Developmental dynamics of emotional dysregulation among sexually abused adolescents: an embedded mixed-methods study

Adolescence is characterized by heightened emotional reactivity and rapid maturation of emotion regulation (ER) capacities. Sexual abuse during adolescence disrupts normal ER development. Adolescents often struggle to modulate intrusive memories, hypervigilance, and intense affect following sexual abuse, resulting in increased distress and maladaptive coping strategies, including non-suicidal self-injury.

Using an embedded mixed-methods design, emotional dysregulation and mental health outcomes among sexually abused adolescents were examined. Three focused group discussions with 18 professionals and 43 key interviews with 25 adolescents (14 with penetrative abuse, including 1 gang rape case, and 11 with non-penetrative abuse) and 18 parents/caregivers (N = 61) were conducted at child-care institutions and hospital settings. Thematic frequency analysis resulted in 572 codes, 38 subthemes/subdomains, and 6 themes/domains across the three sample groups. Multi-informant perspectives and multiple settings were considered to draw more generalizable conclusions. Screening measures, namely the Patient Health Questionnaire-9 (PHQ-9), Screen for Child Anxiety Related Emotional Disorders (SCARED), and the Children's Revised Impact of Event Scale (CRIES-13), were used. Qualitative data focused on emotional impact, triggers, relational difficulties, academic consequences, and coping strategies, while quantitative data assessed depressive, anxiety, and post-traumatic stress symptoms.

Across all groups, themes converged on persistent emotional pain, somatic and affective reactivity, hypervigilance, mistrust in relationships, academic decline, and self-harm. Adolescents consistently reported profound emotional dysregulation, including fear, persistent crying spells, anger outbursts, and social withdrawal. Parents highlighted mood volatility, anger, withdrawal, and emotional numbing, whereas professionals identified chronic dysregulation and attachment ruptures as enduring sequelae of abuse. All adolescents scored above the cutoff on the PHQ-9, while 14 scored above the cutoff on the SCARED, and 13 on the CRIES-13.

The effects of sexual abuse type, gender differences, parental support, and the obtained themes are discussed in the context of impact severity and ER.