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Understanding the Facts About Childhood Sexual Abuse

The sexual abuse of children is an especially uncomfortable subject, but one that must be faced head on. This devastating crime against those who are most vulnerable and unable to protect themselves can only be stopped, however, when we educate ourselves and our children on how to do so. Understanding the facts about childhood sexual abuse (CSA) is vital to the prevention of, or at least effective treatment for, those victimized in this way. The problems related to accomplishing this task, however, take several forms:

The definition about what constitutes abuse is misunderstood. For example, does abuse only involve a child who is taken advantage of by an adult? What about an older child who molests a younger one – is this still abuse?

In fact, CSA occurs when an adult or older child uses a younger child for any kind of sexual stimulation. Such abuse may take many forms, including pressuring someone to engage in sexual activities (the outcome is NOT the point), exposing sexual organs or displaying pornography to a child, or having any physical contact with a child that is sexual in nature. Viewing a child’s genitalia even without contact and/or photographing the child in order to produce pornography also constitutes CSA.

As for statutory assault (rape), this is defined as an adult (over 18 years of age) who engages in sexual activity with someone who is under the age required to legally consent to that behavior. The problem here is that “consenting age” may vary from one jurisdiction to another and can range from 14 to 18 years of age (Waites, 2005).

The statistics regarding the prevalence of abuse are inconsistent. The main reason for this has to do with who is reporting what to whom (if at all). For example, do the numbers include only those cases that are actually investigated by an official agency? What about those that are reported but never prosecuted due to lack of “evidence” or are dropped due to familial or societal pressures? How many cases are never reported at all due to fear and shame?

What must be taken into account are the incredibly large number of abuse survivors that come into the therapist’s office for help but never report to law officials – or even family members, for that matter, for fear of their reaction.

When abuse is disclosed, we are unsure how to respond. Is your first reaction shock? Disbelief? Embarrassment? Shame? In other words, are you so uncomfortable with the topic you are unwilling to discuss it with someone who needs you to honestly listen when he or she reaches out for help? Avoidance is a form of self-protection, but it in no way protects sexual abuse victims from further abuse.

The most essential thing we can do for victims of any kind of abuse is hear what they have to tell us, to believe them, and to come along side and support them, no matter how uncomfortable it makes us, no matter what it costs in our comfort level, and then to connect them with the help and resources they need in order to heal.

What the Research Shows
In a meta-analysis by Pereda, Guilera, Forns, and Gomez-Benito (2009), an attempt to deal with the relative lack of consistent data on CSA was conducted. After reviewing over 65 articles that included data from 22 countries across the world, the study revealed that 7.9% of men and 19.7% of women had suffered some form of CSA prior to the age of 18 years of age. The rates for the United States alone showed that 7.5% of males and 25.3% of females were included in those numbers. What the authors concluded was that CSA was a much more widespread problem than had been previously estimated.

The bottom line here is that even the most conservative rates include an incredibly large number of victims that cannot and should not be ignored. A separate study by Briere and Elliott (2003) found that CSA was all too common in the general population, with 14.2% of males (n = 66) and 32.3% of females (n = 152) in their sample (N = 935) reporting some form of sexual abuse.

CSA Statistics: Children
The statistics on CSA in the United States alone is alarming. Research shows that as many as one in four girls and one in seven boys will be sexually abused during their childhood (Truman, Department of Justice, 2011). Experts all agree, however, that the incidence of sexual abuse is much higher.

According to a comprehensive national survey conducted by Finkelhor, Ormrod, Turner, and Hamby (2012), the highest incidence of sexual abuse occurs in young girls between the ages of 12 and 15 years of age. Sexual abuse also ranks highest among all types of abuse inflicted on children less than 18 years of age. Of offenders who victimized children under age six, 40% were under the age 18 themselves (Snyder, 2000; Bureau of Justice Statistics, 2000; Truman, 2011).

The majority of CSA cases tend to involve perpetrators who are family members or friends. In fact, approximately 90% of children who are victims of sexual abuse know their abuser in some way, while only 10% report being abused by a stranger (Finkelhor, 2012).

Impact of CSA
The impact upon each individual is in part a result of a range of factors. Variables such as the age of the child at the onset of abuse, the relationship of the child with the abuser, and whether the abuse was a single incident versus multiple episodes will not only impact the child but his or her ability to deal with the trauma. The nature of the abuse (for example, traumatic versus non-traumatic abuse, whether there was involvement of violence or sadistic acts, etc.), is also of vital importance when it comes to understanding how CSA impacts the person who has experienced it. Thus, clinicians working with survivors of CSA must not make assumptions about these individuals, as they are not a homogeneous group.

Additionally, the duration and frequency of the abuse will also have an impact on adjustment to or disruption in overall life functioning after CSA has occurred. Individual characteristics such as the personality of the child and the abuser, age and gender of the child, the child’s personality type/temperament, level of resilience, previous life experiences, attachment to caregivers, and effects of disclosure if and when it occurs will all impact both short and long-term outcomes. Cultural factors and the meaning the child extracts from what has transpired will also significantly impact how CSA is experienced (Sanderson, 2004).

Researchers have found that the greatest trauma occurs, however, if the child is closely related to the abuser (Maltz, 2002). For example, when the abuse involves a primary caretaker, and statistics show that it does in 10% of the cases, it can especially impact that child because his or her very basis for safety and trust has been broken in ways that are beyond devastating. This broken trust problem is one that follows victims throughout their lives on multiple levels and can be the most problematic of all; even as adults, many survivors of CSA tend to be less skilled at self-protection than they should and see being victimized as normal or acceptable, and a lifelong pattern of repeated victimization and exploitation often follows. Messman-Moore and Long (2000) confirmed this fact in their study, showing that women abused as children were at higher risk of unwanted sexual contact, physical abuse, and psychological maltreatment as adults. Self-mutilation, numbing, and other dissociative behaviors as a way of coping are common.

Lifelong Effects of CSA
Emotional reactions such as a deep sense of shame, guilt, self-blame, humiliation, or displaced fear are common and often lead to depression, anxiety, and other psychosocial difficulties as a result of distorted beliefs acquired early in life. Post-traumatic stress disorder (PTSD) is common among survivors of CSA. Nightmares, intrusive or recurring thoughts, flashbacks, and hypervigilance are all common of those suffering from PTSD.

Physical effects often reported by survivors of CSA can include chronic pain (especially abdominal or pelvic), a hypersensitive or lowered pain threshold, sleep disturbances, gastrointestinal disturbances, chronic headaches, eating disorders, and overall self-neglect. Compared to those who have never suffered abuse, adults abused as children are more than twice as likely to smoke, are four to five times more likely to abuse illegal drugs and drink alcohol, and to be physically inactive and severely obese (Felitti et al., 1998).

Sexual Effects can include disturbances of desire, arousal, and orgasm and are often a result of the psychological association between sexual activity, violation, and pain suffered during abuse. Survivors are more likely to engage in risk-taking behaviors, contract a sexually transmitted infection, and become pregnant as teenagers. Many gynecologic problems, including chronic pelvic pain, painful intercourse, or other pelvic pain problems, are common diagnoses among survivors (Reissing, Binik, Khalife, Cohen, & Amsel, 2003).

Survivors of CSA also tend to be less likely to have regular Pap tests and are all too often seek little or no prenatal care. According to a report by the American College of Obstetricians and Gynecologists (2011), these symptoms or behavioral consequences among women who were molested as children are and should be screened for on a regular basis. Their study found that the more extreme the abuse, the likelihood of the symptoms associated with abuse becoming apparent would increase. More extreme symptoms (physical, emotional, interpersonal) were also most associated with onset of abuse at an early age, frequent or extended periods of abuse, incest by a parent, or when the abuse included violence or the use of force. Common life events, such as marriage, birth, death, or divorce were also more likely to trigger the return of symptoms that may have otherwise abated for a survivor of CSA.

To say the least, the effects of sexual abuse are devastating. A study on the long-term psychological effects of child and adolescent abuse by Silverman, Reinherz, and Giaconia in 1996 found that physical and sexual abuse before the age of 18 accounted for significantly higher scores in depression, anxiety, emotional and behavioral problems, suicidal ideation, and suicide attempts in abused compared to non-abused individuals. They reported that approximately 80% of the abused young adults in their sample also met the criteria for at least one psychiatric disorder by age 21.

Symptoms of CSA in Children
Children who are being sexually abused will often exhibit certain physical, emotional, or behavioral symptoms, depending upon their age.

For example, a very small child (under 3 years of age) may:

• Cry excessively
• Be extremely fearful, especially around particular people
• Have sleep disturbances
• Experience feeding problems
• Have unexplained vomiting or other gastrointestinal disturbances
• Fail to thrive and reach developmental milestones
Younger children (ages 3 to 9 years) may:

• Regress to behaviors typical for a very young child (thumb sucking, bed wetting)
• Become unusually fearful around certain people
• Withdraw from family and friends, stop talking, isolate
• Begin to show signs of extreme stress (nightmares, sleep disturbances, startle easily)
• Refuse to attend school or preschool (show sudden separation anxiety, etc)
• Refuse to eat or complain of abdominal distress
• Have frequent urinary tract infections or bowel disturbances
• Become overly aggressive, hyperactive, emotional, or surly

Older children and adolescents may show signs of:

• Depression and/or suicidal ideation
• Anxiety
• Sleep disturbances
• Rage, aggression, extreme mood swings
• Eating disorders (anorexia, bulimia)
• PTSD (nightmares, hypervigilance, extreme startle response, difficulty concentrating)
• Poor performance at school
• Promiscuity, substance abuse, and other self-destructive behavior
• Running away from home

The lists above are by no means exhaustive; it pays to be vigilant and to keep the lines of communication open. If your child begins showing any of these symptoms or displays other behaviors that seem to be uncharacteristic, it is important to get help as soon as possible. While changes throughout childhood are certainly normal, extreme changes in personality or character are not and should be investigated by a professional.

Treatment
Because there are a number of dynamics surrounding CSA, the impact that CSA has may look different from person to person. To complicate matters, a child who has experienced CSA has often suffered other abuses alongside molestation, including physical and emotional abuse, neglect, and other factors that will impact his or her ability to heal from such trauma.

Effectively treating CSA can therefore be extremely difficult. When looking at the impact and long-term effects, taking all the variables into account is vital and requires a skilled professional who knows how to work with survivors in this area. A flexible rather than dogmatic approach is clearly required, whether working with children or adult survivors of this type of trauma.

Summary
It is clear that the impact of CSA varies enormously between individuals. Studies show that sexual abuse is associated with a wide variety of physical, emotional, and psychological symptoms (McCauley et al., 1997; Briere & Elliott, 2003; Leserman, 2005; Janssen et al., 2004) as well as a range of psychopathologies (mental and/or behavioral disorders) that may not become apparent until adulthood (Molnar, Buka, & Kessler, 2001). Treatment of, and therefore recovery from, CSA requires time, understanding, and immense patience from a safe and loving support system, but it is possible.

Resources
National Center for Victims of Crime: http://www.victimsofcrime.org/help-for-crime-victims

ChildHelp.org: 1-800-422-4453 http://www.childhelp.org/hotline

HelpGuide.org (Recognizing, Preventing, Reporting Child Abuse): http://www.helpguide.org/mental/child_abuse_physical_emotional_sexual_neglect.htm

How to Report Suspected Child Mistreatment: https://www.childwelfare.gov/responding/how.cfm
(has a link to state by state contact numbers in addition to ChildHelp.org info) https://www.childwelfare.gov/contact.cfm

References

American College of Obstetricians and Gynecologists: Women’s Health Care Physicians. (2011).
Adult manifestations of childhood sexual abuse. Committee on Health Care for
Underserved Women. http://www.acog.org/Resources-And-Publications/Committee-
Opinions/Committee-on-Health-Care-for-Underserved-Women/Adult-Manifestations-of-
Childhood-Sexual-Abuse

Briere, J., & Elliott, D.M. (2003). Prevalence and psychological sequelae of self-reported
childhood physical and sexual abuse in a general population sample of men and women. Child Abuse and Neglect, 27, 1205-1222.

Felitti, V.J., Anda, R.F., Nordenberg, D., Williamson, D.F., Spitz, A.M., Edwards, V.,…Marks,
J.S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The adverse childhood experiences (ACE) study. American Journal of Preventative Medicine, 14, 245-58.

Finkelhor, D., Ormrod, R.,Turner, H., & Hamby, S. (2005). The victimization of children and
youth: A Comprehensive, national survey. Child Maltreatment, 10(1), 5-25. DOI: 10.1177/1077559504271287

Finkelhor, D. (2012). Characteristics of crimes against juveniles. Durham, NH: Crimes Against
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Janssen, I, Krabbendam, L, Bak, M., Hanssen, M., Vollebergh, W., de Graaf, R., & van Os, J.
(2005). Acta Psychiatrica Scandanavia, 109(1), 38-45.

Leserman, J. (2005). Sexual abuse history: Prevalence, health effects, mediators, and
psychological treatment. Psychosomatic Medicine, 67(6), 906-915.

Maltz, W. (2002). Treating the sexual intimacy concerns of sexual abuse survivors. Sexual and
Relationship Therapy, 17(4), 321-327.

McCauley, J., Kern, D.E., Kolodner, K., Dill, L, Schroeder, A.F, DeChant, H.K., Ryden, J.,
Derogatis, L.R., & Bass, E.B. (1997). Clinical characteristics of women with a history of childhood abuse: Unhealed wounds. Journal of American Medical Association, 277(17), 1362-1368.

Messman-Moore, T.L., & Long, P.J. (2000). Child sexual abuse and revictimization in the form
of adult sexual abuse, adult physical abuse, and adult psychological maltreatment. Journal of Interpersonal Violence, 15(5), 489-502. doi: 10.1177/088626000015005003

Molnar, B.E., Buka, S.L., & Kessler, R.C. (2001). Child sexual abuse and subsequent
psychopathology: Results from the national comorbidity survey. American Journal of Public Health, 91(5), 753-760.
See comment in PubMed Commons below

Paras, M.L., Murad, M.H., Chen, L.P., Goranson, E.N., Sattler, A.L., Colbenson,
K.M.,…Zirakzadeh, A. (2009). Sexual abuse and lifetime diagnosis of somatic disorders:
A systematic review and meta-analysis. Journal of the American Medical Association, 302, 550-61. doi: 10.1001/jama.2009.1091

Pereda, N., Guilera, G., Forns, M, & Gomez-Benito, J. (2009). Prevalence of child sexual abuse
in community and student samples: A meta-analysis. Clinical Psychology Review, 29(4),
328-338.

Reissing, E., Binik, Y., Khalife, S., Cohen, D., & Amsel, R. (2003). Etiological correlates of
vaginismus: Sexual and physical abuse, sexual knowledge, sexual self-schema, and
relationship adjustment. Journal of Sex & Marital Therapy, 29(1), 47-59.

Sanderson, C. (2006). Counselling adult survivors of child sexual abuse. London: J. Kingsley.

Silverman, A.B., Reinherz, H.Z., & Giaconia, R.M. (1996). The long-term sequelae of child and
adolescent abuse: A longitudinal community study. Child Abuse & Neglect, 20(8), 709-723.

Snyder, H.N. (2000). Sexual assault of young children as reported to law enforcement: Victim,
incident, and offender characteristics. National Center for Juvenile Justice, Bureau of
Justice Statistics. http://www.bjs.gov/content/pub/pdf/saycrle.pdf

Truman, J.L. (2011). National crime victimization survey 2010. U.S. Department of Justice,
Office of Justice Programs, Bureau of Justice Statistics, September 2011.
(http://bjs.ojp.usdoj.gov/content/pub/pdf/cv10.pdf)

Ullman, S., Najdowski, C., & Filipas, H. (2009). Child sexual abuse, post-traumatic stress
disorder, and substance use: Predictors of revictimization in adult sexual assault survivors. Journal Of Child Sexual Abuse, 18(4), 367-385.

U.S. Department of Justice Website. (2014). Raising awareness about sexual abuse: Facts,
myths, and statistics. Retrieved online August, 2014 at http://www.nsopw.gov/en-US/Education/FactsMythsStatistics?AspxAutoDetectCookieSupport=1

Waites, M. (2005). The age of consent: Young people, sexuality and citizenship. Palgrave
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