<p>I thought I would edit to add a bit of information.  First of all for those who don't know, (I didn't until I looked it up when I saw this question for the first time), the term hebephilia has been proposed to split pedophilia and denote the erotic preference for pubescent children (roughly, ages 11 or 12-14), but it has not become widely used. Along with hebephilia, there is also <a href="https://www.ncbi.nlm.nih.gov/pubmed/18686026" rel="nofollow noreferrer">Pedohebephilia</a> which is erotic preference on both pedophilic and hebephilic levels.</p>

<p>I would also like to address the issue of <a href="https://en.wikipedia.org/wiki/Milo_Yiannopoulos" rel="nofollow noreferrer">Milo Yiannopoulos</a> who seems to have been a topic of discussion, which raised this question.  In the Wikipedia page I linked here and in my edit of the OPs question, it says:</p>

<blockquote>
  <p>Yiannopoulos stated that sexual relationships between 13-year-old boys and adults can be "perfectly consensual," because some 13-year-olds are, in his view, sexually and emotionally mature enough to consent to sex with adults; he spoke favourably both of gay 13-year-old boys having sex with adult men and straight 13-year-old boys having sex with adult women. (<a href="http://www.thedailybeast.com/articles/2017/02/20/cpac-disinvites-milo-yiannopoulos-despite-his-attempt-at-contrition.html" rel="nofollow noreferrer">Source 1</a>) (<a href="http://www.thewrap.com/milo-yiannopoulos-denies-defending-pedophilia-video-jake-tapper/" rel="nofollow noreferrer">Source 2</a>) He used his own experience as an example, saying he was mature enough to be capable of giving consent at a young age.</p>
</blockquote>

<p>The page also states that</p>

<blockquote>
  <p>Defending himself in a press conference, Yiannopoulos alleged that he had been the victim of child abuse, and that "his comments were a way to cope with it".</p>
</blockquote>

<p>I am not going to enter into any debate or express any opinion on what Yiannopoulos said or didn't say — or even what he may have been trying to say — as this is not the forum to do this, but speaking from the standpoint of someone who has, over a period of over 17 years, supported many who have been sexually abused and raped, I can categorically say that different people use many different ways to "cope" with the effects of the past events.  Was he using repression or projection as an <a href="https://en.wikipedia.org/wiki/Defence_mechanisms" rel="nofollow noreferrer">ego-defence mechanism</a>? It's difficult to say.</p>

<p>I have been drafting my answer and editing the draft many times in order to make sure I try not to add anything which might inflame the already heated debate over Yiannopoulos, so here goes.</p>

<p>The question raised here is</p>

<blockquote>
  <p>Are there any fair studies exploring the effects of a sexually maturing teenager (14ish) engaging in sexual behavior with a significantly older adult (at least 23 years old)?</p>
</blockquote>

<p>In <em>The Journal of Criminal Law and Criminology</em> there is an article which examines behavioural scientific research on the subject (<a href="http://scholarlycommons.law.northwestern.edu/cgi/viewcontent.cgi?article=6508&amp;context=jclc" rel="nofollow noreferrer">McCord, D. 1986</a>).</p>

<blockquote>
  <p>A researcher reviewing the literature on the subject, came to the conclusion that little had been learned about child sexual abuse during the preceding twenty-five years.  He also noted that the literature dealing with the sexual abuse of minors, was "scant, unintegrated, and ambiguous. Books on the topic are rare. Articles are scattered and hidden among a wide range of journals, many in non-accessible medical and legal journals."</p>
  
  <p>One reason for the lack of solid research is simply that the subject is a very difficult one to study. Only a small percentage of cases is ever reported. In those cases that are reported, the participants are often reluctant to discuss the situation. As a result of problems like these there are methodological difficulties virtually built into most research projects in the area.</p>
</blockquote>

<p>Comments from research state the following</p>

<ul>
<li>"Children can exhibit the entire gamut of behaviors in response to a sexual assault, ranging from the negative to the positive." (Burgess, et al., 1978)</li>
<li>"Children's immediate reactions to an assault vary." (Leaman, 1980)</li>
<li>"Incest victims show a wide variety of symptom complaints or may show none at all." (Stuart &amp; Greer, 1984; Sgroi, 1975)</li>
<li>"Even those professionals who have a clinical definition with which they are comfortable will still have problems in identifying sexually abused children." (Mrazek, 1987)</li>
</ul>

<p>The reason that such a wide variety of symptoms has been noted is that child sexual abuse is very complex situation from the point of view of the victim.  This can perhaps best be illustrated by comparing it with adult rape, which is, by contrast, very unambiguous from the victim's perspective. In adult rape the victim is <strong>often but not always</strong> coerced by physical force or threats of physical force to engage in sexual activity which he or she does not desire. Under these circumstances, even when there is no physical violence, or threat of physical violence, there is no possibility of the victim enjoying the activity or emerging from the situation with any positive psychological emotions, as consent has not been given. Accordingly, it is not surprising that the reactions of adult victims to forcible rape are remarkably similar to each other and are drastically negative. By contrast, a child sexual abuse victim's feelings may be, and often are, ambivalent. The victim's will is usually much more malleable than an adult's, particularly when the perpetrator may be assuring the child that the activity is normal and even possibly suggesting that it is teaching them what they need to know.</p>

<p>Another point of note which can cause problems for the child in later life is that, although not in all cases, the child may even feel physical pleasure during the activity. As one researcher put it:</p>

<blockquote>
  <p>Contrary to the stereotype, most victims in our study readily acknowledged the positive as well as the negative elements of their experience. They talked about the times the physical sensations felt good, or they remembered how their sexual experience with an adult or family member satisfied a longing for affection and closeness that was rarely met at any other time. (Finkelhor, 1981)</p>
</blockquote>

<p>While this researcher found that 60% of adult women who had been sexually abused as children remembered the experience as primarily negative, only 7% remembered it as primarily positive.</p>

<p>The effects of statutory rape, and childhood sexual abuse <strong>is</strong> complex and whether or not it may be perceived to be consensual, it is generally believed that <strong>informed</strong> consent cannot be given by someone under the legal age of consent. (Abel, et al., 1984).</p>

<h2>References</h2>

<p>Abel, G. G., Becker, J. V., Cunningham-Rathner, J., 1984. <em>Complications, Consent, and Cognitions in Sex Between Children and Adults</em>. International Journal of Law and Psychiatry, 7(1), pp. 69-103. <a href="http://dx.doi.org/10.1016/0160-2527(84)90008-6" rel="nofollow noreferrer">http://dx.doi.org/10.1016/0160-2527(84)90008-6</a></p>

<p>Burgess, A. W., Groth, N. A., Holmstrom, L. L., &amp; Sgroi, S. M., 1978. <em>Sexual assault of children and adolescents</em>. Lexington, MA: D.C. Health.</p>

<p>Finkelhor, D., 1981. <em>Sexually victimized children</em>. New York, NY: Free Press; London: Collier Macmillan.</p>

<p>Leaman, K. M., 1980. <em>Sexual abuse : the reactions of child and family</em> in U.S. Dept. of Health and Human Services, <em>Sexual Abuse of Children: Selected Readings</em>.</p>

<p>Mrazek, P. B., 1987. <em>Definition and recognition of sexual child abuse: historical and cultural perspectives</em> in Sexually abused children and their families. Oxford; New York: Pergamon Press.</p>

<p>McCord, D., 1985. <em>Expert Psychological Testimony about Child Complainants in Sexual Abuse Prosecutions: A Foray into the Admissibility of Novel Psychological Evidence</em>. The Journal of Criminal Law and Criminology, 77(1), pp. 1-68.<br>
Available Free from: <a href="http://scholarlycommons.law.northwestern.edu/jclc/vol77/iss1/1/" rel="nofollow noreferrer">http://scholarlycommons.law.northwestern.edu/jclc/vol77/iss1/1/</a></p>

<p>Sgroi, S. M., 1975. <em>Sexual Molestation of Children: The Last Frontier in Child Abuse</em>, Children Today, 4(3) pp. 18-21.</p>

<p>Stuart, I. R., Greer, J. G, 1984. Victims of Sexual Aggression: Treatment of Children, Women, and Men. Publisher: Chapman &amp; Hall.</p>

CC BY-SA 4.0
2019-03-31T04:09:35.977Z
Re "In adult rape the victim is coerced by physical force or threats of physical force to engage in sexual activity which he or she does not desire." Actually this has been subject of a lot of law changes recently. Simply not giving consent is now considered enough in many legislation for the act to be classified as rape. Famous recent case in Spain: https://www.bbc.com/news/world-europe-46566754
got trolled too much this week
CC BY-SA 4.0
2019-03-31T06:20:12.653Z
@Fizz - That is interesting seeing the Spanish case.  Here in the UK, it has always been rape if consent has not been given, unless it is against a man, in which case it is "sexual assault by penetration".  The only other difference I am aware of in law is that marital rape was not accepted but that changed in relatively recent times.  I made a slight change to my wording to reflect non violent rape and sexual assault as you made a good point there and it was a little badly worded.
Chris Rogers
CC BY-SA 4.0
2021-01-18T02:59:35.327Z
_it is generally believed that informed consent cannot be given by someone under the legal age of consent_ – Odd how the capability of informed consent changes when one crosses jurisdictional borders.
forest
CC BY-SA 4.0
2017-03-17T20:46:25.503Z
2019-03-31T06:18:12.120Z
2019-03-31T06:18:12.120Z
Chris Rogers
<p>Most recent reviews have been fairly decisive on the <a href="https://en.wikipedia.org/wiki/Child_sexual_abuse#Effects" rel="nofollow noreferrer">negative impact of child sexual abuse</a> in general (though noting much variability in outcomes), but uncertain as to the specific effect of age of onset (hebephilia vs pedophilia):</p>

<p><a href="https://www.sciencedirect.com/science/article/abs/pii/014521349290011F" rel="nofollow noreferrer">Beitchman et al (1992)</a>:</p>

<blockquote>
  <p>The existing literature on the long-term sequelae of child sexual
  abuse is reviewed. The evidence suggests that sexual abuse is an
  important problem with serious long-term sequelae;
  ...
  The relation between age of onset of abuse and outcome is still
  equivocal.</p>
</blockquote>

<p><a href="https://www.ncbi.nlm.nih.gov/pubmed/8426874" rel="nofollow noreferrer">Kendall-Tackett et al (1993)</a>:</p>

<blockquote>
  <p>A review of 45 studies clearly demonstrated that sexually abused
  children had more symptoms than nonabused children, with abuse
  accounting for 15-45% of the variance. ... Research is insufficient to
  permit any conclusions about whether early versus late age of onset is
  more likely to lead to greater symptomatology.</p>
</blockquote>

<p><a href="https://www.ncbi.nlm.nih.gov/pubmed/11235837" rel="nofollow noreferrer">Paolucci et al (2001)</a>:</p>

<blockquote>
  <p>A meta-analysis of the published research on the effects of child
  sexual abuse (CSA) was undertaken ... The analyses provide clear
  evidence confirming the link between CSA and subsequent negative
  short- and long-term effects on development. There were no
  statistically significant differences on ds when various potentially
  mediating variables such as ... age when abused ... were assessed.</p>
</blockquote>

<p><a href="https://www.sciencedirect.com/science/article/pii/S0272735809001093" rel="nofollow noreferrer">Maniglio (2009)</a>:</p>

<blockquote>
  <p>Fourteen reviews, including more than 270,000 subjects from 587
  studies, were analyzed. There is evidence that survivors of childhood
  sexual abuse are significantly at risk of a wide range of medical,
  psychological, behavioral, and sexual disorders. ... the results of
  this systematic review do not confirm suspicions that ... age when
  abused ... influence the outcomes of child sexual abuse.</p>
</blockquote>

<p>So at this time, there is no reason to believe that hebephilia is any different from pedophilia in terms of impact.</p>

<p>One notable exception is the <a href="https://en.wikipedia.org/wiki/Rind_et_al._controversy" rel="nofollow noreferrer">Rind et al (1998)</a> review, that pointed out some methodological problems with prior research, notably that subject populations are typically non-randomized - they rely on clinical and legal populations who expectedly report negative outcomes.  However, more recent research has attempted to address this issue using <a href="https://en.wikipedia.org/wiki/Population_study" rel="nofollow noreferrer">population studies</a>, and comes to the same conclusions, for example <a href="https://jamanetwork.com/journals/jamapsychiatry/fullarticle/206025" rel="nofollow noreferrer">Nelson et al (2002)</a>:</p>

<blockquote>
  <p>... general population studies have confirmed findings from these
  samples including increased risk for psychiatric illness ... and other
  adverse outcomes ... associated with self-reported CSA.</p>
</blockquote>

<p>Good survey techniques in such population studies attempt to control for factors such as stigma (as mentioned in the question), by asking independently about child sexual abuse and potential adverse outcomes, rather than asking victims to self-assess those outcomes.  Nonetheless, there may be additional factors to consider, such as <a href="https://en.wikipedia.org/wiki/Child_grooming" rel="nofollow noreferrer">grooming method</a>, cooperation level, perception of harm, etc.</p>

CC BY-SA 3.0
2018-03-25T07:53:00.330Z
2018-03-25T07:53:00.330Z
Arnon Weinberg
<p>Following the <a href="https://en.wikipedia.org/wiki/Milo_Yiannopoulos" rel="nofollow noreferrer">Milo Yiannopoulos</a> shebang, I had a discussion with a friend over the effects on a sexually maturing teenager (14ish) engaging in sexual behavior with a significantly older adult (at least 23 years old). In the discussion, we both realized that in fact we were just spewing opinions at each other, and in reality couldn't point to a fair study showing either the negative or positive effects of such practice.</p>
<p>So, I am wondering: Are there any fair studies exploring the effects? (I expect that social attitudes might sway the victim's feelings toward the experience, but hope that studies can somehow control for that.)</p>

CC BY-SA 3.0
2017-02-22T18:38:51.193Z
Related question: [What is the effect of viewing pornography on children?](https://psychology.stackexchange.com/q/4229/7001)
Arnon Weinberg
<social-psychology><abnormal-psychology><developmental-psychology><sexuality><sexual-assault>
What are the effects of hebephilia on victims?
Daniel Kaufman
# What are the effects of hebephilia on victims?

(Asked by: username_0 on 2017-02-22)

Following the [Milo Yiannopoulos](https://en.wikipedia.org/wiki/Milo_Yiannopoulos) shebang, I had a discussion with a friend over the effects on a sexually maturing teenager (14ish) engaging in sexual behavior with a significantly older adult (at least 23 years old). In the discussion, we both realized that in fact we were just spewing opinions at each other, and in reality couldn't point to a fair study showing either the negative or positive effects of such practice.

So, I am wondering: Are there any fair studies exploring the effects? (I expect that social attitudes might sway the victim's feelings toward the experience, but hope that studies can somehow control for that.)

**Tags:** social-psychology, abnormal-psychology, developmental-psychology, sexuality, sexual-assault

> **Comments:**
> **username_1**: Related question: [What is the effect of viewing pornography on children?](https://psychology.stackexchange.com/q/4229/7001)  

---

## 2 answers

### Answer by username_2 on 2017-03-17. Score: 8

I thought I would edit to add a bit of information. First of all for those who don't know, (I didn't until I looked it up when I saw this question for the first time), the term hebephilia has been proposed to split pedophilia and denote the erotic preference for pubescent children (roughly, ages 11 or 12-14), but it has not become widely used. Along with hebephilia, there is also [Pedohebephilia](https://www.ncbi.nlm.nih.gov/pubmed/18686026) which is erotic preference on both pedophilic and hebephilic levels.

I would also like to address the issue of [Milo Yiannopoulos](https://en.wikipedia.org/wiki/Milo_Yiannopoulos) who seems to have been a topic of discussion, which raised this question. In the Wikipedia page I linked here and in my edit of the OPs question, it says:

> Yiannopoulos stated that sexual relationships between 13-year-old boys and adults can be "perfectly consensual," because some 13-year-olds are, in his view, sexually and emotionally mature enough to consent to sex with adults; he spoke favourably both of gay 13-year-old boys having sex with adult men and straight 13-year-old boys having sex with adult women. ([Source 1](http://www.thedailybeast.com/articles/2017/02/20/cpac-disinvites-milo-yiannopoulos-despite-his-attempt-at-contrition.html)) ([Source 2](http://www.thewrap.com/milo-yiannopoulos-denies-defending-pedophilia-video-jake-tapper/)) He used his own experience as an example, saying he was mature enough to be capable of giving consent at a young age.

The page also states that

> Defending himself in a press conference, Yiannopoulos alleged that he had been the victim of child abuse, and that "his comments were a way to cope with it".

I am not going to enter into any debate or express any opinion on what Yiannopoulos said or didn't say — or even what he may have been trying to say — as this is not the forum to do this, but speaking from the standpoint of someone who has, over a period of over 17 years, supported many who have been sexually abused and raped, I can categorically say that different people use many different ways to "cope" with the effects of the past events. Was he using repression or projection as an [ego-defence mechanism](https://en.wikipedia.org/wiki/Defence_mechanisms)? It's difficult to say.

I have been drafting my answer and editing the draft many times in order to make sure I try not to add anything which might inflame the already heated debate over Yiannopoulos, so here goes.

The question raised here is

> Are there any fair studies exploring the effects of a sexually maturing teenager (14ish) engaging in sexual behavior with a significantly older adult (at least 23 years old)?

In *The Journal of Criminal Law and Criminology* there is an article which examines behavioural scientific research on the subject ([McCord, D. 1986](http://scholarlycommons.law.northwestern.edu/cgi/viewcontent.cgi?article=6508&context=jclc)).

> A researcher reviewing the literature on the subject, came to the conclusion that little had been learned about child sexual abuse during the preceding twenty-five years. He also noted that the literature dealing with the sexual abuse of minors, was "scant, unintegrated, and ambiguous. Books on the topic are rare. Articles are scattered and hidden among a wide range of journals, many in non-accessible medical and legal journals."
>
> One reason for the lack of solid research is simply that the subject is a very difficult one to study. Only a small percentage of cases is ever reported. In those cases that are reported, the participants are often reluctant to discuss the situation. As a result of problems like these there are methodological difficulties virtually built into most research projects in the area.

Comments from research state the following

* "Children can exhibit the entire gamut of behaviors in response to a sexual assault, ranging from the negative to the positive." (Burgess, et al., 1978)
* "Children's immediate reactions to an assault vary." (Leaman, 1980)
* "Incest victims show a wide variety of symptom complaints or may show none at all." (Stuart & Greer, 1984; Sgroi, 1975)
* "Even those professionals who have a clinical definition with which they are comfortable will still have problems in identifying sexually abused children." (Mrazek, 1987)

The reason that such a wide variety of symptoms has been noted is that child sexual abuse is very complex situation from the point of view of the victim. This can perhaps best be illustrated by comparing it with adult rape, which is, by contrast, very unambiguous from the victim's perspective. In adult rape the victim is **often but not always** coerced by physical force or threats of physical force to engage in sexual activity which he or she does not desire. Under these circumstances, even when there is no physical violence, or threat of physical violence, there is no possibility of the victim enjoying the activity or emerging from the situation with any positive psychological emotions, as consent has not been given. Accordingly, it is not surprising that the reactions of adult victims to forcible rape are remarkably similar to each other and are drastically negative. By contrast, a child sexual abuse victim's feelings may be, and often are, ambivalent. The victim's will is usually much more malleable than an adult's, particularly when the perpetrator may be assuring the child that the activity is normal and even possibly suggesting that it is teaching them what they need to know.

Another point of note which can cause problems for the child in later life is that, although not in all cases, the child may even feel physical pleasure during the activity. As one researcher put it:

> Contrary to the stereotype, most victims in our study readily acknowledged the positive as well as the negative elements of their experience. They talked about the times the physical sensations felt good, or they remembered how their sexual experience with an adult or family member satisfied a longing for affection and closeness that was rarely met at any other time. (Finkelhor, 1981)

While this researcher found that 60% of adult women who had been sexually abused as children remembered the experience as primarily negative, only 7% remembered it as primarily positive.

The effects of statutory rape, and childhood sexual abuse **is** complex and whether or not it may be perceived to be consensual, it is generally believed that **informed** consent cannot be given by someone under the legal age of consent. (Abel, et al., 1984).

## References

Abel, G. G., Becker, J. V., Cunningham-Rathner, J., 1984. *Complications, Consent, and Cognitions in Sex Between Children and Adults*. International Journal of Law and Psychiatry, 7(1), pp. 69-103. <http://dx.doi.org/10.1016/0160-2527(84)90008-6>

Burgess, A. W., Groth, N. A., Holmstrom, L. L., & Sgroi, S. M., 1978. *Sexual assault of children and adolescents*. Lexington, MA: D.C. Health.

Finkelhor, D., 1981. *Sexually victimized children*. New York, NY: Free Press; London: Collier Macmillan.

Leaman, K. M., 1980. *Sexual abuse : the reactions of child and family* in U.S. Dept. of Health and Human Services, *Sexual Abuse of Children: Selected Readings*.

Mrazek, P. B., 1987. *Definition and recognition of sexual child abuse: historical and cultural perspectives* in Sexually abused children and their families. Oxford; New York: Pergamon Press.

McCord, D., 1985. *Expert Psychological Testimony about Child Complainants in Sexual Abuse Prosecutions: A Foray into the Admissibility of Novel Psychological Evidence*. The Journal of Criminal Law and Criminology, 77(1), pp. 1-68.  
Available Free from: <http://scholarlycommons.law.northwestern.edu/jclc/vol77/iss1/1/>

Sgroi, S. M., 1975. *Sexual Molestation of Children: The Last Frontier in Child Abuse*, Children Today, 4(3) pp. 18-21.

Stuart, I. R., Greer, J. G, 1984. Victims of Sexual Aggression: Treatment of Children, Women, and Men. Publisher: Chapman & Hall.

> **Comments:**
> **username_3**: Re "In adult rape the victim is coerced by physical force or threats of physical force to engage in sexual activity which he or she does not desire." Actually this has been subject of a lot of law changes recently. Simply not giving consent is now considered enough in many legislation for the act to be classified as rape. Famous recent case in Spain: https://www.bbc.com/news/world-europe-46566754  
> **username_2**: @Fizz - That is interesting seeing the Spanish case.  Here in the UK, it has always been rape if consent has not been given, unless it is against a man, in which case it is "sexual assault by penetration".  The only other difference I am aware of in law is that marital rape was not accepted but that changed in relatively recent times.  I made a slight change to my wording to reflect non violent rape and sexual assault as you made a good point there and it was a little badly worded.  
> **username_4**: _it is generally believed that informed consent cannot be given by someone under the legal age of consent_ – Odd how the capability of informed consent changes when one crosses jurisdictional borders.  

---

### Answer by username_1 on 2018-03-25. Score: 2

Most recent reviews have been fairly decisive on the [negative impact of child sexual abuse](https://en.wikipedia.org/wiki/Child_sexual_abuse#Effects) in general (though noting much variability in outcomes), but uncertain as to the specific effect of age of onset (hebephilia vs pedophilia):

[Beitchman et al (1992)](https://www.sciencedirect.com/science/article/abs/pii/014521349290011F):

> The existing literature on the long-term sequelae of child sexual
> abuse is reviewed. The evidence suggests that sexual abuse is an
> important problem with serious long-term sequelae;
> ...
> The relation between age of onset of abuse and outcome is still
> equivocal.

[Kendall-Tackett et al (1993)](https://www.ncbi.nlm.nih.gov/pubmed/8426874):

> A review of 45 studies clearly demonstrated that sexually abused
> children had more symptoms than nonabused children, with abuse
> accounting for 15-45% of the variance. ... Research is insufficient to
> permit any conclusions about whether early versus late age of onset is
> more likely to lead to greater symptomatology.

[Paolucci et al (2001)](https://www.ncbi.nlm.nih.gov/pubmed/11235837):

> A meta-analysis of the published research on the effects of child
> sexual abuse (CSA) was undertaken ... The analyses provide clear
> evidence confirming the link between CSA and subsequent negative
> short- and long-term effects on development. There were no
> statistically significant differences on ds when various potentially
> mediating variables such as ... age when abused ... were assessed.

[Maniglio (2009)](https://www.sciencedirect.com/science/article/pii/S0272735809001093):

> Fourteen reviews, including more than 270,000 subjects from 587
> studies, were analyzed. There is evidence that survivors of childhood
> sexual abuse are significantly at risk of a wide range of medical,
> psychological, behavioral, and sexual disorders. ... the results of
> this systematic review do not confirm suspicions that ... age when
> abused ... influence the outcomes of child sexual abuse.

So at this time, there is no reason to believe that hebephilia is any different from pedophilia in terms of impact.

One notable exception is the [Rind et al (1998)](https://en.wikipedia.org/wiki/Rind_et_al._controversy) review, that pointed out some methodological problems with prior research, notably that subject populations are typically non-randomized - they rely on clinical and legal populations who expectedly report negative outcomes. However, more recent research has attempted to address this issue using [population studies](https://en.wikipedia.org/wiki/Population_study), and comes to the same conclusions, for example [Nelson et al (2002)](https://jamanetwork.com/journals/jamapsychiatry/fullarticle/206025):

> ... general population studies have confirmed findings from these
> samples including increased risk for psychiatric illness ... and other
> adverse outcomes ... associated with self-reported CSA.

Good survey techniques in such population studies attempt to control for factors such as stigma (as mentioned in the question), by asking independently about child sexual abuse and potential adverse outcomes, rather than asking victims to self-assess those outcomes. Nonetheless, there may be additional factors to consider, such as [grooming method](https://en.wikipedia.org/wiki/Child_grooming), cooperation level, perception of harm, etc.


---

