Meaning-making following sexual abuse: a scoping review and meta-synthesis

Background Exposure to adult sexual assault and child sexual abuse leaves survivors with questions about meaning and the process of meaning-making following sexual abuse may influence survivors’ recovery. Insight in meaning-making following sexual abuse and survivors’ perceptions of the role of meaning-making in recovery informs professionals involved in their care. Objective This scoping review and meta-synthesis of qualitative, mixed methods, and review studies aims to explore survivors’ experiences of meaning-making following sexual abuse. Method We searched six databases: PsycInfo, Ovid Medline ALL, Ovid Evidence-Based Medicine Reviews, PTSDpubs, and Web of Science, and screened 2,158 deduplicated references for inclusion. We followed PRISMA 2020 guidelines for reporting of the systematic search. We integrated findings of the included studies using reflexive thematic analysis. Results Seventy-four studies were included in the review. Methodological approaches included selecting participants based on experiencing resilience and recovery following sexual abuse or participants receiving professional support, and focusing on the role of time, specific survivor actions, specific abuse or post-abuse contexts or cultural contexts. Twelve themes were generated, reflecting experiences of meaning-making following sexual abuse: reframing the abuse, moving from shame towards self-acceptance, understanding one’s own beliefs, reorienting towards religion and spirituality, helping others, connecting with a peer group, building supportive relationships, a secret (not) to be disclosed, recognizing positive change, engaging in activism, honoring strengths and hope, and living with triggers. We grouped the themes into three overarching themes: a changed self, reshaping relationships with others, and mapping out a future self and world. Discussion Experiences of meaning-making involve turning points and transitions, e.g., from receiving to providing support, from retelling to reframing, and deliberate acts of self-care. Our findings suggest that the process of meaning-making following sexual abuse operates at existential, cognitive, emotional, motivational, social, and bodily levels. Attending to these multilayered meanings can facilitate interdisciplinary collaboration and expand professionals’ insight into their roles and responsibilities in trauma-informed care. Efforts to prevent sexual abuse and mitigate its long-term effects should include strengthening peer and community support, fostering cultural connectedness, and promoting social change.