The impacts of child sexual abuse are different for each victim. For many victims, the abuse can have profound and lasting impacts. They experience deep, complex trauma, which can pervade all aspects of their lives, and cause a range of effects across their lifespans. Other victims do not perceive themselves to be profoundly harmed by the experience.

Some impacts on victims are immediate and temporary, while others can last throughout adulthood. Some emerge later in life; others abate only to re-emerge or manifest in response to triggers or events. As victims have new experiences or enter new stages of development over their life courses, the consequences of abuse may manifest in different ways.

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Many complex and interconnected factors can influence the way victims are affected by child sexual abuse. While no single factor can accurately predict how a victim will respond, some factors appear to influence either the severity or type of impacts they experience. These factors include the:

• characteristics of the abuse (such as the type, duration and frequency)
• relationship of the perpetrator to the child
• social, historical and institutional contexts of the abuse
• victim’s circumstances, experiences and characteristics (such as age, gender, disability, prior maltreatment, and experiences with disclosing the abuse).

The sources of strength and resilience that some victims draw on over the course of their lives play a key role in how they cope with and manage the effects of the abuse. We heard that these sources of strength and resilience include:

• strong relationships and social support from families, peers and others
• therapeutic activities
• education, work and leisure activities
• spirituality
• cultural connection
• a variety of inner resources, such as optimism and hope.

Child sexual abuse can affect many areas of a person’s life, including their:

• mental health
• interpersonal relationships
• physical health
• sexual identity, gender identity and sexual behaviour
• connection to culture
• spirituality and religious involvement
• interactions with society
• education, employment and economic security.

For some victims, child sexual abuse results in them taking their own lives.

The impacts of child sexual abuse most commonly described in research and in our private sessions and public hearings were mental health impacts. Of the survivors who provided information in private sessions about the impacts of being sexually abused, 94.9 per cent told us about mental health impacts. These impacts included:

• depression, anxiety and post-traumatic stress disorder (PTSD)
• other symptoms of mental distress such as nightmares and sleeping difficulties
• emotional issues such as feelings of shame, guilt and low self-esteem.

Notably, mental health issues were often described as occurring simultaneously, rather than as isolated problems or disorders.

After mental health, relationship difficulties were the impacts most frequently raised by survivors in private sessions, including difficulties with trust and intimacy, lack of confidence with parenting, and relationship problems. Education and economic impacts were also frequently raised.

For many people, these diverse impacts are interconnected in complex ways, making it difficult to isolate the specific impacts of child sexual abuse. These interconnected impacts can be experienced at the same time or consecutively, as a cascade of effects over a lifetime. For instance, we heard from many survivors that they developed addictions after using alcohol or other drugs to manage the psychological trauma of abuse, which in turn affected their physical and mental health, sometimes leading to criminal behaviour and relationship difficulties.

How institutions respond to child sexual abuse — including their reactions to disclosure, action taken following abuse, and broader prevention and protection measures — can have a profound effect on victims. Institutional responses have the potential to either significantly compound or help alleviate the impacts of the abuse. These include the responses of the institution where the abuse took place and the institutions that have authority over, or responsibility for, that institution. They include the responses of the police, criminal justice system, complaint and oversight bodies, support services and health services.

Throughout this inquiry we heard from many survivors about further impacts they experienced because institutions failed to respond appropriately to child sexual abuse. We also heard how some institutions responded in ways that were actively damaging — for example, by perpetuating the abuse or punishing victims for disclosing it.

Inappropriate or damaging responses by institutions can result in the sexual abuse continuing for the victim, as well as placing other children at risk. Victims and their families can be left feeling betrayed by the institutions they trusted, resulting in fear and distrust of, and contempt for, institutions. Survivors told us that these responses not only compound the impacts of the abuse, but cause additional impacts and re-traumatisation. We heard that some victims were ostracised by the institution because of disclosing the abuse.