From child sexual abuse to psychiatric diagnoses and complex trauma in adolescence

CSA (Childhood Sexual Abuse) represents a major health issue, however its detection in daily psychiatric practice is remains challenging. In adolescents, CSA often takes a back seat to diagnostic and behavioral issues such as suicide attempts and BPD (Borderline Personality Disorder), with which it is frequently associated. Additionally, confusion persists between the perspective of complex trauma and conventional psychiatric diagnoses. This study aimed to compare clinical features of hospitalized adolescents with a history of CSA, to a control group, in order to identify clinical predictors of CSA and of suicidal attempts. The secondary objective was to describe the overlap between PTSD (Post Traumatic Stress Disorder) and BPD, according to cumulative adversity. This study included 425 adolescents aged 13 to 19 years, who were hospitalized in a psychiatric unit. Among these adolescents, 107 had a history of CSA. The findings indicate that CSA plays a significant role in the psychopathology of adolescents. CSA was found to be associated with PTSD, BPD (OR = 1.9, p < 0.01), self-harm (OR = 1.8, p < 0.05), addictive disorders (OR = 1.87, p < 0.05), and parental neglect (p < 0,001). Suicide attempts were also significantly correlated with sexual abuse (OR = 1.78, p < 0.05). Moreover, the combination of factors such as female gender, the presence of BPD, and substance dependence was found to increase the likelihood of a history of sexual abuse in these adolescents by 14.8 times. These findings contribute to the early detection of sexual violence and its consequences, providing valuable insights for healthcare professionals. Additionally, they support the reinforcement of preventive initiatives.