Characteristics that predict exposure to and subsequent intentional viewing of child sexual abuse material among a community sample of Internet users.

BACKGROUND: An important element of reducing the sexual abuse and exploitation of children is to understand the behaviors of individuals who consume child sexual abuse material (CSAM), including the predictors of continued use. OBJECTIVE: To investigate predictors of 'ever viewing' CSAM and subsequent intentional use among individuals in the community. METHOD: This study used multivariate logistic regression analysis to identify significant predictors of ever viewing CSAM (n = 742) in an anonymous survey of 5512 Internet users in the community, and of subsequent intentional CSAM use among a subset of 459 CSAM viewers. RESULTS: The characteristics of respondents that were significantly associated with ever viewing CSAM were being male, older in age (25-34 and 55+ years cf. 18-24 years), residing in Australia, New Zealand, or Canada (cf. the United Kingdom), earlier exposure to adult pornography (<14 years), experiencing childhood physical abuse or neglect, viewing bestiality pornography featuring adults, viewing bondage/S&M (BDSM) pornography featuring adults, being likely (self-reported) to have sexual contact with a child, and visiting pedophilic chat forums online. In the subset sample, almost half (218, 47.5 %) viewed CSAM again intentionally after first exposure. Predictors of subsequent intentional viewing of CSAM after adjusting for age and country of residence were being male, ever experiencing loneliness, searching for CSAM intentionally at first exposure, being likely (self-reported) to have sexual contact with a child, and visiting pedophilic chat forums online. CONCLUSIONS: The findings have strong implications for prevention of first exposure to CSAM, and of continued CSAM use after exposure does occur.

Sexual fulfilment, wellbeing and risk considerations for people with sexual attractions to children.

Research focused on understanding the experiences of individuals with sexual attractions to children and their pursuit of sexual fulfilment faces notable limitations, primarily stemming from ethical and legal challenges, and pervasive social stigma. This review paper explores these challenges and outlines the connections between sexual fulfilment, treatment goals and overall wellbeing. We consider the importance of sexual satisfaction in promoting mental and physical health, and its potential role in reducing the risk of sexually abusive behaviors. Recognizing that promoting healthier and more fulfilling lives extends beyond risk mitigation, the paper highlights future research avenues such as exploring the conceptualization and achievement of sexual satisfaction. In examining alternative perspectives, including the potential risk enhancement associated with achieving sexual fulfilment, we also argue the need for an evidence-based approach and robust research agenda to inform and guide interventions. Through these considerations, the paper aims to encourage a more informed and compassionate understanding of sexual fulfilment for people with sexual attractions to children.

From Non-Traditional Sexual Behavior to Non-Legitimate Victims: Moral Virtue, Victim Blame, and Helping Intentions Toward a Woman Victim of Image-Based Sexual Abuse.

Image-based sexual abuse represents an increasingly common form of gender-based violence, consisting of the act of non-consensually capturing, distributing, or threatening to distribute sexually explicit material depicting another person. The purpose of the present study was to investigate how women victims' noncompliance with traditional female sexuality influences bystanders' perceptions of the phenomenon. Specifically, we experimentally examined whether a woman's sexual agency (high vs. low) and the length (steady vs. transient) of the relationship with the perpetrator affected her moral evaluation, victim blaming, and participants' willingness to support her. A sample of 597 adults (65.7% women, Mage = 31.29 years) took part in the study. The findings indicated that while a transient (vs. steady) relationship with the perpetrator significantly lowered the woman's perceived moral virtue and increased the extent to which she was blamed for the incident, a high (vs. low) woman's sexual agency decreased participants' helping intentions towards her. Additionally, results showed that men were less likely than women to attribute moral virtue and help the victim. Lastly, through the mediation of moral virtue and victim blaming, the length of the relationship indirectly influenced participants' helping intentions.

Five Forms of Coerced "Self-Produced" Child Sexual Exploitation Material: A Critical Interpretive Synthesis.

This review explored how the phenomenon of coerced "self-produced" child sexual exploitation material (CSEM) has been constructed in the literature using Critical Interpretative Synthesis. Selected keywords were systematically searched on relevant databases. Types of papers included were: peer-reviewed research articles; conceptual papers; commentary papers; theses; book chapters; systematic reviews; and government reports. Papers published in English between January 2005 and November 2022 were included. The initial search revealed 1,021 papers, after two reviewers applied the inclusion and exclusion criteria, 38 papers were selected for the final sample. Findings indicated five forms of coerced "self-produced" CSEM: Solicitation; Peer Sexting; Viral Challenge; Sextortion; and Financial Coercion. The forms are described and critically analyzed through an "Accountability Lens." This Lens was developed to be victim-centered including identifying the coercive actions of the person responsible for the exploitation. The review found an absence of a consistent victim-centered approach to how the phenomena of coerced "self-produced" CSEM is understood that would ensure children are not held responsible for being exploited.

Problematic Sexual Behavior in Children: The Influence of Transgressions of Interpersonal Boundaries and Family Adversity Across Generations.

Problematic sexual behavior (PSBs) in children have been linked to difficulties or challenges within the family environment. Despite this association, few studies have examined how interpersonal boundary transgressions influence children's PSBs. Based on a sample of 112 parent-child dyads recruited before undergoing PSB-focused psychotherapy, this study first aims to explore the concept of sexual, physical, and emotional boundary transgressions within the current family environment in relation to reported levels of PSBs. The study further investigates the connections between parents' current boundary transgressions and their past and present family environments. Bivariate analyses revealed a positive correlation between heightened levels of interpersonal boundary transgressions and increased PBS, alongside elevated externalized behaviors. Two hierarchical linear regression models were employed: one to predict children's PSB scores with boundary transgressions as a predictor, and another to predict current boundary transgressions within the family environment. Results showed that current boundary transgressions within the family predicted the level of PSBs. However, once the child's externalized behaviors were considered, boundary transgressions ceased to be significant. Regarding the parents, transgression of interpersonal boundaries within the current family environment was associated with exposure to higher levels of interpersonal boundary transgressions during their childhood, current socioeconomic status, and a higher level of parental psychological distress. Keywords: problematic sexual behavior, PSBs, transgression of interpersonal boundaries, conceptual model, victimization experiences, intergenerational cycle.

Gender-related stigma toward individuals with a history of sexual or physical violence in childhood.

BACKGROUND: Stigma is a key barrier to disclosing traumatic experiences of violence in childhood with adverse consequences for help-seeking behaviour. Disclosing behavior differs by gender and the form of violence experienced. However, there is a lack of comprehensive studies that address societal perceptions of males and females with a history of sexual or physical violence in childhood. Therefore, our aim is to focus on the impact of gender on the perception of individuals who experienced sexual or physical violence in childhood. METHODS: We conducted a study on a representative sample of the German general population in terms of age and gender. Participants were randomly assigned to brief case vignettes addressing sexual or physical violence in childhood. Analyses base on a sample of n = 659 individuals (50.1% female). Stigma was assessed through examining respondents' readiness to address specific traumas in conversation and respondents' attitudes toward the individuals in the vignettes. Mann-Whitney U tests were applied to check for differences between female and male victims and survivors as well as female and male respondents. RESULTS: Our results reveal that male victims and survivors face higher negative stereotypes (harm, unpredictability) and evoke communication barriers more often when compared to female victims and survivors, especially in male respondents. Sexual violence is associated with more distinct gender differences than physical violence. CONCLUSIONS: Findings reflect greater stigma toward male victims and survivors of sexual violence than female ones. Men had a greater tendency to stigmatize - especially toward their same-gender peers. Socially ingrained gender roles may act as a basis for different communication cultures and the notion of victim-perpetrator constellations in which males are not envisaged as victims.

Characteristics of preschool-age children who engage in problematic sexual behaviors with siblings.

BACKGROUND: Problematic sexual behavior (PSB) between siblings can be a form of sibling sexual abuse (SSA). A notable gap in research are studies examining PSB among preschool-age children with siblings. OBJECTIVE: This study examined the impact of child maltreatment, exposure to family sexuality, and use of coercive sexual behavior on preschool-aged children PSB with siblings and with nonsiblings. PARTICIPANTS AND SETTING: All 284 children were ages 3-6 years with PSB who had siblings in the home (197 initiated PSB with siblings and 87 initiated PSB with non-siblings). METHODS: The two groups were compared on types of PSB, use of coercion, child maltreatment history, exposure to family sexuality, and caregiver attitudes. Caregiver report measures were the Child Sexual Behavior Inventory- Third Edition (CSBI-III), the Family Sexuality Index, and intake form on maltreatment experienced (i.e., physical abuse, sexual abuse, emotional abuse, neglect, exposure to domestic violence, caregiver drug use, and failure to protect). RESULTS: Maltreatment history was significant, t(258) = -3.36, p < .001; sibling initiators were associated with higher rates of sexual and physical abuse, and neglect than non-sibling. Exposure to family sexuality was significant with non-sibling initiators demonstrating greater exposure than the sibling group, t(282) = 2.66, p = .008. There was no significance between groups for types of PSB including use of coercion. CONCLUSIONS: Results illuminated unique dynamics of PSB with siblings of preschool-aged children. A developmental framework integrating child maltreatment, impulsivity, environmental factors, and capabilities are key considerations for conceptualization, prevention, and response that is distinct from SSA of adolescents.

Association between childhood maltreatment and obsessive-compulsive disorder comorbid with eating disorders: a cross-sectional study.

BACKGROUND: Obsessive-compulsive disorder (OCD) and eating disorders (ED) share common features, including the presence of obsessions and compulsions, and they often co-occur. Additionally, there is a significant comorbidity between ED and childhood traumatic experiences (CTE), as well as between CTE and OCD. Various biological and environmental factors have been proposed to explain the connection between ED, OCD, and CTE. This study explores the link between CTE and the comorbidity of ED and OCD, with the hypothesis that specific types of CTE may increase the risk of developing OCD in individuals with ED. METHODS: Participants (N = 562) were enrolled at an eating disorder unit in Montpellier, France, between March 2013 and January 2020. The Childhood Trauma Questionnaire (CTQ), Eating Disorder Examination Questionnaire (EDE-Q), and Mini International Neuropsychiatric Interview (MINI) were used to evaluate childhood maltreatment, assess clinical characteristics associated with ED, and categorize participants into two groups: patients with and without OCD. RESULTS: Bivariate analysis revealed that patients with comorbid ED and OCD had higher EDE-Q scores (p < 0.001), more anxiety disorders (p < 0.001), depressive disorders (p = 0.02), post-traumatic stress disorder (PTSD) (p < 0.001), and a higher incidence of sexual abuse (p < 0.001) and physical neglect (p = 0.04) compared to those without OCD. Multivariate analysis showed that the association between CTE and OCD was influenced by the presence of an anxiety disorder (p = 0.01) and a higher EDE-Q total score (p = 0.03), with a significant association with a history of sexual abuse (p = 0.04). CONCLUSIONS: This demonstrates that CTE increases the risk of comorbid OCD in ED patients, correlating with more clinically severe ED and a higher likelihood of anxiety disorders.

This study looked at the link between childhood trauma and the occurrence of both obsessive-compulsive disorder (OCD) and eating disorders (ED). We studied 562 participants who were being treated for eating disorders in Montpellier, France, over a seven-year period. We used various questionnaires to evaluate their childhood experiences, eating disorder symptoms, and the presence of OCD. We found that people with comorbid OCD and ED had more severe eating disorder symptoms and higher rates of anxiety, depression, and PTSD compared to those with just an eating disorder. These individuals were also more likely to have experienced sexual abuse and physical neglect during childhood. Our analysis showed that the connection between childhood trauma and OCD in patients with eating disorders was influenced by the presence of anxiety disorders and more severe eating disorder symptoms. Specifically, a history of sexual abuse was a significant factor. In summary, childhood trauma, especially sexual abuse, increases the risk of having both OCD and an eating disorder. This highlights the importance of screening for OCD and addressing past traumas in patients with eating disorders to provide better, more personalized care.

"Everything Is Changing, We Need to Adapt": Between Tradition and Modernity-Educators Coping with Child Sexual Abuse.

Socio-cultural contexts are formative to how teachers understand, conceptualize, and act when contending with child sexual abuse (CSA) cases among their students. The purpose of the present study was to investigate the experiences of Druze Arab teachers in Israel coping with cases of CSA among their students and the meaning they attribute to CSA in the context of socio-cultural change. Semi-structured interviews were conducted with 12 female Druze elementary school teachers. All of the participants taught in schools located in Druze villages, where the children of Druze families comprise the majority of the student body. The analysis used a thematic approach. The analysis revealed that a transition between tradition and modernity in the Druze socio-cultural group was the central conceptual framework through which the teachers' narratives regarding CSA emerged. As an emblem of modernity, increasing openness around sexual topics was perceived as simultaneously favorable and threatening to both the welfare of children and the well-being of the community. Coping with CSA was viewed as a negotiation between closed (traditional) and open (modern) society, as well as silence and dialogue regarding CSA. This study highlights the importance of preventing teachers' cultural biases from affecting their contributions to CSA interventions, as well as how religion can be a source of strength when confronting CSA. Implications for policy and developing bottom-up, culturally sensitive training, practice, and interventions are discussed.

Interpersonal Difficulties Arising from Child Sexual Abuse: Differences Between Intra-familial and Extra-familial Abuse Victims.

Child sexual abuse (CSA) often has serious implications for the victims. The scientific literature reflects a diversity of sequelae that may appear in the short and long term. Interpersonal difficulties have been shown to be one of the most common consequences. However, studies comparing these sequelae between victims of intra-familial (IF) and extra-familial (EF) CSA are scarce. The aim of this research was to analyze differences in dyadic satisfaction, sexual satisfaction, and attachment patterns in adulthood between Spanish IF victims, EF victims, and non-victims of CSA. The Sexual Victimization Subscale of the Juvenile Victimization Questionnaire, the Relationship Assessment Scale, the New Sexual Satisfaction Scale, and the Adult Attachment Questionnaire were administered to 140 adults (94 CSA victims and 46 non-victims) aged 18 to 54 years. CSA victims scored lower than the non-victims on the personal sexual satisfaction factor and attachment factors characterized by the need for approval, hostile resolution of conflicts, and emotional self-sufficiency. Statistically significant differences were also found between the victim groups in the factors characterized by the need for approval and communication of feelings and comfort with relationships showing the IF group to have more impairment in these areas than the EF group. In conclusion, CSA may have serious implications for the development of victims' interpersonal relationships. The context of sexual abuse and the relationship between victim and offender appears to play a role in the development of relational problems. These findings highlight the need to implement specific strategies in the psychological treatment of victims depending on their relationship with the offender and the environment in which the abuse occurred.

Time as a Category in Survivors' Reports About Child Sexual Abuse: An Explorative Approach to Lifetime Abuse.

Since the 1990s, cases of serious violence and abuse, particularly sexual abuse in educational and social institutions of the Catholic Church, have been reported in numerous countries, including Ireland, the United States, and Australia. In many countries, commissions have been set up to investigate the widespread cases of abuse that could not be prosecuted under criminal law. The testimonies of survivors and other witnesses are used by the commissions of inquiry in their work. Since 2016 the Independent Inquiry into Child Sexual Abuse in Germany has collected more than 2,500 reports from survivors of child sexual abuse. Forty-four testimonies were analyzed in a study seeking to understand more about lifetime abuse. In an explorative analysis, aspects of time as a key category in the reports were identified using the structured content analysis method. The results highlight the importance of time in the reports and during all phases of the survivors' lives. Overall, four themes are relevant: (a) the identification of turning points, (b) time to make sense of what happened, (c) the practice of waiting, and (d) time-bound experiences of testifying.

The Richness of Reports Provided by Children in Israel: Examination of the Impact of Social Affiliations.

Forensic interviews following child sexual abuse (CSA) are of central importance to the children, their families and all those involved. Moreover, the legal system expects rich, forensically relevant reports from the children. The current study focuses on the impact of children's social affiliation on the richness of their reports, and how question types contribute to rich reports. The sample included 314 forensic interviews conducted in Israel between 2015 and 2018. The findings revealed a relationship between child characteristics (gender), abuse characteristics (perpetrator identity, abuse type, abuse frequency) and social affiliation with report richness. Furthermore, question types (free recall prompts, summaries, directive, option-posing, suggestive) moderated the relationship between the child's characteristics, abuse characteristics, and social affiliation with report richness, when these effects were not equal. The findings emphasized that contextual observation of sexually abused children may promote better services for them and, in addition, stressed the importance of advancing future training and practical guidelines for practitioners.

The Landscape of Sexual Harm in the Video Game, Streaming, and Esports Community.

While sexual harm has been studied across a range of contexts, it has not yet been considered within the video game, streaming, and esports community. This study aimed to explore the landscape of sexual harm in this community, specifically, where it has been committed by esports professionals and video game live streamers. Fifty-five victim statements were extracted from online sources (such as Twitter/X and Reddit) and coded into variables relating to offender and victim demographics, offense characteristics, the offense process, and platform(s) used. Descriptive statistics were generated for each variable and Fisher's exact tests were conducted to examine the differences between adult-on-adult and adult-on-child cases. The findings reveal diverse offense outcomes across the sample, ranging from rape to sexual communication with a child. Some offense patterns can be seen in wider sexual offending literature, such as pre-offense alcohol consumption, offending against incapacitated victims (e.g., sleeping), and offending within an established romantic relationship. However, several offense process characteristics unique to the video gaming community were identified. These included offenders using their position of fame within the community to access victims and bypass the need for other coercive behaviors. Online offenses were more common with children and offenders demonstrated a preference for "live" methods, such as voice chat and video calling, rather than instant messaging or sharing images of themselves. This limits the digital evidence left behind and indicates the offenders' greater technological literacy. The study's findings shed light on the sexual harm that exists within this previously unexplored context and highlight areas where esports organizations, live-streaming platforms, and educational providers can do more to safeguard players, fans, and viewers in this community.

"It Will Always Feel Worse Because it Comes with That Added 'Betrayal'": Intersectionality Praxis and Black Young Women Survivors' Perspectives on Cultural Betrayal Trauma Theory.

Because of interlocking oppressions of racism and sexism (e.g. intersectionality), Black women's experiences of high rates of sexual violence are often ignored. A critical Black feminist framework, cultural betrayal trauma theory (CBTT) examines within-group violence in the Black community, which has compounding harm due to inequality. Though quantitative research has found support for CBTT, Black young women survivors' perspectives have not been examined. Therefore, the purpose of the current exploratory study was to engage in intersectionality praxis to qualitatively examine Black young women survivors' perspectives on CBTT through structured thematic analysis and coding based on theory. Respondents (N = 37; 18-30 years), provided their thoughts on CBTT following participating in a quantitative study. With most survivors in agreement that cultural betrayal in trauma is harmful, a key theme was community orientation in understanding both the harm and healing of cultural betrayal trauma. Black young women survivors' resonance with CBTT, as well as their recommendations for community-level solidarity and healing have important implications.

"Mend the rift" therapeutic model for working with sibling sexual abuse: Professionals' perspectives.

BACKGROUND: Sibling sexual abuse (SSA) is considered the most prevalent and longest-lasting type of interfamilial sexual abuse. The psychological implications of SSA may be felt throughout the harmed siblings' lifespan. Nevertheless, SSA receives very little therapeutic attention. OBJECTIVE: The present study explores how professionals dealing with the phenomenon see how to work with such cases. PARTICIPANTS AND SETTING: Fifty-two professionals working in the field of SSA participated in the study and completed closed and open-ended questionnaires. METHODS: A mixed-method research approach was implemented to quantitatively and qualitatively analyze the professionals' responses. RESULTS: The findings addressed three main intervention aspects. The first comprised the key unique therapeutic themes of SSA interventions that differentiate the SSA therapeutic process from other child sexual abuse cases. These included complex familial dynamics (e.g., secrecy climate, loyalty conflict, and intergenerational transmission of trauma) and at-home risk. The second addressed the therapeutic goals, including rebuilding family relationships and promoting safety strategies at home. The third was the SSA intervention structure, defining the structural elements of a holistic therapeutic model for family care. CONCLUSIONS: Based on the findings, a therapeutic model for family intervention in SSA cases was proposed, aiming to define service characteristics, determine who should be involved in the therapeutic process, and identify who should lead the intervention. The research contributes to the advancement of the theoretical and practical knowledge necessary to address the inherent familial complexities in SSA cases and the enhancement of the therapeutic orientation for professionals involved in such cases.

The Relevance of Hypersexuality and Impulsivity in Different Groups of Treatment-Seekers With and Without (Exclusive) Pedophilia.

Hypersexuality and impulsivity are regarded as risk factors for sexual offending against children. Studies exploring these factors in undetected men who offended or are at risk of offending are rare. This study aims to investigate hypersexuality and impulsivity in treatment-seeking men with and without a diagnosis of (exclusive) pedophilia who committed child sexual abuse (CSA), consumed child sexual abuse images (CSAI), or feel at risk of offending sexually. Data were obtained from three child abuse prevention projects in Bamberg, Germany. We employed self-report (BIS-11, HBI), objective measures (TSO), and risk assessment tools (STABLE-2007). We computed Bayesian ordinal logit and binomial generalized linear models to explore differences between groups and to predict lifetime CSA and CSAI. Hypersexuality scores were particularly pronounced in patients with exclusive and non-exclusive pedophilia. Patients without pedophilia scored similarly to nonclinical samples. Impulsivity measures did not consistently differ between groups. We could not predict lifetime CSA and CSAI using impulsivity and hypersexuality measures. Sexual rather than general impulsivity seems to be an issue in men with pedophilia. The motivation to offend in patients without pedophilia is discussed.

Adaptation of the Adverse Childhood Experience Questionnaire for Adults Into Turkish: A Validity and Reliability Study.

Background and Purpose: Questioning the adverse childhood experiences of adults may facilitate their search for help for their physical, social, and psychological well-being. The aim of this study is to determine the validity and reliability of the Adverse Childhood Experience Questionnaire for Adults in Turkish. Methods: This methodological study was conducted with 290 participants. The data collection tools consisted of a personal information form, the Adverse Childhood Experience Questionnaire for Adults, and the Childhood Trauma Experiences Questionnaire Short Form. Results: The number of items in the original questionnaire was 29 and became 24 in the Turkish adaption, which showed content validity, construct validity, and internal consistency reliability (Cronbach's alpha (α) = 0.928). Conclusions: The Adverse Childhood Experience Questionnaire for Adults was found to be valid and reliable for the Turkish population.

Child Maltreatment, Mental Health Disorders, and Health Risk Behaviors in People With Diverse Gender Identities.

This study examined rates of mental health disorders and health risk behaviors in people with diverse gender identities and associations with five types of child maltreatment. We used data from the Australian Child Maltreatment Study (ACMS), a nationally representative survey of Australian residents aged 16 years and more, which was designed to understand the experience of child maltreatment (physical abuse, sexual abuse, emotional abuse, neglect, exposure to domestic violence). Mental disorders-major depressive disorder, generalized anxiety disorder (GAD), alcohol use disorder, post-traumatic stress disorder (PTSD), and health risk behaviors-smoking, binge drinking, cannabis dependence, self-harm, and suicide attempt in the past 12 months were assessed. People with diverse gender identities who experienced child maltreatment were significantly more likely to have GAD (43.3%; 95% CI [30.3, 56.2]) than those who had experienced child maltreatment who were either cisgender men (13.8%; [12.0, 15.5]) or cisgender women (17.4%; [15.7, 19.2]). Similarly, higher prevalence was found for PTSD (21.3%; [11.1, 31.5]), self-harm (27.8%; [17.1, 38.5]) and suicide attempt (7.2%; [3.1, 11.3]) for people with diverse gender identities. Trauma-informed approaches, attuned to the high likelihood of any child maltreatment, and the co-occurrence of different kinds may benefit people with diverse gender identities experiencing GAD, PTSD, self-harm, suicidal behaviors, or other health risk behaviors.

Trust, entrusting and the role of trustworthiness for adult survivors of child sexual abuse.

BACKGROUND: Survivors of Child Sexual Abuse (CSA) are reported to have difficulties in trusting. Yet no previous study investigating CSA survivors' subjective experiences of trust exists and there is a paucity of clinical research into constructs and definitions of "trust." AIMS: To use a phenomenological lens to investigate CSA survivors' descriptions of trust relationships and trustworthy others by privileging their subjective experience. To better understand how trust can be built within therapeutic relationships. METHODS: A qualitative methodology using Interpretative Phenomenological Analysis was conducted within the survivor-research paradigm. The researcher was a person with lived experience of CSA who co-produced the study with CSA survivor advisors and co-constructed interviews with 17 adult CSA survivors. RESULTS: Findings present a "Survivor Trust Enactment Model" that delineates the process of building/repairing relational trust and advancing "transactional trust." Trust is portrayed as nuanced and formed across and according to context, including the demarcation of generalised and relational trust. The findings emphasise that trustees' trustworthiness is key to building trust which challenges assumptions that survivors are deficient in trust. CONCLUSION: The foregrounding of subjective trust experiences challenges diagnostic and clinical views on trust deficiency in adult CSA survivors. The study develops clinical constructs of trust, considers implications for clinical practice, and indicates areas for further research into trust dynamics in therapeutic relationships.