Bringing Shame Out of the Shadows: Identifying Shame in Child Sexual Abuse Disclosure Processes and Implications for Psychotherapy

Abstract

Child sexual abuse (CSA) has been described as a highly stigmatizing experience. Despite the recognition of shame as a significant contributor to psychological distress following CSA, an inhibitor of CSA disclosure, and a challenging emotion to overcome in therapy, limited research has explored the experience of shame with young people who have been sexually abused. This study is unique in examining the transcripts of 47 young people aged 15–25 years from a large-scale study conducted in Ireland and Canada and exploring manifestations of shame in CSA disclosure narratives. Using a thematic analysis of both inductive and deductive coding, the data were examined for implicit, as distinct from explicit, manifestations of shame. Three key themes were identified in this study: languaging shame, avoiding shame, and reducing shame. The study supports previous authors in highlighting the need for nuanced measures of shame in research that takes account of the complexity of this emotion. Conceptualizations in the literature of the distinction between shame and guilt are challenged when these emotions are explored in the context of CSA. Finally, recommendations for working therapeutically with young people who have experienced CSA are offered with a view to addressing shame in therapeutic work.

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https://doi.org/10.1177/08862605211037435
Journal of Interpersonal Violence
2022, Vol. 37(19-20) NP18738 –NP18760
© The Author(s) 2021
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DOI: 10.1177/08862605211037435
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1120916JIVXXX10.1177/08862605211037435Journal of Interpersonal ViolenceMcElvaney et al.
research-article2021
Bringing Shame
Out of the Shadows:
Identifying Shame in
Child Sexual Abuse
Disclosure Processes
and Implications for
Psychotherapy
Rosaleen McElvaney,1 Rusan Lateef2,
Delphine Collin-Vézina2, Ramona Alaggia3 and
Megan Simpson4
Abstract
Child sexual abuse (CSA) has been described as a highly stigmatizing
experience. Despite the recognition of shame as a significant contributor to
psychological distress following CSA, an inhibitor of CSA disclosure, and a
challenging emotion to overcome in therapy, limited research has explored
the experience of shame with young people who have been sexually abused.
This study is unique in examining the transcripts of 47 young people aged
15–25 years from a large-scale study conducted in Ireland and Canada and
exploring manifestations of shame in CSA disclosure narratives. Using a
thematic analysis of both inductive and deductive coding, the data were
examined for implicit, as distinct from explicit, manifestations of shame. Three
key themes were identified in this study: languaging shame, avoiding shame,
and reducing shame. The study supports previous authors in highlighting
the need for nuanced measures of shame in research that takes account of
Corresponding author:
Rosaleen McElvaney, School of Nursing, Psychotherapy and Community Health, Dublin City
University, Ireland.
Email: rosaleen.mcelvaney@dcu.ie
2McGill University, Montreal, Canada
3University of Toronto, Canada
4Carlton University, Ottawa, Canada
1Dublin City University, Dublin, Ireland
2 Journal of Interpersonal Violence
the complexity of this emotion. Conceptualizations in the literature of the
distinction between shame and guilt are challenged when these emotions
are explored in the context of CSA. Finally, recommendations for working
therapeutically with young people who have experienced CSA are offered
with a view to addressing shame in therapeutic work.
Keywords
sexual abuse, child abuse, adolescent victims, sexual assault, support seeking
Introduction
Childhood experiences, including adverse ones such as child sexual abuse
(CSA), play a significant role in the formation of the individual’s sense of self
(Felitti & Anda, 2010). CSA is a highly stigmatizing experience (Kennedy &
Prock, 2018), often experienced as an assault on the self, whereby negative
messages are communicated to the child that then become “incorporated into
the child’s self-image” (Finkelhor & Browne, 1985, p. 532), leaving the child
and emerging adult with feelings of being deeply flawed and damaged as a
human being (Alaggia et al., 2017; Böhm, 2017; Dorahy & Clearwater, 2012;
Feiring & Taska, 2005; Hunter, 2011; McElvaney et al., 2014; Sgroi, 1982;
Whiffen & MacIntosh, 2005). Shame has been cited as a significant barrier to
children’s and adults’ disclosures (Lemaigre et al., 2017; McElvaney, 2015;
Morrison et al., 2018) and to accessing therapeutic support (MacGinley et al.,
2019), a mediating factor between childhood trauma and later psychopathol-
ogy, such as self-harm (Dyer et al., 2017), and presents a challenge to thera-
pists in supporting clients to heal from shame associated with CSA (Paivio &
Pascual-Leone, 2010; Sanderson, 2015).
Despite this, limited research has explored in detail the role of shame
among young people with a history of CSA. Recent qualitative studies on
disclosure processes with both children and adults (Alaggia, 2005; MacGinley
et al., 2019; MacIntosh et al., 2016; Malloy et al., 2019; McElvaney et al.,
2014) suggest that shame is a worthy focus of research, if we are to better
understand the role of shame in meaning making processes and how it is
embedded in other related emotions, cognitions, and coping strategies. Such
exploration could assist in revealing patterns of CSA processing that need to
be recognized and incorporated into therapeutic responses with children and
young people, particularly given the long-term impact of shame evident in
adults who have experienced abuse in childhood (Dorahy & Clearwater,
2012). The hidden nature of shame and the common coping strategies in

McElvaney et al. NP18739
Bringing Shame
Out of the Shadows:
Identifying Shame in
Child Sexual Abuse
Disclosure Processes
and Implications for
Psychotherapy
Rosaleen McElvaney,1 Rusan Lateef2,
Delphine Collin-Vézina2, Ramona Alaggia3 and
Megan Simpson4
Abstract
Child sexual abuse (CSA) has been described as a highly stigmatizing
experience. Despite the recognition of shame as a significant contributor to
psychological distress following CSA, an inhibitor of CSA disclosure, and a
challenging emotion to overcome in therapy, limited research has explored
the experience of shame with young people who have been sexually abused.
This study is unique in examining the transcripts of 47 young people aged
15–25 years from a large-scale study conducted in Ireland and Canada and
exploring manifestations of shame in CSA disclosure narratives. Using a
thematic analysis of both inductive and deductive coding, the data were
examined for implicit, as distinct from explicit, manifestations of shame. Three
key themes were identified in this study: languaging shame, avoiding shame,
and reducing shame. The study supports previous authors in highlighting
the need for nuanced measures of shame in research that takes account of
Corresponding author:
Rosaleen McElvaney, School of Nursing, Psychotherapy and Community Health, Dublin City
University, Ireland.
Email: rosaleen.mcelvaney@dcu.ie
2McGill University, Montreal, Canada
3University of Toronto, Canada
4Carlton University, Ottawa, Canada
1Dublin City University, Dublin, Ireland
2 Journal of Interpersonal Violence
the complexity of this emotion. Conceptualizations in the literature of the
distinction between shame and guilt are challenged when these emotions
are explored in the context of CSA. Finally, recommendations for working
therapeutically with young people who have experienced CSA are offered
with a view to addressing shame in therapeutic work.
Keywords
sexual abuse, child abuse, adolescent victims, sexual assault, support seeking
Introduction
Childhood experiences, including adverse ones such as child sexual abuse
(CSA), play a significant role in the formation of the individual’s sense of self
(Felitti & Anda, 2010). CSA is a highly stigmatizing experience (Kennedy &
Prock, 2018), often experienced as an assault on the self, whereby negative
messages are communicated to the child that then become “incorporated into
the child’s self-image” (Finkelhor & Browne, 1985, p. 532), leaving the child
and emerging adult with feelings of being deeply flawed and damaged as a
human being (Alaggia et al., 2017; Böhm, 2017; Dorahy & Clearwater, 2012;
Feiring & Taska, 2005; Hunter, 2011; McElvaney et al., 2014; Sgroi, 1982;
Whiffen & MacIntosh, 2005). Shame has been cited as a significant barrier to
children’s and adults’ disclosures (Lemaigre et al., 2017; McElvaney, 2015;
Morrison et al., 2018) and to accessing therapeutic support (MacGinley et al.,
2019), a mediating factor between childhood trauma and later psychopathol-
ogy, such as self-harm (Dyer et al., 2017), and presents a challenge to thera-
pists in supporting clients to heal from shame associated with CSA (Paivio &
Pascual-Leone, 2010; Sanderson, 2015).
Despite this, limited research has explored in detail the role of shame
among young people with a history of CSA. Recent qualitative studies on
disclosure processes with both children and adults (Alaggia, 2005; MacGinley
et al., 2019; MacIntosh et al., 2016; Malloy et al., 2019; McElvaney et al.,
2014) suggest that shame is a worthy focus of research, if we are to better
understand the role of shame in meaning making processes and how it is
embedded in other related emotions, cognitions, and coping strategies. Such
exploration could assist in revealing patterns of CSA processing that need to
be recognized and incorporated into therapeutic responses with children and
young people, particularly given the long-term impact of shame evident in
adults who have experienced abuse in childhood (Dorahy & Clearwater,
2012). The hidden nature of shame and the common coping strategies in

NP18740 Journal of Interpersonal Violence 37(19-20)
McElvaney et al. 3
response to shame emotions—to avoid—requires that researchers proactively
focus on this phenomenon in an attempt to shed light on and bring shame out
of the shadows.
Literature Review
Shame is a multi-faceted emotion. Adaptive or healthy shame has been
described as a fast-track physiological response with a social function
(Herman, 2011); a biological hardwired experience that assists the develop-
ing child in conforming to social norms (Schore, 2003). It is considered a
social emotion that requires a cognitive ability to have a sense of self and to
evaluate one’s behavior against social standards (Lewis, 2000). As a mal-
adaptive emotion, shame has been characterized as feelings of inadequacy,
self-condemnation, worthlessness, and vulnerability (Vikan et al., 2010).
Tomkins (1991) described shame as an inner torment, “a sickness of the soul”
where one feels “naked, defeated, alienated, lacking in dignity and worth” (p.
10) while Kaufman (1996) described it as “acutely disturbing and painful” (p.
5), unmatched by any of the other emotions.
Theoretical models of shame consider shame as an “attachment emotion”
(Gilbert & Andrews, 1998, p. 65) with origins in primary attachment relation-
ships. Misattunement between the primary caregiver and the infant, it is sug-
gested, results in a rupturing of the infant’s capacity to regulate their affect,
impairing the child’s sense of interpersonal efficacy and forming the founda-
tion for their later sense of worthlessness. Such models have not, however,
been used to explain the shame associated with the experience of CSA.
Brown (2006), in her model of shame resilience, described how women
moved from feeling trapped, powerless, and isolated to experiencing connec-
tion, power and freedom. This process was achieved through acknowledging
personal vulnerability, being critically aware, reaching out and speaking
shame. Nathanson’s (1992) conceptual model, compass of shame, identifies
four coping styles for addressing shame, representing the polarities of attack
self, withdrawal, attack other, and avoidance. As Elison et al. (2006) sug-
gested, outcomes may be more determined by how one copes with shame
rather than the experience itself. While both models focus on adults’ experi-
ences of shame and neither focuses on CSA-related shame, Brown’s three
components of shame—feeling trapped, powerless, and isolated—are com-
mon themes in young people’s narratives of CSA and resonate with the key
traumagenic dynamics of CSA identified by Finkelhor and Browne (1985).
Nathanson’s coping strategies of attack self and avoidance, in particular, may
4 Journal of Interpersonal Violence
be considered relevant to CSA-shame coping, particularly given how shame
has been postulated as explaining the high prevalence of self-blame in CSA
survivors (LaBash & Papa, 2014) and the prevalence of avoidant responses
among those who have been sexually abused (Rahm et al., 2013).
Sexual victimization violates physical, emotional, and sexual integrity and
is thus notorious for producing shame. In studies of adults, sexual assault has
been associated with higher levels of shame than other traumatic experiences
(Amstadter & Vernon, 2008). DeCou et al. (2019) found that more than 75%
of undergraduate female survivors of sexual assault reported feeling trauma-
related shame, while Wetterlöv et al. (2020) also found an association between
shame and sexual trauma among adolescent girls. CSA related shame can
lead to increased suicidal ideation, substance use, and vulnerabilities to being
re-victimized (Aakvaag et al., 2018; Alix et al., 2017; Holl et al., 2017; Kealy
et al., 2017). Shame can also act as a significant inhibitor to CSA disclosure.
In a study in Israel, 67.8% of young people cited shame as one of three fac-
tors that prevented them from disclosing the abuse (fear, 65.1% and fear of
the abuser, 52.5% were the other two factors; Lev-Wiesel et al. [2016]). Non-
disclosure of CSA may have its own consequences. Negrao et al. (2005)
found that shame and humiliation in non-disclosing women survivors of CSA
was associated with high levels of PTSD symptoms.
Avoidance is a human response to shame, serving to either minimize
exposure to shame or to attempt to prevent further experience of shame
(Elison et al., 2006; Nathanson, 1992). Avoidance is also a coping response
to CSA (Dorahy et al., 2017; Feiring & Taska, 2005; LaBash & Papa, 2014;
Nathanson, 1992; Zupanic & Kreidler, 1998). Whether avoidance as a coping
response to CSA exclusively emanates from the experience of shame is
unknown; nevertheless, the associations warrant further exploration.
Avoidance, as a coping response, may also prevent individuals from acknowl-
edging their own shame response to the experience of sexual abuse. Thus, a
closer examination of coping strategies following CSA may reveal meaning
making processes that help illuminate shame and inform intervention.
Studies of both children (McElvaney et al., 2014) and adults (Hunter,
2011) have identified shame as a key barrier to disclosing CSA. Both con-
scious and unconscious avoidance of thinking about the abuse militate against
the revealing of the abuse. As noted above, avoidance is a common coping
strategy to protect the self from distress. The secrecy surrounding CSA along
with the knowledge that exposure of such experiences reflect negatively on
the self and family may contribute to feelings of shame (Deblinger & Runyon,
2005). All such responses may lead to isolation as the individual avoids social
contact as a means of regulating their experiences of intolerable shame. Even
in the act of disclosing, children and adults often express shame through their

McElvaney et al. NP18741
McElvaney et al. 3
response to shame emotions—to avoid—requires that researchers proactively
focus on this phenomenon in an attempt to shed light on and bring shame out
of the shadows.
Literature Review
Shame is a multi-faceted emotion. Adaptive or healthy shame has been
described as a fast-track physiological response with a social function
(Herman, 2011); a biological hardwired experience that assists the develop-
ing child in conforming to social norms (Schore, 2003). It is considered a
social emotion that requires a cognitive ability to have a sense of self and to
evaluate one’s behavior against social standards (Lewis, 2000). As a mal-
adaptive emotion, shame has been characterized as feelings of inadequacy,
self-condemnation, worthlessness, and vulnerability (Vikan et al., 2010).
Tomkins (1991) described shame as an inner torment, “a sickness of the soul”
where one feels “naked, defeated, alienated, lacking in dignity and worth” (p.
10) while Kaufman (1996) described it as “acutely disturbing and painful” (p.
5), unmatched by any of the other emotions.
Theoretical models of shame consider shame as an “attachment emotion”
(Gilbert & Andrews, 1998, p. 65) with origins in primary attachment relation-
ships. Misattunement between the primary caregiver and the infant, it is sug-
gested, results in a rupturing of the infant’s capacity to regulate their affect,
impairing the child’s sense of interpersonal efficacy and forming the founda-
tion for their later sense of worthlessness. Such models have not, however,
been used to explain the shame associated with the experience of CSA.
Brown (2006), in her model of shame resilience, described how women
moved from feeling trapped, powerless, and isolated to experiencing connec-
tion, power and freedom. This process was achieved through acknowledging
personal vulnerability, being critically aware, reaching out and speaking
shame. Nathanson’s (1992) conceptual model, compass of shame, identifies
four coping styles for addressing shame, representing the polarities of attack
self, withdrawal, attack other, and avoidance. As Elison et al. (2006) sug-
gested, outcomes may be more determined by how one copes with shame
rather than the experience itself. While both models focus on adults’ experi-
ences of shame and neither focuses on CSA-related shame, Brown’s three
components of shame—feeling trapped, powerless, and isolated—are com-
mon themes in young people’s narratives of CSA and resonate with the key
traumagenic dynamics of CSA identified by Finkelhor and Browne (1985).
Nathanson’s coping strategies of attack self and avoidance, in particular, may
4 Journal of Interpersonal Violence
be considered relevant to CSA-shame coping, particularly given how shame
has been postulated as explaining the high prevalence of self-blame in CSA
survivors (LaBash & Papa, 2014) and the prevalence of avoidant responses
among those who have been sexually abused (Rahm et al., 2013).
Sexual victimization violates physical, emotional, and sexual integrity and
is thus notorious for producing shame. In studies of adults, sexual assault has
been associated with higher levels of shame than other traumatic experiences
(Amstadter & Vernon, 2008). DeCou et al. (2019) found that more than 75%
of undergraduate female survivors of sexual assault reported feeling trauma-
related shame, while Wetterlöv et al. (2020) also found an association between
shame and sexual trauma among adolescent girls. CSA related shame can
lead to increased suicidal ideation, substance use, and vulnerabilities to being
re-victimized (Aakvaag et al., 2018; Alix et al., 2017; Holl et al., 2017; Kealy
et al., 2017). Shame can also act as a significant inhibitor to CSA disclosure.
In a study in Israel, 67.8% of young people cited shame as one of three fac-
tors that prevented them from disclosing the abuse (fear, 65.1% and fear of
the abuser, 52.5% were the other two factors; Lev-Wiesel et al. [2016]). Non-
disclosure of CSA may have its own consequences. Negrao et al. (2005)
found that shame and humiliation in non-disclosing women survivors of CSA
was associated with high levels of PTSD symptoms.
Avoidance is a human response to shame, serving to either minimize
exposure to shame or to attempt to prevent further experience of shame
(Elison et al., 2006; Nathanson, 1992). Avoidance is also a coping response
to CSA (Dorahy et al., 2017; Feiring & Taska, 2005; LaBash & Papa, 2014;
Nathanson, 1992; Zupanic & Kreidler, 1998). Whether avoidance as a coping
response to CSA exclusively emanates from the experience of shame is
unknown; nevertheless, the associations warrant further exploration.
Avoidance, as a coping response, may also prevent individuals from acknowl-
edging their own shame response to the experience of sexual abuse. Thus, a
closer examination of coping strategies following CSA may reveal meaning
making processes that help illuminate shame and inform intervention.
Studies of both children (McElvaney et al., 2014) and adults (Hunter,
2011) have identified shame as a key barrier to disclosing CSA. Both con-
scious and unconscious avoidance of thinking about the abuse militate against
the revealing of the abuse. As noted above, avoidance is a common coping
strategy to protect the self from distress. The secrecy surrounding CSA along
with the knowledge that exposure of such experiences reflect negatively on
the self and family may contribute to feelings of shame (Deblinger & Runyon,
2005). All such responses may lead to isolation as the individual avoids social
contact as a means of regulating their experiences of intolerable shame. Even
in the act of disclosing, children and adults often express shame through their

NP18742 Journal of Interpersonal Violence 37(19-20)
McElvaney et al. 5
language and bodily postures (Rahm et al., 2006). Finally, shame can be
heightened by the discovery process as others learn about the abuse, trigger-
ing fears of humiliation and condemnation from others. No other trauma
group are blamed for their ordeal as frequently as sexual assault survivors
(Bhuptani & Messman-Moore, 2019).
Some authors have highlighted the need to focus directly on explicit
shame (Zhu et al., 2019), and on survivors’ lived experiences of shame fol-
lowing CSA (Dorahy & Clearwater, 2012; MacGinley et al., 2019). However,
shame is likely to assume various disguised forms outside the awareness of
the individual and those around them (Dearing & Tangney, 2011; Rahm et al.,
2006). As Michael Lewis (2000) noted, “one’s knowledge of shame is often
limited to the trace it leaves” (p. 1187). In a study of male survivors, Weiss
(2010) reported language such as feeling “humiliated”, “embarrassed”, or
“uncomfortable” rather than ashamed. Shame can be expressed indirectly
through nonverbal and paralinguistic cues (Retzinger, 1995) as well as intra-
personal coping skills (substance use, self-harm; Zhu et al., 2019). Shame
may also manifest as experiences of feeling trapped, isolated, or powerless
(Brown, 2006) or as interpersonal avoidance, withdrawal, or aggression
(Nathanson, 1992). It is central to the field of child abuse and maltreatment
to identify shame experiences and, in particular, to explore how shame mani-
fests itself during childhood and adolescence, in order to distinguish between
shame that is associated with the abuse and disclosure experience during
these years and shame that manifests in adulthood. It may be necessary to
focus directly on these related dynamics, experiences, and processes if we are
to better understand the role of shame in CSA and how to assist in reducing
shame.
One potential avenue of research is to examine the CSA disclosure narra-
tives of young people who have experienced CSA, rather than confining
one’s exploration to explicit shame (i.e., shame that is conscious and acces-
sible to consciousness; MacGinley et al. [2019]). Qualitative research, by its
nature, captures the subjective nuances of particular experiences (Willig,
2008). It facilitates an exploration of how young people make sense of their
experiences in their own language. Drawing on the theoretical models and
research outlined above, this study sought to identify possible manifestations
of implicit shame in the disclosure experiences of young people who had
been sexually abused in childhood or adolescence.
Method
This study is part of a larger study exploring experiences of CSA disclosure
in a sample of young people living in Canada and Ireland (see Collin-Vézina
6 Journal of Interpersonal Violence
et al. [2021] for details). Participants were primarily recruited from commu-
nity-based sexual abuse/assault agencies, hospital-based specialized clinics,
and a child advocacy center. The total sample for this study is 47 participants.
All participants were either currently receiving or had recently received ser-
vices for their CSA experiences. The majority of the youth identified as
female (n = 42, 89.3%), and the remaining identified as male (n = 4, 8.5%),
or non-binary (n = 1, 2.1%). The participants ranged in age from 15 to 25
years, with an average age of 19.3 years. This age group was chosen in rec-
ognition of the WHO definitions of “youth” and “young people” as represent-
ing those aged 15–24 (www.who.int).
Participation in this research was voluntary and had no impact on access
to services provided by the agencies. Ethics approval was obtained from the
research ethics boards of the three universities participating in this project as
well as agencies that had their own internal ethics board. Written consent/
assent was gained prior to conducting the interviews; with participants who
chose a phone interview, consent was obtained verbally and digitally
recorded.
Participants identified diverse racial, cultural, and religious identities, and
reported various abuse characteristics and history. Racial and cultural identi-
ties of participants included Hispanic backgrounds, Indigenous, Croatian,
Québécoise, Haitian, Jamaican, Somalian, Dutch, Caucasian, and Black.
Religious identities included Catholic, Roman Catholic, Jewish, Muslim,
Christian, Agnostic, Atheist, Jehovah’s Witness, and spiritual. In terms of
abuse history, 37 participants reported experiences of CSA by one perpetra-
tor, while 10 participants reported CSA experiences by multiple perpetrators
at either the same or different time points. Two participants experienced both
intrafamilial and extrafamilial abuse. Twenty-three participants experienced
intrafamilial CSA, with two participants experiencing CSA by multiple per-
petrators. Perpetrators included mother’s partner (non-biological father; n =
6), biological father (n = 5), cousin (n = 5), uncle (biological and through
marriage; n = 5), grandfather (n = 2), brother (n = 2), and mother (n = 1).
Twenty-two participants experienced extrafamilial abuse. Perpetrators
included family friend (n = 7), friend/acquaintance (n = 6), stranger (n = 5),
boyfriend (n = 4), friend of sibling or peer (n = 3), online predators (n = 3),
family member of a half-sibling (n = 2), and a cousin’s husband (n = 1). Age
of onset of first sexual abuse experience ranged from 3 years old to 18 years
old. Delays from abuse to disclosure ranged from the same/next day to 18
years. Although it was unclear in some cases, 30 participants reported that
they disclosed 1 year or longer after the onset of the abuse.
Participants were interviewed using a semi-structured interview protocol
that was informed by the Long Interview Method (McCracken, 1988) and

McElvaney et al. NP18743
McElvaney et al. 5
language and bodily postures (Rahm et al., 2006). Finally, shame can be
heightened by the discovery process as others learn about the abuse, trigger-
ing fears of humiliation and condemnation from others. No other trauma
group are blamed for their ordeal as frequently as sexual assault survivors
(Bhuptani & Messman-Moore, 2019).
Some authors have highlighted the need to focus directly on explicit
shame (Zhu et al., 2019), and on survivors’ lived experiences of shame fol-
lowing CSA (Dorahy & Clearwater, 2012; MacGinley et al., 2019). However,
shame is likely to assume various disguised forms outside the awareness of
the individual and those around them (Dearing & Tangney, 2011; Rahm et al.,
2006). As Michael Lewis (2000) noted, “one’s knowledge of shame is often
limited to the trace it leaves” (p. 1187). In a study of male survivors, Weiss
(2010) reported language such as feeling “humiliated”, “embarrassed”, or
“uncomfortable” rather than ashamed. Shame can be expressed indirectly
through nonverbal and paralinguistic cues (Retzinger, 1995) as well as intra-
personal coping skills (substance use, self-harm; Zhu et al., 2019). Shame
may also manifest as experiences of feeling trapped, isolated, or powerless
(Brown, 2006) or as interpersonal avoidance, withdrawal, or aggression
(Nathanson, 1992). It is central to the field of child abuse and maltreatment
to identify shame experiences and, in particular, to explore how shame mani-
fests itself during childhood and adolescence, in order to distinguish between
shame that is associated with the abuse and disclosure experience during
these years and shame that manifests in adulthood. It may be necessary to
focus directly on these related dynamics, experiences, and processes if we are
to better understand the role of shame in CSA and how to assist in reducing
shame.
One potential avenue of research is to examine the CSA disclosure narra-
tives of young people who have experienced CSA, rather than confining
one’s exploration to explicit shame (i.e., shame that is conscious and acces-
sible to consciousness; MacGinley et al. [2019]). Qualitative research, by its
nature, captures the subjective nuances of particular experiences (Willig,
2008). It facilitates an exploration of how young people make sense of their
experiences in their own language. Drawing on the theoretical models and
research outlined above, this study sought to identify possible manifestations
of implicit shame in the disclosure experiences of young people who had
been sexually abused in childhood or adolescence.
Method
This study is part of a larger study exploring experiences of CSA disclosure
in a sample of young people living in Canada and Ireland (see Collin-Vézina
6 Journal of Interpersonal Violence
et al. [2021] for details). Participants were primarily recruited from commu-
nity-based sexual abuse/assault agencies, hospital-based specialized clinics,
and a child advocacy center. The total sample for this study is 47 participants.
All participants were either currently receiving or had recently received ser-
vices for their CSA experiences. The majority of the youth identified as
female (n = 42, 89.3%), and the remaining identified as male (n = 4, 8.5%),
or non-binary (n = 1, 2.1%). The participants ranged in age from 15 to 25
years, with an average age of 19.3 years. This age group was chosen in rec-
ognition of the WHO definitions of “youth” and “young people” as represent-
ing those aged 15–24 (www.who.int).
Participation in this research was voluntary and had no impact on access
to services provided by the agencies. Ethics approval was obtained from the
research ethics boards of the three universities participating in this project as
well as agencies that had their own internal ethics board. Written consent/
assent was gained prior to conducting the interviews; with participants who
chose a phone interview, consent was obtained verbally and digitally
recorded.
Participants identified diverse racial, cultural, and religious identities, and
reported various abuse characteristics and history. Racial and cultural identi-
ties of participants included Hispanic backgrounds, Indigenous, Croatian,
Québécoise, Haitian, Jamaican, Somalian, Dutch, Caucasian, and Black.
Religious identities included Catholic, Roman Catholic, Jewish, Muslim,
Christian, Agnostic, Atheist, Jehovah’s Witness, and spiritual. In terms of
abuse history, 37 participants reported experiences of CSA by one perpetra-
tor, while 10 participants reported CSA experiences by multiple perpetrators
at either the same or different time points. Two participants experienced both
intrafamilial and extrafamilial abuse. Twenty-three participants experienced
intrafamilial CSA, with two participants experiencing CSA by multiple per-
petrators. Perpetrators included mother’s partner (non-biological father; n =
6), biological father (n = 5), cousin (n = 5), uncle (biological and through
marriage; n = 5), grandfather (n = 2), brother (n = 2), and mother (n = 1).
Twenty-two participants experienced extrafamilial abuse. Perpetrators
included family friend (n = 7), friend/acquaintance (n = 6), stranger (n = 5),
boyfriend (n = 4), friend of sibling or peer (n = 3), online predators (n = 3),
family member of a half-sibling (n = 2), and a cousin’s husband (n = 1). Age
of onset of first sexual abuse experience ranged from 3 years old to 18 years
old. Delays from abuse to disclosure ranged from the same/next day to 18
years. Although it was unclear in some cases, 30 participants reported that
they disclosed 1 year or longer after the onset of the abuse.
Participants were interviewed using a semi-structured interview protocol
that was informed by the Long Interview Method (McCracken, 1988) and

NP18744 Journal of Interpersonal Violence 37(19-20)
McElvaney et al. 7
previous research undertaken by the authors (Alaggia, 2005; McElvaney et
al., 2012). The interview covered the following topics: sociodemographic
information, abuse characteristics, what helped or hindered disclosure, per-
ceived and actual outcomes of disclosure, interactions with wider systems
following disclosure, and experiences of discontinuous or recovered memo-
ries. A thematic analysis was conducted consisting of an initial comprehen-
sive open coding process following by a later deductive coding process.
Transcripts were independently coded in the first inductive phase by the first
two authors (RMcE & RL) to capture the young people’s experiences of dis-
closure. The second deductive phase consisted of examining the open codes
for possible manifestations of both explicit and implicit shame. This deduc-
tive analytic process was informed by the literature and took cognizance of
the hidden nature of shame and the need to examine experiences of associ-
ated emotions such as fear, anxiety, sadness as well as experiences of self-
blame, guilt, and isolation. Through a process of selective coding, relevant
codes were examined for their similarities and differences and merged where
sufficient similarities were evident, expanding the definition of the code,
where appropriate.
Establishing Trustworthiness
Throughout the study, specific measures for trustworthiness and rigor were
followed (Drisko, 1997). Prolonged engagement was ensured through the
investigators’ well-established history of conducting sexual abuse research
and practice. Dependability of the data was achieved through verbatim tran-
scriptions of the interviews, and direct participant quotes provided for con-
firmability of the themes. Peer review was utilized by the authors through the
use of multiple coders and regular discussions of emerging findings to reach
consensus. Further, investigator triangulation was adhered to in which mul-
tiple observers were used to attempt “to secure as many differing views as
possible on the behavior in question” (Denzin, 1978, p.102).
Findings
This paper focuses on how shame is manifested in young people’s stories of
CSA disclosure, the possible contributors to the experience of shame as expe-
rienced by these young people, and the markers for reducing shame. Three
major themes using narratives of 47 young people who disclosed CSA
emerged through in-depth thematic analyses: (a) languaging implicit shame
(b) avoiding shame, and (c) reducing shame. All names used to refer to par-
ticipants are pseudonyms.
8 Journal of Interpersonal Violence
Languaging Implicit Shame
One notable finding from the analysis was the rare use of the words “shame”
or “ashamed” by the young people interviewed to communicate explicit
shame. However, an analysis of participants’ narratives revealed the use of
several words to describe experiences that have been identified as associated
with shame, for example, references to the self as “stupid” (i.e., negative self-
evaluation; Dyer et al., 2017), references to perceiving others as viewing
them negatively (i.e., negative evaluation by others; Dyer et al., 2017) and
feeling confused or isolated (Brown, 2006).
Young people described feeling ashamed through the use of words or
phrases such as “dirty secret”, “disgust”, and not wanting to tell someone of
the abuse:
I don’t know, I think it was, it was kind of, like it was eating me alive. Like I
was holding it like, I don’t know, a dirty secret from somebody, a bit ashamed
of it obviously. (Sophia, aged 21)
Other days it totally blocks you, you feel dirty, you’re ashamed, and you feel
disgusting. (Olivia, aged 15)
Implicit shame could be seen to be evident in young people’s articulation of
why they did not want others to know about what happened to them, due to
both negative self-evaluation and the fear of negative evaluation by others: “I
don’t really like people knowing about it because I feel like it taints their
opinion of me” (Amelia, aged 15).
There’s a stigma or prejudice because in fact there was a drug in my glass so….
Y’know lots of people uh, that I know I could have a judgement like “Well yes,
but you were sexually uninhibited. So basically, it’s your fault.” (Lily, aged 24)
Some people don’t understand. Um, and acted negatively towards it, like, why
didn’t you do anything? Like, it makes, it kind of makes me feel like you’re to
blame. (Maria, aged 24)
I just feel like I should have known kind of thing. (Sharon, aged 19)
Like just feeling like you can’t really go to anyone because you feel like it’s
your fault, or like you’re stupid, if you would have done this, you could have
avoided it, so either way it’s on you. (Kaylia, aged 18)
One young person explained how the sexual nature of the abuse impacted on
both her evaluation of herself, how she made sense of what had happened to

McElvaney et al. NP18745
McElvaney et al. 7
previous research undertaken by the authors (Alaggia, 2005; McElvaney et
al., 2012). The interview covered the following topics: sociodemographic
information, abuse characteristics, what helped or hindered disclosure, per-
ceived and actual outcomes of disclosure, interactions with wider systems
following disclosure, and experiences of discontinuous or recovered memo-
ries. A thematic analysis was conducted consisting of an initial comprehen-
sive open coding process following by a later deductive coding process.
Transcripts were independently coded in the first inductive phase by the first
two authors (RMcE & RL) to capture the young people’s experiences of dis-
closure. The second deductive phase consisted of examining the open codes
for possible manifestations of both explicit and implicit shame. This deduc-
tive analytic process was informed by the literature and took cognizance of
the hidden nature of shame and the need to examine experiences of associ-
ated emotions such as fear, anxiety, sadness as well as experiences of self-
blame, guilt, and isolation. Through a process of selective coding, relevant
codes were examined for their similarities and differences and merged where
sufficient similarities were evident, expanding the definition of the code,
where appropriate.
Establishing Trustworthiness
Throughout the study, specific measures for trustworthiness and rigor were
followed (Drisko, 1997). Prolonged engagement was ensured through the
investigators’ well-established history of conducting sexual abuse research
and practice. Dependability of the data was achieved through verbatim tran-
scriptions of the interviews, and direct participant quotes provided for con-
firmability of the themes. Peer review was utilized by the authors through the
use of multiple coders and regular discussions of emerging findings to reach
consensus. Further, investigator triangulation was adhered to in which mul-
tiple observers were used to attempt “to secure as many differing views as
possible on the behavior in question” (Denzin, 1978, p.102).
Findings
This paper focuses on how shame is manifested in young people’s stories of
CSA disclosure, the possible contributors to the experience of shame as expe-
rienced by these young people, and the markers for reducing shame. Three
major themes using narratives of 47 young people who disclosed CSA
emerged through in-depth thematic analyses: (a) languaging implicit shame
(b) avoiding shame, and (c) reducing shame. All names used to refer to par-
ticipants are pseudonyms.
8 Journal of Interpersonal Violence
Languaging Implicit Shame
One notable finding from the analysis was the rare use of the words “shame”
or “ashamed” by the young people interviewed to communicate explicit
shame. However, an analysis of participants’ narratives revealed the use of
several words to describe experiences that have been identified as associated
with shame, for example, references to the self as “stupid” (i.e., negative self-
evaluation; Dyer et al., 2017), references to perceiving others as viewing
them negatively (i.e., negative evaluation by others; Dyer et al., 2017) and
feeling confused or isolated (Brown, 2006).
Young people described feeling ashamed through the use of words or
phrases such as “dirty secret”, “disgust”, and not wanting to tell someone of
the abuse:
I don’t know, I think it was, it was kind of, like it was eating me alive. Like I
was holding it like, I don’t know, a dirty secret from somebody, a bit ashamed
of it obviously. (Sophia, aged 21)
Other days it totally blocks you, you feel dirty, you’re ashamed, and you feel
disgusting. (Olivia, aged 15)
Implicit shame could be seen to be evident in young people’s articulation of
why they did not want others to know about what happened to them, due to
both negative self-evaluation and the fear of negative evaluation by others: “I
don’t really like people knowing about it because I feel like it taints their
opinion of me” (Amelia, aged 15).
There’s a stigma or prejudice because in fact there was a drug in my glass so….
Y’know lots of people uh, that I know I could have a judgement like “Well yes,
but you were sexually uninhibited. So basically, it’s your fault.” (Lily, aged 24)
Some people don’t understand. Um, and acted negatively towards it, like, why
didn’t you do anything? Like, it makes, it kind of makes me feel like you’re to
blame. (Maria, aged 24)
I just feel like I should have known kind of thing. (Sharon, aged 19)
Like just feeling like you can’t really go to anyone because you feel like it’s
your fault, or like you’re stupid, if you would have done this, you could have
avoided it, so either way it’s on you. (Kaylia, aged 18)
One young person explained how the sexual nature of the abuse impacted on
both her evaluation of herself, how she made sense of what had happened to

NP18746 Journal of Interpersonal Violence 37(19-20)
McElvaney et al. 9
her, and actual evaluation by others more negatively than if she had experi-
enced emotional or physical abuse:
It’s not as simplified as emotional or physical, in the sense that, I don’t know
how to explain it but with sexual abuse like, it’s something that’s done to you
but you almost like, you must have done something to provoke it. So you’re
minimized by other people’s reactions when you tell them and by your own,
um, your own self and how you perceive that incident. (Emma, aged 18)
Thus, while explicit references to shame were not prominent in young peo-
ple’s narratives, words associated with shame were evident, as were experi-
ences of negative self-evaluation such as feeling stupid, worthless, and
flawed, feeling they should have known what was happening and perceived
and actual negative evaluation by others, such as being blamed for the abuse
and not being believed. Experiences of confusion and isolation were also
common, all of which served as a barrier to bring the abuse, and therefore the
shame associated with the abuse, to light.
Avoiding Shame
When these young people were able to disclose, to tell their stories, they used
a range of words or phrases to communicate their experiences that often
hinted at abuse but didn’t directly name the experience as abuse, representing
a strong avoidant response. This reluctance to name the experience of abuse,
while in some cases may relate to a lack of knowledge or language, could also
represent an attempt to protect the self from experiencing shame. The most
predominant feature of these attempts to disclose is evident in the not want-
ing to talk about it or feeling uncomfortable talking about what happened. For
some, this was a coping strategy, to deny the reality of what happened and to
feel as if it happened to someone else:
I had like multiple defense mechanisms: I was in denial for me I had … I hadn’t
experienced that, and it was something … don’t … don’t … I don’t know how
to explain it it’s as if it was someone else who had experienced that and not me.
(Chloe, aged 23)
I just blurted it out, like “[abuser] kinda touched me like” and she was like what
ya mean, like he hurt ya, and I said yeah, like I just agreed with her, I didn’t
really like elaborate. (Aoife, aged 25)
Young people spoke of not wanting to talk about their experiences, of feeling
uncomfortable talking about it and of not wanting other people to feel uncom-
fortable. They spoke of how difficult it was to get the words out:
10 Journal of Interpersonal Violence
I just I dunno, I just I got that feeling in my throat, I got it there, I can’t speak
… I just couldn’t speak like, it just wouldn’t come out. (Aoife, aged 25)
It was physically very difficult to actually verbalize the whole thing. Yeah, so
it took me about three or four tries to actually get it out, and then when I did, it
was a long process in itself as well. (Molly, aged 24)
The words or phrases used to describe the abuse itself ranged from: “this
thing happened” (Alice, aged 19), “disclosing that something bad had hap-
pened” (Maria, aged 24); “like he’d do things he’d like he’d say things, or
like touch me or … eh things like that” (Aoife, aged 25) and were character-
ized by an avoidance of using the phrase “sexual abuse”. One young person
described how she tried to communicate that something was wrong, not so
much through her words but through her actions:
And in the first year of secondary school, there was a teacher that I liked a lot,
and once when something had happened over the previous weekend, and when
it was Friday, the bell rang to go home, and I said, “Can I stay here and live in
the school over the weekend? I don’t want to go home.” And then she laughed,
she said, “Come on now, we’ll see each other on Monday” But I didn’t want to
go home. (Charlotte, aged 19)
Reducing Shame
Finally, the analysis of the transcripts identified a range of responses from
others and coping strategies used by participants that were found to be help-
ful in reducing the negative self-evaluations and perceived negative evalua-
tion of others experienced following the abuse. These were illustrated in
having opportunities and experiences of expressing their needs and emotions,
reaching out to others, and receiving support and validation. Through con-
nection with others and the support they received, they came to a realization
that they were not alone and that the abuse wasn’t their fault. Finally, many
young people spoke of their desire to help others.
Young people spoke of how opportunities that facilitated them in speaking
about the abuse and expressing their feelings helped them to reduce self-
blame in particular. Being understood and having someone to talk to outside
the family where they did not have to be worried about the reactions of others
helped them to express themselves, which in turn helped them make sense of
what had happened and who was responsible for the abuse:
You could have a moment in the day where you are like it [is] all my fault.… I
am the reason that this happened like, and they (counsellors) will tell you no …

McElvaney et al. NP18747
McElvaney et al. 9
her, and actual evaluation by others more negatively than if she had experi-
enced emotional or physical abuse:
It’s not as simplified as emotional or physical, in the sense that, I don’t know
how to explain it but with sexual abuse like, it’s something that’s done to you
but you almost like, you must have done something to provoke it. So you’re
minimized by other people’s reactions when you tell them and by your own,
um, your own self and how you perceive that incident. (Emma, aged 18)
Thus, while explicit references to shame were not prominent in young peo-
ple’s narratives, words associated with shame were evident, as were experi-
ences of negative self-evaluation such as feeling stupid, worthless, and
flawed, feeling they should have known what was happening and perceived
and actual negative evaluation by others, such as being blamed for the abuse
and not being believed. Experiences of confusion and isolation were also
common, all of which served as a barrier to bring the abuse, and therefore the
shame associated with the abuse, to light.
Avoiding Shame
When these young people were able to disclose, to tell their stories, they used
a range of words or phrases to communicate their experiences that often
hinted at abuse but didn’t directly name the experience as abuse, representing
a strong avoidant response. This reluctance to name the experience of abuse,
while in some cases may relate to a lack of knowledge or language, could also
represent an attempt to protect the self from experiencing shame. The most
predominant feature of these attempts to disclose is evident in the not want-
ing to talk about it or feeling uncomfortable talking about what happened. For
some, this was a coping strategy, to deny the reality of what happened and to
feel as if it happened to someone else:
I had like multiple defense mechanisms: I was in denial for me I had … I hadn’t
experienced that, and it was something … don’t … don’t … I don’t know how
to explain it it’s as if it was someone else who had experienced that and not me.
(Chloe, aged 23)
I just blurted it out, like “[abuser] kinda touched me like” and she was like what
ya mean, like he hurt ya, and I said yeah, like I just agreed with her, I didn’t
really like elaborate. (Aoife, aged 25)
Young people spoke of not wanting to talk about their experiences, of feeling
uncomfortable talking about it and of not wanting other people to feel uncom-
fortable. They spoke of how difficult it was to get the words out:
10 Journal of Interpersonal Violence
I just I dunno, I just I got that feeling in my throat, I got it there, I can’t speak
… I just couldn’t speak like, it just wouldn’t come out. (Aoife, aged 25)
It was physically very difficult to actually verbalize the whole thing. Yeah, so
it took me about three or four tries to actually get it out, and then when I did, it
was a long process in itself as well. (Molly, aged 24)
The words or phrases used to describe the abuse itself ranged from: “this
thing happened” (Alice, aged 19), “disclosing that something bad had hap-
pened” (Maria, aged 24); “like he’d do things he’d like he’d say things, or
like touch me or … eh things like that” (Aoife, aged 25) and were character-
ized by an avoidance of using the phrase “sexual abuse”. One young person
described how she tried to communicate that something was wrong, not so
much through her words but through her actions:
And in the first year of secondary school, there was a teacher that I liked a lot,
and once when something had happened over the previous weekend, and when
it was Friday, the bell rang to go home, and I said, “Can I stay here and live in
the school over the weekend? I don’t want to go home.” And then she laughed,
she said, “Come on now, we’ll see each other on Monday” But I didn’t want to
go home. (Charlotte, aged 19)
Reducing Shame
Finally, the analysis of the transcripts identified a range of responses from
others and coping strategies used by participants that were found to be help-
ful in reducing the negative self-evaluations and perceived negative evalua-
tion of others experienced following the abuse. These were illustrated in
having opportunities and experiences of expressing their needs and emotions,
reaching out to others, and receiving support and validation. Through con-
nection with others and the support they received, they came to a realization
that they were not alone and that the abuse wasn’t their fault. Finally, many
young people spoke of their desire to help others.
Young people spoke of how opportunities that facilitated them in speaking
about the abuse and expressing their feelings helped them to reduce self-
blame in particular. Being understood and having someone to talk to outside
the family where they did not have to be worried about the reactions of others
helped them to express themselves, which in turn helped them make sense of
what had happened and who was responsible for the abuse:
You could have a moment in the day where you are like it [is] all my fault.… I
am the reason that this happened like, and they (counsellors) will tell you no …

NP18748 Journal of Interpersonal Violence 37(19-20)
McElvaney et al. 11
that it is not your fault like … you completely … he is like completely … he is
the reason that this all happened, and it is his fault…. (Isabelle, aged 16)
Several young people noted the importance of speaking up about the abuse in
order to reduce stigma:
People need to really speak up about it, there’s so much stigma behind it that it
interferes with every aspect of your life. That no matter how much you try to
deny it’s going to, there always with you so if you don’t speak out and help
yourself; you’re not going to live your life, you’re just going to exist. (Clodagh,
aged 21)
Um, but now being 8 years plus since it happened, I have no problem talking
about it and shedding my light on somebody else’s darkness and whatnot,
helping and just everything. Like, really, I’m okay to talk about it. I’ve talked
to counsellors; um they’ve been amazing. (Taylor, aged 24)
The realization that the abuse was not their fault “because you know I didn’t
do anything wrong” (Alex, aged 18), was often described as a result of speak-
ing to others and experiencing positive responses. In particular, they described
how initial reactions to their disclosure of abuse, when communicating empa-
thy and understanding, validated their own experiences and helped them.
Yeah, so when I told him, um, yeah it was kind of … I mean it was just like a
conversation and he was like, yeah, like when I when I said something I was
like “that just really felt messed up,” he was like “yeah, that is messed up” and
he was just, he kind of, like, affirmed my feelings. (Sarah, aged 18)
It felt good to tell her…. I mean I’m sorry that she cried but it felt so good that
someone actually cried and someone like ha! showed me that they felt
something. (Alice, aged 19)
Taking action seemed to be important to young people; future oriented think-
ing was evident:
I started talking about it and kind of researching it. I kind of figured out that it
was really not my fault and like I can’t do anything about it, but I should be able
to do something and if I tell the garda (police) then maybe something will come
out of it. (Isabelle, aged 16)
I just want to believe. Not only believe in general, but to believe in me, to believe
in … in what I can become and believe that I can feel better. (Tara, aged 15)
Support from others played a key role in helping young people in this study
move beyond their experiences of shame.
12 Journal of Interpersonal Violence
With my partner, the fact that he has been very supportive and very
understanding of it was a very positive experience and I think that’s a big part
of why I don’t feel ashamed of it as an event. Like I don’t feel ashamed of that
part of my life is because he doesn’t kind of treat me like a victim or anything
like that and I think that’s really important to me because I do see myself as a
really strong person. (Molly, aged 24)
In particular, support that generated a sense of belonging or made the young
person feel that they were not alone in their experiences or their suffering,
helped to mitigate young people’s sense of isolation:
She [counsellor] understands like and she talks to me and she’s like “You’re not
the only one, because we’re in a center.” She’s like “This center wouldn’t be
here if you were the only one’ and she can really like, they like, they make you
feel like you’re not alone.” (Angela, aged 24)
It’s not like we all walk around with [Um Hmm] name tags that say what’s
happened to us [Um Hmm] but, we’re all together in it [Yea] so you’re not
alone. (Maria, aged 24)
The idea of standing up for themselves was evident in how young people
spoke of the injustice of what had happened to them, and their actions in
seeking justice: “Gonna be really hard to get it out, but you got to do it
because you, you deserve justice” (Isabelle, aged 16).
Finally, an awareness of a greater good coming from their disclosure was
evident in some of the young people’s narratives: “not just for my safety but
the safety of the community” (Maria, aged 24).
I would like the public to know what I’ve gone through, I’ve considered at the
end of it writing a book and my experience and even just doing stuff for the
media to spread awareness and helping out with as many things like this as I
can. (Alex, aged 18)
Discussion
The aim of this study was to explore implicit shame in the narratives of young
people describing their experiences of disclosing CSA. Two key processes
are identified that may help our understanding of the experience of shame
following CSA. First, young people may avoid shame through the language
used to describe their experiences and through non-disclosure, delayed dis-
closure and not wanting to talk about their experiences of abuse. Second,
young people may express shame feelings as self-blame. Both avoidance and
self-blame (conceptualized as “attack self”) are evident in Nathanson’s

McElvaney et al. NP18749
McElvaney et al. 11
that it is not your fault like … you completely … he is like completely … he is
the reason that this all happened, and it is his fault…. (Isabelle, aged 16)
Several young people noted the importance of speaking up about the abuse in
order to reduce stigma:
People need to really speak up about it, there’s so much stigma behind it that it
interferes with every aspect of your life. That no matter how much you try to
deny it’s going to, there always with you so if you don’t speak out and help
yourself; you’re not going to live your life, you’re just going to exist. (Clodagh,
aged 21)
Um, but now being 8 years plus since it happened, I have no problem talking
about it and shedding my light on somebody else’s darkness and whatnot,
helping and just everything. Like, really, I’m okay to talk about it. I’ve talked
to counsellors; um they’ve been amazing. (Taylor, aged 24)
The realization that the abuse was not their fault “because you know I didn’t
do anything wrong” (Alex, aged 18), was often described as a result of speak-
ing to others and experiencing positive responses. In particular, they described
how initial reactions to their disclosure of abuse, when communicating empa-
thy and understanding, validated their own experiences and helped them.
Yeah, so when I told him, um, yeah it was kind of … I mean it was just like a
conversation and he was like, yeah, like when I when I said something I was
like “that just really felt messed up,” he was like “yeah, that is messed up” and
he was just, he kind of, like, affirmed my feelings. (Sarah, aged 18)
It felt good to tell her…. I mean I’m sorry that she cried but it felt so good that
someone actually cried and someone like ha! showed me that they felt
something. (Alice, aged 19)
Taking action seemed to be important to young people; future oriented think-
ing was evident:
I started talking about it and kind of researching it. I kind of figured out that it
was really not my fault and like I can’t do anything about it, but I should be able
to do something and if I tell the garda (police) then maybe something will come
out of it. (Isabelle, aged 16)
I just want to believe. Not only believe in general, but to believe in me, to believe
in … in what I can become and believe that I can feel better. (Tara, aged 15)
Support from others played a key role in helping young people in this study
move beyond their experiences of shame.
12 Journal of Interpersonal Violence
With my partner, the fact that he has been very supportive and very
understanding of it was a very positive experience and I think that’s a big part
of why I don’t feel ashamed of it as an event. Like I don’t feel ashamed of that
part of my life is because he doesn’t kind of treat me like a victim or anything
like that and I think that’s really important to me because I do see myself as a
really strong person. (Molly, aged 24)
In particular, support that generated a sense of belonging or made the young
person feel that they were not alone in their experiences or their suffering,
helped to mitigate young people’s sense of isolation:
She [counsellor] understands like and she talks to me and she’s like “You’re not
the only one, because we’re in a center.” She’s like “This center wouldn’t be
here if you were the only one’ and she can really like, they like, they make you
feel like you’re not alone.” (Angela, aged 24)
It’s not like we all walk around with [Um Hmm] name tags that say what’s
happened to us [Um Hmm] but, we’re all together in it [Yea] so you’re not
alone. (Maria, aged 24)
The idea of standing up for themselves was evident in how young people
spoke of the injustice of what had happened to them, and their actions in
seeking justice: “Gonna be really hard to get it out, but you got to do it
because you, you deserve justice” (Isabelle, aged 16).
Finally, an awareness of a greater good coming from their disclosure was
evident in some of the young people’s narratives: “not just for my safety but
the safety of the community” (Maria, aged 24).
I would like the public to know what I’ve gone through, I’ve considered at the
end of it writing a book and my experience and even just doing stuff for the
media to spread awareness and helping out with as many things like this as I
can. (Alex, aged 18)
Discussion
The aim of this study was to explore implicit shame in the narratives of young
people describing their experiences of disclosing CSA. Two key processes
are identified that may help our understanding of the experience of shame
following CSA. First, young people may avoid shame through the language
used to describe their experiences and through non-disclosure, delayed dis-
closure and not wanting to talk about their experiences of abuse. Second,
young people may express shame feelings as self-blame. Both avoidance and
self-blame (conceptualized as “attack self”) are evident in Nathanson’s

NP18750 Journal of Interpersonal Violence 37(19-20)
McElvaney et al. 13
(1992) compass of shame. Their polar opposites can be seen in Brown’s
(2006) model of developing shame resilience, whereby her participants
described speaking out about their experiences and developing a critical
awareness that they were not to blame for their experiences (unrelated to
CSA). Thus, the current findings support existing models of understanding
shame but, in addition, illustrate how shame is hidden within the CSA disclo-
sure process, highlighting the need for a better understanding of how shame
may be implicit in how victims of CSA express themselves, describe their
experiences and how they cope with the aftermath of CSA. While some
research has specifically focused on shame in a CSA context (MacGinley et
al., 2019; Wetterlöv et al., 2020), this is the first study, to our knowledge, that
examined shame dynamics in young people’s disclosure narratives.
Avoidance as Expression of Implicit Shame
Avoidance represents a thread running through young people’s narratives
through the language they used to describe their experiences, their attempts
to disclose the abuse, and the mechanisms involved in overcoming their
difficulties arising from the abuse, all of which resonate with the literature
on explicit shame. Striking in the narratives of young people was how
shame was expressed. The words shame or feeling ashamed rarely featured.
Implicit shame, however, was clearly articulated in other ways, using
expressions such as “dirty”, feeling “embarrassed”, not wanting people to
know about their experiences and being concerned about how others would
see them if they knew about the abuse. The limited research directly explor-
ing shame in the disclosure process seems unsurprising given the chal-
lenges inherent in speaking directly about experiences that are acknowledged
as shameful in themselves (Kennedy & Prock, 2018). Elison et al. (2006)
critique the research literature on shame for viewing shame as a single con-
struct and the need to reflect the nuanced and hidden language of shame.
They also suggest that practitioners may need to consider the varied implicit
references to shame articulated by those seeking help. Exploring, for exam-
ple, the experience of not wanting others to know about the abuse may
reveal underlying feelings of shame that may need to be brought into aware-
ness and spoken about.
Disclosure in itself can be considered a form of “speaking out” as a means
of reducing shame (Brown, 2006). The decision to disclose is, for many, a
result of acknowledging personal vulnerability and a critical awareness that
sexual abuse is a wrong done to them, that others may be at risk, and that they
need help. Young people in this study described their emerging realization
that the abuse was wrong, a criminal act and one named as such by broader
14 Journal of Interpersonal Violence
society, along with an awareness that “it isn’t just me”. Through receiving
support, they became more critically aware of their “victimhood” and vulner-
ability. Acknowledging personal vulnerability, critical awareness, and reach-
ing out are three of the four stages of Brown’s model of developing shame
resilience (the fourth being speaking shame) and thus may be key processes
in the young person’s experience of overcoming shame associated with CSA.
Brown’s final stage, speaking shame, however, was not evident in these
young people’s narratives; these young people were all engaged with agen-
cies providing support to victims of sexual abuse. It may be that being able to
name one’s experiences as shameful reflects an experience at a later stage of
recovery from the impact of abuse.
Self-Blame as Attacking Self
A second thread permeating participants’ narratives in this study was that of
self-blame, feeling responsible for the abuse and in the case of the final
theme, reducing shame, managing to overcome difficulties associated with
the abuse through shedding this responsibility. Self-blame is a common
impact of sexual assault; a meta-analysis on self-blame after trauma found
that CSA victims had even higher levels of self-blame compared to adult
sexual assault victims (Littleton et al., 2007). It is also a key factor inhibiting
disclosure of sexual assaults in childhood and in adulthood (Dolev-Cohen et
al., 2020; Garrett & Hassan, 2019; McElvaney et al., 2014; Morrison et al.,
2018; Tener, 2018). The associations between experiences of self-blame,
shame, and guilt as impacts of CSA influencing disclosure processes is com-
monly referred to in the literature. Finkelhor and Browne (1985) refer to both
guilt and shame being associated with one of their four key dynamics describ-
ing the impact of CSA: stigmatization. In reviews of CSA disclosure studies,
self-blame, shame, embarrassment, and guilt are often reported within the
same theme and often expressed by study participants interchangeably, for
example, “I felt guilty and like a bad person” (Foster & Hagedorn, 2014, p.
546); “Why would he do that to me like I musta done something or I must just
be a certain type of person” (McElvaney et al., 2014, p. 936). This juxtaposi-
tion of feeling guilt for doing something “bad” with seeing the self as “bad”
challenges one of the key distinctions in the literature between guilt and
shame, where guilt is seen as an adaptive emotion referring to actions (I did
something bad), while shame refers to the entire self (I am bad) (Brown,
2006; Feiring & Taska, 2005; MacGinley et al., 2019; Wetterlöv et al., 2020).
Self-blame (or guilt) for the abuse has been considered at the root of the
child’s deep-seated experience of shame following CSA (Feiring et al.,
1996; Finkelhor & Browne, 1985). The child blames herself for the abuse

McElvaney et al. NP18751
McElvaney et al. 13
(1992) compass of shame. Their polar opposites can be seen in Brown’s
(2006) model of developing shame resilience, whereby her participants
described speaking out about their experiences and developing a critical
awareness that they were not to blame for their experiences (unrelated to
CSA). Thus, the current findings support existing models of understanding
shame but, in addition, illustrate how shame is hidden within the CSA disclo-
sure process, highlighting the need for a better understanding of how shame
may be implicit in how victims of CSA express themselves, describe their
experiences and how they cope with the aftermath of CSA. While some
research has specifically focused on shame in a CSA context (MacGinley et
al., 2019; Wetterlöv et al., 2020), this is the first study, to our knowledge, that
examined shame dynamics in young people’s disclosure narratives.
Avoidance as Expression of Implicit Shame
Avoidance represents a thread running through young people’s narratives
through the language they used to describe their experiences, their attempts
to disclose the abuse, and the mechanisms involved in overcoming their
difficulties arising from the abuse, all of which resonate with the literature
on explicit shame. Striking in the narratives of young people was how
shame was expressed. The words shame or feeling ashamed rarely featured.
Implicit shame, however, was clearly articulated in other ways, using
expressions such as “dirty”, feeling “embarrassed”, not wanting people to
know about their experiences and being concerned about how others would
see them if they knew about the abuse. The limited research directly explor-
ing shame in the disclosure process seems unsurprising given the chal-
lenges inherent in speaking directly about experiences that are acknowledged
as shameful in themselves (Kennedy & Prock, 2018). Elison et al. (2006)
critique the research literature on shame for viewing shame as a single con-
struct and the need to reflect the nuanced and hidden language of shame.
They also suggest that practitioners may need to consider the varied implicit
references to shame articulated by those seeking help. Exploring, for exam-
ple, the experience of not wanting others to know about the abuse may
reveal underlying feelings of shame that may need to be brought into aware-
ness and spoken about.
Disclosure in itself can be considered a form of “speaking out” as a means
of reducing shame (Brown, 2006). The decision to disclose is, for many, a
result of acknowledging personal vulnerability and a critical awareness that
sexual abuse is a wrong done to them, that others may be at risk, and that they
need help. Young people in this study described their emerging realization
that the abuse was wrong, a criminal act and one named as such by broader
14 Journal of Interpersonal Violence
society, along with an awareness that “it isn’t just me”. Through receiving
support, they became more critically aware of their “victimhood” and vulner-
ability. Acknowledging personal vulnerability, critical awareness, and reach-
ing out are three of the four stages of Brown’s model of developing shame
resilience (the fourth being speaking shame) and thus may be key processes
in the young person’s experience of overcoming shame associated with CSA.
Brown’s final stage, speaking shame, however, was not evident in these
young people’s narratives; these young people were all engaged with agen-
cies providing support to victims of sexual abuse. It may be that being able to
name one’s experiences as shameful reflects an experience at a later stage of
recovery from the impact of abuse.
Self-Blame as Attacking Self
A second thread permeating participants’ narratives in this study was that of
self-blame, feeling responsible for the abuse and in the case of the final
theme, reducing shame, managing to overcome difficulties associated with
the abuse through shedding this responsibility. Self-blame is a common
impact of sexual assault; a meta-analysis on self-blame after trauma found
that CSA victims had even higher levels of self-blame compared to adult
sexual assault victims (Littleton et al., 2007). It is also a key factor inhibiting
disclosure of sexual assaults in childhood and in adulthood (Dolev-Cohen et
al., 2020; Garrett & Hassan, 2019; McElvaney et al., 2014; Morrison et al.,
2018; Tener, 2018). The associations between experiences of self-blame,
shame, and guilt as impacts of CSA influencing disclosure processes is com-
monly referred to in the literature. Finkelhor and Browne (1985) refer to both
guilt and shame being associated with one of their four key dynamics describ-
ing the impact of CSA: stigmatization. In reviews of CSA disclosure studies,
self-blame, shame, embarrassment, and guilt are often reported within the
same theme and often expressed by study participants interchangeably, for
example, “I felt guilty and like a bad person” (Foster & Hagedorn, 2014, p.
546); “Why would he do that to me like I musta done something or I must just
be a certain type of person” (McElvaney et al., 2014, p. 936). This juxtaposi-
tion of feeling guilt for doing something “bad” with seeing the self as “bad”
challenges one of the key distinctions in the literature between guilt and
shame, where guilt is seen as an adaptive emotion referring to actions (I did
something bad), while shame refers to the entire self (I am bad) (Brown,
2006; Feiring & Taska, 2005; MacGinley et al., 2019; Wetterlöv et al., 2020).
Self-blame (or guilt) for the abuse has been considered at the root of the
child’s deep-seated experience of shame following CSA (Feiring et al.,
1996; Finkelhor & Browne, 1985). The child blames herself for the abuse

NP18752 Journal of Interpersonal Violence 37(19-20)
McElvaney et al. 15
(attacks self; Nathanson, 1992) or is blamed by others and develops negative
self-attributions that are very much about the whole self (Finkelhor &
Browne, 1985). Self-blame can be seen as a coping strategy to defend the
self against shame, what Nathanson (1992) refers to as “attack self” in his
compass of shame. Thus, guilt, or in this case, self-blame, could be seen as
adaptive in the short term as a means of regaining control following the loss
of control inherent in the abuse experience or as a defense against anxiety.
However, in the longer term this may become maladaptive and manifest as
negative evaluations of the self, which in turn translate into psychopatho-
logical presentations such as depression, anxiety and avoidance associated
with PTSD. Paivio and Pascual-Leone (2010) suggested that guilt is a sec-
ondary emotion often rooted in shame. They suggest that if therapists simply
work with guilt, they will not be able to help the client move beyond shame.
However, guilt, expressed as self-blame, may need to be understood more as
an implicit manifestation of shame. Thus, in the context of CSA, the distinc-
tion drawn between guilt and shame by several authors both in relation to
shame in general (Brown, 2006; Dearing & Tangney, 2011; Tangney &
Dearing, 2002) and CSA-related shame (MacGinley et al., 2019; Wetterlöv
et al., 2020) may be unhelpful.
Implications for Psychotherapy
Disclosure of CSA may be considered a first step towards reducing shame,
moving beyond isolation, and accessing opportunities for attunement and
empathy, both of which will help the child feel connected (Schore, 2003).
Brown (2006) conceptualized support as an antidote to shame, highlighting
the role of support in developing shame resilience. The findings of this study
highlight the importance of both perceived or actual negative evaluations by
others in exacerbating difficulties and the supportive reactions to disclosure
in mitigating the negative impact of the abuse. For those in need of profes-
sional support, some have argued that seeking help in itself is shame-induc-
ing (Blais & Renshaw, 2013) and shame following CSA has been identified
as inhibiting access to therapy (Chouliara et al., 2014). It may be that out-
reach services are particularly needed for those who have experienced CSA
as a way of combating the shame elicited in help-seeking behavior.
Psychoeducation about the impact of abuse may help to normalize the psy-
chological sequelae of CSA to help young people understand that such feel-
ings and experiences are common responses to CSA and that without
psychotherapy, they may struggle unnecessarily to overcome their difficul-
ties. Interestingly, recent research suggests that the anonymity of the online
environment may encourage young people to disclose in seek of support
16 Journal of Interpersonal Violence
(Dolev-Cohen et al., 2020), which suggests that online therapeutic services
may be more accessible for some who have experienced CSA.
Friel (2016) notes the reparative value of the therapeutic relationship in
detoxifying shame, where the client can experience feeling good about them-
selves. However, shame experiences may also be exacerbated within the
therapeutic relationship (Black et al., 2013), particularly given the power
imbalance inherent in the therapist–client dyad (Herman, 2011). While
respect for the client, promoting autonomy, and empowerment of the client
are important in all therapeutic work, particular emphasis on these dynamics
may be necessary when working with those who have experienced CSA.
There is evidence to suggest that focusing directly on the abuse in the
course of therapy with both children and adults following CSA can reduce
shame and negative self-attributions (Deblinger & Runyon, 2005; Sanderson,
2015). While facilitating CSA disclosure may in itself address shame experi-
ences indirectly, the findings from the current study suggest that the therapist
needs to listen for implicit cues of shame in clients’ narratives. Avoidance and
self-blame, in particular, need to be understood as potential avenues to uncov-
ering shame experiences. The language used and the way the abuse is spoken
about may suggest underlying shame that needs to be brought into awareness
and addressed.
Caregivers may also experience shame on hearing that their child has been
sexually abused and may themselves withdraw from their social network.
They may blame themselves for not protecting their children and fear judge-
ments by others of both them and their child (McElvaney & Nixon, 2019),
thus depriving themselves of much needed support, which in turn impacts on
their ability to support their child. Therapeutic responses to young people
following CSA need to also take account of the support needs of caregivers.
Strengths and Limitations
A key strength of this study is the rich and detailed data elicited from a sam-
ple of young people aged 15–25 years old, a population under-represented in
the research literature. Through an examination of their narratives of CSA
disclosure experiences, we were able to identify significant ways of express-
ing shame and highlight possible relationships between shame avoidance and
disclosure avoidance. The study design did not attempt to capture physiologi-
cal manifestations of shame. This would be a useful focus in future CSA–
shame research. A focus on how the participant speaks about their experiences,
level of eye contact, lowered head, blushing, hesitant speech, avoiding talk-
ing about some aspects of their experience could build on the implicit mani-
festations of shame identified in the current study. Participants were asked

McElvaney et al. NP18753
McElvaney et al. 15
(attacks self; Nathanson, 1992) or is blamed by others and develops negative
self-attributions that are very much about the whole self (Finkelhor &
Browne, 1985). Self-blame can be seen as a coping strategy to defend the
self against shame, what Nathanson (1992) refers to as “attack self” in his
compass of shame. Thus, guilt, or in this case, self-blame, could be seen as
adaptive in the short term as a means of regaining control following the loss
of control inherent in the abuse experience or as a defense against anxiety.
However, in the longer term this may become maladaptive and manifest as
negative evaluations of the self, which in turn translate into psychopatho-
logical presentations such as depression, anxiety and avoidance associated
with PTSD. Paivio and Pascual-Leone (2010) suggested that guilt is a sec-
ondary emotion often rooted in shame. They suggest that if therapists simply
work with guilt, they will not be able to help the client move beyond shame.
However, guilt, expressed as self-blame, may need to be understood more as
an implicit manifestation of shame. Thus, in the context of CSA, the distinc-
tion drawn between guilt and shame by several authors both in relation to
shame in general (Brown, 2006; Dearing & Tangney, 2011; Tangney &
Dearing, 2002) and CSA-related shame (MacGinley et al., 2019; Wetterlöv
et al., 2020) may be unhelpful.
Implications for Psychotherapy
Disclosure of CSA may be considered a first step towards reducing shame,
moving beyond isolation, and accessing opportunities for attunement and
empathy, both of which will help the child feel connected (Schore, 2003).
Brown (2006) conceptualized support as an antidote to shame, highlighting
the role of support in developing shame resilience. The findings of this study
highlight the importance of both perceived or actual negative evaluations by
others in exacerbating difficulties and the supportive reactions to disclosure
in mitigating the negative impact of the abuse. For those in need of profes-
sional support, some have argued that seeking help in itself is shame-induc-
ing (Blais & Renshaw, 2013) and shame following CSA has been identified
as inhibiting access to therapy (Chouliara et al., 2014). It may be that out-
reach services are particularly needed for those who have experienced CSA
as a way of combating the shame elicited in help-seeking behavior.
Psychoeducation about the impact of abuse may help to normalize the psy-
chological sequelae of CSA to help young people understand that such feel-
ings and experiences are common responses to CSA and that without
psychotherapy, they may struggle unnecessarily to overcome their difficul-
ties. Interestingly, recent research suggests that the anonymity of the online
environment may encourage young people to disclose in seek of support
16 Journal of Interpersonal Violence
(Dolev-Cohen et al., 2020), which suggests that online therapeutic services
may be more accessible for some who have experienced CSA.
Friel (2016) notes the reparative value of the therapeutic relationship in
detoxifying shame, where the client can experience feeling good about them-
selves. However, shame experiences may also be exacerbated within the
therapeutic relationship (Black et al., 2013), particularly given the power
imbalance inherent in the therapist–client dyad (Herman, 2011). While
respect for the client, promoting autonomy, and empowerment of the client
are important in all therapeutic work, particular emphasis on these dynamics
may be necessary when working with those who have experienced CSA.
There is evidence to suggest that focusing directly on the abuse in the
course of therapy with both children and adults following CSA can reduce
shame and negative self-attributions (Deblinger & Runyon, 2005; Sanderson,
2015). While facilitating CSA disclosure may in itself address shame experi-
ences indirectly, the findings from the current study suggest that the therapist
needs to listen for implicit cues of shame in clients’ narratives. Avoidance and
self-blame, in particular, need to be understood as potential avenues to uncov-
ering shame experiences. The language used and the way the abuse is spoken
about may suggest underlying shame that needs to be brought into awareness
and addressed.
Caregivers may also experience shame on hearing that their child has been
sexually abused and may themselves withdraw from their social network.
They may blame themselves for not protecting their children and fear judge-
ments by others of both them and their child (McElvaney & Nixon, 2019),
thus depriving themselves of much needed support, which in turn impacts on
their ability to support their child. Therapeutic responses to young people
following CSA need to also take account of the support needs of caregivers.
Strengths and Limitations
A key strength of this study is the rich and detailed data elicited from a sam-
ple of young people aged 15–25 years old, a population under-represented in
the research literature. Through an examination of their narratives of CSA
disclosure experiences, we were able to identify significant ways of express-
ing shame and highlight possible relationships between shame avoidance and
disclosure avoidance. The study design did not attempt to capture physiologi-
cal manifestations of shame. This would be a useful focus in future CSA–
shame research. A focus on how the participant speaks about their experiences,
level of eye contact, lowered head, blushing, hesitant speech, avoiding talk-
ing about some aspects of their experience could build on the implicit mani-
festations of shame identified in the current study. Participants were asked

NP18754 Journal of Interpersonal Violence 37(19-20)
McElvaney et al. 17
about others’ responses to their disclosure; however, given the importance of
support as an antidote to shame, a more detailed investigation of support
experiences would be helpful. While all participants were accessed through
support services, we did not gather data about length of time in therapy. Such
information is relevant when considering resilience pathways.
In drawing from a sample across two countries, namely, Ireland and
Canada, it was anticipated that cultural differences would be identified
between countries and between sites (e.g., French-speaking Quebec and
English-speaking Toronto). Although there were a few references to reli-
gious and cultural influences, these did not feature strongly; in fact, themes
were remarkably similar across countries. This finding may suggest that
while it is valuable to consider individual, familial, societal, and cultural
contexts (Zhu et al., 2019), certain aspects of the shame experience follow-
ing CSA are universal.
Conclusion
The child who does not disclose within a timely manner is deprived of the
opportunity of having their negative self-attributions challenged. Their avoid-
ance and withdrawal, characterized by non-disclosure, provides a ripe con-
text for shame to flourish. This avoidance is also evident in the narratives of
those who have disclosed and may, we suggest, combined with the tendency
to blame oneself for the abuse, represent implicit manifestations of shame.
We propose that the distinction in previous research between guilt and shame
is unhelpful in the context of CSA. Rather, guilt (manifested as self-blame)
needs to be viewed as an implicit expression of shame. Therapeutic work
with those who have experienced CSA needs to consider the challenge of
acknowledging shame and communicating shame. Given that the instinctive
human reaction to shame is to avoid, professionals need to be particularly
sensitive to implicit manifestations of shame, such as guilt and self-blame, in
their attempts to support those affected by CSA and bring shame out of the
shadows.
Acknowledgments
The authors wish to acknowledge the assistance of Mireille De La Sablonnière-
Griffin, Emma Brennan, Christina Treacy, and Naoise Delaney who assisted with the
research project.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research,
authorship, and/or publication of this article.
18 Journal of Interpersonal Violence
Funding
The author(s) disclosed receipt of the following financial support for the research,
authorship, and/or publication of this article: This study was funded by Social Sciences
and Humanities Research Council (SSHRC).
ORCID iDs
Rosaleen McElvaney https://orcid.org/0000-0002-0204-7270
Rusan Lateef https://orcid.org/0000-0002-1068-7067
References
Aakvaag, H. F., Thoresen, S., Strøm, I. F., Myhre, M., & Hjemdal, O. K. (2018).
Shame predicts revictimization in victims of childhood violence: A prospec-
tive study of a general Norwegian population sample. Psychological Trauma:
Theory, Research, Practice, and Policy, 11(1), 43–50. https://doi.org/10.1037/
tra0000373
Alaggia, R. (2005). Disclosing the trauma of child sexual abuse: A gender analysis.
Journal of Loss and Trauma, 10(5), 453–470.
Alaggia, R., Collin-Vezina, D., & Lateef, R. (2017). Facilitators and barriers to child
sexual abuse (CSA) disclosures: A Research update (2000–2016). Trauma,
Violence and Abuse, 20(2), 260–283. https://doi.org/10.1177/1524838017697312
Alix, S., Cossette, L., Hébert, M., Cyr, M., & Frappier, J. (2017). Posttraumatic stress
disorder and suicidal ideation among sexually abused adolescent girls: The medi-
ating role of shame. Journal of Child Sexual Abuse, 26(2), 158–174. https://doi.
org/10.1080/10538712.2017.1280577
Amstadter, A. B., & Vernon, L. L. (2008). Emotional reactions during and after
trauma: A comparison of trauma types. Journal of Aggression, Maltreatment &
Trauma, 16(4), 391–408. https://doi.org/10.1080/10926770801926492
Bhuptani, P. H., & Messman-Moore, T. L. (2019). Blame and shame in sexual
assault. In W. T. O’Donohue & P. A. Schewe (Eds.), Handbook of sexual
assault and sexual assault prevention (pp. 309–322). Springer Nature. http://doi.
org/10.1007/978-3-030-23645-8_18
Black, R. S., Curran, D., & Dyer, K. F. (2013). The impact of shame on the thera-
peutic alliance and intimate relationships. Journal of Clinical Psychology, 69(6),
646–654. https://doi.org/10.1002/jclp.21959
Blais, R. K., & Renshaw, K. D. (2013). Stigma and demographic correlates of help-
seeking intentions in returning service members. Journal of Traumatic Stress,
26(1), 77–85. https://doi.org/10.1002/jts.21772
Brown, B. (2006). Shame and resilience theory: A grounded theory study on women
and shame, families in society. The Journal of Contemporary Social Services,
87(1), 43–52. http://doi.org/10.1606/1044-3894.3483
Chouliara, Z., Karatzias, T., & Gullone, A. (2014). Recovering from childhood sexual
abuse: A theoretical framework for practice and re-search. Journal of Psychiatric
and Mental Health Nursing, 21(1), 69–78. https://doi.org/10.1111/jpm.12048

McElvaney et al. NP18755
McElvaney et al. 17
about others’ responses to their disclosure; however, given the importance of
support as an antidote to shame, a more detailed investigation of support
experiences would be helpful. While all participants were accessed through
support services, we did not gather data about length of time in therapy. Such
information is relevant when considering resilience pathways.
In drawing from a sample across two countries, namely, Ireland and
Canada, it was anticipated that cultural differences would be identified
between countries and between sites (e.g., French-speaking Quebec and
English-speaking Toronto). Although there were a few references to reli-
gious and cultural influences, these did not feature strongly; in fact, themes
were remarkably similar across countries. This finding may suggest that
while it is valuable to consider individual, familial, societal, and cultural
contexts (Zhu et al., 2019), certain aspects of the shame experience follow-
ing CSA are universal.
Conclusion
The child who does not disclose within a timely manner is deprived of the
opportunity of having their negative self-attributions challenged. Their avoid-
ance and withdrawal, characterized by non-disclosure, provides a ripe con-
text for shame to flourish. This avoidance is also evident in the narratives of
those who have disclosed and may, we suggest, combined with the tendency
to blame oneself for the abuse, represent implicit manifestations of shame.
We propose that the distinction in previous research between guilt and shame
is unhelpful in the context of CSA. Rather, guilt (manifested as self-blame)
needs to be viewed as an implicit expression of shame. Therapeutic work
with those who have experienced CSA needs to consider the challenge of
acknowledging shame and communicating shame. Given that the instinctive
human reaction to shame is to avoid, professionals need to be particularly
sensitive to implicit manifestations of shame, such as guilt and self-blame, in
their attempts to support those affected by CSA and bring shame out of the
shadows.
Acknowledgments
The authors wish to acknowledge the assistance of Mireille De La Sablonnière-
Griffin, Emma Brennan, Christina Treacy, and Naoise Delaney who assisted with the
research project.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research,
authorship, and/or publication of this article.
18 Journal of Interpersonal Violence
Funding
The author(s) disclosed receipt of the following financial support for the research,
authorship, and/or publication of this article: This study was funded by Social Sciences
and Humanities Research Council (SSHRC).
ORCID iDs
Rosaleen McElvaney https://orcid.org/0000-0002-0204-7270
Rusan Lateef https://orcid.org/0000-0002-1068-7067
References
Aakvaag, H. F., Thoresen, S., Strøm, I. F., Myhre, M., & Hjemdal, O. K. (2018).
Shame predicts revictimization in victims of childhood violence: A prospec-
tive study of a general Norwegian population sample. Psychological Trauma:
Theory, Research, Practice, and Policy, 11(1), 43–50. https://doi.org/10.1037/
tra0000373
Alaggia, R. (2005). Disclosing the trauma of child sexual abuse: A gender analysis.
Journal of Loss and Trauma, 10(5), 453–470.
Alaggia, R., Collin-Vezina, D., & Lateef, R. (2017). Facilitators and barriers to child
sexual abuse (CSA) disclosures: A Research update (2000–2016). Trauma,
Violence and Abuse, 20(2), 260–283. https://doi.org/10.1177/1524838017697312
Alix, S., Cossette, L., Hébert, M., Cyr, M., & Frappier, J. (2017). Posttraumatic stress
disorder and suicidal ideation among sexually abused adolescent girls: The medi-
ating role of shame. Journal of Child Sexual Abuse, 26(2), 158–174. https://doi.
org/10.1080/10538712.2017.1280577
Amstadter, A. B., & Vernon, L. L. (2008). Emotional reactions during and after
trauma: A comparison of trauma types. Journal of Aggression, Maltreatment &
Trauma, 16(4), 391–408. https://doi.org/10.1080/10926770801926492
Bhuptani, P. H., & Messman-Moore, T. L. (2019). Blame and shame in sexual
assault. In W. T. O’Donohue & P. A. Schewe (Eds.), Handbook of sexual
assault and sexual assault prevention (pp. 309–322). Springer Nature. http://doi.
org/10.1007/978-3-030-23645-8_18
Black, R. S., Curran, D., & Dyer, K. F. (2013). The impact of shame on the thera-
peutic alliance and intimate relationships. Journal of Clinical Psychology, 69(6),
646–654. https://doi.org/10.1002/jclp.21959
Blais, R. K., & Renshaw, K. D. (2013). Stigma and demographic correlates of help-
seeking intentions in returning service members. Journal of Traumatic Stress,
26(1), 77–85. https://doi.org/10.1002/jts.21772
Brown, B. (2006). Shame and resilience theory: A grounded theory study on women
and shame, families in society. The Journal of Contemporary Social Services,
87(1), 43–52. http://doi.org/10.1606/1044-3894.3483
Chouliara, Z., Karatzias, T., & Gullone, A. (2014). Recovering from childhood sexual
abuse: A theoretical framework for practice and re-search. Journal of Psychiatric
and Mental Health Nursing, 21(1), 69–78. https://doi.org/10.1111/jpm.12048

NP18756 Journal of Interpersonal Violence 37(19-20)
McElvaney et al. 19
Collin-Vézina, D., De La Sablonnière-Griffin, M., Sivagurunathan, M., Lateef, R.,
Alaggia, R., McElvaney, R., & Simpson, M. (2021). “How many times did I
not want to live a life because of him”: The complex connections between child
sexual abuse, disclosure, and self-injurious thoughts and behaviors. Borderline
Personality Disorder and Emotion Dysregulation, 8(1), 1–13. https://doi.
org/10.1186/s40479-020-00142-6
Dearing, R. L., & Tangney, J. P. E. (2011). Shame in the therapy hour. American
Psychological Association.
Deblinger, E., & Runyon, M. K. (2005). Understanding and treating feelings of shame
in children who have experienced maltreatment. Child Maltreatment, 10(4), 364–
376. https://doi.org/10.1177/1077559505279306
DeCou, C. R., Mahoney, C. T., Kaplan, S. P., & Lynch, S. M. (2019). Coping self-effi-
cacy and trauma-related shame mediate the association between negative social
reactions to sexual assault and PTSD symptoms. Psychological Trauma: Theory,
Research, Practice, and Policy, 11(1), 51. https://doi.org/10.1037/tra0000379
Denzin, N. K. (1978). The research act: A theoretical introduction to sociological
methods (2nd ed.). McGraw-Hill.
Dolev-Cohen, M., Ricon, T., & Levkovich, I. (2020). #WhyIdidn’treport: Reasons
why young Israelis do not submit complaints regarding sexual abuse. Children and
Youth Services Review, 115. https://doi.org/10.1016/j.childyouth.2020.105044
Dorahy, M. J., & Clearwater, K. (2012). Shame and guilt in men exposed to childhood
sexual abuse: A qualitative investigation. Journal of Child Sexual Abuse, 21(2),
155–175. https://doi.org/10.1080/10538712.2012.659803
Dorahy, M. J., McKendry, H., Scott, A., Yogeeswaran, K., Martens, A., & Hanna, D.
(2017). Reactive dissociative experiences in response to acute increases in shame
feelings. Behaviour Research and Therapy, 89, 75–85. https://doi.org/10.1016/j.
brat.2016.11.007
Drisko, J. (1997). Strengthening qualitative studies and reports: Standards to promote
academic integrity. Journal of Social Work Educa-tion, 33(1), 185–197. http://
doi.org/10.1080/10437797.1997.10778862
Dyer, K. F. W., Dorahy, M. J., Corry, M., Black, R., Matheson, L., Coles, H., Curran,
D., Seager, L., & Middleton, W. (2017). Comparing shame in clinical and non-
clinical populations: Preliminary findings. Psychological Trauma: Theory,
Research, Practice, and Policy, 9(2), 173–180. http://dx.doi.org/10.1037/
tra0000158
Elison, J., Pulos, S., & Lennon, R. (2006). Shame-focused coping: An empirical study
of the compass of shame. Social Behavior and Personality: An International
Journal, 34(2), 161–168. https://doi.org/10.2224/sbp.2006.34.2.161
Feiring, C., & Taska, L. S. (2005). The persistence of shame following sexual abuse:
A longitudinal look at risk and recovery. Child Maltreatment, 10(4), 337–349.
https://doi.org/10.1177/1077559505276686
Feiring, C., Taska, L. S., & Lewis, M. (1996). A process model for understanding
adaptation to sexual abuse: The role of shame in defining stigmatization. Child
Abuse & Neglect, 20, 767–782. https://doi.org/10.1016/0145-2134(96)00064-6
20 Journal of Interpersonal Violence
Felitti, V., & Anda, R. (2010). The relationship of adverse childhood experiences to
adult medical disease, psy-chiatric disorders and sexual behavior: Implications
for healthcare. In R. Lanius, E. Vermetten, & C. Pain (Eds.), The impact of early
life trauma on health and disease: The hidden epidemic (pp. 77–87). Cambridge
University Press. http://doi.org/10.1017/CBO9780511777042.010
Finkelhor, D., & Browne, A. (1985). The traumatic impact of child sexual abuse: A
conceptualization. American Journal of Orthopsychiatry, 55(4), 530–541. http://
doi.org/10.1111/j.1939-0025.1985.tb02703.x
Foster, J. M. & Hagedorn, W. B. (2014). Through the eyes of the wounded: A narrative
analysis of children’s sexual ab use experiences and recovery process. Journal of
Child Sexual Abuse, 23(5), 538-557. https://doi.org/10.1080/10538712.2014.918072
Friel, J. A. (2016).What detoxifies shame in integrative psychotherapy? An
Interpretative Phenomenological Analysis. British Journal of Psychotherapy,
32(4), 532–546. http://doi.org/10.1111/bjp.12246
Garrett, A., & Hassan, N. (2019). Understanding the silence of sexual harass-
ment victims through the #Why I didn’t report movement. https//arxiv.org/
abs.1906.00895.pdf
Gilbert, P., & Andrews, B. (Eds.). (1998). Shame: Interpersonal behavior, psychopa-
thology, and culture. Oxford University Press.
Herman, J. L. (2011). Posttraumatic stress disorder as a shame disorder. In R. L.
Dearing & J. P. Tangney (Eds.), Shame in the therapy hour (pp. 261–275).
American Psychological Association.
Holl, J., Wolff, S., Schumacher, M., Höcker, A., Arens, E. A., Spindler, G., Stopsack,
M., Südhof, J., Hiller, P., Klein, M., Schäfer, I., & Barnow, S. (2017). Substance
use to regulate intense posttraumatic shame in individuals with childhood abuse
and neglect. Development and Psychopathology, 29(3), 737–749. https://doi.
org/10.1017/S0954579416000432
Hunter, S. V. (2011). Disclosure of child sexual abuse as a life-long process:
Implications for health professionals. Australian and New Zealand Journal of
Family Therapy, 32(2), 159–172. http://doi.org/10.1375/anft.32.2.159
Kaufman, G. (1996). The psychology of shame: Theory and treatment of shame-based
syndromes (2nd ed.). Springer Pub.
Kealy, D., Spidel, A., & Ogrodniczuk, J. S. (2017). Self-conscious emotions and
suicidal ideation among women with and without history of childhood sexual
abuse. Counselling & Psychotherapy Research, 17(4), 269–275. https://doi.
org/10.1002/capr.12140
Kennedy, A. C., & Prock, K. A. (2018). “I still feel like I am not normal”: A review
of the role of stigma and stigmatization among female survivors of child sexual
abuse, sexual assault, and intimate partner violence. Trauma, Violence, & Abuse,
19(5), 512–527. https://doi.org/10.1177/1524838016673601
LaBash, H., & Papa, A. (2014). Shame and PTSD symptoms. Psychological Trauma:
Theory, Research, Practice, and Policy, 6(2), 159. https://doi.org/10.1037/
a0032637

McElvaney et al. NP18757
McElvaney et al. 19
Collin-Vézina, D., De La Sablonnière-Griffin, M., Sivagurunathan, M., Lateef, R.,
Alaggia, R., McElvaney, R., & Simpson, M. (2021). “How many times did I
not want to live a life because of him”: The complex connections between child
sexual abuse, disclosure, and self-injurious thoughts and behaviors. Borderline
Personality Disorder and Emotion Dysregulation, 8(1), 1–13. https://doi.
org/10.1186/s40479-020-00142-6
Dearing, R. L., & Tangney, J. P. E. (2011). Shame in the therapy hour. American
Psychological Association.
Deblinger, E., & Runyon, M. K. (2005). Understanding and treating feelings of shame
in children who have experienced maltreatment. Child Maltreatment, 10(4), 364–
376. https://doi.org/10.1177/1077559505279306
DeCou, C. R., Mahoney, C. T., Kaplan, S. P., & Lynch, S. M. (2019). Coping self-effi-
cacy and trauma-related shame mediate the association between negative social
reactions to sexual assault and PTSD symptoms. Psychological Trauma: Theory,
Research, Practice, and Policy, 11(1), 51. https://doi.org/10.1037/tra0000379
Denzin, N. K. (1978). The research act: A theoretical introduction to sociological
methods (2nd ed.). McGraw-Hill.
Dolev-Cohen, M., Ricon, T., & Levkovich, I. (2020). #WhyIdidn’treport: Reasons
why young Israelis do not submit complaints regarding sexual abuse. Children and
Youth Services Review, 115. https://doi.org/10.1016/j.childyouth.2020.105044
Dorahy, M. J., & Clearwater, K. (2012). Shame and guilt in men exposed to childhood
sexual abuse: A qualitative investigation. Journal of Child Sexual Abuse, 21(2),
155–175. https://doi.org/10.1080/10538712.2012.659803
Dorahy, M. J., McKendry, H., Scott, A., Yogeeswaran, K., Martens, A., & Hanna, D.
(2017). Reactive dissociative experiences in response to acute increases in shame
feelings. Behaviour Research and Therapy, 89, 75–85. https://doi.org/10.1016/j.
brat.2016.11.007
Drisko, J. (1997). Strengthening qualitative studies and reports: Standards to promote
academic integrity. Journal of Social Work Educa-tion, 33(1), 185–197. http://
doi.org/10.1080/10437797.1997.10778862
Dyer, K. F. W., Dorahy, M. J., Corry, M., Black, R., Matheson, L., Coles, H., Curran,
D., Seager, L., & Middleton, W. (2017). Comparing shame in clinical and non-
clinical populations: Preliminary findings. Psychological Trauma: Theory,
Research, Practice, and Policy, 9(2), 173–180. http://dx.doi.org/10.1037/
tra0000158
Elison, J., Pulos, S., & Lennon, R. (2006). Shame-focused coping: An empirical study
of the compass of shame. Social Behavior and Personality: An International
Journal, 34(2), 161–168. https://doi.org/10.2224/sbp.2006.34.2.161
Feiring, C., & Taska, L. S. (2005). The persistence of shame following sexual abuse:
A longitudinal look at risk and recovery. Child Maltreatment, 10(4), 337–349.
https://doi.org/10.1177/1077559505276686
Feiring, C., Taska, L. S., & Lewis, M. (1996). A process model for understanding
adaptation to sexual abuse: The role of shame in defining stigmatization. Child
Abuse & Neglect, 20, 767–782. https://doi.org/10.1016/0145-2134(96)00064-6
20 Journal of Interpersonal Violence
Felitti, V., & Anda, R. (2010). The relationship of adverse childhood experiences to
adult medical disease, psy-chiatric disorders and sexual behavior: Implications
for healthcare. In R. Lanius, E. Vermetten, & C. Pain (Eds.), The impact of early
life trauma on health and disease: The hidden epidemic (pp. 77–87). Cambridge
University Press. http://doi.org/10.1017/CBO9780511777042.010
Finkelhor, D., & Browne, A. (1985). The traumatic impact of child sexual abuse: A
conceptualization. American Journal of Orthopsychiatry, 55(4), 530–541. http://
doi.org/10.1111/j.1939-0025.1985.tb02703.x
Foster, J. M. & Hagedorn, W. B. (2014). Through the eyes of the wounded: A narrative
analysis of children’s sexual ab use experiences and recovery process. Journal of
Child Sexual Abuse, 23(5), 538-557. https://doi.org/10.1080/10538712.2014.918072
Friel, J. A. (2016).What detoxifies shame in integrative psychotherapy? An
Interpretative Phenomenological Analysis. British Journal of Psychotherapy,
32(4), 532–546. http://doi.org/10.1111/bjp.12246
Garrett, A., & Hassan, N. (2019). Understanding the silence of sexual harass-
ment victims through the #Why I didn’t report movement. https//arxiv.org/
abs.1906.00895.pdf
Gilbert, P., & Andrews, B. (Eds.). (1998). Shame: Interpersonal behavior, psychopa-
thology, and culture. Oxford University Press.
Herman, J. L. (2011). Posttraumatic stress disorder as a shame disorder. In R. L.
Dearing & J. P. Tangney (Eds.), Shame in the therapy hour (pp. 261–275).
American Psychological Association.
Holl, J., Wolff, S., Schumacher, M., Höcker, A., Arens, E. A., Spindler, G., Stopsack,
M., Südhof, J., Hiller, P., Klein, M., Schäfer, I., & Barnow, S. (2017). Substance
use to regulate intense posttraumatic shame in individuals with childhood abuse
and neglect. Development and Psychopathology, 29(3), 737–749. https://doi.
org/10.1017/S0954579416000432
Hunter, S. V. (2011). Disclosure of child sexual abuse as a life-long process:
Implications for health professionals. Australian and New Zealand Journal of
Family Therapy, 32(2), 159–172. http://doi.org/10.1375/anft.32.2.159
Kaufman, G. (1996). The psychology of shame: Theory and treatment of shame-based
syndromes (2nd ed.). Springer Pub.
Kealy, D., Spidel, A., & Ogrodniczuk, J. S. (2017). Self-conscious emotions and
suicidal ideation among women with and without history of childhood sexual
abuse. Counselling & Psychotherapy Research, 17(4), 269–275. https://doi.
org/10.1002/capr.12140
Kennedy, A. C., & Prock, K. A. (2018). “I still feel like I am not normal”: A review
of the role of stigma and stigmatization among female survivors of child sexual
abuse, sexual assault, and intimate partner violence. Trauma, Violence, & Abuse,
19(5), 512–527. https://doi.org/10.1177/1524838016673601
LaBash, H., & Papa, A. (2014). Shame and PTSD symptoms. Psychological Trauma:
Theory, Research, Practice, and Policy, 6(2), 159. https://doi.org/10.1037/
a0032637

NP18758 Journal of Interpersonal Violence 37(19-20)
McElvaney et al. 21
Lemaigre, C., Taylor, E. P., & Gittoes, C. (2017). Barriers and facilitators to disclos-
ing sexual abuse in childhood and adolescence: A systematic review. Child Abuse
& Neglect, 70, 39–52. https://doi.org/10.1016/j.chiabu.2017.05.009
Lev-Wiesel, R., Eisikovits, Z., First, M., Gottfried, R., & Mehlhausen, D. (2016).
Prevalence of child maltreatment in Israel: A national epidemiological study.
Journal of Child and Adolescent Trauma, 11, 141–150. http://doi.org/10.1007/
s40653-016-0118-8
Lewis, M. (2000). Self-conscious emotions: Embarrassment, pride, shame, and guilt.
In M. Lewis & J. Haviland (Eds.), Handbook of emotions (pp. 623–636). Guilford
Press.
Littleton, H. L., Magee, K. T., & Axsom, D. (2007). A meta-analysis of self-attribu-
tions following three types of trauma: Sexual victimization, illness, and injury.
Journal of Applied Social Psychology, 37(3), 515–538. http://doi.org/10.1111/
j.1559-1816.2007.00172.x
MacGinley, M., Breckenridge, J., & Mowll, J. (2019). A scoping review of adult
survivors’ experiences of shame following sexual abuse in childhood. Health &
Social Care in the Community, 27, 1135–1146. http://doi.org/10.1111/hsc.12771
MacIntosh, H., Fletcher, K., & Collin-Vézina, D. (2016). “I was like damaged, used
goods”: Thematic analysis of disclosures of childhood sexual abuse to romantic
partners. Marriage & Family Review, 52(6), 598–611. https://doi.org/10.1080/0
1494929.2016.1157117
Malloy, L. C., Sutherland, J. E., & Cauffman, E. (2019). Sexual abuse disclosure
among incarcerated female adolescents and young adults. Child Abuse & Neglect,
116(1), 104147. https://doi.org/10.1016/j.chiabu.2019.104147
McCracken, G. (1988). The long interview: Qualitative research methods. Sage.
McElvaney, R. (2015). Disclosure of child sexual abuse: Delays, non-disclosure and
partial Disclosure. What the research tells us and implications for practice. Child
Abuse Review, 24, 159–169. https://doi.org/10.1002/car.2280
McElvaney, R., Greene, S., & Hogan, D. (2014). To tell or not to tell? Factors influencing
young people’s informal disclosures of child sexual abuse. Journal of Interpersonal
Violence, 29(5), 928–947. https://doi.org/10.1177/0886260513506281
McElvaney, R., & Nixon, E. (2019). Parents’ experiences of their child’s disclosure of
child sexual abuse. Family Process, 59(4), 1773–1788. https://doi.org/10.1111/
famp.12507
Morrison, S. E., Bruce, C., & Wilson, S. (2018). Children’s disclosure of sexual
abuse: A systematic review of qualitative research exploring barriers and facilita-
tors. Journal of Child Sexual Abuse, 27(2), 176–194. https://doi.org/10.1080/10
538712.2018.1425943
Nathanson, D. L. (1992). Shame and pride: Affect, sex, and the birth of the self. W.
W. Norton & Company.
Negrao, C., Bonanno, G. A., Noll, J. G., Putnam, F. W., & Trickett, P. K. (2005).
Shame, humiliation, and childhood sexual abuse: Distinct contributions
22 Journal of Interpersonal Violence
and emotional coherence. Child Maltreat-ment, 10(4), 350–363. http://doi.
org/10.1177/1077559505279366
Paivio, S. C., & Pascual-Leone, A. (2010). Emotion-focused therapy for complex
trauma: An integrative approach. American Psychological Association. http://
doi.org/10.1037/12077-000
Rahm, G. B., Renck, B., & Ringsberg, K. C. (2006). “Disgust, disgust beyond descrip-
tion” - shame cues to detect shame in disguise, in interviews with women who
were sexually abused during childhood. Journal of Psychiatric and Mental Health
Nursing, 13(1), 100–109. https://doi.org/10.1111/j.1365-2850.2006.00927.x
Rahm, G. B., Renck, B., & Ringsberg, K. C. (2013). Psychological distress among
women who were sexually abused as children. International Journal of Social
Welfare, 22(3), 269–278. https://doi.org/10.1111/j.1468-2397.2012.00898.x
Retzinger, S. M. (1995). Identifying shame and anger in discourse. American Behavioral
Scientist, 38(8), 1104–1113. https://doi.org/10.1177/0002764295038008006
Sanderson, C. (2015). Counselling skills for working with shame. Jessica Kingsley
Publishers.
Schore, A. N. (2003). Affect dysregulation and disorders of the self (Norton Series on
Interpersonal Neurobiology). W. W. Norton & Company.
Sgroi, S. (1982). Handbook of clinical intervention in child sexual abuse. Simon and
Schuster.
Tangney, J. P., & Dearing, R. L. (2002). Shame and guilt. Guilford Press.
Tomkins, S. S. (1991). Affect/imagery/consciousness. Vol. 3: The negative affects:
Anger and fear. Springer.
Vikan, A., Hassel, A. M., Rugset, A., Johansen, H. E., & Moen, T. (2010). A test
of shame in outpatients with emotional disorder. Nordic Journal of Psychiatry,
64(3), 196–202. http://doi.org/10.3109/08039480903398177
Weiss, K. G. (2010). Male sexual victimization: Examining men’s experiences of
rape and sexual assault. Men and Masculinities, 12(3), 275–298. http://doi.
org/10.1177/1097184X08322632
Wetterlöv, J., Andersson, G., Proczkowska, M., Cederquist, E., Rahimi, M., &
Nilsson, D. (2020). Shame and guilt and its relation to direct and indirect experi-
ence of trauma in adolescence, a brief report. Journal of Family Violence. https://
doi.org/10.1007/s10896-020-00224-7
Whiffen, V. E., & MacIntosh, H. B. (2005). Mediators of the link between childhood
sexual abuse and emotional distress: A critical re-view. Trauma, Violence, &
Abuse, 6(1), 24–39. https://doi.org/10.1177/1524838004272543
Willig, C. (2008). Introducing qualitative research in psychology: Adventures in the-
ory and method (2nd ed.). McGraw-Hill and Open University Press.
Zhu, R., Wu, H., Xu, Z., Tang, H., Shen, X., Mai, X., & Liu, C. (2019). Early dis-
tinction between shame and guilt processing in an interpersonal context. Social
Neuroscience, 14(1), 53–66. https://doi.org/10.1080/17470919.2017.1391119
Zupanic, M. K., & Kreidler, M. C. (1998). Shame and the fear of feeling. Perspectives
in Psychiatric Care, 35(2), 29–34. https://doi.org/10.1111/j.1744-6163.1999.
tb00572.x

McElvaney et al. NP18759
McElvaney et al. 21
Lemaigre, C., Taylor, E. P., & Gittoes, C. (2017). Barriers and facilitators to disclos-
ing sexual abuse in childhood and adolescence: A systematic review. Child Abuse
& Neglect, 70, 39–52. https://doi.org/10.1016/j.chiabu.2017.05.009
Lev-Wiesel, R., Eisikovits, Z., First, M., Gottfried, R., & Mehlhausen, D. (2016).
Prevalence of child maltreatment in Israel: A national epidemiological study.
Journal of Child and Adolescent Trauma, 11, 141–150. http://doi.org/10.1007/
s40653-016-0118-8
Lewis, M. (2000). Self-conscious emotions: Embarrassment, pride, shame, and guilt.
In M. Lewis & J. Haviland (Eds.), Handbook of emotions (pp. 623–636). Guilford
Press.
Littleton, H. L., Magee, K. T., & Axsom, D. (2007). A meta-analysis of self-attribu-
tions following three types of trauma: Sexual victimization, illness, and injury.
Journal of Applied Social Psychology, 37(3), 515–538. http://doi.org/10.1111/
j.1559-1816.2007.00172.x
MacGinley, M., Breckenridge, J., & Mowll, J. (2019). A scoping review of adult
survivors’ experiences of shame following sexual abuse in childhood. Health &
Social Care in the Community, 27, 1135–1146. http://doi.org/10.1111/hsc.12771
MacIntosh, H., Fletcher, K., & Collin-Vézina, D. (2016). “I was like damaged, used
goods”: Thematic analysis of disclosures of childhood sexual abuse to romantic
partners. Marriage & Family Review, 52(6), 598–611. https://doi.org/10.1080/0
1494929.2016.1157117
Malloy, L. C., Sutherland, J. E., & Cauffman, E. (2019). Sexual abuse disclosure
among incarcerated female adolescents and young adults. Child Abuse & Neglect,
116(1), 104147. https://doi.org/10.1016/j.chiabu.2019.104147
McCracken, G. (1988). The long interview: Qualitative research methods. Sage.
McElvaney, R. (2015). Disclosure of child sexual abuse: Delays, non-disclosure and
partial Disclosure. What the research tells us and implications for practice. Child
Abuse Review, 24, 159–169. https://doi.org/10.1002/car.2280
McElvaney, R., Greene, S., & Hogan, D. (2014). To tell or not to tell? Factors influencing
young people’s informal disclosures of child sexual abuse. Journal of Interpersonal
Violence, 29(5), 928–947. https://doi.org/10.1177/0886260513506281
McElvaney, R., & Nixon, E. (2019). Parents’ experiences of their child’s disclosure of
child sexual abuse. Family Process, 59(4), 1773–1788. https://doi.org/10.1111/
famp.12507
Morrison, S. E., Bruce, C., & Wilson, S. (2018). Children’s disclosure of sexual
abuse: A systematic review of qualitative research exploring barriers and facilita-
tors. Journal of Child Sexual Abuse, 27(2), 176–194. https://doi.org/10.1080/10
538712.2018.1425943
Nathanson, D. L. (1992). Shame and pride: Affect, sex, and the birth of the self. W.
W. Norton & Company.
Negrao, C., Bonanno, G. A., Noll, J. G., Putnam, F. W., & Trickett, P. K. (2005).
Shame, humiliation, and childhood sexual abuse: Distinct contributions
22 Journal of Interpersonal Violence
and emotional coherence. Child Maltreat-ment, 10(4), 350–363. http://doi.
org/10.1177/1077559505279366
Paivio, S. C., & Pascual-Leone, A. (2010). Emotion-focused therapy for complex
trauma: An integrative approach. American Psychological Association. http://
doi.org/10.1037/12077-000
Rahm, G. B., Renck, B., & Ringsberg, K. C. (2006). “Disgust, disgust beyond descrip-
tion” - shame cues to detect shame in disguise, in interviews with women who
were sexually abused during childhood. Journal of Psychiatric and Mental Health
Nursing, 13(1), 100–109. https://doi.org/10.1111/j.1365-2850.2006.00927.x
Rahm, G. B., Renck, B., & Ringsberg, K. C. (2013). Psychological distress among
women who were sexually abused as children. International Journal of Social
Welfare, 22(3), 269–278. https://doi.org/10.1111/j.1468-2397.2012.00898.x
Retzinger, S. M. (1995). Identifying shame and anger in discourse. American Behavioral
Scientist, 38(8), 1104–1113. https://doi.org/10.1177/0002764295038008006
Sanderson, C. (2015). Counselling skills for working with shame. Jessica Kingsley
Publishers.
Schore, A. N. (2003). Affect dysregulation and disorders of the self (Norton Series on
Interpersonal Neurobiology). W. W. Norton & Company.
Sgroi, S. (1982). Handbook of clinical intervention in child sexual abuse. Simon and
Schuster.
Tangney, J. P., & Dearing, R. L. (2002). Shame and guilt. Guilford Press.
Tomkins, S. S. (1991). Affect/imagery/consciousness. Vol. 3: The negative affects:
Anger and fear. Springer.
Vikan, A., Hassel, A. M., Rugset, A., Johansen, H. E., & Moen, T. (2010). A test
of shame in outpatients with emotional disorder. Nordic Journal of Psychiatry,
64(3), 196–202. http://doi.org/10.3109/08039480903398177
Weiss, K. G. (2010). Male sexual victimization: Examining men’s experiences of
rape and sexual assault. Men and Masculinities, 12(3), 275–298. http://doi.
org/10.1177/1097184X08322632
Wetterlöv, J., Andersson, G., Proczkowska, M., Cederquist, E., Rahimi, M., &
Nilsson, D. (2020). Shame and guilt and its relation to direct and indirect experi-
ence of trauma in adolescence, a brief report. Journal of Family Violence. https://
doi.org/10.1007/s10896-020-00224-7
Whiffen, V. E., & MacIntosh, H. B. (2005). Mediators of the link between childhood
sexual abuse and emotional distress: A critical re-view. Trauma, Violence, &
Abuse, 6(1), 24–39. https://doi.org/10.1177/1524838004272543
Willig, C. (2008). Introducing qualitative research in psychology: Adventures in the-
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Author Biographies
Rosaleen McElvaney is Principal Psychotherapist at Children’s Health Ireland
(CHI), and Assistant Professor of Psychotherapy in the School of Nursing,
Psychotherapy and Community Health at Dublin City University. She is the author of
two books: Finding the Words: Talking Children Through the Tough Times (Veritas,
2015) and Helping Children Tell About Sexual Abuse: Guidance for Helpers (Jessica
Kingsley, 2016).
Rusan Lateef is a PhD student in the School of Social Work at McGill University at
the Centre for Research on Children and Families (CRCF). Rusan’s doctoral research
will focus on child sexual abuse and shame and the therapeutic process for child sex-
ual abuse survivors.
Delphine Collin-Vézina is the Director of the Centre for Research on Children and
Families at McGill University, a licensed clinical psychologist, and a Full Professor
at the McGill School of Social Work. She is also an Associate Member in the
Department of Pediatrics where she holds the Nicolas Steinmetz and Gilles Julien
Chair in Community Social Pediatrics.
Ramona Alaggia is a Professor at the Factor-Inwentash Faculty of Social Work
University of Toronto and the Margaret & Wallace McCain Family Chair in Child &
Family. The 3rd edition of her book Cruel but Not Unusual: Violence in Relationships
and Families in Canada will be released in 2021.
Megan Simpson is a faculty member of the School of Social Work in Carleton
University, Ottawa, Ontario, who specializes in child welfare, culture, and child sex-
ual abuse. Megan completed her PhD from McGill University in Montreal. She is a
member of the research group on social responses to complex trauma.