Psychiatric morbidity in adult survivors of childhood trauma.

This review focuses on child sexual abuse (CSA) as a prototype of childhood trauma and evaluates the evidence on psychiatric morbidity in adult survivors. An association between CSA and a wide range of psychiatric morbidity has been consistently documented in general population studies. The interpretation of this observed association is fraught with uncertainty that stems primarily from: (1) the retrospective nature of the data on CSA from adults' reports on their early experiences; (2) the adverse family context in which it occurs, which presents a major challenge for evaluating the effect of CSA per se; (3) the well documented lifetime comorbidity among psychiatric disorders, which leaves open questions about the specificity of CSA outcomes in adulthood. Twin study methods offer a solution to the problem of the familial context of CSA. Ascertainment of age of onset of adult disorders in future studies would increase the utility of findings for formulating psychological and biological causal models on the CSA-adult disorders connection. However, the retrospective nature of data on child abuse, because of legal and ethical restraints on research on children, is a formidable obstacle to advancing knowledge in this field.