Skip to main content
    • Aa
    • Aa

The impact of sexual abuse on female development: Lessons from a multigenerational, longitudinal research study

  • Penelope K. Trickett (a1), Jennie G. Noll (a2) and Frank W. Putnam (a2)

This is a report on the research design and findings of a 23-year longitudinal study of the impact of intrafamilial sexual abuse on female development. The conceptual framework integrated concepts of psychological adjustment with theory regarding how psychobiological factors might impact development. Participants included 6- to 16-year-old females with substantiated sexual abuse and a demographically similar comparison group. A cross-sequential design was used and six assessments have taken place, with participants at median age 11 at the first assessment and median age 25 at the sixth assessment. Mothers of participants took part in the early assessments and offspring took part at the sixth assessment. Results of many analyses, both within circumscribed developmental stages and across development, indicated that sexually abused females (on average) showed deleterious sequelae across a host of biopsychosocial domains including: earlier onsets of puberty, cognitive deficits, depression, dissociative symptoms, maladaptive sexual development, hypothalamic–pituitary–adrenal attenuation, asymmetrical stress responses, high rates of obesity, more major illnesses and healthcare utilization, dropping out of high school, persistent posttraumatic stress disorder, self-mutilation, Diagnostic and Statistical Manual of Mental Disorders diagnoses, physical and sexual revictimization, premature deliveries, teen motherhood, drug and alcohol abuse, and domestic violence. Offspring born to abused mothers were at increased risk for child maltreatment and overall maldevelopment. There was also a pattern of considerable within group variability. Based on this complex network of findings, implications for optimal treatments are elucidated. Translational aspects of extending observational research into clinical practice are discussed in terms that will likely have a sustained impact on several major public health initiatives.

Corresponding author
Address correspondence and reprint requests to: Penelope K. Trickett, School of Social Work, Montgomery Ross Fisher Building, University of Southern California, Los Angeles, CA 90899-0411; E-mail:
Hide All
Ainsworth M. D. S., Blehar M. C., Waters E., & Wall S. (1978). Patterns of attachment. Hillsdale, NJ: Erlbaum.
Armstrong J. G., Putnam F. W., Carlson E. B., Libero D. Z., & Smith S. R. (1997). Development and validation of a measure of adolescent dissociation: The Adolescent Dissociative Experiences Scale. Journal of Nervous and Mental Disease, 185, 491497.
Barnes J., Noll J., Putnam F., & Trickett P. (2009). Sexual and physical revictimization among victims of severe childhood sexual abuse. Child Abuse & Neglect, 33, 412420.
Bauer A. M., Quas J. A., & Boyce W. T. (2002). Associations between physiological reactivity and children's behavior: Advantages of a multisystem approach. Journal of Developmental & Behavioral Pediatrics, 23, 102113.
Beaudoin A. S., Carbonneau N., Godbout N., Bouchard S., & Sabourin S. (2007). Validation préliminaire du Questionnaire d'Activités et d'Attitudes à l'Égard de la Sexualité [Preliminary validation of the Sexual Activities and Attitudes Questionnaire]. Canadian Journal of Behavioral Science, 39, 301306.
Bell R. Q. (1953). Convergence: An accelerated longitudinal approach. Child Development, 24, 145152.
Belsky J., Steinberg L., & Draper P. (1991). Childhood experience, interpersonal development, and reproductive strategy: An evolutionary theory of socialization. Child Development, 62, 647670.
Bergman B., & Brismar B. (1994). Hormone levels and personality traits in abusive and suicidal male alcoholics. Alcoholism: Clinical and Experimental Research, 18, 311316.
Bonanno G. A., Colak D. M., Keltner D., Shiota M. N., Papa A., Noll J. G., et al. (2007). Context matters: The benefits and costs of expressing positive emotion among survivors of childhood sexual abuse. Emotion, 7, 824837.
Bonanno G. A., Keltner D., Noll J. G., Putnam F. W., Trickett P. K., LeJeune J., et al. (2002). When the face reveals what words do not: Facial expressions of emotion, smiling, and the willingness to disclose childhood sexual abuse. Journal of Personality and Social Psychology, 83, 94110.
Bonanno G. A., Noll J. G., Putnam F. W., O'Neill M., & Trickett P. K. (2003). Predicting the willingness to disclose childhood sexual abuse from measures of repressive coping and dissociative tendencies. Child Maltreatment, 8, 302318.
Bremner D., Vermetten E., & Kelley M. E. (2007). Cortisol, dehydroepiandrosterone, and estradiol measured over 24 hours in women with childhood sexual abuse-related posttraumatic stress disorder. Journal of Nervous and Mental Disease, 195, 919927.
Briere J., & Runtz M. (1987). Post-sexual abuse trauma: Data and implications for clinical practice. Journal of Interpersonal Violence, 2, 367379.
Carlson E. B., & Putnam F. W. (1993). An update on the Dissociative Experiences Scale. Dissociation, 6, 1627.
Carrion V. G., Weems C. F., Ray R. D., Glaser B., Hessl D., & Reiss A. L. (2002). Diurnal salivary cortisol in pediatric posttraumatic stress disorder. Biological Psychiatry, 51, 575582.
Cattell R. B., & Horn J. L. (1978). A check on the theory of fluid and crystallized intelligence with description of new subtest designs. Journal of Educational Measurement, 15, 139164.
Crittenden P. M. (1992). Quality of attachment in the preschool years. Development and Psychopathology, 4, 209241.
Crittenden P. M. (1997–2005). School-age assessment of attachment coding manual. Unpublished manuscript, Miami, FL.
DeBellis M. D. (2001). Developmental traumatology: The psychobiological development of maltreatment children and its implications for research, treatment and policy. Development and Psychopathology, 13, 537561.
De Bellis M. D., Chrousos G. P., Dorn L. D., Burke L., Helmers K., Kling M. A., et al. (1994). Hypothalamic–pituitary–adrenal axis dysregulation in sexually abused girls. Journal of Clinical Endocrinology and Metabolism, 78, 249255.
Dunlop S. A., Archer M. A., Quinlivan J. A., Beazley L. D., & Newnham J. P. (1997). Repeated prenatal corticosteroids delay myelination in the ovine central nervous system. Journal of Maternal–Fetal Medicine, 6, 309313.
Dunn L., & Dunn L. (1981). Manual for the Peabody Picture Vocabulary Test—Revised. Circle Pines, MN: American Guidance Service.
Ekman P., Friesen W. V., & Hager J. C. (2002). The Facial Action Coding System (2nd ed.). Salt Lake City, UT: Research Nexus eBook.
Ellis B. J., McFadyen-Ketchum S., Dodge K. A., Pettit G. S., & Bates J. E. (1999). Quality of early family relationships and individual differences in the timing of pubertal maturation in girls: A longitudinal test of an evolutionary model. Journal of Personality and Social Psychology, 77, 387401.
Farnfield S., Hautamäki A., Nørbech P., & Sahhar N. (2010). DMM assessments of attachment and adaptation: Procedures, validity and utility. Clinical Child Psychology and Psychiatry, 15, 313328.
Felitti V. J., Anda R. F., Nordenberg D., Williamson D. F., Spitz A. M., Edwards V., et al. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine, 14, 245258.
Fergusson D. M., Horwood L. J., & Woodward L. J. (2000). The stability of child abuse reports: A longitudinal study of the reporting behavior of young adults. Psychological Medicine, 30, 529544.
Friedrick W. M., Beilke R. L., & Urquiza A. J. (1987). Children from sexually abusive families: A behavioral comparison. Journal of Interpersonal Violence, 2, 391402.
Greenberg J. B. (2001). Childhood sexual abuse and sexually transmitted diseases in adults: A review of and implications for STD/HIV programmes. International Journal of STD & AIDS, 12, 777783.
Grella C. H., & Joshi V. (2003). Treatment processes and outcomes among adolescents with a history of abuse who are in drug treatment. Child Maltreatment, 8, 718.
Gunnar M. R., Gonzalez C. A., Goodlin B. L., & Levine S. (1981). Behavioral and pituitary–adrenal responses during a prolonged separation period in infant rhesus macaques. Psychoneuroendocrinology, 6, 6575.
Harter S. (1985). The perceived competence scale for children. Child Development, 53, 8797.
Harter S. (1988). Manual for the perceived competence scale for adolescence. Unpublished manuscript, University of Denver, Department of Psychology.
Heim C., Ehlert U., & Hellhammer D. H. (2000). The potential role of hypocortisolism in the pathophysiology of stress-related bodily disorders. Psychoneuroendocrinology, 25, 135.
Hill A. B. (1965). The environment and disease: Association or causation? Proceedings of the Royal Society of Medicine, 58, 295300.
Horowitz L. (1995). Factors affecting utilization of treatment services by sexually abused girls. MS thesis, Catholic University of America.
Horowitz L. (1998). The relationship of childhood sexual abuse to revictimization: Mediating variables and developmental processes. Doctoral dissertation, Catholic University of America.
Howard K. S., & Brooks-Gunn J. (2009). The role of home-visiting programs in preventing child abuse and neglect. The Future of Children, 19, 119146.
Jareb H. (1995). Developmental patterns of comorbidity in sexually abused girls. MS thesis, American University.
Kaufman J., & Zigler E. (1987). Do abused children become abusive parents? American Journal of Orthopsychiatry, 57, 186192.
Kim K. (2007). Parenting practice among non-offending mothers of sexually abused girls and its impact on the abused girls' behavioral adjustment: Perspectives from a multigenerational, longitudinal study. Doctoral dissertation, University of Southern California, Los Angeles.
Kim K., Chung I., & Trickett P. K. (2007). Social support characteristics among mothers with and without childhood sexual abuse trauma. Korean Journal of Social Welfare Studies, 35, 215237.
Kim K., Noll J. G., Putnam F. W., & Trickett P. K. (2007). Psychosocial characteristics of nonoffending mothers of sexually abused girls: Findings from a prospective, multigenerational study. Child Maltreatment, 12, 338351.
Kim K., Trickett P. K., & Putnam F. W. (2010). Childhood experiences of sexual abuse and later parenting practices among non-offending mothers of sexually abused and comparison girls. Child Abuse & Neglect, 34, 610622.
Klein D. N., Arnow B. A., Barkin J. L., Dowling F., Kocsis J. H., Leon A. C., et al. (2009). Early adversity in chronic depression: Clinical correlates and response to pharmacology. Depression and Anxiety, 26, 701710.
Kovacs M. (1981). Rating scales to assess depression in school-aged children. Acta Paedopsychiatrica, 46, 305315.
Krinsley K. E., Weathers F. W., Vielhauer M. J., Newman E., Walker E. A., Kaloupek D. G., et al. (1994). Manual for the evaluation of lifetime stressors. Boston: National Center for Posttraumatic Stress Disorder, Behavioral Science Division.
Kwako L. E., Noll J. G., Putnam F. W., & Trickett P. K. (2010). Childhood sexual abuse and attachment: An intergenerational perspective. Clinical Child Psychology and Psychiatry, 15, 407422.
Layne C. M., Olsen J. A., Baker A., Legerski J.-P., Isakson B., Pašalić A., et al. (2010). Unpacking trauma exposure risk factors and differential pathways of influence: Predicting postwar mental distress in Bosnian adolescents. Child Development, 81, 10531076.
Margolin G., Burman B., John R. S., & O'Brien M. (1990). The Domestic Conflict Index. Unpublished manuscript, University of Southern California.
Mausert-Mooney R. (1992). Appeal and vulnerability patterns in girl victims of incest. Unpublished manuscript., Western Michigan University.
McCloskey K. A., & Bailey J. A. (2000). The ingergenerational transmission of risk for child sexual abuse. Journal of Interpersonal Violence, 15, 10191035.
Mendle J., Turkheimer E., & Emery R. E. (2007). Detrimental psychological outcomes associated with early pubertal timing in adolescent girls. Developmental Review, 27, 151171.
Messman T. L., & Long P. J. (1996). Child sexual abuse and its relationship to revictimization in adult women: A review. Clinical Psychology Review, 16, 397420.
Mikton C., & Butchart A. (2009). Child maltreatment prevention: A systematic review of reviews. Bulletin of the World Health Organization, 87, 353361.
Miller G. E., Chen E., & Zhou E. S. (2007). If it goes up, must it come down? Chronic stress and the hypothalamic–pituitary–adrenocortical axis in humans. Psychological Bulletin, 133, 2545.
National Center on Child Abuse and Neglect. (1988). NIS-2: Second study of national incidence and prevalence of child abuse and neglect. Washington, DC: Author.
Negrao C., Bonanno G. A., Noll J. G., Putnam F. W., & Trickett P. K. (2005). Shame, humiliation, and childhood sexual abuse: Comparing discrete and clinical theories of emotion. Child Maltreatment, 10, 350363.
Negriff S., Noll J. G., Shenk C. E., Putnam F. W., & Trickett P. K. (2010). Associations between nonverbal behaviors and subsequent sexual attitudes and behaviors of sexually abused and comparison girls. Child Maltreatment, 15, 180189.
Nemeroff C. B., Heim C. M., Thase M. E., Klein D. N., Rush A. J., Schatzberg A. F., et al. (2003). Differential responses to psychotherapy versus pharmacotherapy in patients with chronic forms of major depression and childhood trauma. Proceedings of the National Academy of Sciences of the United States of America, 100, 1429314296.
Neumann A., Ojong T. N., Yanes P. K., Tumiel-Berhalter L., Daigler G. E., & Blondell R. D. (2010). Differences between adolescents who complete and fail to complete residential substance abuse treatment. Journal of Addictive Diseases, 29, 427435.
Noll J. G. (2004, March). Long-term effects of childhood sexual abuse on female development. Paper presented at the 2nd Annual International Congress on Woman's Mental Health. Washington, DC.
Noll J. G., Barnes J., & Trickett P. K. (2010, March). Sexual and physical (re) victimization of sexually abused females: The plausible role of global dysregulation. Paper presented at the Society for Research on Adolescence Biennial Meeting, Philadelphia, PA.
Noll J. G., Horowitz L. A., Bonanno G. A., Trickett P. K., & Putnam F. W. (2003). Revictimization and self-harm in females who experienced childhood sexual abuse: Results from a prospective study. Journal of Interpersonal Violence, 18, 14521471.
Noll J. G., Newland R., & Hulsmann J. A. (2006, March). Teen pregnancy and sexual abuse. Paper presented at the Society for Research in Adolescents National Meeting, San Francisco, CA.
Noll J. G., Schulkin J., Trickett P. K., Susman E. J., Breech L., & Putnam F. W. (2007). Differential pathways to preterm delivery for sexually abused and comparison women. Journal of Pediatric Psychology, 32, 12381248.
Noll J. G., Shenk C. E., Yeh M. T., Ji J., Putnam F. W., & Trickett P. K. (2010). Receptive language and educational attainment for sexually abused females. Pediatrics, 126, e615e622.
Noll J. G., & Trickett P. K. (2009, June). Accelerated puberty associated with childhood sexual abuse. Paper presented at the International Colloquium of Pubertal Development, Stress and Health, Bretesche, France.
Noll J. G., Trickett P. K., Harris W. W., & Putnam F. W. (2009). The cumulative burden borne by offspring whose mothers were sexually abused as children. Journal of Interpersonal Violence, 24, 424449.
Noll J. G., Trickett P. K., & Putnam F. W. (2000). Social network constellation and sexuality of sexually abused and comparison girls in childhood and adolescence. Child Maltreatment, 5, 323337.
Noll J. G., Trickett P. K., & Putnam F. W. (2003). A prospective investigation of the impact of childhood sexual abuse on the development of sexuality. Journal of Consulting and Clinical Psychology, 71, 575586.
Noll J. G., Trickett P. K., Susman E. J., & Putnam F. W. (2006). Sleep disturbances and childhood sexual abuse. Journal of Pediatric Psychology, 31, 469480.
Noll J. G., Zeller M. H., Trickett P. K., & Putnam F. W. (2007). Obesity risk for female victims of childhood sexual abuse: A prospective study. Pediatrics, 120, e61e67.
Olds D., Henderson C., Chamberlin R., & Tatelbaum R. (1986). Prevention of child abuse and neglect: A randomized trial of nurse home visitation. Pediatrics, 78, 6578.
Olds D., Kitzman H. J., Cole R. E., Hanks C. A., Arcoleo K. J., Anson E. A., et al. (2010). Enduring effects of prenatal and infancy home visiting by nurses on maternal life course and government spending: Follow-up of a randomized trial among children at age 12 years. Archives of Pediatrics Adolescent Medicine, 164, 419424.
Oviedo-Joekes E., Marchand K., Guh D., Marsh D. C., Brissette S., Krausz M., et al. (in press). History of reported sexual or physical abuse among long-term heroin users and their response to substitution treatment, Addictive Behaviors.
Pasquali R., Cantobelli S., Casimirri F., Capelli M., Bortoluzzi L., Flamia R., et al. (1993). The hypothalamic–pituitary–adrenal axis in obese women with different patterns of body fat distribution. Journal of Clinical Endocrinology & Metabolism, 77, 341346.
Pence B. W. (2009). The impact of mental health and traumatic life experiences on antiretroviral treatment outcomes for people living with HIV/AIDS. Journal of Antimicrobial Chemotherapy, 63, 636640.
Putnam F. W., Helmers K., Horowitz L. A., & Trickett P. K. (1995). Hypnotizability and dissociativity in sexually abused girls. Child Abuse & Neglect, 19, 645655.
Putnam F. W., Helmers K., & Trickett P. K. (1993). Development, reliability, and validity of a child dissociation scale. Child Abuse & Neglect, 17, 731741.
Putnam F. W., & Trickett P. K. (1987). The psychobiological effects of child sexual abuse. New York: W. T. Grant Foundation.
Putnam F. W., & Trickett P. K. (1993). Child sexual abuse: A model of chronic trauma. Psychiatry, 56, 8295.
Raison C. L., & Miller A. H. (2003). When not enough is too much: The role of insufficient glucocorticoid signaling in the pathophysiology of stress related disorders. American Journal of Psychiatry, 160, 15541565.
Reich W. (2000). Diagnostic Interview for Children and Adolescents. Journal of the American Academy of Child & Adolescent Psychiatry, 39, 5966.
Rosen G. M., & Davison G. C. (2003). Psychology should list empirically supported principles of change (ESPs) and not credential trademarked therapies or other treatment packages. Behavior Modification, 27, 300312.
Rosmond R. (2003). Stress induced disturbances of the HPA axis: A pathway to type 2 diabetes? Medical Science Monitor 9, RA35RA39.
Roth A., & Fonagy P. (2005). What works for whom?: A critical review of psychotherapy research (2nd ed.). New York: Guilford Press.
Rubin D. M., O'Reilly A. L. R., Luan X., Dai D., Localio A. R., & Christian C. W. (in press). Variation in pregnancy outcomes following statewide implementation of a prenatal home visitation program. Archives of Pediatrics Adolescent Medicine.
Russell D. E. H. (1986). The secret trauma: Incest in the lives of girls and women. New York: Basic Books.
Schaie K. W., & Hertzog C. (1982). Longitudinal methods. In Wolman B. B. (Ed.), Handbook of developmental psychology. New York: Prentice Hall.
Shenk C. E., Noll J. G., Putnam F. W., & Trickett P. K. (2010). A prospective examination of the role of childhood sexual abuse and physiological asymmetry in the development of psychopathology. Child Abuse & Neglect, 34, 752761.
Sickel A. E., Noll J. G., Moore P. J., Putnam F. W., & Trickett P. K. (2002). The long-term physical health and healthcare utilization of women who were sexually abused as children. Journal of Health Psychology, 7, 583597.
Silverman W. K., Ortiz C. D., Viswesvaran C., Burns B. J., Kolko D. J., Putnam F. W., et al. (2008). Evidence-based psychosocial treatments for children and adolescents exposed to traumatic events. Journal of Clinical Child and Adolescent Psychology, 37, 156183.
Sternberg E. M., & Gold P. W. (2002). The mind–body interaction in disease. Scientific American, 12, 8289.
Susman E. J. (2006). Psychobiology of persistent antisocial behavior: Stress, early vulnerabilities and the attenuation hypothesis. Neuroscience & Biobehavioral Reviews, 30, 376389.
Teutsch S., & Harris J. (2003). Introduction. In Haddix A., Teutsch S. & Corso P. (Eds.), Prevention effectiveness (pp. 110). New York: Oxford University Press.
Theodore A. D., Chang J. J., Runyan D. K., Hunter W. M., Bangdiwala S. I., & Agans R. (2005). Epidemiologic features of the physical and sexual maltreatment of children in the Carolinas. Pediatrics, 115, e331e337.
Trickett P. K. (1983). The interaction of cognitive styles and classroom environment in determining first-graders' behavior. Journal of Applied Developmental Psychology, 4, 4364.
Trickett P. K., & Everett B. (1988). Mothers' Developmental History Questionnaire. Unpublished manuscript, Bethesda, MD.
Trickett P. K., McBride-Chang C., & Putnam F. W. (1994). The classroom performance and behavior of sexually abused females. Development and Psychopathology, 6, 183194.
Trickett P. K., Noll J. G., Reiffman A., & Putnam F. W. (2001). Variants of intrafamilial sexual abuse experience: Implications for short- and long-term development. Development and Psychopathology, 13, 10011019.
Trickett P. K., Noll J. G., Susman E. J., Shenk C. E., & Putnam F. W. (2010). Attenuation of cortisol across development for victims of sexual abuse. Development and Psychopathology, 22, 165175.
Trickett P. K., & Putnam F. W. (1990–1993). Sexual abuse of females: Effects in childhood. Washington, DC: National Institute of Mental Health.
Trickett P. K., & Putnam F. W. (1993). Impact of child sexual abuse on females: Toward a developmental, psychobiological integration. Psychological Science, 4, 8187.
Trickett P. K., Reiffman A., Horowitz L. A., & Putnam F. W. (1997). Characteristics of sexual abuse trauma and the prediction of developmental outcomes. In Cicchetti D. & Toth S. L. (Eds.), Developmental perspectives on trauma: Theory, research, and intervention (Vol. 8). New York: University of Rochester Press.
Udry R. (1988). The Sexual Activity Questionnaire for Girls and Boys. Unpublished manuscript.
van der Kolk B. A. (2005). Developmental trauma disorder: Toward a rational diagnosis for children with complex trauma histories. Psychiatric Annals, 35, 401408.
Westfall J. M., Mold J. & Fagnan L. (2007). Practice-based research—“Blue Highways” on the NIH Roadmap. Journal of the American Medical Association, 297, 403413.
Widom C. S., & Morris S. (1997). Accuracy of adult recollections of childhood victimization: Part 2. Childhood Sexual Abuse. Psychological Assessment, 9, 3446.
Williams L. M. (1994). Recall of childhood trauma: A prospective study of women's memories of child sexual abuse. Journal of Consulting & Clinical Psychology, 62, 11671176.
Williamson D. F., Thompson T. J., Anda R. F., Dietz W. H., & Felitti V. (2002). Body weight and obesity in adults and self-reported abuse in childhood. International Journal of Obesity and Related Metabolic Disorders, 26, 10751082.
Wolfe V. V., Gentile C., Michienzi T., & Sas L. (1991). The Children's Impact of Traumatic Events Scale: A measure of post-sexual-abuse PTSD symptoms. Behavioral Assessment, 13, 359383.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Development and Psychopathology
  • ISSN: 0954-5794
  • EISSN: 1469-2198
  • URL: /core/journals/development-and-psychopathology
Please enter your name
Please enter a valid email address
Who would you like to send this to? *


Full text views

Total number of HTML views: 84
Total number of PDF views: 725 *
Loading metrics...

Abstract views

Total abstract views: 2315 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 22nd October 2017. This data will be updated every 24 hours.