Childhood sexual assault (CSA) occurs when an adult engages in a sexual manner with a minor (Rape, Abuse, and Incest National Network [RAINN], 2022) and is one of the major adverse childhood experiences (Felitti et al., 1998). Some examples of CSA are exposing genitals to a minor, fondling, sending inappropriate sexual content online or through texts and phone conversations, sex with a minor, or sex trafficking of a minor. According to Finkelhor and colleagues (2014), 26.6% girls and 5.1% boys under the age of 17 years have experienced sexual abuse/assault. The impact of sexual violence is wide-ranging; individuals who have experienced sexual violence endorse increased rates of anxiety, depression, post-traumatic stress, and other debilitating mental health outcomes (Dworkin et al., 2021; Jaconis et al., 2020).

Body image is a complex psychological phenomenon that refers to how individuals perceive themselves and feel about their bodies and is more than an objective visual observation of one’s shape or size; and is instead an interaction between sociocultural, psychological, and biological influences (Cash & Deagle, 1997; Slade, 1988). A variety of factors can influence body image (Van Vonderen & Kinnally, 2012; Wade et al., 2003) and body image dissatisfaction has been associated with outcomes such as lower health related behaviors, eating disorders, and stimulant use (Grogan, 2006). Body image seems to be especially salient for sexual assault survivors, as sexual violence has been associated with eating disorders (Wonderlich et al., 1997), body image disturbance, and issues with social relationships (Blanchard-Dallaire & Hébert, 2014; Jaconis et al., 2020; Kennedy & Prock, 2018). Additionally, body image disturbance predicts higher rates of post-traumatic stress, depression, and anxiety in female survivors of sexual abuse/assault (Jaconis et al., 2020; Weaver et al., 2014).

Furthermore, interpersonal and intrapersonal interactions with sociocultural environments can impact body image negatively as well (Cafri et al., 2005; Clark & Tiggemann, 2008). Body image is inherently influenced by culture and ideal body types can vary based on identity, culture, and temporal era (Atkins, 2012; Cash & Deagle, 1997; Lowe, 2006; Watson et al., 2019). The Western thin ideal is associated with worse body image outcomes for women (Harper & Tiggemann, 2008; Nouri et al., 2011) and women with lower body image satisfaction endorse heightened awareness of the Western ideal (Cafri et al., 2005; Clay et al., 2005). Research also suggests that internalization of cultural thin ideals, rather than mere awareness of them, is associated with higher levels of body image disturbance (Cafri et al., 2005; Cribb & Haase, 2016; Dittmar et al., 2009; Suisman et al., 2014). However, the relationship between exposure to the thin ideal is not straightforward; many people presented with the thin ideal, do not develop a negative self-concept or poor body image (Quick & Byrd-Bredbenner, 2014).

Internalization of cultural ideals can lead to body image dissatisfaction. From the social constructivist point of view, knowledge and reality are constructed through the internalization of the interaction between the individuals and their sociocultural contexts (Mascolo, 1994; Vygotsky, 1978). Perceptions of one’s body would be a logical extension of this understanding (Bartky, 1990). Therefore, sociocultural influences on how an individual perceives herself may be more pervasive than previously envisioned. Pressures may be extended through family and peer relationships who present with an overconcern of how an individual’s body looks; this phenomenon has been linked to increased body image dissatisfaction in individuals extending across various cultures (Levine et al., 2009; McCabe & Ricciardelli 2003). Parental pressure significantly correlated with body image disturbance in Korean adolescent women (You et al., 2017), Japanese women (Yamamiya et al., 2008), and Black women (Kelch-Oliver & Ancis, 2011; Rodgers et al., 2021). Additionally, peer influence also impacted body image disturbance in Asian (Javier & Belgrave, 2019) and Black women (Kelch-Oliver & Ancis, 2011). Other pressures may come through religion (Boyatzis & Quinlan, 2008) or socioeconomic status (O’Dea & Caputi, 2001).

Sociocultural influences also impact survivors’ recovery process (Brown, 2008; Bryant-Davis, 2005). Traditionally, trauma has been viewed as an interaction between the individual and the traumatic event where recovery is viewed as an individual process. However, the individual’s environment and the context in which the traumatic event took place are often underestimated (Brown, 2008; Bryant-Davis, 2005; Harvey, 1996). Most individual’s identities exist as complex intersectionalities of age, sex, sexuality, gender, race, ethnicity, nationality, ability, education, religion/spirituality, socioeconomic status, location, politics, and more (Bronfenbrenner, 2005). Additionally, the values, traditions, attitudes, and beliefs of communities in which an individual exists can affect the meaning-making process (Herman, 2015; Park, 2010). In turn, sociocultural responses and resources can either act as protective factors, have no effect, or effect the recovery process in a detrimental way. The ecological view of trauma understands that any trauma is an interaction between the individual, the traumatic event, and the sociocultural environment (Harvey, 1996). Therefore, recovery (Herman, 2015) and posttraumatic growth (Calhoun & Tedeschi, 2006) would also be affected by sociocultural contexts.

Research on sexual assault survivors has indicated that survivors often experience “silencing” when sharing their experiences (Ahrens, 2006, p. 263). Survivors often question the validity of their assault because they have not found support after sharing their experiences (Hills et al., 2021; Khan et al., 2018; LeMaire et al., 2016; Peterson & Muhlenhard, 2004). For survivors of CSA, this wound can be deeper as shame and self-blame set in (Herman, 2015), especially when social supports engage in survivor blaming, idealistic thinking, or rape myths (Ahrens, 2006). Survivors are therefore vulnerable to being tormented not only by the person who assaulted them, but also by the sociocultural contexts within which they reside (Ahrens, 2006; Ullman, 2010).

Current Study

To our knowledge, researchers have yet to investigate the impact childhood sexual assault (CSA) on body image. Our aim for this study was to explore the lived experiences of survivors of CSA, their meaning making process of the assault, and how messages from their sociocultural environment affected their relationship with, and perception of, their bodies.

Method

Qualitative research is appropriate when trying to gain insight and depth into participant’s experiences (Moustakas, 1994; Smith & Osborn, 2008). We used a phenomenological design to derive descriptive and analytical data from participants, which would help provides insight into participant’s lived experiences (Creswell, 2014; Patton, 2015). How an individual experienced a phenomenon was paramount to us, and we aimed to capture the essence of the experience as perceived and interpreted by the individuals who lived it (Moustakas, 1994; Smith & Osborn, 2008). We used interpretive phenomenological analysis (IPA) for coding and data analysis as IPA aims to deeply understand and explore how an individual is making meaning of their lived experiences as they move through life within their specific sociocultural contexts (Smith & Osborn, 2008). Generalizability to an entire population is not the intention of IPA; it requires homogeneity of experiences within participants so that the core of the experience, can be highlighted. Within IPA, the researcher plays an active role and engages in meaning making of the data while participants are trying to make meaning of their lived experiences, i.e., double hermeneutics (Smith & Osborn, 2008). This is because the intention and motivation of the researcher choosing to study the phenomenon is as important as the phenomenon itself.

Our research team consisted of three researchers (two Counselor Educators and one Counseling Psychologist) belonging to a prominent state university in the southern United States and three Counseling Psychology doctoral students. As IPA expects the researchers to engage in their own process as they engage with the participants’ data, we include our motivations, interest, and process under the methodological integrity and reflexivity section.

Participants and Procedure

Our participants entrusted us with their intimate stories, and helped us understand their experiences, for which we are grateful. As IPA aims to explore how participants’ make meaning of their experiences rather than generalize the findings to a larger population, therefore, our relatively small sample size sufficed (Smith et al., 2009). Our intention was to recruit up to 15 participants and we interviewed eleven (n = 11) individuals whose gender was assigned as female at birth and who had experienced CSA between the ages of 4–17 years of age. Most of our participants had experienced at least one incident of CSA. We had a wide range of ages, ethnicities, and backgrounds. Ages ranged between 23 and 67 years. Six participants identified as White, of which five identified as cisgender, heterosexual women and one identified as non-binary. Of these remaining participants, two identified as Latina, two identified as Asian, cisgender heterosexual women, and one identified as a Black/African American, cisgender pansexual woman.

On receiving approval from the Institutional Review Board (IRB), the research team posted recruitment flyers in print, through social media platforms, and by sending via emails to our contacts. The flyers included a QR code and survey link that directed potential participants to a Qualtrics survey screening for study eligibility and requesting contact information. The PI emailed the informed consent to eligible participants and answered any questions from them. Once potential participants were comfortable with going ahead with the interview, the PI set a scheduled time according to participant convenience.

The PI and second author conducted semi-structured interviews lasting approximately 45–60 min via teleconferencing software called Zoom. Questions focused on their current views of their body image, how those views were influenced socioculturally as they were growing up, what role the CSA had on how they viewed their bodies after the assault, and the process of recovery post trauma. Before starting the audio/video recording, researchers discussed the informed consent, answered any participant questions, and obtained verbal consent for participation. Once the recording began, the participant was asked to repeat their verbal consent. Once the interviews were completed, the audio recordings were transcribed by research assistants, verified for accuracy, and stored according to IRB approved confidentiality procedures. Each participant was sent a $40 e-gift card as an appreciation for their time, effort, and for sharing their stories.

Data Analysis

The IPA guidelines as proposed by Smith and Osborn (2008) were followed closely for coding and data analysis. PI and second author independently coded interviews, with the last author acting as a tiebreaker, if there was disagreement. First, the PI and second author coded the first two transcripts and met once to ensure consensus for our coding method. Subsequently, the remaining transcripts were sequentially analyzed as recommended by Smith and Osborn (2008). Throughout the coding process, PI and second author met four times for approximately two hours each to discuss “objects of concern” and “experiential claims” (Larkin & Thompson, 2012, p. 106). Objects of concern are what stand out to the researchers as important to the participant and experiential claims are what provide meaning to the object of concern. Once the PI and second author had gone through this process for each transcript, we met twice to discuss and calibrate on “emerging title themes” (Smith & Osborn, 2008, p. 68) and “superordinate themes” for each participant (Smith & Osborn, 2008, p. 72). Each emerging theme was highlighted by participant first and then connected between participants to arrive on superordinate themes which became the basis of our findings.

Methodological Integrity and Reflexivity

Larkin and Thompson (2012) suggest reflexive journaling, peer review, supervision, and detailed audit trails as a means of procedural integrity. As the PI and second author completed the interviews as well as the coding and organization of themes, only these members engaged in reflexive processes. The PI utilized reflexive journaling and memos on NVivo after coding each transcript. Additionally, PI discussed the effect of the data on her own journey in personal counseling. The second author discussed the impact of coding participants’ stories on her within peer consultation and with a psychologist. In addition, she completed informal journal entries about her evolving thoughts on the data during the coding process. During coding meetings, we utilized peer supervision and shared how we made meaning of the data through our unique lens’. We also debriefed on how the data was affecting us personally. The PI was responsible for maintaining an audit trail.

As a team, all authors hope to add to the literature regarding the importance of sociocultural factors in shaping individual experiences and meaning making, to understand the impact of CSA by highlighting survivors’ voices, and to shed light on the pervasive marginalized and discriminatory aspects that oppress women internally and externally, vis-à-vis body image.

Findings

Four major themes emerged from data analysis procedures. These include sociocultural impacts, meaning making of the critical event, i.e., childhood sexual assault, body descriptions of how participants currently view their bodies, and internal processes of the individual that have shaped how they view their bodies, specifically thoughts and emotions, and behaviors. We would like to emphasize that most of the themes were intertwined and interrelated. To provide a holistic picture of the participants’ experiences, we did not break them into more specific parts as they would lose their meaning as well as contextual significance.

Sociocultural Impacts

Sociocultural impacts emerged as a major theme and is further composed of sub-themes: family relationships, peer relationships, societal and environmental influences, and cultural and ethnic influences. These sub-themes are contextual to each participant first, through which some common ideas emerged along with some unique contexts as well. These contexts affect individuals directly – the closer the contact, the higher the possibility of influence (Bronfenbrenner, 2005; Calhoun & Tedeschi, 2006; Herman, 2015).

Family relationships. The first sub-theme was family relationships. Family members have a significant influence on the way we think, feel, and behave. Our values and beliefs are influenced by this group’s proximity and presence across multiple stages of our initial development (Bronfenbrenner, 2005; Calhoun & Tedeschi, 2006; Herman, 2015). For example, Participant #11 shares the words she remembers her mother used to comment on her body:

[Mother] used to tell me um- you’re as big as a horse say- she was short, she was about the size of 5’2, I’m about 5’8 and she would say ‘you know you’ve got thighs like ham hocks’ I remember. ‘Your thighs are big hams’ she’d say- ‘you’re a big horse’.

Exact words and phrases were not the only potent memories our participants had of their families. Participant #3 received specific messages about body type from her parents after she completed fitness assessments at school each year:

My mom would read me the letter and say ‘we have to do something about this. Let’s go to the doctor’ and then…it was another diet…sometimes of my choice and sometimes imposed on me and sometimes a little of both, but there was never the message that it was okay to be the size that I was or the shape that I was, the weight that I was…there was never the message of it’s okay to be a larger body.

This quote demonstrates that the absence of positive messages can be just as impactful as the presence of negative messages.

We can trace the trajectory of the cultural and ethnic influences that affected stereotypes of the family system, which in-turn influenced the behavior of the family towards participants. Specific to our data, family members responses were central to distinct events in our participants’ lives. For example, Participant #3 shares her experiences of hitting puberty and her parents’ responses:

[T]here was this huge expectation on me to- to be very feminine like- uh- to wear high heels and wear makeup from a young age like as soon as I hit puberty my dad was like here, I bought this [makeup] for you at the store- you know *laughs* it like- it’s just a strange thing and I- I did it a lot of my adolescence of being the girly girl because that was the expectation of me.

Participant #10 shared implicit and explicit messages she received from her parents and extended family members when growing up:

Growing up I get [got] a lot of comments from my parents and […] aunts and uncles on my mom’s side just making comments about how I’m like a ‘big boned girl’ or like how ‘you need to feed her less because she’s growing too big’ um- so it’d be my Asian-American side given that they you know- strive for the smaller stature and the smaller physique and I just wasn’t born that way.

Even though the messages were filtered in through the family system (Bronfenbrenner, 2005), they were being influenced from the contexts outside the family system.

Peer relationships. The second sub-theme was peer relationships. Peers are a significant part of our lives, both developmentally and for social support. In this sub-theme, we included statements that may have come from participant’s friends, classmates, teammates, and other peers close in age. None of the experiences described to us were positive in nature. For example, Participant #8 shared about their overall experience of adolescence in this way:

I got bullied um- or like made fun of definitely in adolescent years and high school and…growing up…in a very sort of rural isolated um- small town in southeast Texas…in that environment there was a lot of like tough love and like people make fun of everyone […] it’s just kind of harsh

One particular incident they remembered all these years later involves someone leaving a poem in their locker that said, “fatty fatty 2 × 4 your boobs couldn’t fit through any door”. Sharing this they add, “I will remember this forever it was so stupid”, highlighting the impact of bullying on this participant due to how others perceived their body, and the depth of impact portrayed by the memory of the exact words of the poem. Comments coming from peer groups seemed particularly impactful for other participants as well. For example, Participant #1 shared:

[G]rowing up I was taller, and I just like went through puberty earlier so um, I was definitely like- called fat and like pointed out. Like I was just “othered” I was “othered” very easily…because I just didn’t look the way other young girls did.

Any deviation from the norm or societal standard of a certain body type, was enough for her to be ostracized. If we look at this behavior with critical analysis, did the stereotype come from the other students going through puberty, or was there a sociocultural influence on the observation of similarities being viewed as “normal” and differences being viewed as criteria for “othering” coming from environmental influences that her classmates had internalized.

Within peer relationships, romantic partners can have a particularly impactful role on body image as well. Participant #6 described how her view of her boyfriend’s social media use impacted her:

I noticed my boyfriend follow accounts of people that… he don’t know them, and those girls all have very large breasts… I feel very disappointing and so hurt and so angry because I think … I mentioned earlier that my boyfriend will praise my body, and then I look at their breasts and compare with my breasts and they’re so… mine are a lot smaller so I feel like everything he told me is a lie.

The discrepancy between her boyfriend’s words and behaviors and the impact that observation had on her is depicted succinctly through this quote, highlighting that impact comes not only through what is explicitly said but also through behaviors.

Societal and environmental influences. The third and a key sub-theme that emerged from our data includes socially constructed influences, for example, beauty and health standards, disciplining, and comparison to others. We also categorized environmental influences into this sub-theme as both the social and environmental influences affect how people make meaning of their world (Mascolo, 1994; Vygotsky, 1978).

Demonstrating the entanglement between themes, Participant #9 discussed the converging influences of family and society. She said, “I think um my parents’ eating habits and dieting…in the household made it seem like, like you can’t get fat”. Adding complexity to our understanding of this theme, Participant #2 identified a common reality in the media:

[G]oing to the movie theatre or watching a Netflix series and a lot of those shows kind of have like a specific image of what women should look like or just the fact that there is specific pattern of all of them looking kind of like thinner and tan and kind of seeing that image so often it’s really easy for me at least to think about it and compare myself.

This participant’s experiences are an example of the deceptive ways in which implicit messages in one’s environment can impact cognition. Here we have two women who are interpreting the messages of dieting and social representation of women, as a standard for how women should look. However, societal and environmental influences were not isolated to the media or parents’ dieting habits. For Participant #4, specific aspects of her parents’ lives created a unique yet abusive family environment:

The environment we grew up in, the alcohol and stuff it- because my parents weren’t happy with themselves and um, I don’t ever think that they wanted me, they just […] ended up pregnant with me and she- she didn’t want kids anyways […] my dad has never made me feel like I was a burden. She [mother] definitely did, and she had childhood manic depression and a lot of stuff, and I think that a lot of her mental health focuses, that instead of putting them on herself she put them onto me. You know, like, if like if I can get her a little bit fatter, my mom was always bragging that she was smaller than me.

This quote highlights the reciprocal cycle of familial patterns and environmental factors that can lead to mental health issues of one parent and abandonment or resignation from the other parent; the cycle can negatively impact a child within the family system. We observe an abusive environment being created for this participant by her mother via the use of societal stigmatization of weight gain. This was unique for Participant #4.

Another unique context was that of Participant #1, who was influenced not only personally but also professionally by societal standards and undue environmental severity:

I think especially being in the performance industry where it is such a visual medium. Um, so much of your worth and your ability to be able to work and support yourself and be successful is based on the way you look. Um, and the way that you are categorized.

She explains how she interprets the messages being given to her career and social channels:

I have to improve the presentation of myself by losing weight […] if my face isn’t at a certain level […] I have to then lose weight in order to compensate for the features like on my face that I can’t change. Uh, because surgically if I wanted, that’s how like I would change my face, but I could lose weight without doing that.

Her understanding was the in order to be competitive in her career alongside conventionally attractive women she has to “work twice as hard to get half of the things”. That “it feels like being pretty or being conventionally attractive is the rent you have to pay in order to exist in this world like happily”.

The intersection of societal standards of attractiveness and how these standards dominate her career resulted in discriminatory practices this participant experienced. She was left feeling marginalized and to deal with the pressure of having to fight her natural body type to be successful and pay the rent to compensate.

Cultural and ethnic influences. The fourth and another key sub-theme that emerged from the data were the specific cultural and ethnic influences that our participants described experiencing through family, extended family, or peers as well as indirectly through sociocultural standards of beauty, health, or attractiveness. Several participants linked these to their ethnicity. For example, Participant #6 shared specific Taiwanese societal influences:

… I think a lot of Taiwanese are crazy about South Korean K-Pop, so all of the girl members of K-pop they are so slim, and they have no body fat at all. And that is a beauty standard now for Taiwanese... Another thing I just realized is how Taiwanese people…like my friends and my family…when they haven’t seen you in a while, they will first comment on your body and say ‘hey, you lose weight or hey, you gain some weight.’ So, that is a very common and socially acceptable thing to do.

Especially for this participant, her self-perception of her body depended on the context in which she was in at a particular time. At one point she said, “from an Eastern standard, I’m from Taiwan, from an Eastern standard I think my body is pretty normal, normal size, and from Western standard, my body is shorter and smaller size.” Her Taiwanese identity clearly shaped her specific media influences. Unique to this participant, it normalized body shaming being a part of social interactions.

Similarly, Participant #3 connected her Latina identity with her body image:

I’m Latina and I think that has kinda had a negative influence on my body image because there’s this expectation that- that you should be thin to be pretty in-in Latinx culture and you know- my aunts and…women in my family…they refer to each other as “flaka” or “gorda” which, that means like skinny and fatty essentially but like in sort of a diminutive since like- a like a- term of endearment so it sounds really insulting to someone not from our culture.

Participant #7, also a Latina, explains how the collective pressure from with family, society, ethnicity, and culture intersects:

Trying to look a certain way or be a certain weight to fit the Mexican or Latina um type of stereotype…grew up with like parents and a-a grandparent that were constantly like focused on how much I ate and how *laughs* what I look like and ‘oh you’re gaining weight’, ‘oh you didn’t wear makeup’, and ‘oh you look like this’, and ya know like them constantly making these comments. Um and so I think those were big factors

Meaning Making of Critical Event

Meaning making of the critical event was the second major theme that emerged from our data. Meaning making is a process where an individual stories and re-stories their experiences to integrate the experiences into a coherent narrative (Park, 2010). For our study, the critical event was the experience of CSA. Each participant shared how the assault shaped their ideas and opinions about various aspects of sexuality, body image, family, peer, and romantic relationships, society, culture, and environment. Several participants directly connected their sexual assault to their body image. Participant #8 shared:

...even now it still makes me feel like a little disgusted by my body instead of you know like that person was coercive and took advantage of me and all that stuff. I know this is very sort of normal response, but I think that in particular along with the bullying stuff I mentioned before is one of the more salient things that comes to mind...

Their quote highlights the intersection of their sexual assault and bullying that took place as a teenager and how they interpreted it and internalized it. It also speaks to the disconnect between the cognitive understanding of a freeze or fawn response during trauma contesting with the emotional impact a traumatic event can have on an individual. Similarly, participant #3 shared how her sexual assault exacerbated existing body image issues:

I’ve had a hard time with body image throughout my life. Um, I’m in recovery from an eating disorder- um, from bulimia, and so it’s been a process but like I think when it [assault] first happens, I was 15 when it happened, and I felt really bad about my body afterward. Very- very shameful of it and-and I think that probably contributed to-to my problems with eating.

She articulates the intersection of her own preexisting vulnerabilities at the individual level and her assault by a close member of her extended family – a person who she should have been able to trust and feel safe with, and the impact that assault had on her at the individual level.

This theme emerged on a more complicated level for Participant #11. When asked how she would describe her body currently, she used the word controlled (see page 24). Here she had connected more with the word uncontrolled. She said that when she was younger:

…the combination of food and sex being the two things that are, go back to my word ‘controlled.’ […] and you know in sex there’s an element of loss of control and even in happy good sex you know you want to have loss of control, but if loss of control is dangerous, if loss of control makes you fat, if loss of control makes you a slut, then there’s problems.

This quote shows how inextricably tied body size and sex are for survivors of CSA and this participant’s convoluted nature of control. She describes a slippery slope that starts with losing control with food and ends with her being a problem. She contrasts this with the knowledge that releasing control is a necessary part of life, in this instance during sex.

Some participants spoke about how their assault was their first experience with sex and how that was uniquely impactful. Participant #9 shared, “I think it [the assault] made me, it forced me into thinking of myself as a more sexual, like my body is a more sexual thing”.

This quote highlights the impact of experiencing sexual assault during childhood can have on an individual, her word choices of force and wasn’t ready portray that impact.

Several participants described how they are affected by their assault during sex currently, with their partners or within romantic relationships. Participant #1 shared:

I don’t completely blank out, but…I do feel very detached from my body for like a day or two after I have sex… my body doesn’t feel like mine...I feel like two different…women sewn together like at the waist, if that makes sense.

The disconnection between mind and body is apparent throughout the quote; we can also observe the depersonalization between her and the experience of pleasure through any sexual contact because of her past sexual trauma. Participant #10 discussed how sex within a relationship has been impacted because of her CSA and the resulting internal turmoil for her:

I’ve been married for four years now, no going onto five years now and I’ve still not been able to consummate my marriage, if you know what I mean. Um, perhaps *pauses* it’s going to be mainly because of my sexual assault um- as a child um- but I still have difficulty consummating my marriage yeah five years in, so yeah. I’m still working for- working towards it…

Participant #6 went a step further into the experience of “silencing” that survivors of CSA often experience when they disclose their assault; as if being assaulted wasn’t the end, not they are being “punished” for sharing (Ahrens, 2006, p. 263). In an email to the PI after her interview, which was imperative to include, she said:

If I have a body that meets the beauty standard, I am worried about getting the comment: Of course, the perpetrator wants to assault you because you are so attractive/sexy. This is your fault. If I have a body that does not meet the beauty standard, I am worried about getting the comment: Why do people want to assault you? Are you sure you were being assaulted? You are unattractive. The perpetrator had no good taste. The perpetrator finds you attractive/sexy and you should be grateful for this validation. This made me feel really confused about my body because either way people would make comments about my body and how it relates to the sexual trauma.

Her lens speaks to the complex sociocultural responses towards sexual assault and how it has become a judgment to further oppress and marginalize survivors instead of validating their experiences as fact.

Consistent with other research on sexual assault survivors (Hills et al., 2021; Khan et al., 2018; LeMaire et al., 2016; Peterson & Muhlenhard, 2004), several participants meaning making process included questioning the validity of the assault. Similar to participant #6’s insights, participant #7 actually questioned her assault and shared:

… I think that also like not saying anything about it and not talking to anyone and not reaching out, and then constantly trying to deal with the fact of like maybe, maybe it wasn’t […] maybe I, I’m overexaggerating, ya know, like trying to figure out how to make myself feel better about it or give myself some kind of control. Um, but I think that if I would’ve spoken out sooner…whether it be like I need to see a counselor or this is what happened to me, can someone help, I think my body image- the way that I view my body would be very different, because it was embedded in me for years.

Other participants shared they had internalized the voices of others, including that of the person who assaulted them, during their meaning making process. Participant #10 shared the effects of some of those words:

[…] my abuser just so happened to be someone who made these comments about my body going into my teenage years…had a lot of impact on me just with my sexual assault past and that same person having the same power over my body as I was trying to-to develop and grow and so in that sense this had a grip on my life you know in how I feel about my body for so long and so when I finally decided to cut him off from my life in my mid-20s […]

Even years after cutting him off, she still feels pressure, as she adds, “I’m still feeling like I have to please somebody with the way that I look”. She seems to have internalized his ideas, the power he had over her body during the assault, and her internal thoughts and feelings related to her own body through his words. It was as though he had assaulted both her body and mind.

The meaning making for participant #4 was extremely enmeshed within various systems of influence, and speaks to the inseparable aspects of her sociocultural being:

[…] what that rape did was reiterate that what I had done in childhood, [starts to cry] if you got fat and gained weight nobody wanted you, nobody hurt you, nobody bothered you…it was like, the fat became like a bug repellant to people, and you know, at a younger age it worked until I got to be a teenager and I didn’t want to keep…being overweight and fat

Her feelings of abandonment by her father, being at the will of her emotionally unhealthy and abusive mother and feeling unwanted internally is challenging by itself. And then, “the first time you get small, you get raped, you end up pregnant. It’s like you got punished for wanting to be normal”. This devastating meaning that she derived from her experiences, displays the pervasive effects of abuse in various forms on various levels.

Self-perception of Body Image

Self-perception of body image was the third major theme that emerged from our data. All our participants had different ways of describing their bodies, some aspects like size, weight, and their perceptions about how their bodies looked physically stood out and are highlighted in this theme. Participant #1 shared about how her perception of self and body differ:

I’m a little on the bigger side. I feel like I take up more space than I would uh- prefer to? Um, I feel like the words that come to mind sometimes are like “hulking” …there’s definitely sometimes a disconnect between um- my body and like how I interact with space…in public places usually and there’s like a- um, need to like- make myself smaller.

She creates a visceral description of how she views her body with her use of the word hulking, which expresses how women internalize society’s messages about minimizing the amount of space they take up (Bartky, 1990; Butler, 2004). Participant #4 shares the dissonance she experiences and her relationship with her weight:

I’m half the woman that I used to be, but I’m still in my opinion, according to scales and stuff, I’m still obese but for me even though I’m half of what I used to be, I still see me at 400 pounds…[A]t the end of the day…I will never be what I want to be in my opinion, because the way that I see other people I, so far, I don’t see myself that way.

She is the same participant who described achieving a certain look at 16 years of age as “normal”. We might have ventured to explore the origin and influences on her understanding of normality, but she expresses here that she thinks her body image will be a continued struggle for her, despite successfully losing weight. There is an irreconcilable fragmentation presented by this participant. She believes that she can never look like others, even though she does after losing weight successfully. She also believes that people will never perceive her the way she wants to be perceived because she will never look the way she wants to appear.

Further complexity of fragmentation and dissonance was added by participant #7, who described her body in the context of her sexual assault and the extent of the dissonance she felt:

[F]or many years after my assault, I was very uncomfortable with my body, I just didn’t know…how to look at it, I didn’t know how to be in it, I didn’t know…it was just very, it, it felt like it was…a[n] out of body experience. Like…my head is me, but my body isn’t me.

Similarly, Participant #11 compared how she perceives her body now versus how she has felt about her body in the past by stating, “I would say that presently […] tall…Umm, lean and controlled. In the past, I would describe it [her body] as tall… I think I felt big, large- large, uh - not controlled”. Her use of words like controlled and not controlled was unique, which she later explained were due to her preoccupation with weighing, constantly monitoring, and measuring what she eats, being strict with her diet, and exercise routines.

Very few participants used positive ways of describing their bodies. When they did so, they often co-existed with negative descriptions, allowing us a view into the complex understanding they have of their bodies. For instance, Participant #5 negotiated an alternative frame of mind for her body through her involvement in sports, “I…see myself as an athlete when I present myself and it makes me more comfortable in that way because I’m using my strength and it doesn’t put me in a weird, kind of vulnerable, weak spot.” Participant #9 was the only individual who described her body in favorable terms using words like “strong”, “resilient”, and “capable”. She stated, “I love my body. Sometimes I don’t like it but um mostly I really- it really helps me in a lot of ways”. Though she was the only one to describe her body positively, she still created a distinction between liking and loving it - her body is defined through its instrumental role in her existence.

Internal Processes

Self-perceptions of body image provided by participants were also deeply connected to their thoughts, feelings, and how they resulted in certain behaviors. This theme provides us an understanding of their internal states and how they processed and internalized what was being presented to them through sociocultural messages. Their experiences with sexual assault still affected some of the participants and the internal processes were closely tied to the assault, and through their responses, we can see the interconnectedness. For example, participant #5 shared the pattern of her thoughts:

[For] my dad it’s just like it’s you know it’s like it didn’t happen, but years later now we’re coming to ask like, “Oh well you know they’ve, they’ve really been working on themselves and … they found God and they’ve had their children and it’s like you know we really want you and your siblings to have a good close relationship on both sides of the family” but there’s a part of me that’s like “you’re kind of skating around the biggest part [inaudible] in this relationship”…it’s definitely a part of me that doesn’t go away because I’ve learned to pretty much repress it ‘cause everyone else has.

Because everyone else seems to have pushed it aside and ignored the reality, she does so too. From a social constructivist point of view (Mascolo, 1994; Vygotsky, 1978) as children learn through imitation, so if her family brushed the reality under the rug, it was natural that she followed suit. Participant #3 shared her confusion because the person who assaulted her had called her “a tease”:

[T]hat message that that I had done something to provoke him treating me that way, um, that was really hard for me. I wondered was it because of my body in some way- you know having a larger chest… is that somehow a part of it, you know? On the one hand negative message is that my body was too big and therefore unlovable, and also messages that I’m desirable and then that’s my fault that I get treated poorly sexually…It was very strange…

This last statement connects to Participant #6’s thoughts she shared via email with the PI (see page 21). Participant #3 added:

[T]here was also this thought in my mind that if it was really that bad what didn’t I fight back, why did I freeze in the moment, why didn’t I do more than just cry and say ‘no’? Why didn’t I kick him or do something, you know? So, there was kind of this anger at myself and my body for having that freeze reaction.

Inconsistent messages resulted in confusion and frustration, and when she could not find any reasonable explanation for being assaulted, she internalized and blamed herself and her body, evoking thoughts of self-betrayal.

Participant #2 had changed the way she dressed after her experiences with abuse and assault. She reported that over time she had started making changes, yet sometimes still struggled. She stated, “I’m still kind of like that [protecting herself by wearing conservative clothing], I would say…probably like two years ago, maybe a little more like that, but just kind of…protecting myself with what I was wearing”.

Feelings were equally important for our participants. Most appeared in the form of internalization. For example, participant #7 shared consistent doubts about her not being good enough and reaching for body appearance criteria that she wasunable to achieve:

I always feel like my body isn’t good enough. Like I-I don’t know how to- there’s a word I’m trying to figure out…like I’m constantly trying to reach for a goal. It’s like-it’s it’s always…in the process. I feel like my body’s always in the process and not good enough and always has to be better

Participant #8 shares further self-judgement and internalization:

...when I look at my body I’m like “eww”- I don’t think anyone would…be attracted to this body and the only way you know I have managed to have those intimate relationships with people were when people were just abusing a power dynamic because that’s just what it’s good for...I definitely see myself as ugly, or un- I don’t know “unusable”, or like “damaged” I guess is better- yeah like nobody would want this…

Although our participants did not currently meet diagnostic criteria for eating disorders, many engaged in maladaptive eating behaviors. This showed up as a complex interaction of thoughts and feelings resulting from the sexual assault and sociocultural influences, that had manifested as maladaptive behavioral patterns over the years. Participant #11 highlighted this understanding by connecting her eating habits that summer directly to her sexual assault:

[T]hat summer I remember I started to eat a lot … I never was anorexic, I never was bulimic, but I did binge eating and then I’d compensate for my dieting, so it was like dieting- binge eating, and…I remember that starting that summer.

She refers to “that summer” as when she was being groomed and was assaulted by an older man. Furthering our understanding of behavioral manifestations, Participant #10 shares her hyper-focus on calorie counting and exercise:

[W]hen I wake up in the morning the first thing, I think about is ah, like how much can I eat today, how little can I eat today? How much can I eat today compared to yesterday? Did I overeat yesterday, should I try to limit myself today…I exercise every day and that is because I feel inadequate in how I feel about my body.

The interrelated nature of thoughts, feelings, and how they influenced participant behaviors was observed throughout our interviews. The influence that sociocultural factors had on these internal processes was apparent as well. We developed an understanding of how these patterns were influential and discuss them below along with limitations and possible future directions for research.

It would be remiss not to mention that the impacts of time and developmental journey on a survivor’s relationship with their body and trauma recovery was important for the process of growth and recovery for some participants. Increased individuation, growth, acceptance, and perceived agency over one’s body emerged for some participants over time, however, these were universal experiences for all participants and are therefore beyond the scope of this manuscript.

Discussion

The purpose of our study was to explore the lived experiences of survivors of CSA, their meaning making process of the assault, and how messages from their sociocultural environment affected their relationship with, and perception of, their bodies.

Throughout our study, we found that sociocultural contexts are inseparable from the individual (Bronfenbrenner, 2005; Vygotsky, 1978), i.e., the individual is their context and vice versa, because the individual internalizes the culture, values, beliefs, attitudes, and societal rules conditioned by the context they live in. Our participants’ stories demonstrate the extent to which sociocultural contexts can affect an individual and their journey post trauma. We confirmed that family, peers, friends, societal and cultural expectations, rules, and representations, as well as the presence or absence of helpful social supports can have a profound influence on an individual’s self-perception of, and relationship with their bodies after experiencing an event such as CSA.

We found that messages received from participants’ sociocultural environment deeply affected the process of meaning making for our participants after CSA had occurred. We also found that these messages about their bodies, were confusing and conflicting for our participants, and pervasively affected the way in which our participants not only made meaning of their assault but also how they internalized others’ perceptions of their bodies. In some case, this resulted in negative self-perceptions about their own bodies and in some cases, even an unhealthy relationship with their bodies. Some of these affects were evidenced by changes in their behavior especially related to eating, monitoring, controlling the eating-exercising, or over exercising patterns, which in some cases was self-imposed and, in some cases was expected through sociocultural channels.

The four major themes that emerged from our data were: sociocultural influences, meaning making of the critical event, i.e., CSA; self-perceptions of body image; and internal processes, specifically thoughts, feelings, and resulting behaviors from the lens of their experiences with CSA. Sociocultural impacts, which included subthemes of family relationships, peer relationships, societal and environmental influences, as well as cultural and ethnic influences, provided insight into how messages were received by our participants. Messages through close encounters like family and friends were more salient to participants than messages from broader societal sources, which is supported by previous research (Bronfenbrenner, 2005; Calhoun & Tedeschi, 2006; Herman, 2015).

Although not as impactful as close contacts, messages received through community, societal standards, or cultural expectations, or media representation of women were also highlighted by our participants as influential and aligned with previous research (Cafri et al., 2005; Clark & Tiggemann, 2008). For example, our participants who identified as Latina or Asian discussed receiving frequent body-related messages and endorsed pressures to adhere to specific standards of beauty and attractiveness that were guided by their culture. Additionally, some participants endorsed that their struggles with unhealthy eating habits either developed from a need to cope with the CSA, were exacerbated by the CSA, or had already been present because of unhealthy upbringing by neglectful parents. This aspect connected to the theme of meaning making of the critical event, which is this case was CSA. It provided insight into the participants’ process of moving through and beyond their trauma(s). We found that patterns of silencing, questioning the validity of the assault, as well as patterns of self-blame and shame were prevalent and track with previous research (Ahrens, 2006).

Human beings and their sociocultural contexts are two parts of an inextricable whole – a cause and effect explained through how humans derive meaning from our lives (Bronfenbrenner, 2005; Harvey, 1996; Vygotsky, 1978), a complexity was observed throughout our data. We also observed the intersection of the individual, their sociocultural context, and the traumatic event, i.e., CSA, and how that resulted in participants making meaning as well as how their experiences impacted their body image both internally and externally (Herman, 2015; Park, 2010).

Participant self-descriptions of their body image, either currently, in the past, or throughout their lives following CSA, provided insight into the internal processes of how this self-perception was shaped. In talking about their thoughts, emotions, and resulting behaviors, we gained insights into the participants’ internal processes of meaning making, specifically in relationship to their sociocultural contexts that emerged to the forefront. This was a unique discovery through our data. The pervasiveness of the internalized messages from our participants’ unique sociocultural contexts highlighted how a traumatic experience can be exacerbated by lack of support. Furthermore, words used to describe our participants’ body or appearance, by the person(s) responsible for their assault, were particularly impactful to our participants, due to the internalization of the words rather than mere remembrance of them. It was as if the person had not only assaulted the body but also the mind of the survivors, which denotes a pervasive power and control over the survivors, long after the CSA ended.

Additionally, because we interviewed participants as adults, we gained a retrospective perspective to their process and journey(s) post trauma. Understanding how the individual is making meaning and coming to conclusions about themselves is imperative from the ecological perspective. Over time, the messages our participants received regarding their CSA, along with comments from others that imposed certain ideas onto the survivor’s body, impacted our participants’ recovery and future growth. We grasped many specific cultural influences through our participant’s stories, even when these cultural nuances were not targeted at the individual directly, it often resulted in internalization of those messages and self-judgement through that lens. Through our data we found evidence that by the time our participants realized that they had internalized flawed points of view, they had already suffered an emotional toll and formed a negative self-perception of their bodies.

Through our study, we believe that we have provided an in-depth perspective of the intersectionality between CSA and body image concerns understood within sociocultural contexts, which is something that has not been done before.

Limitations

Our participant pool for this study was cross sectional and racial/ethnic diversity represented in the sample is not representative of the US population. The number of participants is less compared to other qualitative studies and could be considered a limitation. However, our data provides in-depth narratives and contextual perspectives from our participants, which is unique. An additional limitation to consider is that we explicitly recruited participants who were willing to discuss their CSA and their body image. We also recruited only individuals assigned female at birth. Both these decisions were motivated by the tenets of IPA, which asks specifically for homogeneity in participants (Smith & Osborn, 2008). Lastly, the format and type of questions asked during the interviews rarely elicited desirable experiences which we believe was due to the severity of both topics, i.e., CSA and body image concerns.

Implications

For this research study, we aimed to explore the lived experiences of survivors of CSA, their meaning making process of the assault, and how messages from their sociocultural environment affected their relationship with, and perception of, their bodies. The complexity of our participants’ stories and themes from our data helped us observe some poignant patterns. Self-definition can be developed socially, implying that we define and redefine our view of self by internalizing the responses we decode from our sociocultural contexts, for example, parents, siblings, peers, and extended family members. Words, pictures, and/or media representations of the rejection of body types that do not fit into mainstream definitions of beauty can also affect one’s body image and self-perception through people who are closer to us within the sociocultural contexts and place emphasis on said norms or representations.

Dismissal, shaming, and blaming of CSA survivors can affect how individuals perceive themselves. Perceived and actual lack of support can negatively impact recovery for CSA with body image concerns. The voice(s) of person who assaulted them, is frequently adopted by the survivors, in a vicious cycle of power and control, and even though the survivor may recognize it cognitively, they might have a tough time letting go of it emotionally, leading to further harm.

Without the knowledge of the sociocultural contexts in which an individual exists, an incomplete picture of the survivor’s trauma might be created. For mental health professionals working with survivors of CSA with body image concerns, we recommend that they consider the complexity of the issue and gain an understanding of the survivor’s sociocultural contexts before focusing on just one aspect for treatment: CSA or body image. Placed contextually, professionals would be able to gain a holistic understanding that may prove more effective, culturally sensitive, and trauma-informed compared to evidence-based practices that might be reductionistic in their approach. For medical practitioners, our research provides unique insight into the socio-emotional aspects of a CSA survivor. We suggest taking a trauma-informed approach to their work with CSA survivors especially with gynecological procedures. For social workers and case managers working for child protective services, we provide useful insight into internal processes of CSA survivors, that may be utilized to inform agency procedures, practices, and policies.

Future Research

We collected stories from a specific sample of CSA survivors who were assigned female at birth by following the tenets of IPA, which highlights many potential avenues for future research. Further studies with survivors of CSA including all genders, CSA survivors from settings where the survivor’s body can be under scrutiny, for example performing arts and athletics, can be conducted. The role of social media in influencing body image could provide insight and implications for effects on younger and future generations. Additionally, it might be useful to conduct research that can distinguish between assault and abuse, and possibly gain insight into the effects of one incident versus pervasive CSA over of a long period of time. CSA can deeply affect mental health; therefore, it might also be beneficial to research the relationship between CSA, body image, and self-harm. Lastly, because IPA aims to explore the lived experiences of participants rather generalizing, it could be beneficial to utilize research designs with a larger participant pool to evaluate generalizability and enable further exploration into other sociocultural contexts.

We hope our research will help researchers take a sociocultural lens to identify what specific practices outside the professional mental health realm may benefit CSA survivors with body image concerns; for example, psychoeducation about the effects of CSA and ways to provide support for survivors for parents, educators, as well as other professionals in educational and professional settings (Felitti et al., 1998) and social justice endeavors to help eliminate silencing of CSA survivors (Ahrens, 2006).