Sexual abuse alone, especially since it happened to her as a child, is WAY more than enough to result in her struggles. Many people don't realize that when sexual abuse happens to a child, its very different than when it happens to an adult. It interrupts normal development. Instead of progressing in ways that "normal" kids do, SA victims are sidetracked onto a different path. Its not something you can get over easily, and some never really "catch up" to be at the same place as everyone else. One thing I've noticed in myself is that while everyone else was learning how to be social, make friends, form relationships, I was struggling with keeping myself safe. Everyone else was able to take safety for granted, but because I didn't have a strong foundation, I wasn't able to work on developing in other ways. Look up the pyramid of needs to see more of what I'm talking about. Abuse survivors oftentimes struggle at the bottom of the pyramid while other people can move up and be more successful. It will explain a lot.