Childhood Sexual Abuse

not as common; some will respond to treatment. Treatment can identify those at a high risk of recidivism.

CHILDHOOD SEXUAL ABUSE

Child sexual abuse is also referred to as child molestation. It often involves an older adolescent or adult perpetrator and a child victim. As mentioned, there are many forms of child sexual abuse that both include and do not include actual physical contact. Child abuse of this form is worldwide and, in parts of the world, child marriage is the most common type of this abuse.

Most child sexual abuse happens when the perpetrator knows the victim in some way. About 20 percent of females and 8 percent of males undergo this type of abuse globally. The majority of perpetrators are male; female offenders will commit acts of abuse against boys mainly but sometimes against girls.

Being a child abuser does not necessarily mean the person is a pedophile. A pedophile is someone who has a sexual interest mainly in children who have not yet reached puberty. Child sexual abuse is a broader term that can mean any type of sexual exploitation of a child; it can also include child on child sexual abuse and sibling sexual abuse. Because children cannot consent, all such acts are considered criminal behavior.

Child sexual abuse survivors are harmed in many ways. There is an increased risk of depression, PTSD, dissociation, anxiety, sleep problems, somatization, substance abuse, and eating disorders. The strongest indicator of sexual abuse in a child is sexual acting out, although things like regressive behaviors, social withdrawal, conduct disorders, ADHD, and animal cruelty can be signs of abuse. Self-harm behaviors are particularly common in sex abuse survivors.

Surprisingly, only about 59 to 79 percent of sexually abused children will have psychological symptoms. The risk of symptoms is greater if the abuser is the child’s relative, if threats of force are used, or if intercourse or attempted intercourse has occurred. The duration and frequency of the abuse also plays a role.

Chronic and early sexual abuse is linked to an increased risk of dissociation, which can include amnesia of the events. These children often experience emotional numbness and feel cut off from others, which can exacerbate the degree of poor psychological and social functioning. Many of these children grow up to have substance abuse as a way to self-medicate their symptoms. Other phenomena in these children include dissociative identity disorder, personality disorders, certain eating disorders, and complex PTSD.

There can be many physiological and neurological effects of child sexual abuse. Injury to the anus and genitals can be permanent or can lead to death. The child will also have a higher risk for STDs and other vaginal infections. There are changes in the central nervous system, including a reduction in certain areas of the brain and simultaneous excitation and under-development of the limbic system.

Incest is sexual contact between a child and a related adolescent or adult. This is a widespread form of abuse that has a great chance of psychological damage to the child. Most incest is between a father and daughter or between a stepfather and daughter, although mother to son incest does exist as does father to son incest. Sibling incest is more common than it was once believed to be.

There are several forms of child sexual abuse. Sexual assault involves rape, sodomy, or other penetrative behavior in order to achieve sexual gratification. Sexual exploitation involves child pornography or prostituting a child for profit or sexual gratification. Sexual grooming involves preparing a child to accept their sexual advances.

The child who received some type of personal or social support after disclosing the abuse tend to do better or suffer for a shorter period of time than those who did not get any support. Negative support is associated with a worsened outcome in the child. Lack of support by the child’s primary caregivers probably indicates prior relational disturbances in the family; this also worsens the outcome for the child.

Treatment of the child survivor depends on when they present for treatment, the circumstances surrounding their presentation, and the presence of other comorbidities. Children and adolescents respond to individual therapy, group therapy, or family therapy. The younger the child, the more likely it is that parental involvement is necessary.

Adults with a sexual abuse history often have a different presenting complaint than that of abuse. Common complaints are eating disorders, substance abuse, depression, interpersonal conflict, and personality disorders. Some will need to be treated for the presenting complaint rather than the abuse itself. Ultimately, things like cognitive restructuring and treatments like eye movement desensitization and reprocessing or EMDR may be necessary.

Perpetrators of sexual abuse know their victim 82 percent of the time. More than 95 percent of offenders are male. There are two types of offender motivation. One is called “fixated motivation” and the other is called “regressed motivation”. Those who are fixators have an attraction to children primarily, while regressors have a greater range of adult relationships. Some will offend against anyone; it doesn’t necessarily have to be a child. Others will exhibit violent and sadistic motives against both those known to the victim and strangers.

Because most sexually abused children do not offend as adults and because most perpetrators do not report sexual abuse themselves, it is less common than it used to be to believe that there is some type of cycle of violence that indicates a relationship between the two. Remember too that not all sexual offenders against children are pedophiles.

The rate of recidivism is lower for sex offenders than it is for other types of criminals. About 42 percent of offenders will do it again after being released from prison. The risk is highest shortly after being released from incarcerations.

Some children are abused by one or more juvenile offenders without an adult being involved in the abuse. Usually this involves some type of coercion or force and is called child on child sexual abuse. Inter-sibling abuse or just sibling sexual abuse happens between siblings in a nuclear family. Children who abuse other children are more likely to have been abused themselves, which is not necessarily the case for adult offenders.

There is no known cure for pedophilia, although there are treatments that are used for both child sexual abusers and pedophiles. Some treatments are focused on changing the offender, while others are focused primarily on reducing recidivism. Offenders are taught to spot the warning signs of relapse and to intervene before this occurs.

Child sexual abuse is against the law practically everywhere in the world and there are usually sever penalties for the behavior. The United Nations has specific treaties that protect children’s rights in this area, condemning all forms of sexual abuse, including child prostitution and child pornography. There are directives in parts of the world that specifically address the commercial exploitation of children for sexual purposes.