Childhood Abuse, Sexual Health, and Psychiatric Comorbidity: What Is the Independent Effect of Trauma?

Childhood maltreatment, sexual, physical, and emotional abuse, is linked to adult psychiatric morbidity and impaired sexual health, yet whether subtypes exert independent effects once cumulative adversity, familial dysfunction, and shared genetic liability are accounted for remains contested. This narrative review addresses that question through structured searches of PubMed/MEDLINE, PsycINFO, Web of Science, and Google Scholar (January 2000–June 2026), combining terms for childhood abuse, maltreatment subtypes, adult psychiatric disorders, sexual dysfunction, sexual risk behavior, and revictimization, supplemented by hand-searching reference lists of retrieved reviews. Studies were included if they reported quantitative associations between childhood maltreatment (sexual, physical, or emotional abuse, or neglect) and adult psychiatric or sexual-health outcomes in general-population or clinical samples, using prospective, retrospective, quasi-experimental, or co-twin control designs; case reports, non-English sources, and pediatric-outcome-only studies were excluded. Sixty-one sources meeting these criteria, spanning meta-analyses, prospective birth-cohort studies, co-twin control and other genetically informed designs, and mechanistic neurobiological research, were synthesized. Maltreatment predicts a broad transdiagnostic spectrum of adult outcomes, including depression, anxiety, posttraumatic stress disorder, substance use disorders, borderline personality disorder, sexual dysfunction, risky sexual behavior, and revictimization, with clear dose-response gradients. When maltreatment types are modeled simultaneously, emotional abuse emerges as the strongest independent predictor, while sexual abuse retains domain-specific associations with sexual-health outcomes after adjustment for shared genetic and environmental confounds. HPA-axis dysregulation, emotion dysregulation, dissociation, and attachment disruption are implicated as converging mechanisms. The review identifies gaps in sample diversity, particularly male, sexual- and gender-minority, and non-Western populations, limiting generalizability and warranting future research priority.