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Child sexual abuse (CSA) has received considerable attention since the late 1970s from mental health care professionals, legislative, judicial, and law enforcement personnel, the media, and the lay public (Rind & Tromovitch, 1997 ). Much of this attention has focused on possible effects of CSA on psychological adjustment, as is shown in the professional literature and popular press ( Pope & Hudson, 1995 ) and in the information and entertainment media ( Esman, 1994 ; Kutchinsky, 1992 ; West & Woodhouse, 1993 ).
The media have frequently presented lurid CSA cases combined with high prevalence estimates, creating the image that CSA produces intensely negative effects for all of its victims ( Esman, 1994 ; Kutchinsky, 1992 ; West & Woodhouse, 1993 ).
Many publications in the popular press and the professional literature have similarly portrayed CSA as a "special destroyer of adult mental health" ( Seligman, 1994 , p. 232), and some have attempted to explain much or all of adult psychopathology as a consequence of CSA ( Esman, 1994 ; Nash, Hulsey, Sexton, Harralson, & Lambert, 1993 ).
Examples in the professional literature include
Opinions expressed in the media and by many popular press and professional writers imply that CSA has certain basic properties or qualities irrespective of the population of interest. These implied properties are
The purpose of the current review was to examine these implied basic properties. Our goal was to address the question: In the population of persons with a history of CSA, does this experience cause intense psychological harm on a widespread basis for both genders?
An important first step is to discuss terminology.
The term child sexual abuse has been used in the psychological literature to describe virtually all sexual interactions between children or adolescents and significantly older persons, as well as between same-age children or adolescents when coercion is involved.
The indiscriminate use of this term and related terms such as victim and perpetrator has been criticized because of concerns about scientific validity (e.g., Kilpatrick, 1987 ; Nelson, 1989 ; Okami, 1990 ; Rind & Bauserman, 1993 ).
Kilpatrick argued that researchers have often failed to distinguish between "abuse" as harm done to a child or adolescent and "abuse" as a violation of social norms, which is problematic because it cannot be assumed that violations of social norms lead to harm.
Nelson argued that the indiscriminate use of terms suggesting force, coercion, and harm reflects and maintains the belief that these interactions are always harmful, thereby threatening an objective appraisal of them.
Rind and Bauserman demonstrated experimentally that appraisals of nonnegative sexual interactions between adults and
adolescents described in scientific reports can be biased by the use of negatively loaded terms such as CSA.
Problems of scientific validity of the term CSA are perhaps most apparent when
contrasting cases such as
By combining events likely to produce harm with those that are not into a unitary category of CSA, valid understanding of the pathogenicity of CSA is threatened ( Okami, 1994 ).
The tendency by researchers to label cases such as the latter as abuse reflects the slippage of legal and moral constructs into scientific definitions ( Okami, 1990, 1994 ).
Basing scientific classifications of sexual behavior on legal and moral criteria was pervasive a half century ago ( Kinsey, Pomeroy, & Martin, 1948 ); more recently, this practice has been confined to a much smaller set of sexual behaviors, particularly those labeled CSA.
With these caveats in mind regarding the scientific shortcomings of the term CSA, we have nevertheless retained it for use in the current article because of its pervasive use in the scientific literature and because many researchers as well as lay persons view all types of sociolegally defined CSA as harmful.
On the basis of the terminology used in studies reviewed in the current article, CSA is generally defined as
a sexual interaction involving either physical contact or no contact (e.g., exhibitionism) between either a child or adolescent and someone significantly older, or between two peers who are children or adolescents when coercion is used.