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Journal of Child Sexual Abuse
ISSN: 1053-8712 (Print) 1547-0679 (Online) Journal homepage: http://www.tandfonline.com/loi/wcsa20
A Scoping Review of Challenges in Adult Intimate
Relationships After Childhood Sexual Abuse
Ben Farid Røjgaard Nielsen, Gitte Wind, Tine Tjørnhøj-Thomsen & Bente
Martinsen
To cite this article: Ben Farid Røjgaard Nielsen, Gitte Wind, Tine Tjørnhøj-Thomsen & Bente
Martinsen (2018): A Scoping Review of Challenges in Adult Intimate Relationships After Childhood
Sexual Abuse, Journal of Child Sexual Abuse
To link to this article: https://doi.org/10.1080/10538712.2018.1491915
Published online: 24 Jul 2018.
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A Scoping Review of Challenges in Adult Intimate
Relationships After Childhood Sexual Abuse
Ben Farid Røjgaard Nielsen
a
, Gitte Wind
a
, Tine Tjørnhøj-Thomsen
b
,
and Bente Martinsen
c
a
Section of Nursing, University College Copenhagen, Copenhagen, Denmark;
b
National Institute of
Public Health, University of Southern Denmark, Copenhagen, Denmark;
c
Section for Nursing, Aarhus
University, Aarhus, Denmark
ABSTRACT
Childhood sexual abuse is a severe problem worldwide.
Childhood sexual abuse can be detrimental to children and
their abilities to cope with and communicate in their subse-
quent adult intimate relationships. The aim of this review was
to generate and summarize knowledge about how childhood
sexual abuse manifests in adult intimate relationships so
healthcare professionals can incorporate this knowledge into
treatment and care. A scoping review methodology was
selected because it supports examination of the extent,
range, and nature of research activity. A content analysis of
the studies included in this review led to three thematic cate-
gories of challenges in adult intimate relationships after child-
hood sexual abuse: (a) relationship satisfaction, (b) sexual
satisfaction, and (c) communication and trust.
ARTICLE HISTORY
Received 21 December 2017
Revised 7 May 2018
Accepted 14 June 2018
KEYWORDS
Child sexual abuse; self and
partner report; relationship
satisfaction; intimate
relationship; sexual
satisfaction
Introduction
Childhood sexual abuse (CSA) is a severe problem worldwide (Karstoft, Beck, &
Elklit, 2012; Pereda, Guilera, Forns, & Gomez-Benito, 2009). CSA can be detri-
mental to children and their abilities to cope with and communicate in subse-
quent adult intimate relationships (Perry, 2009). The noun “intimate”refers to a
person with whom one has a particularly close relationship. This relationship is a
familiar and very close affective connection with another as a result of a bond
that is formed through knowledge and experience of the other. Healthcare
professionals may play an important role in the treatment and care of adults
who have experienced CSA (Walker, Sheffield, Larson, & Holman, 2011).
Assisting adults in gaining skills that will help them develop close relationships,
especially with intimate partners, is considered an important goal in helping
them overcome some of the long-term effects of CSA (Walker et al., 2011). A
positive intimate relationship may increase adults’feelings of safety, helping
them gain positive interpersonal experiences (Walker et al., 2011).
CONTACT Ben Farid Røjgaard Nielsen bnni@phmetropol.dk Tagensvej 86. 2200 KBH N, Denmark
Color versions of one or more of the figures in the article can be found online at www.tandfonline.com/wcsa.
JOURNAL OF CHILD SEXUAL ABUSE
https://doi.org/10.1080/10538712.2018.1491915
© 2018 Taylor & Francis
CSA can affect adult relationships in negative ways (Unger & Luca, 2014),
including increased instability in relationships and a greater risk of sexual
problems and negativity toward partners (Isely, Isely, Freiburger, &
McMackin, 2008). In addition, a body of evidence demonstrates that rela-
tional issues in adults who have experienced CSA pertain to fear of intimate
contact and problems related to pregnancy, childbirth, and parenting
(Colman & Widom, 2004; Nguyen, Karney, & Bradbury, 2017; Roberts, O
́
Connor, Dunn, & Golding, 2004). Both adults exposed to CSA and their
intimate partners report higher levels of emotional intensity and greater
contempt and defensiveness in relationships (Walker et al., 2011).
Experiencing CSA is also a risk factor for later divorce and relationship
abandonment (Colman & Widom, 2004). Despite this emerging evidence,
knowledge about adult intimate relationships after CSA is sparse.
Aim
The aim of this review is to generate and summarize knowledge about how
CSA manifests in adult intimate relationships so healthcare professionals can
incorporate this knowledge into treatment and care. The review is relevant
for healthcare professionals caring for adults with a history of CSA. It is
critical to understand how CSA affects adult intimate relationships in order
to provide healthcare professionals with an evidence base for care and to
enhance global care and treatment for adults who have experienced CSA.
This knowledge can help healthcare professionals identify unique needs and
issues in adult intimate relationships and develop more systemic ways of
involving couples in their treatment and care.
Methods
A scoping review methodology was selected because it supports examination
of the breadth and nature of research activity (Arksey & O’Malley, 2005).
This allows for the rapid identification of current methods and research gaps
within literature (Arksey & O’Malley, 2005). By mapping existing research,
our scoping review will identify potential research gaps and future research
needs. We followed guidelines from Arksey and O’Malley (2005) for con-
ducting a scoping review.
This review mapped the current state of knowledge about challenges in
adult intimate relationships in which at least one partner experienced CSA.
Our research question was: What knowledge does the existing literature offer
about how CSA manifests in adult intimate relationships?
A literature search was conducted for relevant articles published
between 2000 and 2017. The electronic databases PubMed, CINAHL,
and PsycINFO were selected because they index studies relevant to our
2B. F. R. NIELSEN ET AL.
research question, and the search strategy was tailored to the specifica-
tions of each database. The following search terms were used: intimate
partner, close partner, intimate partnership, close partnership, relationship
satisfaction, partnership satisfaction, childhood sexual, abuse, challenges,
interpersonal relations, and intimate relationships. The search terms were
used alone and in combinations using the Boolean operators “AND”
and “OR.”
The final search was carried out in September 2017 in consultation with a
health librarian. Quantitative and qualitative research studies using primary
and secondary sources, including systematic reviews, published in English
between 2000 and 2017 were included. We excluded studies addressing
substance abuse and interpersonal and other forms of violence in adult
relationships. Our initial searches yielded 71 possible articles, and two addi-
tional studies were added after reviewing article reference lists. After remov-
ing duplicates and studies that did not meet inclusion criteria, 16 articles
remained (Table 1).
We began the analysis by collecting general information from each article,
including author(s), title and year, aim and country, methods, and partner
perspective. We then performed a qualitative analysis of the manifest con-
tent, inspired by Graneheim and Lundman (2004). When reading the
included articles, constellations of sentences with the same core meaning
were condensed. These condensed meaning units were assigned codes
describing the contents. Each meaning unit primarily refers to a descriptive
level of content and contains a number of subcategories that can be under-
stood as an expression of the manifest content of the text (Figure 1). In the 16
included papers, we identified three categories and a number of subcate-
gories. One of the authors (B.F.R.N.) performed the first qualitative analysis.
To increase credibility, all authors discussed the categories and subcategories.
The process from condensing through discussion was iterative and repeated
as necessary.
Results
Of the 16 studies we identified, only two included the perspectives of
relationship partners of adults with a history of CSA. We identified three
thematic categories of challenges in adult intimate relationships after CSA
that addressed our research question: (a) relationship satisfaction, (b) sexual
satisfaction, and (c) communication and trust.
Relationship satisfaction
CSA is associated with negative intimate relationship outcomes, including
decreased satisfaction in intimate relationships.
JOURNAL OF CHILD SEXUAL ABUSE 3
Table 1. Included studies.
Authors (year) Friesen et al. (2010)
Country New Zealand
Aim (n) To examine the links between CSA exposure, life-course experiences through
adolescence and adulthood, and adult intimate relationship experiences in one
data set (900 adults)
Methods Quantitative method
Partner perspective No
Authors (year) Testa et al. (2005)
Country USA
Aim (n) To examine how CSA experiences and partner characteristics may influence
women’s relationships (732 women)
Methods Quantitative method
Partner perspective No
Authors (year) Izdebska, Beisert, and Roszyk (2015)
Country Poland
Aim (n) To verify the hypothesis that there is a relationship between severity of child abuse
and intensity of collusion in partner relationship (94 women and 76 men)
Methods Quantitative method
Partner perspective No
Authors (year) Rellini, Vujanovic, Gilbert, and Zvolensky (2012)
Country USA
Aim (n) To examine relations among childhood maltreatment difficulties in emotion
regulation and sexual and relationship satisfaction among young women reporting
current involvement in committed romantic relationships (192 women)
Methods Quantitative method
Partner perspective No
Authors (year) MacIntosh and Johnson (2008)
Country Canada
Aim (n) To explore emotionally focused therapy for couples with CSA survivors and their
partner (10 couples)
Methods Quantitative method
Partner perspective Yes
Authors (year) Liang, Williams, and Siegel (2006)
Country USA
Aim (n) To examine the effects of CSA on the intimate and marital relationships of adult
survivors (136 women)
Methods Qualitative
Partner perspective No
Authors (year) Nguyen et al. (2017).
Country USA
Aim (n) To examine the effect of childhood abuse on newlyweds’initial levels of satisfaction
and on change in satisfaction over time (414 newlywed couples)
Methods Qualitative
Partner perspective Yes
Authors (year) Knapp, Knapp, Brown, and Larson (2017)
Country USA
Aim (n) To explore relational consequences affecting adult relationship. What are female
survivors of sexual abuse in childhood self-reports of their conflict resolution styles?
(457 heterosexual couples in which female partners experienced CSA)
Methods Quantitative
Partner perspective No
Authors (year) Lassri, Luyten, Fonagy, and Shahar (2018)
Country UK
Aim (n) To examine whether self-criticism and attachment avoidance mediate the impact of
CSA on prospective romantic relationship satisfaction among otherwise well-
functioning young women (59 women)
Methods Quantitative
(Continued )
4B. F. R. NIELSEN ET AL.
Gender differences
After CSA, men and women may experience different types of challenges in
adult intimate relationships. One study, including only men (Nelson, 2015),
did not report any issues related to relationship satisfaction and CSA.
However, Larson and Lamont (2005) reported that women with CSA may
wait an average of 1.5 years longer to marry due to expectations that
marriage will be difficult, unsatisfactory, and present a high level of conflict.
In another recent study (Nguyen et al., 2017), CSA significantly predicted the
initial relationship satisfaction of newlyweds. Spouses with a history of CSA
Table 1. (Continued).
Partner perspective No
Authors (year) Davis et al. (2001)
Country USA
Aim (n) To examine the relationship among interpersonal functioning, symptomatology,
and CSA (315 women)
Methods Quantitative
Partner perspective No
Authors (year) Nelson (2015)
Country USA
Aim (n) To evaluate the relationship between adult attachment and relationship satisfaction
among men abused during childhood (73 men)
Methods Quantitative
Partner perspective No
Authors (year) Bradbury and Shaffer (2012)
Country USA
Aim (n) To examine the mediating role of emotional dysregulation in relation between
retrospective reports of childhood emotional maltreatment and current satisfaction
in a romantic relationship 492 (135 men, 357 women)
Methods Quantitative
Partner perspective No
Authors (year) Aubin (2010)
Country USA
Aim (n) To explore how CSA affects adulthood relationship in women (18 women)
Methods Quantitative
Partner perspective No
Authors (year) Nelson and Wampler (2000)
Country USA
Aim (n) The focus of this study is on the association between reported childhood physical
and sexual abuse and current individual stress symptoms, relationship satisfaction,
and family adjustment. (96 couples)
Methods Quantitative
Partner perspective Yes
Authors (year) Larson and Lamont (2005)
Country USA
Aim (n) This study investigated the relationship of CSA to marital attitudes and perceived
readiness for marriage in single young adult women (622 women)
Methods Quantitative
Partner perspective Yes
Authors (year) McDonald and Tijerino (2013)
Country Canada
Aim (n) To examine the experiences of male CSA survivors (59 men)
Methods Qualitative
Partner perspective No
JOURNAL OF CHILD SEXUAL ABUSE 5
reported more symptoms of depression and, among husbands, displayed
more negative communication.
Spouses with a history of CSA were also less satisfied with their marriage,
even as newlyweds; wives with a history of CSA experienced a decline in
satisfaction over time, compared to women without a comparable history
(Nguyen et al., 2017). Husbands who had not experienced CSA but married
women who had were negatively impacted by their wives’history of abuse.
However, husbands who shared a history of CSA with their wives were not
negatively affected by their wives’childhood abuse (Nguyen et al., 2017).
Relationships may be a powerful force in how individuals develop and
change, yet their impact varies with life stage. Abusive experiences at the
hands of others early in life are particularly formative, whereas relationships
later in life may do little to alter those experiences, for better or for worse
(Nguyen et al., 2017). When couples are involved in treatment and care in
which a history of CSA is openly acknowledged in interventions that are
designed to promote acceptance of the unique histories and experiences each
partner brings to the relationship, it appears to be more fruitful than treat-
ment that focuses solely on changing communication patterns in the rela-
tionship (Nguyen et al., 2017).
Acceptance may be particularly helpful when spouses adopt the view that
their own or their partner’s sensitivity or trust difficulties can fundamentally
change or that the non-abused partner can alleviate interpersonal difficulties
of the abused partner. However, positive expectations for the partner and
relationship that are not met are associated with steeper declines in relation-
ship satisfaction (Nguyen et al., 2017).
Childhood sexual
abuse is associated
with lower
relationship
satisfaction and
investment. The
studies support a
connection between
CSA and
functioning in adult
partnership,
including a great
fear of intimacy.
Genders also may
experience
challenges in
different ways
Meaning
unit
Relationship
satisfaction
Code
1. Gender
differences
2. Decreased
satisfaction
3. Great fear of
intimacy
Sub-
categories
Figure 1. Relationship between meaning units, codes, and subcategories.
6B. F. R. NIELSEN ET AL.
Increased self-criticism and attachment avoidance
Both self-criticism and attachment avoidance refer to the extent to which
individuals avoid closeness with others. CSA may give rise to increased self-
criticism in adulthood, suggesting a tendency to internalize a critical attitude
toward the self (Lassri, Luyten, Fonagy, & Shahar, 2018). Increased self-
criticism may be linked in turn to decreased satisfaction in intimate relation-
ships (Lassri et al., 2018). Relationship dissatisfaction might then further
increase attachment avoidance tendencies, leading to a continuing decrease
in relationship satisfaction over time (Lassri et al., 2018). CSA may lead to a
chronic vicious cycle related to intimate relationships, via an indirect effect
leading from self-criticism to unsatisfying intimate relationships.
Sexual satisfaction
Sexual dysfunction
Adults with CSA have a high level of sexual distress in their intimate adult
relationships (Rellini & Meston, 2007). One study investigating potential
differences between sexual dysfunction and sexual satisfaction among
women with CSA demonstrated that even though women were distressed
about their sexuality, they did not exhibit sexual dysfunction (Testa, VanZile-
Tamsen, & Livingston, 2005).
Sexual risk
Lower relationship satisfaction may also lead to a higher number of sexual
partners (Friesen, Woodward, Horwood, & Fergusson, 2010). Testa et al.
(2005) suggest that the higher sexual risk status of adults exposed to CSA,
including higher numbers of sexual partners and rates of sexually transmitted
infection (STI), can be at least partially explained by the quality of the
intimate relationships. A history of CSA is associated with having more
aggressive and more sexually risky partners. One consequence of the ten-
dency to affiliate with riskier partners is a high rate of STI resulting from a
current relationship.
Great fear of intimacy
CSA also affects the ability to develop and maintain a stable long-term
intimate relationship (McDonald & Tijerino, 2013). It is associated with a
great fear of intimacy in intimate adult relationships (Davis, Petretic-Jackson,
& Ling, 2001). Being touched can trigger flashbacks and negative emotions,
making it difficult to be physically close to others as an intimate partner
(McDonald & Tijerino, 2013). Adults with CSA mentioned different strate-
gies they used to become accustomed to being touched in a safe environ-
ment, such as massage therapy or through a counselor’s light touch on the
shoulder (McDonald & Tijerino, 2013).
JOURNAL OF CHILD SEXUAL ABUSE 7
Communication and trust
Poor communication and less trust were issues in intimate adult relation-
ships in which one partner had a history of CSA. Individuals who have
experienced abuse often report problems with emotional distance and isola-
tion (Nelson & Wampler, 2000).
Emotional flooding and numbing
Couples in which one partner had been exposed to CSA reported high levels of
emotional intensity in their communications (Nelson & Wampler, 2000)and
greater contempt and defensiveness in their relationships (Walker et al., 2011).
Individuals with CSA found it particularly challenging to regulate their response
when their partner was directed to reach out to them and ask them to help in
meeting a relational goal. They had difficulty controlling their emotions. On the
opposite side of the spectrum from emotional flooding, emotional numbing
emerged as a result of fearing emotional overwhelm and loss of control.
Emotional numbing and extreme control characterized the responses of many
adults with CSA to emotionally challenging situations. Adults exposed to CSA
experienced emotions in an all-or-nothing way, being either dysregulated and
flooded with affect or numbed out (MacIntosh & Johnson, 2008).
Discussion
The findings from this review provide an important initial exploration of
adult intimate relationships after CSA. The impact of CSA on adult intimate
relationships requires further research. However, this review contributes to
the understanding and knowledge of healthcare professionals caring for
adults with a history of CSA. The studies included in this review reveal
that they face challenges related to decreased relationship satisfaction,
decreased sexual satisfaction, and poor communication and low trust levels
in intimate relationships.
Some evidence indicates that involving both relationship partners in
treatment may be more fruitful than focusing only on the partner with a
history of CSA. Therefore, healthcare professionals should seek to involve
patients with CSA and their partners in treatment encounters. Efforts are
needed to strengthen future research in this area, but couple-oriented inter-
ventions appear promising.
Study limitations
The 16 studies we included were conducted in five different countries, and
only two were conducted in Europe. Thus, the generalizability of our findings
to adults with a history of CSA across the world is unknown. Only three
8B. F. R. NIELSEN ET AL.
studies employed qualitative methods, and only two included partners of
adults with a history of CSA in intimate relationships, rendering it difficult to
draw any conclusions about their perspectives.
More research is needed, particularly qualitative studies that allow a nuanced
understanding of the perspectives of both adults with a history of CSA and their
partners in intimate relationships. Given early evidence that including partners
may increase the effectiveness of treating adults with a history of CSA, enhan-
cing healthcare professionals’understanding of how intimate relationships
affect health with evidence-based knowledge is important. Establishing relation-
ships with both the adult exposed to CSA and the partner when the patient first
enters treatment may well be an essential part of high-quality care.
Compliance with Ethical Standards
All procedures followed were in accordance with the ethical standards of the responsible
committee on human experimentation (institutional and national) and with the Helsinki
Declaration of 1975, as revised in 2000. Informed consent was obtained from all patients for
being included in the study.
Notes on contributors
Ben Farid Røjgaard Nielsen is a Senior Lecturer at University College Copenhagen,
Denmark. Section of Nursing in Copenhagen (Denmark).
Gitte Wind is a Senior Associate Lecturer at University College Copenhagen, Section of
Nursing in Copenhagen, (Denmark).
Tine Tjørnhøj-Thomsen is a professor at National Institute of Public Health, University of
Southern Denmark, Copenhagen (Denmark).
Bente Martinsen is an assistant professor at Section of Nursing, Department of Public Health,
Aarhus University, Aarhus (Denmark).
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JOURNAL OF CHILD SEXUAL ABUSE 11
