Когнитивные последствия травмы сексуального насилия над несовершеннолетними: обзор литературы

Актуальность. Высокая распространенность сексуального насилия над несовершеннолетними и многообразие его краткосрочных и долгосрочных последствий давно известны в научных кругах, а когнитивно-­ ориентированные вмешательства при работе с пострадавшими получают все большее распространение в последние десятилетия. Несмотря на это, эмоциональные и поведенческие проблемы нередко выходят на первый план, оставляя когнитивные аспекты травмы «в тени» более ярких симптомов.
Цель настоящей статьи – провести обзор исследований когнитивного компонента травмы в рамках парадигм нейрокогнитивного функционирования, когнитивного развития и когнитивных моделей в психологии и психотерапии для обобщения имеющихся данных.
Материал и методы. Для поиска литературы по проблеме использовались электронные научные ресурсы: PubMed, ResearchGate, ScienceDirect, Google Scholar и SpringerLink. Первоначальный поиск был ограничен источниками за последние 5 лет, однако для иллюстрации некоторых ключевых последствий, которые не всегда подробно освещаются в более поздних исследованиях, были включены отдельные исследовательские статьи предыдущих лет.
Результаты и их анализ. Проведенный анализ показал, что пережитый опыт сексуального насилия может негативно сказываться на нейроразвитии, формировании психических процессов и особенностях обработки информации, а также оставлять след в представлениях и убеждениях пострадавших на разных этапах их жизни.
Заключение. Дополнительные исследования могут предоставить возможности для более всесторонней оценки как отдельных последствий травмы, так и комплексной взаимосвязи между ее различными когнитивными аспектами.

1. Aas M., Navari S., Gibbs A.A. [et al.]. Is there a link between childhood trauma, cognition, and amygdala and hippocampus volume in first-episode psychosis? Schizophrenia Research. 2012; 137(1-3): 73–79. DOI: 10.1016/j.schres.2012.01.035.

2. Adnani S., Lamaarbi O.M., Ahami A.O.T. The prevalence of early maladaptive schemas, anxiety, and coping strategies in adolescent girls who are survivors of sexual abuse: A case report. International Journal of Environmental Studies. 2024; 82(1): 60–74. DOI: 10.1080/00207233.2024.2424690.

3. Alix S., Cossette L., Cyr M. [et al.]. Self-blame, shame, avoidance, and suicidal ideation in sexually abused adolescent girls: A longitudinal study. Journal of Child Sexual Abuse. 2020; 29(4): 432–447. DOI: 10.1080/10538712.2019.1678543.

4. Almuneef M. Long term consequences of child sexual abuse in Saudi Arabia: A report from national study. Child Abuse & Neglect. 2021; 116: 1–8. DOI: 10.1016/j.chiabu.2019.03.003.

5. Amédée L.M., Cyr C., Hébert M. Profiles of self-regulation and their association with behavior problems among sexually abused children. Development and Psychopathology. 2024: 1–13. DOI: 10.1017/S0954579424001196.

6. Amédée L.M., Cyr C., Jean-Thorn A. [et al.]. Executive functioning in child victims of sexual abuse: A multiinformant comparative study. Child Abuse & Neglect. 2024; 152: 1–11. DOI: 10.1016/j.chiabu.2024.106737.

7. Assini-Meytin L.C., Thorne E.J., Sanikommu M. [et al.]. Impact of child sexual abuse on socioeconomic attainment in adulthood. Journal of Adolescent Health. 2022; 71(5): 594–600. DOI: 10.1016/j.jadohealth.2022.05.013.

8. Atmaca S., Gençöz T. Exploring revictimization process among Turkish women: The role of early maladaptive schemas on the link between child abuse and partner violence. Child Abuse & Neglect. 2016; 52: 85–93. DOI: 10.1016/j.chiabu.2016.01.004.

9. Banaj N., Pellicano C. Childhood Trauma and Stigma. In: Spalletta G., Janiri D., Piras F., Sani G., eds. Childhood Trauma in Mental Disorders. Cham: Springer; 2020: 413–430. DOI: 10.1007/978-3-030-49414-8_19.

10. Bastos A., Volchan E., Erthal F. Posttraumatic stress disorder and history of child sexual abuse: Blunted response of midcingulate cortex to aversive pictures. IBRO Neuroscience Reports. 2023; 15: 534–535. DOI: 10.1016/j.ibneur.2023.08.1053.

11. Biedermann S.V., Meliss S., Simmons C. [et al.]. Sexual abuse but not posttraumatic stress disorder is associated with neurocognitive deficits in South African traumatized adolescents. Child Abuse & Neglect. 2018; 80: 257–267. DOI: 10.1016/j.chiabu.2018.04.003.

12. Boyd M., Kisely S., Najman J. [et al.]. Child maltreatment and attentional problems: A longitudinal birth cohort study. Child Abuse & Neglect. 2019; 98: 1–12. DOI: 10.1016/j.chiabu.2019.104170.

13. Boyda D., McFeeters D., Dhingra K. [et al.]. Childhood maltreatment and psychotic experiences: Exploring the specificity of early maladaptive schemas. Journal of Clinical Psychology. 2018; 74(12): 2287–2301. DOI: 10.1002/jclp.22690.

14. Brenner I., Bachner-Melman R., Lev-Ari L. [et al.]. Attachment, sense of entitlement in romantic relationships, and sexual revictimization among adult CSA survivors. Journal of Interpersonal Violence. 2021; 36(19-20): 10720–10743. DOI: 10.1177/0886260519875558.

15. Brown M.J., Amoatika D., Addo P.N.O. [et al.]. Childhood sexual trauma and subjective cognitive decline: An assessment of racial/ethnic and sexual orientation disparities. Journal of Applied Gerontology. 2023; 42(10): 2129– 2138. DOI: 10.1177/07334648231175299.

16. Caouette J., Cossette L., Hébert M. Do you see what I see? Emotion recognition competencies in sexually abused school-aged children and non-abused children. Journal of Child Sexual Abuse. 2023; 32(7): 813–828. DOI: 10.1080/10538712.2023.2243926.

17. Chiasson C., Moorman J., Romano E. [et al.]. The influence of emotion on working memory: Exploratory fMRI findings among men with histories of childhood sexual abuse. Child Abuse & Neglect. 2021; 122: 105340. DOI: 10.1016/j.chiabu.2021.105340.

18. Collin-Vézina D., De La Sablonnière-Griffin M., Sivagurunathan M. [et al.]. “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. 2021; 8: 1–13. DOI: 10.1186/s40479-020-00142-6.

19. De la Peca-Arteaga V., Nogueira S.O., Lynskey M. [et al.]. The relationship between childhood physical and sexual abuse and adolescent cannabis use: A systematic review. Frontiers in Psychiatry. 2021; 12: 1–12. DOI: 10.3389/fpsyt.2021.631245.

20. Dhyatmika M.A., Hermahayu, Faizah R. Post-traumatic effects in survivors of childhood sexual abuse: A study literature. Journal of Islamic Communication and Counseling. 2024; 3(1): 62–71. DOI: 10.18196/jicc.v3i1.51.

21. Ensink K., Bégin M., Normandin L., et al. Mentalization and dissociation in the context of trauma: Implications for child psychopathology. Journal of Trauma & Dissociation. 2016; 18(1): 11–30. DOI: 10.1080/15299732.2016.1172536.

22. Finkelhor D., Browne A. The traumatic impact of child sexual abuse: A conceptualization. American Journal of Orthopsychiatry. 1985; 55(4): 530–541. DOI: 10.1111/j.1939-0025.1985.tb02703.x.

23. Fletcher K. A systematic review of the relationship between child sexual abuse and substance use issues. Journal of Child Sexual Abuse. 2020: 1–20. DOI: 10.1080/10538712.2020.1801937.

24. Gervasio M., Beatty A., Kavanaugh B. [et al.]. The association between neurocognition and sexual abuse within a children’s psychiatric inpatient program. The Clinical Neuropsychologist. 2020: 189–206. DOI: 10.1080/13854046.2020.1781932.

25. Gruhn M.A., Compas B.E. Effects of maltreatment on coping and emotion regulation in childhood and adolescence: A meta-analytic review. Child Abuse & Neglect. 2020; 103: 1–12. DOI: 10.1016/j.chiabu.2020.104446.

26. Gudjonsson G., Vagni M., Maiorano T. [et al.]. Trauma symptoms of sexual abuse reduce resilience in children to give “no” replies to misleading questions. Personality and Individual Differences. 2021; 168: 1–5. DOI: 10.1016/j.paid.2020.110378.

27. Gudjonsson G., Vagni M., Maiorano T. [et al.]. The relationship between trauma symptoms and immediate and delayed suggestibility in children who have been sexually abused. Journal of Investigative Psychology and Offender Profiling. 2020; 17(3): 250–263. DOI: 10.1002/jip.1554.

28. Gundogdu U., Eroglu M. Executive functions and theory of mind skills of sexually abused female adolescents and their externalizing and the internalizing behavioral problems. Journal of Child Sexual Abuse. 2021; 30(4): 427–441. DOI: 10.1080/10538712.2021.1901169.

29. Hawkins M.A.W., Layman H.M., Ganson K.T. [et al.]. Adverse childhood events and cognitive function among young adults: Prospective results from the national longitudinal study of adolescent to adult health. Child Abuse & Neglect. 2021; 115: 1–9. DOI: 10.1016/j.chiabu.2021.105008.

30. Heim C.M., Mayberg H.S., Mletzko T. [et al.]. Decreased cortical representation of genital somatosensory field after childhood sexual abuse. American Journal of Psychiatry. 2013; 170(6): 616–623. DOI: 10.1176/appi.ajp.2013.12070950.

31. Hébert M., Tremblay-Perreault A., Myre G. The interplay of depression and hostile attributions in the link between PTSD symptoms and peer victimization in child victims of sexual abuse. Child Psychiatry & Human Development. 2021; 52: 291–300. DOI: 10.1007/s10578-020-01011-7.

32. Huang Y.L., Fonagy P., Feigenbaum J. [et al.]. Multidirectional pathways between attachment, mentalizing, and posttraumatic stress symptomatology in the context of childhood trauma. Psychopathology. 2020; 53(1): 48–58. DOI: 10.1159/000506406.

33. Keeshin B.R., Strawn J.R., Out D. [et al.]. Cortisol awakening response in adolescents with acute sexual abuse related posttraumatic stress disorder. Depression and Anxiety. 2014; 31: 107–114. DOI: 10.1002/da.22154.

34. Kim S.Y., An S.J., Han J.H. [et al.]. Childhood abuse and cortical gray matter volume in patients with major depressive disorder. Psychiatry Research. 2023; 319: 114990. DOI: 10.1016/j.psychres.2022.114990.

35. Kolacz J., Hu Y., Gesselman A.N. [et al.]. Sexual function in adults with a history of childhood maltreatment: Mediating effects of self-reported autonomic reactivity. Psychological Trauma: Theory, Research, Practice, and Policy. 2020; 12(3): 281–290. DOI: 10.1037/tra0000498.

36. König J., Kopp B., Ziegelmeier A. [et al.] Young people’s trauma-related cognitions before and after cognitive processing therapy for post-traumatic stress disorder. Psychology and Psychotherapy: Theory, Research and Practice. 2021; 94(1): 33–44. DOI: 10.1111/papt.12263.

37. Krause-Utz A., Dierick T., Josef T. [et al.]. Linking experiences of child sexual abuse to adult sexual intimate partner violence: The role of borderline personality features, maladaptive cognitive emotion regulation, and dissociation. Borderline Personality Disorder and Emotion Dysregulation. 2021; 8: 1–12. DOI: 10.1186/s40479-021-00150-0.

38. Langevin R., Kenny S., Kern A. [et al.]. Sexual abuse and sleep in children and adolescents: a systematic review. Sleep Medicine Reviews. 2022; 64: 1–45. DOI: 10.1016/j.smrv.2022.101628.

39. Langevin R., Marshall C., Wallace A. [et al.]. Disentangling the associations between attention deficit hyperactivity disorder and child sexual abuse: A systematic review. Trauma, Violence, & Abuse. 2023; 24(2): 369–389. DOI: 10.1177/15248380211030234.

40. Lawson D.M., Akay-Sullivan S. Considerations of dissociation, betrayal trauma, and complex trauma in the treatment of incest. Journal of Child Sexual Abuse. 2020; 29(6): 677–696. DOI: 10.1080/10538712.2020.1751369.

41. Letkiewicz A.M., Weldon A.L., Tengshe C. [et al.]. Cumulative childhood maltreatment and executive functioning in adulthood. Journal of Aggression, Maltreatment & Trauma. 2020; 30(4): 547–563. DOI: 10.1080/10926771.2020.1832171.

42. LoPilato A.M., Zhang Y., Pike M. [et al.]. Associations between childhood adversity, cognitive schemas and attenuated psychotic symptoms. Early Intervention in Psychiatry. 2021; 15(4): 818–827. DOI: 10.1111/eip.13017.

43. Lorzangeneh S., Esazadegan A. The role of early maladaptive schema domains and childhood trauma in predicting cognitive distortions. Journal of Research in Psychopathology. 2022; 3(8): 1–8. DOI: 10.22098/jrp.2022.10098.1049.

44. Lumley M.N., Harkness K.L. Specificity in the relations among childhood adversity, early maladaptive schemas, and symptom profiles in adolescent depression. Cognitive Therapy and Research. 2007; 31(5): 639–657. DOI: 10.1007/s10608-006-9100-3.

45. Maciel L., Basto-Pereira M. Child sexual abuse: The detrimental impact of its specific features. Child Indicators Research. 2020; 13: 2117–2133. DOI: 10.1007/s12187-020-09730-y.

46. MacIntosh H.B., Ménard A.D. Couple and parenting functioning of childhood sexual abuse survivors: A systematic review of the literature (2001–2018). Journal of Child Sexual Abuse. 2021; 30(3): 353–384. DOI: 10.1080/10538712.2020.1847227.

47. Manukrishnan, Bhagabati K. Surviving childhood sexual abuse: A qualitative study of the long-term consequences of childhood sexual abuse on adult women’s mental health. Journal of Psychosexual Health. 2024; 5(4): 253–262. DOI: 10.1177/26318318231221948.

48. Mansueto G., Cavallo C., Palmieri S. [et al.]. Adverse childhood experiences and repetitive negative thinking in adulthood: A systematic review. Clinical Psychology & Psychotherapy. 2021; 28(3): 557–568. DOI: 10.1002/cpp.2590.

49. Marques N.M., Belizario G.O., de Almeida Rocca C.C. [et al.]. Psychological evaluation of children victims of sexual abuse: Development of a protocol. Heliyon. 2020; 6(3): 1–7. DOI: 10.1016/j.heliyon.2020.e03552.

50. Marshall D.F., Passarotti A.M., Ryan K.A. [et al.]. Deficient inhibitory control as an outcome of childhood trauma. Psychiatry Research. 2016; 235: 7–12. DOI: 10.1016/j.psychres.2015.12.013.

51. Mii A.E., McCoy K., Coffey H.M. [et al.]. Attention problems and comorbid symptoms following child sexual abuse. Journal of Child Sexual Abuse. 2020; 29(8): 924–943. DOI: 10.1080/10538712.2020.1841353.

52. Miley L.N., Fox B., Muniz C.N. [et al.]. Does childhood victimization predict specific adolescent offending? An analysis of generality versus specificity in the victim-offender overlap. Child Abuse & Neglect. 2020; 101: 1–12. DOI: 10.1016/j.chiabu.2019.104328.

53. Mitchell J.M., Becker-Blease K.A., Soicher R.N. Child sexual abuse, academic functioning and educational outcomes in emerging adulthood. Journal of Child Sexual Abuse. 2021; 30(3): 278–297. DOI: 10.1080/10538712.2020.1847228.

54. Mojallal M., Simons R.M., Simons J.S. Childhood maltreatment and adulthood proneness to shame and guilt: The mediating role of maladaptive schemas. Motivation and Emotion. 2021; 45(2): 197–210. DOI: 10.1007/s11031-021-09866-6.

55. Navalta C.P., Polcari A., Webster D.M. [et al.]. Effects of childhood sexual abuse on neuropsychological and cognitive function in college women. The Journal of Neuropsychiatry and Clinical Neurosciences. 2006; 18(1): 45–53. DOI: 10.1176/jnp.18.1.45.

56. Peverill M., Sheridan M.A., Busso D.S. [et al.]. Atypical prefrontal-amygdala circuitry following childhood exposure to abuse: Links with adolescent psychopathology. Child Maltreatment. 2019; 24(4): 411–423. DOI: 10.1177/1077559519852676.

57. Pilkington P.D., Bishop A., Younan R. Adverse childhood experiences and early maladaptive schemas in adulthood: A systematic review and meta-analysis. Clinical Psychology & Psychotherapy. 2021; 28(3): 569–584. DOI: 10.1002/cpp.2533.

58. Quiroga-Garza A., Almela-Ojeda M.J. Sexual abuse in childhood: Emerging syndromes in adulthood. An International Collection of Multidisciplinary Approaches to Violence and Aggression. 2022: 1–19. DOI: 10.5772/intechopen.105888.

59. Sánchez-Caja P., Perez Nieto M.Á., Pascual Nicolás D. Neuropsychological implications of child sexual abuse: A literature review. Revista Argentina de Clínica Psicológica. 2020; 29(5): 601–610. DOI: 10.24205/03276716.2020.1057.

60. Sanz-Martin A., García-León I.A. Differential effect of emotional stimuli on performance on verbal and facial priming tasks and their relation to PTSD symptoms in girls with intrafamiliar sexual abuse. Cognitive Therapy and Research. 2022; 46: 1087–1100. DOI: 10.1007/s10608-022-10313-0.

61. Sanz-Martin A., Preciado-Mercado S., Inozemtseva O. Social skills and behavioral problems in adolescents with child sexual abuse, and their relation to basal cortisol. Journal of Behavioral and Brain Science. 2022; 12(5): 252–270. DOI: 10.4236/jbbs.2022.125014.

62. Sheffler J.L., Stanley I., Sachs-Ericsson N. ACEs and mental health outcomes. Adverse Childhood Experiences. 2020: 47–69. DOI: 10.1016/B978-0-12-816065-7.00004-5.

63. Simsek Ş., Yüksel T., Kaplan İ. [et al.]. Examining the levels of BDNF and cortisol in children and adolescent victims of sexual abuse – A preliminary study. Comprehensive Psychiatry. 2015; 61: 23–27. DOI: 10.1016/j.comppsych.2015.04.013.

64. Sinnamon G. A neurodevelopmental perspective of early-life sexual abuse: Characteristics, consequences, and treatment. In: Bryce I., Petherick W., eds. Child Sexual Abuse: Forensic Issues in Evidence, Impact, and Management. Elsevier Academic Press; 2020: 179–220. DOI: 10.1016/B978-0-12-819434-8.00010-6.

65. Sinko L., Regier P., Curtin A. [et al.]. Neural correlates of cognitive control in women with a history of sexual violence suggest altered prefrontal cortical activity during cognitive processing. Women’s Health. 2022; 18: 1–13. DOI: 10.1177/17455057221081326.

66. Strathearn L., Giannotti M., Mills R. [et al.]. Long-term cognitive, psychological, and health outcomes associated with child abuse and neglect. Pediatrics. 2020; 146(4): 1–15. DOI: 10.1542/peds.2020-0438.

67. Taj T., Mulukuri N.V.L.S., Raj B. Impact on physical and mental health of sexually abused children. In: Shaik A., Thota S.L., Atmakuri L.R., eds. Child Sexual Abuse. Singapore: Springer; 2024: 135–143. DOI: 10.1007/978-981-99-8745-0_13.

68. Tejada A.J., Linder S.M. The influence of child sexual abuse on preschool-aged children. Early Child Development and Care. 2018; 190(12): 1–11. DOI: 10.1080/03004430.2018.1542384.

69. Tomoda A., Navalta C.P., Polcari A. [et al.]. Childhood sexual abuse is associated with reduced gray matter volume in visual cortex of young women. Biological Psychiatry. 2009; 66(7): 642–648. DOI: 10.1016/j.biopsych.2009.04.021.

70. Tremblay-Perreault A., Amédée L.M., Hébert M. Peer victimization in sexually abused children: The mediating role of post-traumatic stress symptoms. International Journal of Child and Adolescent Resilience. 2017; 5(1): 4–19. URL: https://www.ijcar-rirea.ca/index.php/ijcar-rirea/article/view/213 (дата обращения/accessed: 24.03.2025).

71. Trickett P.K., Gordis E., Peckins M.K. [et al.]. Stress reactivity in maltreated and comparison male and female young adolescents. Child Maltreatment. 2014; 19: 27–37. DOI: 10.1177/1077559513520466.

72. Tsur N., Najjar A.A., Katz C. “Explode into small pieces”: Suicidal ideation among child sexual abuse survivors. Child Abuse & Neglect. 2022; 131: 105780. DOI: 10.1016/j.chiabu.2022.105780.

73. Usta M.B., Tuncel O.K., Akbas S. [et al.]. Decreased dehydroepiandrosterone sulphate levels in adolescents with post-traumatic stress disorder after single sexual trauma. Nordic Journal of Psychiatry. 2016; 70: 116–120. DOI: 10.3109/08039488.2015.1056752.

74. Vasilopoulou E., Karatzias T., Hyland P. [et al.]. The mediating role of early maladaptive schemas in the relationship between childhood traumatic events and complex posttraumatic stress disorder symptoms in older adults (> 64 years). Journal of Loss and Trauma. 2019; 25(2): 141–158. DOI: 10.1080/15325024.2019.1661598.

75. Veer I.M., Oei N.Y.L., van Buchem M.A. [et al.]. Evidence for smaller right amygdala volumes in posttraumatic stress disorder following childhood trauma. Psychiatry Research: Neuroimaging. 2015; 233(3): 436–442. DOI: 10.1016/j.pscychresns.2015.07.016.

76. Weihmann R., Delcea C. Symptomatology of reconstitution of trauma in adults with a history of childhood sexual abuse: An approach from the perspective of S-ONapp application. International Journal of Advanced Studies in Sexology. 2022; 4(1): 31–40. DOI: 10.46388/ijass.2022.4.3.

77. Weissman D.G., Lambert H.K., Rodman A.M. [et al.]. Reduced hippocampal and amygdala volume as a mechanism underlying stress sensitization to depression following childhood trauma. Depression and Anxiety. 2020; 37(9): 916–925. DOI: 10.1002/da.23062.

78. Welsh M.C., Peterson E., Jameson M.M. History of childhood maltreatment and college academic outcomes: Indirect effects of hot executive function. Frontiers in Psychology. 2017; 8: 1–13. DOI: 10.3389/fpsyg.2017.01091.

79. Wiss D.A., Brewerton T.D., Tomiyama A.J. Limitations of the protective measure theory in explaining the role of childhood sexual abuse in eating disorders, addictions, and obesity: an updated model with emphasis on biological embedding. Eat Weight Disord. 2022; 27: 1249–1267. DOI: 10.1007/s40519-021-01293-3.

80. Yoder J., Grady M.D., Precht M. Relationships between early life victimization, antisocial traits, and sexual violence: Executive functioning as a mediator. Journal of Child Sexual Abuse. 2019; 28(6): 667–689. DOI: 10.1080/10538712.2019.1588819.

81. Young J.E., Klosko J.S., Weishaar M.E. Schema therapy: A practitioner’s guide. New York: Guilford Press; 2006. 436 p.

82. Yuan Y., Peterson E.O., Cutshaw O. [et al.]. Neural patterns of recovery from negative emotion after blocked rewards in adolescents with varying sexual abuse trauma [Preprint]. SSRN; 2024: 1–63. DOI: 10.2139/ssrn.4891859.

83. Zheng S., Stewart J.G., Bagby R.M. [et al.]. Specific early maladaptive schemas differentially mediate the relations of emotional and sexual maltreatment to recent life events in youth with depression. Clinical Psychology & Psychotherapy. 2022; 29(3): 1020–1033. DOI: 10.1002/cpp.2681.