What is Sexual Abuse?

No-one in your family has the right to touch you in ways that make you feel uncomfortable. No-one has the right to trick you, confuse you, or force you into doing sexual things. This is called sexual abuse. Sexual abuse includes someone touching your private parts (e.g. breasts, vagina, penis, anus) or making you touch theirs. It can also include rape (e.g. putting a penis or another part of their body into your vagina, anus or mouth), or other things that make you feel uncomfortable (e.g. making sexual comments about you or 'perving' at you in a sexual way, making you watch them masturbate, rubbing their body against you in a sexual way, trying to tongue kiss you, or making you look at sexual pictures or videos). Most sexual abusers are male, and a few are female. It is not true that sexual abuse happens because 'a man cannot control his sexual urges'. The abuser knows that they are doing, and they make a choice to abuse their position of trust and power. If any of these things have happened to you, it can make you feel really horrible. The first thing to remember is that it isn't your fault, no matter what. The abuser is always responsible for the abuse. It's very hard to know what to do when someone hurts you like this. It doesn't make you a bad person, and you don't deserve to be treated in this way. Unfortunately, many children and young people experience sexual abuse. It's against the law for anyone to treat you like this. Sexual abuse can be very confusing. The person doing the abuse might be someone you trust. By treating you like this, they've betrayed your trust in them, and this is very wrong. Also, often the person who does it to you will tell you things like: 'it's normal' 'don't tell anyone' 'it's our secret'. This can make you feel frightened to tell anyone. But there are things you can do, and people you can talk to. You don't have to deal with this alone. Read 'Frequently Asked Questions about Sexual Abuse' See 'Steps to Working it Out' for ideas on what you can do Read the True Stories from Young People who experienced Abuse

* (This quote is from Krystal, from A Guide for Young Women about Sexual Assault, Northern Centre Against Sexual Assault, 2002)

http://www.burstingthebubble.com/what-is-sexual-abuse.htm

Understanding Child Sexual Abuse

Education, Prevention, and Recovery

What is Child Sexual Abuse?
There is no universal definition of child sexual abuse. However, a central characteristic of any abuse is the dominant position of an adult that allows him or her to force or coerce a child into sexual activity. Child sexual abuse may include fondling a child's genitals, masturbation, oral-genital contact, digital penetration, and vaginal and anal intercourse. Child sexual abuse is not solely restricted to physical contact; such abuse could include noncontact abuse, such as exposure, voyeurism, and child pornography. Abuse by peers also occurs.

Accurate statistics on the prevalence of child and adolescent sexual abuse are difficult to collect because of problems of underreporting and the lack of one definition of what constitutes such abuse. However, there is general agreement among mental health and child protection professionals that child sexual abuse is not uncommon and is a serious problem in the United States.

The impact of sexual abuse can range from no apparent effects to very severe ones. Typically, children who experience the most serious types of abuse—abuse involving family members and high degrees of physical force—exhibit behavior problems ranging from separation anxiety to posttraumatic stress disorder. However, children who are the victims of sexual abuse are also often exposed to a variety of other stressors and difficult circumstances in their lives, including parental substance abuse. The sexual abuse and its aftermath may be only part of the child's negative experiences and subsequent behaviors. Therefore, correctly diagnosing abuse is often complex. Conclusive physical evidence of sexual abuse is relatively rare in suspected cases. For all of these reasons, when abuse is suspected, an appropriately trained health professional should be consulted.

http://www.apa.org/releases/sexabuse/

Sexual abuse of children and minors

http://en.wikipedia.org/wiki/Sexual_abuse

Main article: Child sexual abuse

Child sexual abuse is a form of child abuse in which a child is abused for the sexual gratification of an adult or older adolescent.^[4][5] In addition to direct sexual contact, child sexual abuse also occurs when an adult indecently exposes their genitalia to a child, asks or pressures a child to engage in sexual activities, displays pornography to a child, or uses a child to produce child pornography.^[4][6][7]

Effects of child sexual abuse include guilt and self-blame, flashbacks, nightmares, insomnia, fear of things associated with the abuse (including objects, smells, places, doctor's visits, etc.), self-esteem issues, sexual dysfunction, chronic pain, addiction, self-injury, suicidal ideation, somatic complaints, depression,^[8] post-traumatic stress disorder,^[9] anxiety,^[10], other mental illnesses (including borderline personality disorder and dissociative identity disorder^{[citation needed]}), propensity to re-victimization in adulthood,^[11] and physical injury to the child, among other problems.^[12]
Sexual abuse by a family member is a form of incest, and can result in more serious and long-term psychological trauma, especially in the case of parental incest.^[13]

Approximately 15% to 25% of women and 5% to 15% of men were sexually abused when they were children.^{[14][15][16][17][18]} Most sexual abuse offenders are acquainted with their victims; approximately 30% are relatives of the child, most often fathers, uncles or cousins; around 60% are other acquaintances such as friends of the family, babysitters, or neighbors; strangers are the offenders in approximately 10% of child sexual abuse cases. Most child sexual abuse is committed by men; women commit approximately 14% of offenses reported against boys and 6% of offenses reported against girls.^[14] Most offenders who abuse pre-pubescent children are pedophiles,^[19][20] however a small percentage do not meet the diagnostic criteria for pedophilia.^[21]

definition of sexual abuse in general

Sexual abuse, also referred to as molestation, is the forcing of undesired sexual behavior by one person upon another, when that force falls short of being a sexual assault. The offender is referred to as a sexual abuser or (often pejoratively) molester.^[1] The term also covers any behavior by any adult towards a child to stimulate either the adult or child sexually. When the victim is younger than the age of consent, it is referred to as child sexual abuse.


http://en.wikipedia.org/wiki/Sexual_abuse

effects of sexual abuse

Effects

Psychological harm

Child 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] eating disorders, 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.^{[11][29][30][31][32][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.^{[31][39][40][41][42]} 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.^{[9][22][44][45]} 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 PTSD

Child 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 post traumatic stress disorder resulting from child sexual abuse, even without actual or threatened injury or violence.^[54]

Research factors

Because 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.^[7][22][59]

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."^[60] The study was criticized for flawed methodology and conclusions,^[61][62] though its publication by peer-review has been tacitly or implicitly defended.^[63][64] Following extensive publicity, the US Congress condemned the study for its conclusions and for providing material used by pedophile organizations to justify their activities.^[65] Russell 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.^[66]

Physical harm

Injury

Depending on the age and size of the child, and the degree of force used, child sexual abuse may cause internal lacerations and bleeding. In severe cases, damage to internal organs may occur, which, in some cases, may cause death.^[67] 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.^[68]

Infections

Child sexual abuse may cause infections and sexually transmitted diseases.^[69] Depending on the age of the child, due to a lack of sufficient vaginal fluid, chances of infections are higher. Vaginitis has also been reported.^[69]

Neurological damage

Research has shown that traumatic stress, including stress caused by sexual abuse, causes notable changes in brain functioning and development.^[70][71] 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;"^[72] Teicher et al. (1993) found that an increased likelihood of "ictal temporal lobe epilepsy-like symptoms" in abused subjects;^[73] Anderson et al. (2002) recorded abnormal transverse relaxation time in the cerebellar vermis of adults sexually abused in childhood;^[74] 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;^[75] and Ito et al. (1993) found increased electrophysiological abnormalities in sexually abused children.^[76]

Some studies indicate that sexual or physical abuse in children can lead to the overexcitation of an undeveloped limbic system.^[75] Teicher et al. (1993)^[73] 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.^[73][77]

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.^[78]

Incest

Main article: Incest

Incest 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] One researcher stated that more than 70% of abusers are immediate family members or someone very close to the family.^[79] Another researcher stated that about 30% of all perpetrators of sexual abuse are related to their victim, 60% of the perpetrators are family acquaintances, like a neighbor, babysitter or friend and 10% of the perpetrators in child sexual abuse cases are strangers.^[11] 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.^[80]

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.^[81] 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.^[82][83] Similarly, some argue that sibling incest may be as common, or more common, than other types of incest: Goldman and Goldman^[84] reported that 57% of incest involved siblings; Finkelhor reported that over 90% of nuclear family incest involved siblings;^[85] while Cawson et al. show that sibling incest was reported twice as often as incest perpetrated by fathers/stepfathers.^[86]

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.^[81]

Types of child sexual assault

Child sexual abuse includes a variety of sexual offenses, including:

• sexual assault – a term defining offenses in which an adult touches a minor for the purpose of sexual gratification; for example, rape (including sodomy), and sexual penetration with an object.^[87] Most U.S. states include, in their definitions of sexual assault, any penetrative contact of a minor’s body, however slight, if the contact is performed for the purpose of sexual gratification.^[88]
• sexual molestation – a term defining offenses in which an adult engages in non-penetrative activity with a minor for the purpose of sexual gratification; for example, exposing a minor to pornography or to the sexual acts of others.^[89]
• sexual exploitation – a term defining offenses in which an adult victimizes a minor for advancement, sexual gratification, or profit; for example, prostituting a child,^[90] and creating or trafficking in child pornography.^[91]
• sexual grooming - defines the social conduct of a potential child sex offender who seeks to make a minor more accepting of their advances, for example in an online chat room.^[92]

Disclosure

Children 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.^[93][94] In general, studies have found that children need support and stress-reducing resources after disclosure of sexual abuse.^[95][96] Negative social reactions to disclosure have actually been found to be harmful to the survivor’s well being.^[97] 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, post traumatic stress disorder symptoms, and dissociation.^[98] 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.^[96] Although hearing a victim’s disclosure might be uncomfortable, for the sake of the victim’s well-being, 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.^[99] Dr. Asa Don Brown has indicated: "A minimization of the trauma and its effects is commonly injected into the picture by parental caregivers to shelter and calm the child. It has been commonly assumed that focusing on children’s issues too long will negatively impact their recovery. Therefore, the parental caregiver teaches the child to mask his or her issues."^[100]

^{http://en.wikipedia.org/wiki/Child_sexual_abuse#Effects}

child sexual abuse

Child sexual abuse is a form of child abuse in which an adult or older adolescent abuses a child for sexual stimulation.^[1][2] Forms of CSA include asking or pressuring a child to engage in sexual activities (regardless of the outcome), indecent exposure of the genitals to a child, displaying pornography to a child, actual sexual contact against a child, physical contact with the child's genitals, viewing of the child's genitalia without physical contact, or using a child to produce child pornography.^[1][3][4]

The effects of child sexual abuse include depression,^[5] post-traumatic stress disorder,^[6] anxiety,^[7] propensity to re-victimization in adulthood,^[8] and physical injury to the child, among other problems.^[9] Sexual abuse by a family member is a form of incest, and can result in more serious and long-term psychological trauma, especially in the case of parental incest.^[10]

Approximately 15% to 25% of women and 5% to 15% of men were sexually abused when they were children.^{[11][12][13][14][15]} Most sexual abuse offenders are acquainted with their victims; approximately 30% are relatives of the child, most often brothers, fathers, uncles or cousins; around 60% are other acquaintances such as friends of the family, babysitters, or neighbors; strangers are the offenders in approximately 10% of child sexual abuse cases.^[11] Most child sexual abuse is committed by men; studies show that women commit 14% to 40% of offenses reported against boys and 6% of offenses reported against girls.^[11][12][16] Most offenders who abuse pre-pubescent children are pedophiles,^[17][18] however a small percentage do not meet the diagnostic criteria for pedophilia.^[19]

Under the law, "child sexual abuse" is an umbrella term describing criminal and civil offenses in which an adult engages in sexual activity with a minor or exploits a minor for the purpose of sexual gratification.^[4][20] The American Psychiatric Association states that "children cannot consent to sexual activity with adults", and condemns any such action by an adult: "An adult who engages in sexual activity with a child is performing a criminal and immoral act which never can be considered normal or socially acceptable behavior."^[21]

^{source: http://en.wikipedia.org/wiki/Child_sexual_abuse}

What is Sexual Abuse?

Sexual Abuse Definition. Sexual abuse is any sort of non-consensual sexual contact. Sexual abuse can happen to men or women of any age. Sexual abuse by a partner/intimate can include derogatory name calling, refusal to use contraception, deliberately causing unwanted physical pain during sex, deliberately passing on sexual diseases or infections and using objects, toys, or other items (e.g. baby oil or lubricants) without consent and to cause pain or humiliation.

Child Sexual Abuse. Medem defines child sexual abuse as "any sexual act with a child performed by an adult or an older child." Child sexual abuse could include a number of acts, including but not limited to:

• Sexual touching of any part of the body, clothed or unclothed;
• Penetrative sex, including penetration of the mouth;
• Encouraging a child to engage in sexual activity, including masturbation;
• Intentionally engaging in sexual activity in front of a child;
• Showing children pornography, or using children to create pornography;
• Encouraging a child to engage in prostitution.

http://www.pandys.org/whatissexualabuse.html

the effects of sexual abuse

Volumes have been written on the topic of sexual abuse, analyzing it from every angle. When one reads what has been written, perhaps the most striking thing about it is the power to disrupt lives: a single abusive act disrupts not just the life of a child, but dozens of lives. If we are to reduce and repair the damage done by sexual abuse, we must truly understand how sexual abuse effects children and birth, foster, and adoptive families.


The Survivor
The impact of sexual abuse on children can be devastating and long-lasting. Because children are victimized by someone they should be able to trust and depend on, they may not realize that the abuse is wrong and not their fault. According to Faulkner (1996), sexually-abused children report feeling that something is wrong with them, that the abuse is their own fault, and that they should blame themselves for the abuse. Many children encounter disbelief or dismissal of their claims because adults do not wish to acknowledge that abuse is occurring. Consequently, victims may feel inadequate, embarrassed, isolated, guilty, shameful, and powerless (Faulkner, 1996). For these reasons, many people suppress what they perceive as a shameful secret until later in life.
Even after much time has passed, the effects of sexual abuse are powerful. Finkelhor and Browne (1986) found the long-term effects of maltreatment to include poor self-esteem, difficulty trusting others, anxiety, feelings of isolation and stigma, depression, self-destructive tendencies, sexual maladjustment, and substance abuse.
In 1998, Hughes and colleagues published the results of a study of 18 adult women who reported sexual abuse prior to age 12. These women revealed that they suffered from low rates of secondary school completion, long-term mistrust of others, illness, depression, dissociation, sleep problems, self-injury and self-mutilation, eating disorders, agoraphobia, and painful memories (Hughes, et al., 1998). These findings affirm what other researchers have found: a clear link between a history of child sexual abuse and higher rates in adult life of depression, anxiety, substance abuse, eating disorders, and post traumatic stress disorder (Mullen & Fleming, 1998).
The negative effects of incest, the most common form of sexual abuse, can be compounded by the reactions of parents, siblings, and other important people in the child's life. For example, siblings of the survivor may blame the abused child, not the abuser, either because they believe the perpetrator's denials or simply because of what reporting the abuser has done to the family. And when a child wonders if her mother knew about the abuse but did nothing to stop it, she can lose trust in both parents, not just one (Sheinberg & Fraenkel, 1998).


The Survivor's Family
When a child is reported to have been sexually abused by a family member, the whole family is affected. Often family members feel they must choose whom to side with and whom to blame. Meanwhile the family is flooded with shame and invaded by police and social workers.
While this is necessary for the safety of children, social workers must do what they can to support the bonds among all family members, particularly between siblings an between a nonoffending parent and the children.
This can be a challenge. Societal norms and expectations about the responsibility mothers bear for what happens inside their homes influence us tremendously. The degree to which our cultural values may lead us to blame nonoffending mothers "is exemplified" by the findings of Dietz and Craft (1980), who reported that most social workers believed that mothers are as responsible for the sexual abuse as the offender, despite the fact that 78 percent of the mothers in their study were being physically abused by the same offender who abused the child" (Massat & Lundy, 1998).
Yet emerging research indicates that we need to support mothers more, if only for the children's sake (Corcoran, 1998). Some research has shown that a child's ability to recover from sexual abuse may be influenced by the support she receives from the nonoffending parent. Adams-Tucker (1982) and others suggest that a parent's failure to believe and support a child who reports abuse may compound a child's feelings of betrayal and isolation. Conversely, evidence is growing that maternal support is critical for a child's recovery for both the short and long term (Corcoran, 1998).
Nonoffending parents need support. Often they are in a state of shock, because their child has been sexually abused, and strained by their efforts to decide whether to report the abuse.
And as soon as they make it known what their spouses or significant others have done, the relationship between these mothers and the rest of the world changes. In their 1998 article, Massat and Lundy explored the "costs" of reporting sexual abuse for 104 nonoffending parents. They found these parents faced many issues as a direct result of reporting incest, including problems with family members (54%), a decline in income (55%), difficulty with their job (26%) or having to find a new job (26%), and having to find a new place to live (50%).
These mothers may lack the emotional resources and support systems needed to deal with these challenges. Indeed, to protect the child's privacy, mothers may decide not to rely on the support networks they do have, let alone reach out to establish new ones (Corcoran, 1998). All of this underscores the importance of understanding each family's needs and connecting them to formal and informal supports and concrete services whenever possible.

The Offender
The fathers, uncles, and other family members who sexually abuse children are affected by the abuse, too. Most of them live double lives: one as an upstanding family man, one as an obsessed, self-loathing sex offender.
Regardless of how we feel about them, incest perpetrators are still very important to the families they have betrayed. In psychological terms they are still "central attachments" for the family. As such, the family is certain to have contradictory, confused feelings about these men.
To help children and their families heal and prevent future maltreatment, it is important that social workers try to ensure that offenders receive treatment from experienced, trained therapists.
An important part of many treatment programs for sexual offenders are "apology sessions." In this phase of treatment the offender writes a letter to his victim and then, in the presence of the therapist, the child, and the rest of the family he reads it aloud, assuring the child that the abuse was entirely his fault and that he is sorry for what he has done (Wylie, 1998). This clarification from the person who has harmed them can be helpful to children struggling to come to terms with sexual abuse and the relationships it has damaged.


Foster & Adoptive Parents
Foster and adoptive parents are also affected when a child is sexually abused. Down the line they must care for children in emotional turmoil because of the abuse and the disruption of their families. To do this effectively, parents must learn everything they can about the short and long term effects of sexual abuse.
A particular challenge for many families is learning how to cope with children's sexualized language and behavior. Parenting children who have been sexually abused requires knowledge about setting boundaries (e.g., about touching) and special understanding when it comes to certain behaviors, such as a child's need to masturbate.
To succeed in establishing a solid foundation with a child who has been sexually abused, foster and adoptive parents must help the child reconcile her past and present lives. As Fahlberg (1991) explains, "The success of a new relationship isn't dependent upon the memory of an earlier one fading; rather, the new one is likely to prosper when the two relationships are kept clear and distinct." Helping a child build a life book is one way for foster and adoptive parents to help a child make sense of her past.
Therefore foster and adoptive parents must support birth parent-child ties. To make this possible, they may want to adopt the policy of Brenda Crider, a North Carolina foster parent. "I never run parents down to their kids," she says. "When these kids know you accept their parents, regardless of what they've done, the kids are easier to deal with. This makes sense. Kids are looking for approval, and if you disapprove of their parents then they think you disapprove of them, too" (Crider, 1998).

source: http://www.practicenotes.org/vol5_no2/effects_of_sexual_abuse.htm

Sexual Abuse Effects

Sexual abuse effects on children and youth can be evident in emotional, physical and behavioural ways. These effects can be just as devastating whether there was only one occurrence or there were repeated occurrences. Sexual abuse cannot be compared, because each abuse experience is unique.


Vulnerability Factors:
Children are vulnerable to sexual abuse because of their age, size and innocence. When a child or youth is molested, she/he learns that adults cannot be trusted for care and protection: well-being is disregarded, and there is a lack of support and protection. These lead to grief, depression, extreme dependency, inability to judge trustworthiness in others, mistrust, anger and hostility. And as if all that isn't enough, children's bodies often respond to the sexual abuse, bringing on shame and guilt.

Points to consider:
» Children/youth are unable to protect themselves and stop the abuse.
» Children/youth are susceptible to force.
» Children/youth are susceptible to the use of trickery by offenders.
» Often times, children/youth have no control over their own bodies.
» All too often, children/youth are unable to make others believe them.

The above factors lead to:
» anxiety
» fear
» shame
» a sense of inadequacy
» the need to control situations and others
» a perception of self as victim
» identification with the aggressor


Factors That Influence Sexual Abuse Effects

Miraculously, not all children or youth molestation victims display signs that something is wrong.
FACT: Between 21% and 36% of sexually abused children will display few or no symptoms (Oates, O'Toole, Lynch, Stern & Cooney, 19941).

Why do some victims display a multitude of emotional and behavioural effects, while others display few or none? In spite of few or no outward symptoms, child and youth victims do suffer emotionally.
These emotional effects come in varying degrees, depending on the following six factors:

The nature of the relationship between the victim and the offender: the closer the emotional relationship, the greater the emotional trauma.

The age of the child when the abuse began and the duration of the sexual relationship: an ongoing sexual relationship with repeated contacts is generally more traumatic and usually produces more sexual abuse effects than a single contact.

The type of sexual activity the victim is exposed to: sexual acts involving strictly non-contact sexual abuse appears less traumatic than sexual acts that involve contact. It is important to note, however, that trauma and the sexual abuse effects are still very real when any type of sexual abuse occurs.
For an excellent discussion written by Colette Dowling, M.S.W. about sexual abuse in school girls, check out www.womens-wellbeing-and-mental-health.com. Colette is an internationally renown lecturer and author of eight books, including her best-seller The Cinderella Complex, which has been in print for 25 years.

The degree of physical aggression directed at the victim: violence adds to the trauma of the abuse. Being physically abused, having a mother who is mentally ill, not having someone to confide in, and being socially isolated are significant predictors for childhood sexual abuse (Fleming, Mullen & Bammer, 19972).

The response the victim receives when she/he discloses the abuse: healing is apparent when a disclosure is met with compassion and is followed with effective intervention; if the victim is met with skepticism and accusations, anger, or no response at all when she/he discloses, the sexual abuse effects are compounded.

The availability of a supportive person in the victim's life: a caring, loving, nurturing, and listening person in the victim's life lessens the trauma; a lack of a supportive person intensifies the abuse and leaves the victim feeling even more lonely, helpless, and unworthy.


Emotional and Physical Sexual Abuse Effects:
Molested children suffer many losses, including:
self-esteem and self-worth
trust
childhood, including the opportunity to play and learn
the opportunity for normal growth and development
intimacy
control over his/her body
normal loving and nurturing
safety and security



Behavioural Sexual Abuse Effects:
* nightmares, phobias, and regressive behaviours such as thumb-sucking and bed-wetting
* learning problems
* clinging and smothering
* insecurity, which put the child at risk for further abuse and exploitation
* psychosomatic complaints such as stomachaches and headaches
* precocious sexual activity--a young child knows more than they should about sexual activity; child may exhibit seductive behaviour

FACT: 17% of abused children exhibit age inappropriate sexual behaviour (Trocme & Wolfe, 2001, p.283).

FACT: Of the sexual abuse effects exhibited, sexualized behaviour is the most consistent indicator of sexual abuse (Cavanagh Johnson et. al., 1995, pp.50-514).
*with young children, a preoccupation with sexual organs of self, parents and others--often this shows itself in language and art
*aggression and bullying behaviours

FACT: 14% of abused children exhibit behaviour problems (Trocme & Wolfe, 2001, p.285).
sudden changes in eating and/or sleeping habits
depression and anxiety
FACT: 29% of abuse children exhibit depression or anxiety (Trocme & Wolfe, 2001, p.286).
refusal to change clothes in front of others
isolation
obsessively good behaviour
obsessed with cleanliness
relationship problems


FACT: 13% of abused children exhibit negative peer involvement (Trocme & Wolfe, 2001, p.287).
anti-social behaviour
unwillingness to participate in social activities
running away


FACT: 85% of runaways in Toronto have been sexually abused(Conference on Child Victimization & Child Offending, 20008).
truancy / long absence from school


FACT: 10% of abused children have irregular school attendance (Trocme & Wolfe, 2001, p.289).
long absence from participation in extracurricular activities
dissociation--a child's existence is dependent on his/her ability to separate from the pain, which, in the most repulsive cases, may result in multiple personalities
risky behaviours such as firestarting, stealing and other delinquencies
animal cruelty
alcohol and drug abuse


FACT: According to the Conference on Child Victimization & Child Offending (200010), sexual abuse effects on children with a history of molestation reflect that they are seven times more likely to become drug/alcohol dependent


FACT: In a sexual abuse effects study of 938 adolescents admitted to residential, therapeutic communities for the treatment of substance abuse and related disorders, 64% of the girls and 24% of the boys reported histories of sexual abuse (Hawke, Jainchill, & DeLeon, 2000, pp.35-4711).
dysfunctional relationships
avoiding confrontation
self-harm, including cutting and burning
paranoid behaviour


FACT: Post Traumatic Stress Disorder (PTSD) is one of the sexual abuse effects that plague sexually abused children and adult survivors of child abuse. Symptoms experienced are similar to those experienced by Vietnam veterans and may include sleep disturbances, anxiety and depression, which negatively impact on their daily psychosocial functioning and for which many seek professional help (Wiehe, 1998, p.5012).
preoccupation with sex
promiscuous behaviour
compulsive and aggressive sexual behaviours
self-destructive sexual behaviour and prostitution


FACT: 98% of female street youth in British Columbia reported being victims of physical or sexual abuse as compared to 32% of female youths in schools. 59% of male street youth reported being victims of physical or sexual abuse as compared to 15% of male youth in schools (Beauvais et al., 2001, p.6213).
in adulthood, sexual dysfunction--avoidance of or phobic reactions to sexual intimacy
becomes the abuser


FACT: Studies done by Haywood, Kravitz, Wasyliw, Goldberg and Cavanaugh in 1996 reflect some disturbing sexual abuse effects. The study found that the odds of becoming a child molester were 5.43 times greater for adult male victims of childhood sexual abuse than for adult male non-victims (Lee, Jackson, Pattison, & Ward, 2002, p.8814).
attempted and completed suicide


FACT: Children with a history of sexual molestation are ten times more likely to attempt suicide (Conference on Child Victimization & Child Offending, 200015).
Sexual abuse effects on the child or youth are connected to the child/youth's life before, during and after the sexual contact. We must understand that the effects apply every bit as much to the disclosure and intervention as it does to the abuse itself. Sexual abuse effects continue long after the abuse stops.


source: http://www.child-abuse-effects.com/sexual-abuse-effects.html

What are the Effects of Child Sexual Abuse?

Children and adolescents who have been sexually abused can suffer a range of psychological and behavioral problems, from mild to severe, in both the short and long term. These problems typically include depression, anxiety, guilt, fear, sexual dysfunction, withdrawal, and acting out. Depending on the severity of the incident, victims of sexual abuse may also develop fear and anxiety regarding the opposite sex or sexual issues and may display inappropriate sexual behavior. However, the strongest indication that a child has been sexually abused is inappropriate sexual knowledge, sexual interest, and sexual acting out by that child.
The initial or short-term effects of abuse usually occur within 2 years of the termination of the abuse. These effects vary depending upon the circumstances of the abuse and the child's developmental stage but may include regressive behaviors (such as a return to thumb-sucking or bed-wetting), sleep disturbances, eating problems, behavior and/or performance problems at school, and nonparticipation in school and social activities.
But the negative effects of child sexual abuse can affect the victim for many years and into adulthood. Adults who were sexually abused as children commonly experience depression. Additionally, high levels of anxiety in these adults can result in self-destructive behaviors, such as alcoholism or drug abuse, anxiety attacks, situation-specific anxiety disorders, and insomnia. Many victims also encounter problems in their adult relationships and in their adult sexual functioning.
Revictimization is also a common phenomenon among people abused as children. Research has shown that child sexual abuse victims are more likely to be the victims of rape or to be involved in physically abusive relationships as adults are.
In short, the ill effects of child sexual abuse are wide ranging. There is no one set of symptoms or outcomes that victims experience. Some children even report little or no psychological distress from the abuse, but these children may be either afraid to express their true emotions or may be denying their feelings as a coping mechanism. Other children may have what is called "sleeper effects." They may experience no harm in the short run, but suffer serious problems later in life.

sources: http://www.apa.org/releases/sexabuse/effects.html
http://www.apa.org/releases/sexabuse/effects.html

SOSIOLOGICAL IMAGES OF CHILD SEXUAL ABUSE

SOSIOLOGICAL IMAGES OF CHILD SEXUAL ABUSE

Child sexual abuse is a form of child abuse in which an adult or older adolescent abuses a child for sexual stimulation. Below are sociological images which are designed to encourage all kinds of people to exercise and develop their sociological imagination by presenting brief sociological discussions of compelling and timely imagery that spans the breadth of sociological inquiry.

These incredibly creepy set of images are created in a Brazilian anti-pedophilia campaign (the organization is called CERCA). The first image is the ad with the lights on, the second with the lights off:

-Sexual Abuse Towards Children-

"They spent their whole childhood hoping someone would set them free. And yet even now they are still living with a past that can only be described as hell on earth...," said a Psychologist, Dr Reina Michaelson.

.

Who are the Perpetrators of Child Sexual Abuse?

Who are the Perpetrators of Child Sexual Abuse?

Studies on who commits child sexual abuse vary in the findings, but the most common finding is that the majorities of sexual offenders are family members or are otherwise known to the child. Sexual abuse by strangers is not nearly as common as sexual abuse by family members. Research further shows that men perpetrate most instances of sexual abuse, but there are cases in which women are the offenders.

The key statistic that is so often overlooked and rarely discussed is that 95% of Child Abuse and Sexual Abuse are perpetrated by family members. 79% of perpetrators are parents. Other relatives accounted for 7% and unmarried partners of parents and “other” accounted for 4% and 5% of abuse.

Therefore, most of the perpetrators of child sexual abuse are from the family members of the child. Thus, if we want to decrease child abuse our efforts would be far more effective if we focused our attention on the family rather than the few sensationalized Internet-based incidents.

A great place for schools to put their efforts if they want to reduce the incidence of child and sexual abuse is in training their staffs to identify the warning signs. Although educators report more abuse than any other sector of society, incidents continue to be severely under-reported.

SEXUAL ABUSE VICTIMS

The number one reason child sexual abuse victims don't tell is that they are afraid they won't be believed.





Why Children Don't Tell
Sexual abuse is shrouded in secrecy. Child and adolescent sexual abuse victims are encouraged to keep the abuse secret because:

Children fear reprisals from the offender.

Offenders tell the child that no one will believe them; and that even if someone does believe, the child will be blamed for the abuse.

Offenders openly threaten the safety of the child and/or members of the child's family.

Offenders tell the child the perpetrator will get into trouble if anyone discloses the sexual abuse. This is particularly fearsome for the child when the perpetrator is a family member, because the child fears abandonment.

Offenders promise gifts and rewards and offer bribes for the child to keep the secret. With young children, this can be candy, toys, trips to McDonald's. With youth, it can be videos, DVDs, rides in a car, sports tickets, sports equipment, clothes, makeup, jewellery, money, anything that is valued by the youth.


Male victims of sexual abuse constitute an extremely under-identified, under-served and frequently misunderstood population. Prevalence rates for males ranged from 3% - 29% (as cited in Barnett et al., 1997, p. 761).

Though sexual abuse is under-reported by both males and females, males are in a unique position. They are far less likely to disclose sexual abuse due to the issues identified in the table below.



Why Males Don't Disclose

A cultural bias maintains that males cannot be victims. Males are expected to be confident, knowledgeable, and aggressive. To be a victim means one is an inadequate male.

If the boy's body has responded sexually, he feels he is somehow responsible for the sexual abuse.

Male victims of sexual abuse struggle with issues of homosexuality as most offenders are male. Their homophobia plus their confusion and fear encourage silence. Not to mention the social stigma attached to homosexuality.

If a boy receives money for sex, he is less likely to be perceived as a victim.

If a boy has a homosexual orientation, he is often blamed for the "seduction" of the older male, instead of being acknowledged as a legitimate victim of sexual abuse.

Molestation by an older female is often viewed positively as a kind of "initiation rite" into manhood. Cultural pressure encourages participation while denying feelings.

Male victims of sexual abuse, more than female victims, may fear loss of freedom and independence if the sexual abuse should be made public.

Fear of reprisals from the offender plays a role in under-reporting.

When boys are victimized, they tend to be blamed more for their abuse and are viewed as less in need of care and support.

Boys fear negative judgment by family and friends.

Embarrassment and/or confusion prevent male victims of sexual abuse from disclosing.

our discussion today on 26 august

today we had discussed our research questions and research objectives in our english class..
we decided about 3 research questions and 3 research objectives.

so if you all have any additional research questions n objectives,
we can discuss it later.

we also had discussed about the content of our report that we want to contribute.

so this is our main points of discussion

research questions (RQ):
1. what is children sexual abuse?
2. why sexual harrassment is occurs among children?
3. what is the best way to prevent this brutality happens again towards children?
4. what tpes of common sexual abuse that always occurs towards them?

research objectives (RO):
1. to explain what is sexual abuse and why its happen among children.
2. to find out which type of children that expose to this brutality?
3. to suggest the best way to cope this social problem from happen again and again.
4. to describe common sexual harrassment that always happen towards children.

common types of sexual abuse

The clinical definition of sexual abuse continues to expand as our society recognizes a broader range of activities perpetrated by sexual offenders. A single episode of sexual abuse may fall into several categories.

Child Sexual Abuse:
The sexual abuse of children by adults or by older children or peers who dominate and control through sexual activity. Older boys who make girls undress and then fondle them, for example. It can be committed by strangers but most often is perpetrated by adults or older children in trusted caretaking roles.


Incest:
The most common form of child sexual abuse. Sexual abuse of children by other family members, including mother or father, step-parents, aunts, uncles, cousins, and grandparents.

Molestation:
Sexual abuse involving sexual stimulation to body and genital areas, including penetration. It can happen at any age, by a perpetrator of any age.

Stranger Rape:
Violence, anger, and power expressed sexually in an attack on a victim. It may involve penetration of body openings (oral, anal, and vaginal) but does not have to.

Date or Acquaintance Rape:
Sexual abuse, not necessarily violent perpetrated by someone known to the victim, often a peer in a trusted social relationship.

Marital Rape:
Sexual abuse perpetrated by one spouse on the other or by a sexual partner in any long-term committed relationship.

Sexual Assault:
Physical attack to victims sexual body parts, often involving force or violence. This term can cover a wide range of activites and often describes the rape of boys and men.

Exhibitionism or Exposure:
Displaying the naked body or parts of the naked body in an effort to shock, intimidate, or sexually arouse a victim.

Voyeurism:
Invasion of a victim's privacy either secretively or openly with the intent of gaining sexual gratification.

Obscene Phone Calls:
Invasion of a victim's privacy with sexually suggestive messages over the telephone in an effort to shock, intimidate, or sexually arouse a victim.

Sadistic Sexual Abuse:
Sexual abuse in which the offender incites or tries to incite reactions of dread, horror, or pain in the victim as a means of increasing the offender's sexual arousal during the abuse. May involve use of physical restraint, quasi-religious rituals, multiple simultaneous perpetrators, use of animals, insertion of foreign objects, mutilation or torture.

Sexual Exploitation:
Objectification and use of victims, by means of sexual activity or photographic imagery, to gain money or sexual gratification.

Sexual Harrassment:
Use of gender, status, and power differences to intimidate or control a victim, or to require sexual involvement. May be expressed as flirting and sexual suggestiveness.

Gender Attack:
Exposure to actions that demean the sexual gender of a victim, often with sexual overtones, such as cross dressing a child or verbally denigrating a victim's gender.

Gay Bashing:
Verbal or physical attacks directed against a victim's perceived homosexual orientation.

Sexual Violence:
Acts of violence involving or harming sexual parts of the victim's body.

Note: Legal definitions of sexual abuse are much narrower and can't be relied on in determining if an experience was sexual abuse. ...no laws protect victims from certain types of sexual abuse, such as spousal rape, sexual harassment, gender attack, gay bashing, and abuse perpetrated in indirect and subtle forms.


resources:
http://soulselfhelp.on.ca/types.html

sexual abuse of children

Renee Z. Dominguez, Ph.D.
Connie F. Nelke, Ph.D.
Bruce D. Perry, M.D., Ph.D.


For: Encyclopedia of Crime & Punishment
Berkshire Publishing GroupGreat Barrington, MAIn Press: 2001

This is a ChildTrauma Academy version of a chapter to be published in Encyclopedia of Crime & Punishment, 2001.
Official Citation:
Dominquez, R. Z., Nelke, C.F. and Perry, B.D. Child Sexual Abuse in: Encyclopedia of Crime and Punishment Vol 1.(David Levinson, Ed.) Sage Publications, Thousand Oaks pp 202-207, 2002
* ChildTrauma Academy, Houston, TX and La Rabida Children’s Hospital, Chicago, IL* * ChildTrauma Academy, Houston, TX and Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX*** ChildTrauma Academy, Houston, TX and Children’s Mental Health Programs, Alberta Mental Health Board, Calgary, CA

Introduction

Child sexual abuse is a significant public health problem in the United States and across the world. In the United States one out of three females and one out of five males have been victims of sexual abuse before the age of 18 years. Sexual abuse occurs across all ethnic/racial, socioeconomic, and religious groups. Unfortunately, sexual abuse is considered a relatively common experience in the lives of children. A report released by the National Institute of Justice in 1997 revealed that of the 22.3 million children between the ages of 12 and 17 years in the United States, 1.8 million were victims of a serious sexual assault/abuse. There are gender differences with regard to sexual abuse incidents; specifically, girls are at twice the risk than boys for sexual victimization throughout childhood and at eight times the risk during adolescence. Because significant physical, emotional, social, cognitive and behavioral problems are related to childhood trauma, the need to more effectively address the issue has become paramount.There are a number of commonly held misconceptions regarding child sexual abuse in the United States. These include the following: sexual abuse is limited to sexual intercourse between an adult and a child; the perpetrator of the sexual abuse is always a stranger; and rape occurs with adult women, not children. However, these beliefs are false. Sexual abuse involves a range of activities including non-contact and contact offenses (see Table1); stranger abuse comprises only a small percentage of total victimizations; and children are approximately three times more likely than adults to be victims of rape. In fact, among females, almost 30% of all forcible rapes occur before the age of 11 years, and another 32% occur between the ages of 11 and 17.Researchers in this area use somewhat different “criteria” for sexual abuse; the most common definition of sexual abuse, however, is any sexual activity involving a child where consent is not or cannot be given. Sexual contact between an adult and a minor child, as well as an older teen and a younger child, are both examples of sexual abuse. Depending upon the age at which a state deems a child capable of giving consent, sexual abuse between two minors can also occur. For example, the law in Texas dictates that there be greater than a three-year age differential between children in order to be considered sexual abuse. The types of sexual abuse vary widely and include both physical contact as well as non-contact offenses. Despite the choices made by laws and research criterion, the impact of a forced or coerced sexual activity can be devastating on a child even if the action cannot be legally or academically described as sexual abuse.All states require some kind of mandated child abuse reporting. Child abuse reporting laws most often require specified professionals (e.g., physicians, teachers) who have contact with children to report to law enforcement, the department of social services, or children protection agencies incidents in which abuse is suspected. These laws were developed in order to better protect children. From state to state, it varies as to who is mandated to report and what abuse acts require reporting. For example, according to California Penal Code there are two categories of sexual abuse that are reportable: sexual assault and sexual exploitation. According to the code, sexual assault includes rape and rape in concert, oral copulation and sodomy, lewd and lascivious acts upon a child under the age of 14, penetration of a genital and/or anal opening by a foreign object, and child molestation. Sexual exploitation includes conduct involving matter depicting minors engaged in obscene acts; promoting, aiding, or assisting a minor to engage in prostitution; a live performance involving obscene sexual conduct, or posing for a pictorial depiction involving obscene conduct for commercial purposes; and depicting a child in or knowingly developing a pictorial depiction in which a child engages in obscene sexual conduct.
Effects of Sexual AbuseThere are a significant number of negative short-term effects of sexual abuse that impact a child’s functioning. The most commonly experienced effect of sexual abuse is posttraumatic stress disorder (PTSD). Posttraumatic stress disorder is a clinical syndrome whose symptoms fall into three clusters: reenactment of the traumatic event; avoidance of cues associated with the event or general withdrawal; and physiological hyper-reactivity. A recent review article suggested over 50% of sexually abused children meet at least partial criteria of PTSD and another study suggested a third of all sexually abused children develop full diagnostic criteria. If not effectively addressed, PTSD can become a chronic problem affecting the child well into adulthood. The development of sexualized behavior, also called sexually reactive behavior, is another common negative short-term effect of sexual abuse. Children who have been sexually abused engage in more sexualized behavior when compared to children who are not victims of sexual abuse, and when compared to clinical samples of children with other mental health issues. A recent report suggested that about a third of children who have been sexually abused subsequently manifest this symptom. Additionally, a third or more of child victims of sexual abuse report depression and anxiety. Other frequently occurring symptoms include promiscuity (38%), general behavior problems (30%), poor self-esteem (35%), and disruptive behavior disorders (23%). In some important recent research conducted, in part, by the Centers for Disease Control, risk for health problems in adult life including heart disease were increased by adverse childhood events, including sexual abuse.It is estimated that somewhere between 21-49% of child sexual abuse victims appear asymptomatic post-victimization. Potential explanations for this include: difficulties with the methods used to detect problems in children, delays in symptom development post-sexual abuse, underreporting of symptoms, resiliency, and mitigating factors that may make the impact of the abuse less severe for some children.Mitigating factors can increase or decrease distress related to sexual abuse and include characteristics of the crime itself, characteristics of the individual child, and characteristics of the environment. Regarding the crime itself, sexual abuse involving force and penetration are associated with increased distress as are multiple victimizations. If the perpetrator of the crime is a parent rather than an adult stranger or older child, the child is also more likely to experience distress. Child characteristics include age and developmental level. With advanced cognitive development, a child’s perspective regarding the victimization may include more or less distress. Children with lower self-esteem experience increased levels of distress. Children whose coping methods include avoidance are also more apt to develop distress symptoms. Characteristics of the environment include children who have a supportive relationship with an adult, parent, or sibling. These individuals generally have better adjustment than children who experience little support. Similarly, family cohesiveness is also a positive buffer for child victims of sexual abuse. Parental distress is associated with child distress, i.e., the more the parent is negatively affected by the crime, the more the child is negatively affected.Evidence suggests that the negative psychological impact of child sexual abuse persists over time, often into adulthood. Potential long-term effects of child sexual abuse include depression, anxiety, posttraumatic stress disorder, sexual dysfunction, and substance abuse. Further, among the female adult outpatient population, individuals with sexual abuse histories as children were twice as likely to attempt suicide than their non-abused counterparts. Across the lifespan, individuals who were sexually abused as children are four times more likely to be at risk for developing a psychiatric disorder and are about three times more likely to abuse substances than their non-abused counterparts. It is estimated that approximately one third of child sexual abuse victims experience PTSD as adult survivors. Among women whose abuse involved penetration, an increased risk associated for the development of PTSD is experienced, resulting in about two thirds of this population developing PTSD at some point during their lifetime.Identification of Sexual Abuse It is rare for a child to speak directly about sexual abuse. Evidence of physical trauma to the genitals or mouth, genital or rectal bleeding, sexually transmitted disease, pregnancy, unusual and offensive odors, and complaints of pain or discomfort of the genital area can all be indicators. An aware medical practitioner may notice these symptoms during a physical examination. However, in most cases of sexual abuse, there are no physical indicators of the crime. It is rare to actually have positive medical findings upon medical examination, although such findings can provide powerful corroboration of a child’s account of sexual abuse. Most often, children who are victims of sexual abuse exhibit emotional or behavioral characteristics that may indicate distress. These neuropsychiatric symptoms (see Table 2) indicate a distressed child. The presence of any one of these indicators does not necessarily mean that the child is or has been sexually abused. Children with several of these symptoms, however, are often referred for mental health evaluations. Most disclosures from children are to trusted friends or adults in their life – the teacher, coach, pastor, grandparent or therapist. The reaction of the adult to whom a child discloses sexual abuse can significantly impact the child’s subsequent adjustment. It is important for the adult to be respectful, caring, and believing. A response involving panic, shock, or disbelief, or an overly emotional response can negatively impact the child. Children often feel badly and blame themselves for the sexual abuse. Therefore, a response in which the adult communicates that the abuse was not the child’s fault and that disclosing the information was the right thing to do is recommended. Preparing the child for the potential aftermath of the disclosure is also important. For example, if the adult to whom the child disclosed is a mandated reporter, the local child protection agency or law enforcement will have to be notified. If the adult to whom the child disclosed is a non-offending parent, the parent must take steps to protect the child from further abuse, including reporting the abuse to the proper authorities. In some states (e.g., Texas), if a non-offending parent fails to report, sexual abuse charges can be filed against them as well. The legal process can be especially intimidating, confusing, and frightening for children. Many aspects of the process (such as providing testimony and multiple interviews) can be overwhelming for children. It is estimated that the average number of interviews a child victim whose case is going through the court system undergoes is eleven. It is often said that during this time, a child can potentially be “re-traumatized.” The pre-trial phase can be more distressful for the child than the disclosure phase because the pre-trial phase often involves ongoing investigation, multiple interviews, and protracted fear of perpetrator retaliation. Children report a number of courtroom related fears. Approximately 95% report being frightened to testify and many children report that the day they testified was the worst day of their lives. Other reported fears include retaliation by the perpetrator, being sent to jail, being punished for making a mistake, having to prove their innocence, crying on the witness stand, describing the details of the offense(s) in front of strangers, and not understanding the questions which are being asked.Intervention There are several modalities of psychological treatment that have demonstrated positive benefits for child victims of sexual abuse. These include individual psychotherapy, group-based psychotherapy, and treatments that involve the entire family. When treatment for this population is trauma-focused, structured, and targets the specific symptoms of sexual abuse, it can be effective at reducing short-term and long-term effects. Individual treatment usually involves the child and a therapist meeting together for an hour a week. The therapist may be a master’s level clinician, social worker, psychologist, or psychiatrist. Despite varied professional backgrounds, it is important that the treating therapist have specific training and expertise in working with child victims of sexual abuse. Different techniques may be used to process the sexual abuse experience, normalize reactions, and develop adaptive coping strategies to address symptoms of depression, anxiety, and PTSD. Trauma-focused play therapy, trauma-focused cognitive-behavioral therapy, and eye movement desensitization and reprocessing therapy are all specific individual child-focused interventions that may be appropriate treatment for child sexual abuse. Group-based psychotherapy can be particularly powerful for sexual abuse victims; they are exposed to other victims and subsequently do not feel alone. Moreover, this modality is useful in helping child victims understand that people cannot simply look at them and identify them as a sexual abuse victim. Treatment interventions that involve the entire family include family preservation services, attachment-trauma therapy, and Parents United programs. The focus of these interventions is to strengthen the parent-child relationship in order to help process the trauma and to ultimately increase the level of family functioning.Treatment is also available to the offender of sexual abuse. While highly controversial and with questionable documentation of efficacy, sexual molestation of children is a treatable, but not curable behavior problem. The primary goal of the treatment of sexual offenders is to minimize the likelihood that the individual will re-offend. This is best achieved by modifying emotional, cognitive, behavioral, environmental, and psychological factors, which support the desire, capacity, and opportunity to offend. Cognitive-behavioral therapies, including Relapse Prevention, have proven to be the most successful at reducing recidivism rates. The recidivism rate for individuals who undergo cognitive behavioral treatment and/or Relapse Prevention is estimated to be 8.1% compared to 25.6% who are untreated (Alexander, 1999). Treatment often occurs in a group therapy context and involves approximately 100-150 weekly sessions. When offenders have particular needs that cannot be addressed within this therapeutic context, adjunct treatments are often utilized as a supplement (e.g., substance abuse treatment, individual psychotherapy, anger management training).Central to cognitive-behavioral therapies and Relapse Prevention is the belief that sexual abuse is something that does not “just happen.” The overwhelming majority of the time there are identifiable behaviors in which offenders engage prior to offending. Successful treatment involves educating the sexual offender about this process of sexual offending and facilitating an understanding of his particular pattern of offending. Within this conceptualization, it is important to teach sexual offenders how to identify circumstances that place them at greater risk for re-offending. Based on the offender’s understanding of his behavior, he can then learn to identify problematic behaviors early in this cycle, modify his behavior, and consequently reduce the liklihood that he will re-offend. Other important areas of treatment include accepting responisiblity for offending, developing victim empathy, and correcting faulty thinking patterns. In the end, however, the most effective way to prevent subsequent abusing is to decrease or eliminate opportunity; offenders should not have uncontrolled access to vulnerable children or previous victims.PreventionPrevention of child sexual abuse occurs on three levels: primary, secondary, and tertiary prevention. Primary prevention targets services to the general population in order to decrease the frequency and occurrence of child sexual abuse. Recently, public awareness campaigns have emerged to address the issue. There is some indication that in the last couple of years, the incidence of sexual abuse may be decreasing and some experts have attributed this to an increase in public awareness at the primary prevention level as a possible explanation. Secondary prevention targets services to specific groups that are considered at high risk in order to avoid child sexual abuse from occurring. Examples of secondary prevention programs include child assault prevention programs and safety education taught to children in schools. These programs may increase a child’s knowledge of sexual abuse and how to respond, and may even facilitate subsequent disclosures, which ultimately may reduce child sexual abuse from occurring. Tertiary prevention targets services to victims of child sexual abuse with the goal of minimizing its negative effects and avoiding reoccurrence. Examples of such programs were described in the Intervention section above. Although evidence suggests that trauma-focused interventions are effective at reducing specific sexual abuse related symptoms, more research is needed to understand how this works.There are two major deterrents to prevention efforts in the area of child sexual abuse: lack of efficacy for prevention services and lack of adequate resources. It is imperative that prevention services document that they do indeed prevent child sexual abuse. Adequate resources are needed, both for treatment of victims of child sexual abuse and for prevention services that reach the broader population. Once effective primary prevention techniques are established, adequate funding for tertiary programs may be more easily attainable and this problem may be more appropriately addressed.Summary and Future DirectionsChild sexual abuse is a pervasive problem in the United States that affects individuals of all racial and socioeconomic backgrounds. The short-term and long-term effects of sexual abuse have been well documented and highlight the need for effective psychological interventions. Evidence also suggests that participation in legal proceedings following sexual abuse can be further distressing for the child sexual abuse victim. Future research efforts should focus on prevention efforts and therapeutic intervention for these child victims. Furthermore, efforts should be focused towards making the legal system more child-victim friendly in order to minimize further helplessness, distress and even trauma during this process.ReferencesAlexander, M.A. (1999). Sexual offender treatment efficacy revisited. Sexual Abuse: A Journal of Research and Treatment, 11 (2), 101-116.Briere, J., Berliner, L., Bulkley, J.A., Jenny, C., & Reid, T., (1996). The APSAC Handbook on Child Maltreatment. Sage Publications: Thousand Oaks, CA.Finkelhor, D. (1979). What’s wrong with sex between adults and children? Ethics and the problem of sexual abuse. American Journal of Orthopsychiatry, 49, 692-697.Harris, G.E., Cross, J.C., Vincent, J.P., Mikalsen, E., & Dominguez, R.Z. (2001). Giving kids a chance: Helping victimized children and their families. A Guide for professionals in educational settings. Washington: DC: U.S. Department of Justice, National Institute of Justice.MacFarlane, K. & Waterman, J. et al.(1986). Sexual Abuse of Young Children. New York, New York: Guilford Press.Perry. B.P., & Azad, I. (1999). Posttraumatic stress disorder in children and adolescents. Current Opinion in Pediatrics, 11, 310-316.Saunders, B.E., Berliner, L., & Hanson, R.F. (2001). Guidelines for the Psychosocial Treatment of Intrafamilial Child Physical and Sexual Abuse (Draft Report: April 6, 2001). Charleston, SC
Tables
TABLE 1: TYPES OF SEXUAL ABUSE (OF CHILDREN)
Non-Contact



· Photographing the child for sexual purposes

· Showing the child pornographic materials

· Sexualized talk with the child

· Making fun of or ridiculing the child's sexual development, preferences, or organs

· Verbal and emotional abuse of a sexual nature

· Exposing genital area to child for sexual gratification

· "Peeping" in on child while dressing, showering, using the restroom

· Masturbating in front of the child

· Making the child witness others being sexually abused
Contact



· Touching the child sexually

· Invasive care of the child's genitals

· Stripping the child to hit/spank; obtaining sexual gratification out of hitting

· Making the child touch the adult sexually

· Making the child masturbate the adult

· Making the child engage in oral sex

· Making the child engage in vaginal or anal intercourse

· Making the child engage in prostitution

· Making the child engage in sexual activity with animals

TABLE 2: RANGE OF SYMPTOMS THAT MAY BE PRESENT IN SEXUALLY ABUSED CHILDREN
Sexual/Physical Symptoms



· Attempts to touch the genitals of others

· Sexualized play

· Detailed and age-inappropriate knowledge of sexual activity

· Excessive masturbatory behavior

· Reluctance to undress

· Avoidance of touch

· Increased startle response

· Hypervigilance

· Extreme fluctuations in heart rate (above 100 bpm or below 60 bpm)

· Sleep disturbance (bed wetting, nightmares)

· Drastic change in appetite somatic complaints

· Enuresis/encopresis

· Substance use

· Fatigue/exhaustion


Emotional Symptoms



· Regression to younger developmental stage

· Lack of affect

· Withdrawal/depression

· Anxiety/irritability/fear

· Phobias

· Excessive guilt

· Feelings of helplessness

· Low self-esteem

· Obsessive ideas

· Self-hate

· Hyperalertness

· Dissociation


Behavioral Symptoms



· Abrupt change in behavior or personality

· Aggression

· Excessive crying

· Over compliance

· School adjustment problems/sudden drop in school performance

· Temper tantrums

· Truancy or runaway behavior

· Self-mutilating/suicidal ideation/gestures/attempts

· Flashbacks/Avoidance

· Nightmares

· Lack of trust/social isolation/lack of friendships

· Hyperarousal