EffectsPsychological harmChild sexual abuse can result in both short-term and long-term harm, including psychopathology in later life.[9][22] Psychological, emotional, physical, and social effects include depression,[5][23][24] post-traumatic stress disorder,[6][25] anxiety,[7] poor self-esteem, dissociative and anxiety disorders; general psychological distress and disorders such as somatization, neurosis, chronic pain,[24]sexualized behavior,[26] school/learning problems; and behavior problems including substance abuse,[27][28] destructive behavior, criminality in adulthood and suicide. [29][30][31][32][11][33] A specific characteristic pattern of symptoms has not been identified[34] and there are several hypotheses on the causality of these associations.[5][35][36]
A study funded by the USA National Institute of Drug Abuse found that "Among more than 1,400 adult females, childhood sexual abuse was associated with increased likelihood of drug dependence, alcohol dependence, and psychiatric disorders. The associations are expressed as odds ratios: for example, women who experienced nongenital sexual abuse in childhood were 2.93 times more likely to suffer drug dependence as adults than were women who were not abused." [28]
Long term negative effects on development leading to re-victimization in adulthood are also associated with child sexual abuse.[8][27] Studies have established a causal relationship between childhood sexual abuse and certain specific areas of adult psychopathology, including suicidality, antisocial behavior, PTSD, anxiety and alcoholism.[37] Adults with a history of abuse as a child, especially sexual abuse, are more likely than people with no history of abuse to become frequent users of emergency and medical care services[24] A study comparing middle-aged women who were abused as children with non-abused counterparts found significantly higher health care costs for the former.[38] Sexually abused children suffer from more psychological symptoms than children who have not been abused; studies have found symptoms in 51% to 79% of sexually abused children.[39][40][41][42][31] The risk of harm is greater if the abuser is a relative, if the abuse involves intercourse or attempted intercourse, or if threats or force are used.[43] The level of harm may also be affected by various factors such as penetration, duration and frequency of abuse, and use of force.[44][45][9][22] The social stigma of child sexual abuse may compound the psychological harm to children,[46][47] and adverse outcomes are less likely for abused children who have supportive family environments.[48][49]. Young children who are abused sexually by adult females may incur double traumatization due to the widespread denial of female-perpetrated child sexual abuse by non-abusing parents, professional caregivers and the general public.[50] Turner and Maryanski in Incest: Origins of the Taboo (2005), suggest that mother-son incest causes the most serious damage to children in comparison to mother-daughter, father-daughter and father-son child incest. Crawford asserts that our socially repressed view of female and maternal sexuality conceals both the reality of female sexual pathologies and the damage done by female sexual abuse to children.[51] Dissociation and PTSDChild abuse, including sexual abuse, especially chronic abuse starting at early ages, has been found to be related to the development of high levels of dissociative symptoms, which includes amnesia for abuse memories.[52] The level of dissociation has been found to be related to reported overwhelming sexual and physical abuse.[53] When severe sexual abuse (penetration, several perpetrators, lasting more than one year) had occurred, dissociative symptoms were even more prominent.[53] Child sexual abuse independently predicts the number of symptoms for PTSD a person displays, after controlling for possible confounding variables, according to Widom (1999), who wrote "sexual abuse, perhaps more than other forms of childhood trauma, leads to dissociative problems ... these PTSD findings represent only part of the picture of the long-term psychiatric sequelae associated with early childhood victimization ... antisocial personality disorder, alcohol abuse, and other forms of psychopathology."[6] Children may develop symptoms of posttraumatic stress disorder resulting from child sexual abuse, even without actual or threatened injury or violence.[54] Research factorsBecause child sexual abuse often occurs alongside other possibly confounding variables, such as poor family environment and physical abuse,[55] some scholars argue it is important to control for those variables in studies which measure the effects of sexual abuse.[22][35][56][57] In a 1998 review of related literature, Martin and Fleming, state "The hypothesis advanced in this paper is that, in most cases, the fundamental damage inflicted by child sexual abuse is due to the child's developing capacities for trust, intimacy, agency and sexuality, and that many of the mental health problems of adult life associated with histories of child sexual abuse are second-order effects."[58] Other studies have found an independent association of child sexual abuse with adverse psychological outcomes.[35][22][7] Kendler et al. (2000) found that most of the relationship between severe forms of child sexual abuse and adult psychopathology in their sample could not be explained by family discord, because the effect size of this association decreased only slightly after they controlled for possible confounding variables. Their examination of a small sample of CSA-discordant twins also supported a causal link between child sexual abuse and adult psychopathology; the CSA-exposed subjects had a consistently higher risk for psychopathologic disorders than their CSA non-exposed twins.[35] A 1998 meta-analysis by Rind et al generated controversy by suggesting that child sexual abuse does not always cause pervasive harm; that some college students reported such encounters as positive experiences; and that the extent of psychological damage depends on whether or not the child described the encounter as "consensual." [59] The study was criticized in published reviews by scientists for flawed methodology and conclusions,[60][61][62][63] though it's publication by peer-review has been tacitly or implicitly defended.[64][65][66] Following extensive publicity, the US Congress condemned the study for its conclusions and for providing material used by pedophile organizations to justify their activities.[67] Russell (1999) speculated that the perception of a sexually abusive event as 'positive' could stem from a mechanism for coping with traumatic experiences, a form of rationalization.[68] Physical harmInfections and injuryDepending on the age and size of the child, and the degree of force used, child sexual abuse may cause infections, sexually transmitted diseases,[69] or internal lacerations. In severe cases, damage to internal organs may occur, which, in some cases, may cause death.[70] Herman-Giddens et.al. found six certain and six probable cases of death due to child sexual abuse in North Carolina between 1985-1994. The victims ranged in age from 2 months to 10 years. Causes of death included trauma to the genitalia or rectum and sexual mutilation.[71] Vaginitis has also been reported.[69] Neurological damageResearch has shown that traumatic stress, including stress caused by sexual abuse, causes notable changes in brain functioning and development.[72][73] Various studies have suggested that severe child sexual abuse may have a deleterious effect on brain development. Ito et al. (1998) found "reversed hemispheric asymmetry and greater left hemisphere coherence in abused subjects;"[74] Teicher et al. (1993) found that an increased likelihood of "ictal temporal lobe epilepsy-like symptoms" in abused subjects;[75] Anderson et al. (2002) recorded abnormal transverse relaxation time in the cerebellar vermis of adults sexually abused in childhood;[76] Teicher et al. (1993) found that child sexual abuse was associated with a reduced corpus callosum area; various studies have found an association of reduced volume of the left hippocampus with child sexual abuse;[77] and Ito et al. (1993) found increased electrophysiological abnormalities in sexually abused children.[78] Some studies indicate that sexual or physical abuse in children can lead to the overexcitation of an undeveloped limbic system.[77] Teicher et al. (1993)[75] used the "Limbic System Checklist-33" to measure ictal temporal lobe epilepsy-like symptoms in 253 adults. Reports of child sexual abuse were associated with a 49% increase to LSCL-33 scores, 11% higher than the associated increase of self-reported physical abuse. Reports of both physical and sexual abuse were associated with a 113% increase. Male and female victims were similarly affected.[75][79] Navalta et al. (2006) found that the self-reported math Scholastic Aptitude Test scores of their sample of women with a history of repeated child sexual abuse were significantly lower than the self-reported math SAT scores of their non-abused sample. Because the abused subjects verbal SAT scores were high, they hypothesized that the low math SAT scores could "stem from a defect in hemispheric integration." They also found a strong association between short term memory impairments for all categories tested (verbal, visual, and global) and the duration of the abuse.[80] PrevalenceUnited States and EuropeChild sexual abuse occurs frequently in Western society.[81] Prevalence estimates range between 10% in the UK[82] and up to 62% for females and 16% for males in the United States.[83][84] The US Department of Health and Human Services reported 83,600 substantiated reports of sexually abused children in 2005.[85][86] The total number of incidents that were not reported is even larger.[87] Surveys have shown that one fifth to one third of all women reported some sort of childhood sexual experience with a male adult.[88] Based on a literature review of 23 studies, Goldman & Padayachi found that the prevalence of child sexual abuse varied between 7-62% for girls and 4-30% for boys.[89] A 1992 survey studying father-daughter incest in Finland reported that of the 9,000 15-year old high school girls who filled out the questionnaires, of the girls living with their biological fathers, 0.2% reported father-daughter incest experiences; of the girls living with a stepfather, 3.7% reported sexual experiences with him. The reported counts included only father-daughter incest and did not include prevalence of other forms of child sexual abuse. The survey summary stated, "the feelings of the girls about their incestual experiences are overwhelmingly negative."[90] Others argue that prevalence rates are much higher, and that many cases of child abuse are never reported. One study found that professionals failed to report approximately 40% of the child sexual abuse cases they encountered[91] A study by Lawson & Chaffin indicated that many children who were sexually abused were "identified solely by a physical complaint that was later diagnosed as a venereal disease...Only 43% of the children who were diagnosed with venereal disease made a verbal disclosure of sexual abuse during the initial interview."[92] It has been found in the epidemiological literature on CSA that there is no identifiable demographic or family characteristic of a child that can be used to bar the prospect that a child has been sexually abused.[83] In schoolsIn US schools, according to the US Department of Education.[93], "nearly 9.6% of students are targets of educator sexual misconduct sometime during their school career." In studies of student sex abuse by male and female educators, male students were reported as targets in ranges from 23% to 44%.[93] In U.S. school settings same-sex (female and male) sexual misconduct against students by educators "ranges from 18-28% or reported cases, depending on the study"[94] Underreported forms of abuseSignificant underreporting of sexual abuse of boys by both women and men is believed to occur due to sex stereotyping, social denial, the minimization of male victimization, and the relative lack of research on sexual abuse of boys.[95] Sexual victimization of boys by their mothers or other female relatives is especially rarely researched or reported. Sexual abuse of girls by their mothers, and other related and/or unrelated adult females is beginning to be researched and reported despite the highly taboo nature of female-female child sex abuse. In studies where students are asked about sex offenses, they report higher levels of female sex offenders than found in adult reports.[96] This under-reporting has been attributed to cultural denial of female-perpetrated child sex abuse,[97] because "males have been socialized to believe they should be flattered or appreciative of sexual interest from a female"[98] and because female sexual abuse of males is often seen as 'desirable' and/or beneficial by judges, mass media pundits and other authorities.[99] AfricaThe prevalence of child sexual abuse in Africa is compounded by a belief that sexual intercourse with a virgin will cure a man of HIV or AIDS. This belief is especially common in South Africa, which has the highest number of HIV-positive citizens in the world. According to official figures, one in eight South Africans are infected with the virus.[100] Eastern Cape social worker Edith Kriel notes that "child abusers are often relatives of their victims - even their fathers and providers."[101] More than 67,000 cases of sexual assaults against children were reported in 2000 in South Africa. Child welfare groups believe that the number of unreported incidents could be up to 10 times that number.[101] Researcher Suzanne Leclerc-Madlala states that the myth that sex with a virgin is a cure for AIDS is not confined to South Africa: "Fellow AIDS researchers in Zambia, Zimbabwe and Nigeria have told me that the myth also exists in these countries and that it is being blamed for the high rate of sexual abuse against young children."[102] AsiaIn one survey, 2.5% of Taiwenese adolescents report having experienced childhood sexual abuse.[103] IncestIncest between a child or adolescent and a related adult has been identified as the most widespread form of child sexual abuse with a huge capacity for damage to a child. [10] 70% of all perpetrators of sexual abuse are related to their victim. [104] Child sexual abuse offenses where the perpetrator is related to the child, either by blood or marriage, is a form of incest described as intrafamilial child sexual abuse.[105] The most-often reported form of incest is father-daughter and stepfather-daughter incest, with most of the remaining reports consisting of mother/stepmother-daughter/son incest.[106] Father-son incest is reported less often, however it is not known if the prevalence is less, because it is under-reported by a greater margin.[107][108] Prevalence of parental child sexual abuse is difficult to assess due to secrecy and privacy; some estimates show 20 million Americans have been victimized by parental incest as children.[106] Types of child sexual assaultChild sexual abuse includes a variety of sexual offenses, including:
DisclosureChildren who received supportive responses following disclosure had less traumatic symptoms and were abused for a shorter period of time than children who did not receive support [115][116] In general, studies have found that children need support and stress-reducing resources after disclosure of sexual abuse [117] [118] Negative social reactions to disclosure have actually been found to be harmful to the survivor’s wellbeing [119] One study reported that children who received a bad reaction from the first person they told, especially if the person was a close family member, had worse scores as adults on general trauma symptoms, posttraumatic stress disorder symptoms, and dissociation [120] Another study found that in most cases when children did disclose abuse, the person they talked to did not respond effectively, blamed or rejected the child, and took little or no action to stop the abuse [118] Although hearing a victim’s disclosure might be uncomfortable, for the sake of the victim’s wellbeing, it is important to be able to respond effectively. Showing that you understand and take seriously what the child is saying is an important first step. The American Academy of Child and Adolescent Psychiatry provides guidelines for what to say to the victim and what to do following the disclosure [121] TreatmentThe initial approach to treating a person who has been a victim of sexual abuse is dependant upon several important factors:
The goal of treatment is not only to treat current mental health issues, but to prevent future ones. Children and AdolescentsChildren often present for treatment in one of several circumstances, including criminal investigations, custody battles, problematic behaviors, and referrals from CPS.[122] The three major modalities for therapy with children and teenagers are Family Therapy, Group Therapy, and Individual Therapy. Which course is used depends on a variety of factors that must be assessed on a case by case basis. For instance, treatment of young children generally requires strong parental involvement, and can benefit from family therapy. Adolescents tend to be more independent, can benefit from individual or group therapy. The modality also shifts during the course of treatment, for example group therapy is rarely used in the initial stages, as the subject matter is very personal and/or embarrassing.[122] Major factors that affect both the pathology and response to treatment include the type and severity of the sexual act, its frequency, the age at which it occurred, and the child’s family of origin. Adult SurvivorsAdults with a history of sexual abuse often present for treatment with a secondary mental health issue, which can include substance abuse, personality disorders, depression, and conflict in romantic or interpersonal relationships. Generally the approach is to the present problem, rather than the abuse itself. Treatment is highly varied and depends on the person’s specific issues. For instance, a person with a history of sexual abuse suffering from severe depression would be treated for depression. Sexual abuse is associated with many sub-clinical behavioral issues as well, including re-victimization in the teenage years, a bipolar-like switching between sexual compulsion and shut-down, and distorted thinking on the subject of sexual abuse (for instance, that it is common and happens to everyone). Frequently, victims do not make the connection between their abuse and their present pathology. Female victims who were abused before age 12 also will sometimes have a curious vocal inflection recognizable by clinicians, reminiscent of a child speaking, though at present this has not been studied or explained. PedophiliaThe term "pedophilia" refers to persistent feelings of attraction in an adult or older adolescent toward prepubescent children, whether the attraction is acted upon or not.[123][124][125] A person with this attraction is called a "pedophile".[126] According to the Mayo Clinic, approximately 95% of child sexual abuse incidents are committed by the 88% of child molestation offenders who meet the diagnostic criteria for pedophilia;[16] and pedophilic child molestors commit ten times more sexual acts against children than non-pedophilic child molestors.[16] On the other hand, papers by Okami and Goldberg (1992), and Kevin Howells (1981), state that most data they had reviewed suggest that pedophiles make up a minority of incarcerated child sex offenders.[127][128] In law enforcement, the term "pedophile" is generally used to describe those accused or convicted of child sexual abuse under sociolegal definitions of child (including both prepubescent children and adolescents younger than the local age of consent);[17] however, not all child sexual offenders are pedophiles and not all pedophiles engage in sexual abuse of children.[129][130][18] Law enforcement and legal professionals have begun to use the term predatory pedophile,[131] a phrase coined by children's attorney Andrew Vachss, to refer specifically to pedophiles who engage in sexual activity with minors.[132] The term emphasizes that child sexual abuse consists of conduct chosen by the perpetrator.[133] OffendersAdult offendersDemographicsOffenders are more likely to be relatives or acquaintances of their victim than strangers.[134] A 2006-2007 Idaho study of 430 cases found that 82% of juvenile sex offenders were known to the victims (acquaintances 46% or relatives 36%).[135] [136] More offenders are male than female, though the percentage varies between studies. The percentage of incidents of sexual abuse by female perpetrators that come to the attention of the legal system is usually reported to be between 1% and 4%.[137] Studies of sexual misconduct in US schools with female offenders have shown mixed results with rates between 4% to 43% of female offenders.[98] Maletzky (1993) found that, of his sample of 4,402 convicted pedophilic offenders, 0.4% were female.[138] Another study of a non-clinical population found that, among those in the their sample that had been molested, as much as a third were molested by women.[139] In U.S. schools, educators who offend range in age from "21 to 75 years old, with an average age of 28" with teachers, coaches, substitute teachers, bus drivers and teacher's aides (in that order) totaling 69% of the offenders.[140] Psychological AspectsOffenses may be facilitated by cognitive distortions of the offender, such as minimization of the abuse, victim blaming, and excuses.[141] Early research in the 1970s and 80s began to classify offenders based on their motivations and traits. Groth and Birnbaum (1978) categorized child sexual offenders into two groups, "fixated" and "regressed."[142] Fixated were described as having an primary attraction to children, whereas regressed had largely maintained relationships with other adults, and were even married. This study also showed that adult sexual orientation was not related to the sex of the victim targeted, e.g. men who molested boys had previously had adult heterosexual relationships.[142] Later work (Holmes and Holmes, 2002) expanded on the types of offenders and their psychological profiles. They are divided thus[143]:
Child and young adolescent offendersWhen a prepubescent child is sexually abused by one or more other children or adolescent youths, and no adult is directly involved, it is defined as child-on-child sexual abuse. The definition includes any sexual activity between children that occurs without consent, without equality, or as a result of coercion,[144] whether the offender uses physical force, threats, trickery or emotional manipulation to compel cooperation. When sexual abuse is perpetrated by one sibling upon another, it is known as "intersibling abuse", a form of incest. [145] International lawChild sexual abuse is outlawed in every developed country, generally with severe criminal penalties, including in some jurisdictions, life imprisonment or capital punishment.[146][147] An adult's sexual intercourse with a child below the legal age of consent is defined as statutory rape,[148] based on the principle that a child is not capable of consent and that any apparent consent by a child is not considered to be legal consent. One hundred forty nations are signatories to the United Nations Convention on the Rights of the Child. This international treaty defines a set of protections which signatories agree to provide for the children of their respective countries.[149] Articles 34 and 35 require that signatories protect their nations’ children from all forms of sexual exploitation and sexual abuse. This includes outlawing the coercion of a child to perform sexual activity, the prostitution of children, and the exploitation of children in creating pornography. Signatories also agree to prevent abduction, sale, or trafficking of children.[150] HistoryChild sexual abuse has gained public attention in the past few decades and has become one of the most high-profile crimes. Since the 1970s the sexual abuse of children and child molestation has increasingly been recognized as deeply damaging to children and thus unacceptable for society as a whole. While sexual use of children by adults has been present throughout history, it has only become the object of significant public attention in recent times. Early writingsThe first published work dedicated specifically to child sexual abuse appeared in France in 1857: Medical-Legal Studies of Sexual Assault (Etude Médico-Légale sur les Attentats aux Mœurs), by Auguste Ambroise Tardieu, the noted French pathologist and pioneer of forensic medicine (Masson, 1984, pp. 15-25). The rise of public concernChild sexual abuse became a public issue in the 1970s and 1980s. Prior to this point in time sexual abuse remained rather secretive and socially unspeakable. Studies on child molestation were nonexistent until the 1920s and the first national estimate of the number of child sexual abuse cases was published in 1948. By 1968 forty four states had enacted mandatory laws that required physicians to report cases of suspicious child abuse. Legal action began to become more prevalent in the 1970s with the enactment of the Child Abuse and Treatment Act in 1974 in conjunction with the creation of the National Center for Child Abuse and Neglect. Since the creation of the Child Abuse and Treatment Act, reported child abuse cases have increased dramatically. Finally, the National Abuse Coalition was created in 1979 to create pressure in congress to create more sexual abuse laws. Second wave feminism brought greater awareness of child sexual abuse and violence against women, and made them public, political issues. Judith Lewis Herman, Harvard professor of psychiatry, wrote the first book ever on father-daughter incest when she discovered during her medical residency that a large number of the women she was seeing had been victims of father-daughter incest. Herman notes that her approach to her clinical experience grew out of her involvement in the civil rights movement. [151] Her second book Trauma and Recovery, considered a classic and ground-breaking work[152][153] coined the term complex post-traumatic stress disorder[154]." In it she defines this concept not only in terms of prolonged trauma, but in terms of what she calls "subjection to totalitarian control." Examples of this concept include:
In 1986, Congress passed the Child Abuse Victims' Rights Act, giving children a civil claim in sexual abuse cases. The number of laws created in the 1980s and 1990s began to create greater prosecution and detection of child sexual abusers. During the 1970s a large transition began in the legislature related to child sexual abuse. Megan's Law which was enacted in 2004 gives the public access to knowledge of sex offenders nationwide.[156] Anne Hastings described these changes in attitudes towards child sexual abuse as "the beginning of one history's largest social revolutions."[157] According to John Jay College of Criminal Justice professor B.J. Cling,
See also
Notes
|