medicine book series (TASM)


Trauma occurs when a subject happens to be exposed to death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence; historical studies raised much interest on the persistent role of past traumatic experiences on people’s current lives. Confrontation with trauma results in the release of important neurochemical factors, capable of compromising subjective integrative capacity and the ordinary process of neurodevelopment. DSM-5 classifies trauma- and stressor-related disorders in a specific chapter that includes the reactive attachment disorder, the disinhibited social engagement disorder, acute stress disorder, the adjustment disorders, and post-traumatic stress disorder.

Numerous studies have, moreover, demonstrated the existence of a substantial association between childhood trauma and dissociation. In humans, in fact, two different reaction mechanisms are possible when facing danger: the hyperarousal pathway and the dissociation pathway. Many authors suggested that dissociative symptoms have, in these cases, a specific role of defense. Among personality disorders, borderline personality disorder, mainly characterized by a recurring pattern of instability in relationships, affectivity, and behavior, is a particularly common diagnosis among victims of childhood sexual trauma. The objective of this chapter is to address some of the possible psychological and physical consequences of exposure to violence and traumatic events.


  1. 1.
    Siracusano A. Manuale di Psichiatria. Rome: Il pensiero scientifico; 2014.Google Scholar
  2. 2.
    Maj MMC, Siracusano A. Lessico di Psicopatologia. Rome: Il Pensiero Scientifico Editore; 2010.Google Scholar
  3. 3.
    Bowlby J. Attachment and loss. New York: Basic; 1969.Google Scholar
  4. 4.
    Basile KC. Prevalence of wife rape and other intimate partner sexual coercion in a nationally representative sample of women. Violence Vict. 2002;17(5):511–24.CrossRefPubMedGoogle Scholar
  5. 5.
    Abrahams N, Devries K, Watts C, Pallitto C, Petzold M, Shamu S, et al. Worldwide prevalence of non-partner sexual violence: a systematic review. Lancet. 2014;383(9929):1648–54. Scholar
  6. 6.
    Black DS, Sussman S, Unger JB. A further look at the intergenerational transmission of violence: witnessing interparental violence in emerging adulthood. J Interpers Violence. 2010;25(6):1022–42. Scholar
  7. 7.
    Gonzalez A, Del Rio-Casanova L, Justo-Alonso A. Integrating neurobiology of emotion regulation and trauma therapy: reflections on EMDR therapy. Rev Neurosci. 2017;28(4):431–40. Scholar
  8. 8.
    Yehuda R, Hoge CW, McFarlane AC, Vermetten E, Lanius RA, Nievergelt CM, et al. Post-traumatic stress disorder. Nat Rev Dis Primers. 2015;1:15057. Scholar
  9. 9.
    Brand BL. What we know and what we need to learn about the treatment of dissociative disorders. J Trauma Dissociation. 2012;13(4):387–96. Scholar
  10. 10.
    Meng L, Chen Y, Xu X, Chen T, Lui S, Huang X, et al. The neurobiology of brain recovery from traumatic stress: a longitudinal DTI study. J Affect Disord. 2017;225:577–84. Scholar
  11. 11.
    Kalaf J, Coutinho ESF, Vilete LMP, Luz MP, Berger W, Mendlowicz M, et al. Sexual trauma is more strongly associated with tonic immobility than other types of trauma – a population based study. J Affect Disord. 2017;215:71–6. Scholar
  12. 12.
    Moller A, Sondergaard HP, Helstrom L. Tonic immobility during sexual assault – a common reaction predicting post-traumatic stress disorder and severe depression. Acta Obstet Gynecol Scand. 2017;96(8):932–8. Scholar
  13. 13.
    Gandubert C, Scali J, Ancelin ML, Carriere I, Dupuy AM, Bagnolini G, et al. Biological and psychological predictors of posttraumatic stress disorder onset and chronicity. A one-year prospective study. Neurobiol Stress. 2016;3:61–7. Scholar
  14. 14.
    Birmes P, Brunet A, Carreras D, Ducasse JL, Charlet JP, Lauque D, et al. The predictive power of peritraumatic dissociation and acute stress symptoms for posttraumatic stress symptoms: a three-month prospective study. Am J Psychiatry. 2003;160(7):1337–9. Scholar
  15. 15.
    Jeter WK, Brannon LA. Moving beyond “sticks and stones”: chronic psychological trauma predicts posttraumatic stress symptoms. J Trauma Dissociation. 2014;15(5):548–56. Scholar
  16. 16.
    Bonanno GA. Loss, trauma, and human resilience: have we underestimated the human capacity to thrive after extremely aversive events? Am Psychol. 2004;59(1):20–8. Scholar
  17. 17.
    American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Washington: American Psychiatric Association; 2013.CrossRefGoogle Scholar
  18. 18.
    Perrin S. Children exposed to trauma should be screened for symptoms of PTSD. Evid Based Ment Health. 2014;17(4):107. Scholar
  19. 19.
    Robinaugh DJ, McNally RJ. Trauma centrality and PTSD symptom severity in adult survivors of childhood sexual abuse. J Trauma Stress. 2011;24(4):483–6. Scholar
  20. 20.
    Lang AJ, Rodgers CS, Laffaye C, Satz LE, Dresselhaus TR, Stein MB. Sexual trauma, posttraumatic stress disorder, and health behavior. Behav Med. 2003;28(4):150–8. Scholar
  21. 21.
    Herman J. Trauma and recovery. New York: Basic; 1962.Google Scholar
  22. 22.
    Sack M. Diagnostic and clinical aspects of complex post-traumatic stress disorder. Nervenarzt. 2004;75(5):451–9.CrossRefPubMedGoogle Scholar
  23. 23.
    Terock J, Van der Auwera S, Janowitz D, Spitzer C, Barnow S, Miertsch M, et al. From childhood trauma to adult dissociation: the role of PTSD and alexithymia. Psychopathology. 2016;49(5):374–82. Scholar
  24. 24.
    Kong SS, Kang DR, Oh MJ, Kim NH. Attachment insecurity as a mediator of the relationship between childhood trauma and adult dissociation. J Trauma Dissociation. 2017;19:1–18. Scholar
  25. 25.
    Ozcetin A, Belli H, Ertem U, Bahcebasi T, Ataoglu A, Canan F. Childhood trauma and dissociation in women with pseudoseizure-type conversion disorder. Nord J Psychiatry. 2009;63(6):462–8. Scholar
  26. 26.
    Johnston C, Dorahy MJ, Courtney D, Bayles T, O’Kane M. Dysfunctional schema modes, childhood trauma and dissociation in borderline personality disorder. J Behav Ther Exp Psychiatry. 2009;40(2):248–55. Scholar
  27. 27.
    van der Kolk BA, van der Hart O. Pierre Janet and the breakdown of adaptation in psychological trauma. Am J Psychiatry. 1989;146(12):1530–40. Scholar
  28. 28.
    Sam Warner TW. Between subjugation and survival: women, borderline personality disorder and high security mental hospitals. J Contemp Psychother. 2004;34(3):265–78.CrossRefGoogle Scholar
  29. 29.
    Cattane N, Rossi R, Lanfredi M, Cattaneo A. Borderline personality disorder and childhood trauma: exploring the affected biological systems and mechanisms. BMC Psychiatry. 2017;17(1):221. Scholar
  30. 30.
    Flasbeck V, Enzi B, Brune M. Childhood trauma affects processing of social interactions in borderline personality disorder: an event-related potential study investigating empathy for pain. World J Biol Psychiatry. 2017:1–11.
  31. 31.
    Westphal M, Olfson M, Bravova M, Gameroff MJ, Gross R, Wickramaratne P, et al. Borderline personality disorder, exposure to interpersonal trauma, and psychiatric comorbidity in urban primary care patients. Psychiatry. 2013;76(4):365–80. Scholar
  32. 32.
    Goodman M, New A, Siever L. Trauma, genes, and the neurobiology of personality disorders. Ann N Y Acad Sci. 2004;1032:104–16. Scholar
  33. 33.
    van der Kolk BA. The neurobiology of childhood trauma and abuse. Child Adolesc Psychiatr Clin N Am. 2003;12(2):293–317, ix.CrossRefPubMedGoogle Scholar
  34. 34.
    Guendelman S, Garay L, Mino V. Neurobiology of borderline personality disorder. Rev Med Chil. 2014;142(2):204–10. Scholar
  35. 35.
    van der Kolk B. Posttraumatic stress disorder and the nature of trauma. Dialogues Clin Neurosci. 2000;2(1):7–22.PubMedPubMedCentralGoogle Scholar
  36. 36.
    Roller C, Martsolf DS, Draucker CB, Ross R. The sexuality of childhood sexual abuse survivors. Int J Sex Health. 2009;21(1):46–60. Scholar
  37. 37.
    Canton-Cortes D, Cortes MR, Canton J. Child sexual abuse, attachment style, and depression: the role of the characteristics of abuse. J Interpers Violence. 2015;30(3):420–36. Scholar
  38. 38.
    Statham DJ, Heath AC, Madden PA, Bucholz KK, Bierut L, Dinwiddie SH, et al. Suicidal behaviour: an epidemiological and genetic study. Psychol Med. 1998;28(4):839–55.CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    Jumper SA. A meta-analysis of the relationship of child sexual abuse to adult psychological adjustment. Child Abuse Negl. 1995;19(6):715–28.CrossRefPubMedGoogle Scholar
  40. 40.
    Paolucci EO, Genuis ML, Violato C. A meta-analysis of the published research on the effects of child sexual abuse. J Psychol. 2001;135(1):17–36. Scholar
  41. 41.
    Klonsky ED, Moyer A. Childhood sexual abuse and non-suicidal self-injury: meta-analysis. Br J Psychiatry. 2008;192(3):166–70. Scholar
  42. 42.
    Galaif ER, Stein JA, Newcomb MD, Bernstein DP. Gender differences in the prediction of problem alcohol use in adulthood: exploring the influence of family factors and childhood maltreatment. J Stud Alcohol. 2001;62(4):486–93.CrossRefPubMedGoogle Scholar
  43. 43.
    Smolak L, Murnen SK. A meta-analytic examination of the relationship between child sexual abuse and eating disorders. Int J Eat Disord. 2002;31(2):136–50.CrossRefPubMedGoogle Scholar
  44. 44.
    Wonderlich SA, Crosby RD, Mitchell JE, Thompson K, Smyth JM, Redlin J, et al. Sexual trauma and personality: developmental vulnerability and additive effects. J Personal Disord. 2001;15(6):496–504.CrossRefGoogle Scholar
  45. 45.
    Rind B, Tromovitch P, Bauserman R. A meta-analytic examination of assumed properties of child sexual abuse using college samples. Psychol Bull. 1998;124(1):22–53.CrossRefPubMedGoogle Scholar
  46. 46.
    Whitaker DJ, Le B, Karl Hanson R, Baker CK, McMahon PM, Ryan G, et al. Risk factors for the perpetration of child sexual abuse: a review and meta-analysis. Child Abuse Negl. 2008;32(5):529–48. Scholar
  47. 47.
    Lewis DO, Pincus JH, Bard B, Richardson E, Prichep LS, Feldman M, et al. Neuropsychiatric, psychoeducational, and family characteristics of 14 juveniles condemned to death in the United States. Am J Psychiatry. 1988;145(5):584–9. Scholar
  48. 48.
    Yuan NP, Koss MP, Stone M. The psychological consequences of sexual trauma. National online resource center on violence against women VAWnetorg. 2006.Google Scholar
  49. 49.
    Turchik JA, Hebenstreit CL, Judson SS. An examination of the gender inclusiveness of current theories of sexual violence in adulthood: recognizing male victims, female perpetrators, and same-sex violence. Trauma Violence Abuse. 2016;17(2):133–48. Scholar
  50. 50.
    Maniglio R. The impact of child sexual abuse on health: a systematic review of reviews. Clin Psychol Rev. 2009;29(7):647–57. Scholar
  51. 51.
    Reading R, Rannan-Eliya Y. Evidence for sexual transmission of genital herpes in children. Arch Dis Child. 2007;92(7):608–13. Scholar
  52. 52.
    Sharpe D, Faye C. Non-epileptic seizures and child sexual abuse: a critical review of the literature. Clin Psychol Rev. 2006;26(8):1020–40. Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Cinzia Niolu
    • 1
    • 2
    Email author
  • Giulia Lisi
    • 1
  • Alberto Siracusano
    • 1
    • 2
  1. 1.Psychiatry, Department of Systems MedicineUniversity of Rome Tor VergataRomeItaly
  2. 2.Psychiatry and Clinical Psychology UnitFondazione Policlinico Tor VergataRomeItaly

Personalised recommendations