A nurse is counseling a teenage girl who has disclosed that she was sexually abused by her uncle when she was younger. The nurse should assess the girl for possible signs and symptoms of:

The correct answer is D. All of the above are common indicators of sexual abuse in children.

Choice A Reason: Difficulty walking or sitting may indicate that the child has been subjected to genital trauma or anal penetration.

Choice B Reason: Frequent urinary tract infections may indicate that the child has been exposed to sexually transmitted infections or has poor hygiene due to lack of care or supervision.

Choice C Reason: Changes in behavior or mood may indicate that the child is experiencing fear, anxiety, depression, anger, guilt, shame, or confusion as a result of the sexual abuse.

Choice A Reason: Post-traumatic stress disorder (PTSD) is a mental health condition that can develop after experiencing or witnessing a traumatic event, such as sexual abuse. Symptoms of PTSD include re-experiencing the trauma through flashbacks, nightmares, or intrusive thoughts; avoiding reminders of the trauma; feeling numb or detached; and having increased arousal, such as being easily startled, irritable, or hypervigilant.

Choice B Reason: Depression is a mood disorder that causes persistent feelings of sadness, hopelessness, and loss of interest in activities that were once enjoyable. Symptoms of depression include low mood, low self-esteem, guilt, worthlessness, fatigue, insomnia or hypersomnia, appetite changes, weight changes, difficulty concentrating, and suicidal thoughts or behaviors.

Choice C Reason: Substance abuse is the harmful use of alcohol, drugs, or other substances that impair one's physical or mental health or social functioning. Substance abuse can be a coping mechanism for some survivors of sexual abuse, as they may use substances to numb their pain, escape their reality, or self-medicate their symptoms.

Choice D Reason: Eating disorders are serious mental health conditions that involve abnormal eating behaviors and attitudes toward food and body weight. Eating disorders can be triggered by sexual abuse, as survivors may develop distorted body image, low self-esteem, shame, guilt, or a sense of loss of control over their lives. Eating disorders can include anorexia nervosa (restricting food intake to achieve extreme thinness), bulimia nervosa (binging on large amounts of food and then purging through vomiting, laxatives, or exercise), binge eating disorder (binging on large amounts of food without purging), or other specified feeding or eating disorder (OSFED) (having symptoms of an eating disorder that do not meet the full criteria for any specific diagnosis).

Choice E Reason: All of the above are possible signs and symptoms of sexual abuse in children and adolescents. However, not all survivors of sexual abuse will develop these conditions, and not all people with these conditions have experienced sexual abuse. Therefore, it is important to assess each individual case holistically and provide appropriate support and referrals as needed.