Forensic Psychological Harm in Victims of Child Sexual Abuse: A Meta-analytic Review

Background/aim: In child sexual abuse (CSA) cases, the forensic evaluation of psychological harm is crucial for substantiating victim testimony and informing compensation awards. Posttraumatic Stress Disorder (PTSD) is the primary diagnosis for assessing forensic harm, as it establishes the causal l...

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Main Authors: Blanca Cea, Álvaro Montes, Alexander Trinidad, Ramón Arce
Format: Article
Language:English
Published: Sociedad Española de Psicología Jurídica y Forense 2025-07-01
Series:European Journal of Psychology Applied to Legal Context
Subjects:
Online Access: https://journals.copmadrid.org/ejpalc/art/ejpalc2025a10
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author Blanca Cea
Álvaro Montes
Alexander Trinidad
Ramón Arce
author_facet Blanca Cea
Álvaro Montes
Alexander Trinidad
Ramón Arce
author_sort Blanca Cea
collection DOAJ
description Background/aim: In child sexual abuse (CSA) cases, the forensic evaluation of psychological harm is crucial for substantiating victim testimony and informing compensation awards. Posttraumatic Stress Disorder (PTSD) is the primary diagnosis for assessing forensic harm, as it establishes the causal link between the harm and the CSA event. Thus, a meta-analysis was conducted to estimate the effect of CSA victimization on PTSD development and the probability of resulting psychological harm, and to determine the incremental harm attributable to CSA victimization. Method: A total of 126 primary studies were selected, yielding 195 effect sizes and a cumulative sample of 29,517 victims. Random effects psychometric meta-analyses were performed, correcting effect sizes for sampling error and criterion unreliability to obtain the true effect size (δ). Results: An overall large true effect size (δ = 0.93) was found between CSA victimization and PTSD outcomes. Given the heterogeneity of the studies, moderating variables were examined, revealing that female victims (δ = 0.99), intrafamilial abuse (δ = 1.68) and penetrative acts (δ = 1.23) were associated with significantly higher psychological harm attributable to CSA victimization than males (δ = 0.68), extrafamilial abuse (δ = 1.24) and non-penetrative sexual touching (δ = 1.01), respectively. The prevalence of PTSD diagnosis in CSA survivors was estimated at 33.95%. The incremental harm due to CSA victimization was estimated at 42.2% in general, with specific higher rates for intrafamilial abuse (64.3%) and for victims of penetration (54.4%). Conclusions: These findings provide robust evidence of the psychological harm (PTSD) resulting from CSA victimization and identify specific abuse characteristics that exacerbate such a harm. The judicial implications for the burden of proof are discussed and gold standards for civil compensation to victims are suggested as follows: a general gold standard of 42.2% for victims of CSA, and higher gold standards for victims of intrafamilial abuse (64.3%) and victims of penetration (54.4%).
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spelling doaj-art-c10d7780828d4b9fbf2f5dcd6815625b2025-08-20T03:34:45ZengSociedad Española de Psicología Jurídica y ForenseEuropean Journal of Psychology Applied to Legal Context1889-18611989-40072025-07-0117211112910.5093/ejpalc2025a1011320559Forensic Psychological Harm in Victims of Child Sexual Abuse: A Meta-analytic ReviewBlanca Cea0Álvaro Montes1Alexander Trinidad2Ramón Arce3Universidad de Santiago de Compostela, Santiago de Compostela , Spain, Universidad de Santiago de Compostela, Spain;Universidad de Santiago de Compostela, Santiago de Compostela , Spain, Universidad de Santiago de Compostela, Spain;University of Cologne, Cologne , Germany, University of Cologne, GermanyUniversidad de Santiago de Compostela, Santiago de Compostela , Spain, Universidad de Santiago de Compostela, Spain;Background/aim: In child sexual abuse (CSA) cases, the forensic evaluation of psychological harm is crucial for substantiating victim testimony and informing compensation awards. Posttraumatic Stress Disorder (PTSD) is the primary diagnosis for assessing forensic harm, as it establishes the causal link between the harm and the CSA event. Thus, a meta-analysis was conducted to estimate the effect of CSA victimization on PTSD development and the probability of resulting psychological harm, and to determine the incremental harm attributable to CSA victimization. Method: A total of 126 primary studies were selected, yielding 195 effect sizes and a cumulative sample of 29,517 victims. Random effects psychometric meta-analyses were performed, correcting effect sizes for sampling error and criterion unreliability to obtain the true effect size (δ). Results: An overall large true effect size (δ = 0.93) was found between CSA victimization and PTSD outcomes. Given the heterogeneity of the studies, moderating variables were examined, revealing that female victims (δ = 0.99), intrafamilial abuse (δ = 1.68) and penetrative acts (δ = 1.23) were associated with significantly higher psychological harm attributable to CSA victimization than males (δ = 0.68), extrafamilial abuse (δ = 1.24) and non-penetrative sexual touching (δ = 1.01), respectively. The prevalence of PTSD diagnosis in CSA survivors was estimated at 33.95%. The incremental harm due to CSA victimization was estimated at 42.2% in general, with specific higher rates for intrafamilial abuse (64.3%) and for victims of penetration (54.4%). Conclusions: These findings provide robust evidence of the psychological harm (PTSD) resulting from CSA victimization and identify specific abuse characteristics that exacerbate such a harm. The judicial implications for the burden of proof are discussed and gold standards for civil compensation to victims are suggested as follows: a general gold standard of 42.2% for victims of CSA, and higher gold standards for victims of intrafamilial abuse (64.3%) and victims of penetration (54.4%). https://journals.copmadrid.org/ejpalc/art/ejpalc2025a10 posttraumatic stress disorderforensic evaluationvictimizationburden of proofforensic expertisecompensation to victims
spellingShingle Blanca Cea
Álvaro Montes
Alexander Trinidad
Ramón Arce
Forensic Psychological Harm in Victims of Child Sexual Abuse: A Meta-analytic Review
European Journal of Psychology Applied to Legal Context
posttraumatic stress disorder
forensic evaluation
victimization
burden of proof
forensic expertise
compensation to victims
title Forensic Psychological Harm in Victims of Child Sexual Abuse: A Meta-analytic Review
title_full Forensic Psychological Harm in Victims of Child Sexual Abuse: A Meta-analytic Review
title_fullStr Forensic Psychological Harm in Victims of Child Sexual Abuse: A Meta-analytic Review
title_full_unstemmed Forensic Psychological Harm in Victims of Child Sexual Abuse: A Meta-analytic Review
title_short Forensic Psychological Harm in Victims of Child Sexual Abuse: A Meta-analytic Review
title_sort forensic psychological harm in victims of child sexual abuse a meta analytic review
topic posttraumatic stress disorder
forensic evaluation
victimization
burden of proof
forensic expertise
compensation to victims
url https://journals.copmadrid.org/ejpalc/art/ejpalc2025a10
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