There has been increasing awareness of the prevalence of childhood sexual abuse (CSA) and the psychological damage that this can cause. In recent years there have been many cases of alleged abuse within institutions that have led to litigation for compensation. One issue that has arisen in these cases and is of significance in clinical practice is whether CSA is a causative factor in the later development of schizophrenia or psychotic illnesses presenting with delusions and hallucinations.

In a recent case in Birmingham, UK,¹ involving a man in his thirties who was abused by a Catholic priest, the causation of schizophrenia was claimed to be the CSA that he had suffered. The judge stated: “The likelihood as it seems to be is the terrible abuse to which ‘A’ was subjected led to his both suffering post traumatic stress disorder and that disorder of the mind which is symptomatic of schizophrenia”. Based on the expert evidence of psychiatrists presented in court, the judge accepted that the claimant was suffering from schizophrenia; he also clarified that “what is important is that his adult psychiatric problems, however they are classified, were caused by his childhood sexual abuse difficulties” and awarded a large sum of money to the CSA victim who developed symptoms of schizophrenia in adulthood.

PREVALENCE OF CHILDHOOD SEXUAL ABUSE

Due to variations in the definition of abuse, studies in the last three decades have found the prevalence rates of CSA vary widely from 2.9–27% among women and 0–16% among men.² These rates are also complicated by possible under reporting of cases because of stigma, guilt, embarrassment, suppression of painful memories and the private nature of the issue.

PSYCHIATRIC MORBIDITY AND LONG TERM PSYCHOLOGICAL SEQUELAE

There have been large numbers of studies looking at rates of CSA in various …