Childhood Sexual Abuse and Psychopathology

Childhood Sexual Abuse (CSA) is associated with a wide range of psychopathological consequences, including mood, anxiety, obsessive-compulsive, dissociative and personality disorders, eating disorders, psychosis, substance abuse, and post-traumatic stress disorder and with an increased risk of suicide and non-suicidal self-harming. Complex post-traumatic stress disorder is a new diagnosis proposed by the International Classification of Diseases that encompasses the effects of chronic trauma on self-organization. Several moderators of the relationship between CSA and psychopathology have been identified, including age at the abuse, gender, attachment style, social support, characteristics of the perpetrator, and biological underpinnings. Among the mediators of this association, literature highlighted emotion dysregulation, dissociation, impulsivity, mental pain, neuroticism, body image disturbance, structural and functional modifications of the central nervous system, and alterations of hypothalamic–pituitary–adrenal axis and of ghrelin levels. In the last years, increasing evidence demonstrated that childhood trauma, including CSA, is not just a risk factor, but also a modifier of the phenotypic presentation of psychiatric disorders, leading to the hypothesis of the existence of a “maltreated eco-phenotype” of these conditions characterised by grater severity, different neurobiological correlates, and reduced treatment response. This has several clinical implications, including the necessity of providing specific interventions when a history of CSA is detected.