| Introduction
Reported incidents
of child sexual abuse are markedly on the rise.
What is especially shocking is the fact that these
reports represent only a small portion of actual
occurrences of sexual abuse. Incest affects individuals
and families regardless of class, income, profession,
religion or race. The statistics are truly alarming.
It is currently estimated that one-third of all
children are sexually abused before the age of
18. This includes 40% of all females and 30% of
all males. The vast majority of these reports
involve very young children, below age seven.
Every year in
this country, two million children are brutally
beaten or sexually abused. 340,000 new cases were
reported in 1989 (U.S. Advisory Board, April,
1991). Of these abused children, 3,000 to 5,000
die every year. In New York State alone, 200 bodies
of sexually and physically abused children are
found each year and not even identified. These
are the ultimate victims.
Children who are
neglected or sexually abused are known to have
lower IQs and an increased risk of depression,
suicide and drug problems. Abused children are
53% more likely to be arrested as juveniles, and
38% more likely to be arrested for a violent crime.
During preschool years, abused children are more
likely to get angry, refuse direction from teachers,
and lack enthusiasm. By the time they reach grade
school, they are more prone to being easily distracted,
lacking in self-control, and not well-liked by
peers. l
Myths
There are many
commonly held beliefs about sexual abuse. One
is that abusers are always men. In fact, reports
of female perpetrators are on the rise, involving
both male and female victims. At least 5% of abusers
are known to be women. Another myth is that the
abuser is usually a stranger. More than 70% of
abusers are immediate family members or someone
very close to the family. Remember - bad guys
don't always look bad; they're often the people
we love. A third myth is that the abuser is always
hated. Often the victim loves and protects the
perpetrator. Some children feel "special"
about the abuse. It may be the only attention
or physical contact they're getting. Because of
this, some survivors even into adulthood will
deal with the abuse by minimizing it. Thus, they
make the abuser and the events "OK",
to make it feel like they're okay. An additional
myth is that only females are sexually abused.
In fact, 30% of all male children are molested
in some way, compared to 40% of females.
Occurrence
of Abuse
If you are one
of the survivors, you are acutely aware that these
numbers represent much more than statistics. They
represent the pain and anguish and shattered dreams
of so many individuals. You are also aware, if
you are a survivor, that it's often not the mysterious
stranger in a trench coat who commits this type
of crime. Typically it's a friend, a parent, someone
you love and trust - and it often happens at home.
The effects of this kind of brutal betrayal are
shattering and may last a lifetime.
Specialists in
the addiction field (alcohol, drugs and eating
disorders) estimate that up to 90 percent of their
patients have a known history of some form of
abuse. Recent studies (Calam, 19892;
Blume, 19893) point out that substance
abuse, including "food abuse," is a
frequent aftermath of early sexual abuse. Current
studies (Koopmans, 19904) demonstrate
that the vast majority of children and adolescents
who attempt suicide have a history of sexual abuse
as well. However, many individuals are resistant
to seeking treatment for sexual abuse. This is
especially true for males and adolescents. Men
are often extremely reluctant to admit to any
history of abuse and often fail to identify it
as such. Many survivors are in denial of the effects
of early abuse and may fail to see any connection
with later tendencies toward ongoing abusive relationships,
feelings of self-loathing, inability to trust,
or problems with intimacy. Some patients denigrate
themselves further, claiming that their abuse
could not have been "as bad" as that
of other victims. All abuse is bad.
Defining
Sexual Abuse
The diversity
of examples and case histories may lead one to
ask, "What is sexual abuse?" There are
many definitions. One of the most succinct is
provided by the Incest Survivors Resource Network.5
They state "the erotic use of a child,
whether physically or emotionally, is sexual exploitation
in the fullest meaning of the term, even if no
bodily contact is ever made." This last point
- "no bodily contact" - is crucial.
A parent who exposes a child to intercourse or
deviant sexual behaviors or pornographic materials
is abusing that child. New York State law now
clarifies that such abuse is a crime. The law
defines a sexually abused child as one whose parent
or person legally responsible for the child's
care, commits, allows to be committed, permits
or encourages a sex offense against the child,
including prostitution, incest, obscene sexual
performance or sexual conduct.
Sexual abuse in
the extreme includes ritual and cult abuse. Ritual
abuse involves a specific rite or form in which
the abuse is encapsulated. Cult abuse embraces
a "religious" or spiritual belief system,
usually Satanic. Cults may consist of individual
"dabblers" or small, isolated groups.
They may also include generations within families
or whole segments of communities. They operate
by destroying all bonding for their victims, and
surrounding the child with total unpredictability
or powerlessness. Drugs or trickery may be employed...sometimes
even murder.
Defining
Incest
Incest was traditionally
defined as sex between close relatives. But incest
is, above all, abuse; abuse by the very person(s)
entrusted with the child's care. Incest is "any
use of a minor child to meet the sexual or sexual/emotional
needs of one or more persons whose authority is
derived through ongoing emotional bonding with
that child."6
Incest is especially
common in alcoholic families, where judgment and
boundaries are impaired. If the perpetrator always
commits the act while under the influence of alcohol
or some other substance, (s)he may have no memory
of the events. Victims also may or may not remember.
The trauma may be so severe that part or all of
the abuse is blocked from conscious memory. This
may continue for many years until something triggers
a "flashback," although the effects
of the abuse, emotionally or behaviorally, continue
all along. The protective role of such blocking
must be explained to patients who may, in fact,
experience increasing flashbacks as treatment
continues.
My own growing
awareness of this led to the start of the Survivors'
Group Program at South Oaks Hospital in July,
1988. I began with five women patients. Within
a year and a half, I was easily able to expand
the groups and the program to include six times
that many patients from the hospital - men and
women, adolescents and adults. This grew into
a full-scale Sexual Abuse Recovery Program with
inpatient, outpatient, and aftercare components.
It was the first unit of its kind on the East
Coast, and was unique for Long Island, despite
the pervasiveness of individuals with life problems
stemming from a background of abuse. Survivors
are everywhere.
Reporting
Sexual Abuse
Health professionals
are legally obligated by New York State to report
suspected child abuse when there exists reasonable
cause to suspect. Absolute certainty is not required.
The professional may be civilly or criminally
liable if no report is made and is provided legal
immunity for making the report. The call is made
to the New York State Central Register of Child
Abuse (1-800-342-3720). Anyone may call this number
to report suspected abuse.
Identifying
Abused Children
No child is psychologically
prepared to deal with ongoing or intensive sexual
stimulation. Even very young children, two or
three years old, may sense that the sexual activity
is "wrong," but they are unable to stop
it. Children are frequently threatened that if
they tell anyone, they will be killed or sent
away, or their puppy will be killed; or their
whole family will breakup.
Children subjected
to sexual over-stimulation, with or without threats,
will develop problems. Those older than five years
of age become caught between loyalty to or dependence
on the perpetrator, and shame at doing something
"wrong." Over time, the child develops
low self-esteem, feelings of being worthless or
"dirty," and an abnormal view of sexuality.
How do you recognize such children? There are
many signs:
- Withdrawal and mistrust of
adults
- Difficulty relating to others
except in sexual or seductive ways
- Unusual interest in or avoidance
of all things sexual or physical
- Sleep problems, nightmares,
fears of going to bed
- Frequent accidents or self-injurious
behaviors
- Refusal to go to school,
or to the doctor, or home
- Secretiveness or unusual
aggressiveness
- Sexual components to drawings
and games
- Neurotic reactions (obsessions,
compulsiveness, phobias)
- Habit disorders (biting,
rocking)
- Wears long sleeves in hot
weather (to hide bruises?)
- Unusual sexual knowledge
or behavior
- Forcing sexual acts on other
children
- Extreme fear of being touched
- Unwillingness to submit to
physical examination
Specific physical
indicators of recent sexual abuse include:
- Difficulty in walking or
sitting
- Torn, stained or bloody clothing
- Pain or itching in genital
area
- Bruises or bleeding in genital
area or mouth
- Pregnancy or sexually transmitted
diseases, especially in preteens
- Repeated urinary infections
or genital blockages
Identifying
Adults Abused As Children
The effects of
early sexual abuse last well into adulthood, affecting
relationships, work, family, and life in general.
Individual symptomatology tends to fall into four
areas: 7
1. Damaged
goods: Low self-esteem, depression, self-destructiveness
(suicide and self-mutilation), guilt, shame, self-blame,
constant search for approval and nurturance.
2. Betrayal:
Impaired ability to trust, blurred boundaries
and role confusion, rage and grief, difficulty
forming relationships.
3. Helplessness:
Anxiety, fear, tendency towards re-victimization,
panic attacks.
4. Isolation:
Sense of being different, stigmatized, lack of
supports, poor peer relations.
Adult incest survivors
may demonstrate some of the following symptoms:
- Fear of the dark, fear of
sleeping alone, nightmares, night terrors
- Difficulty with swallowing,
gagging
- Poor body image, poor self-image
in general
- Wearing excessive clothing
- Addictions, compulsive behaviors,
obsessions
- Self-abuse, skin-carving
(also addictive),
- Phobias, panic attacks, anxiety
disorders, startle response
- Difficulties with anger/rage
- Splitting/ de-personalization,
shutdown under stress
- Issues with trust, intimacy,
relationships
- Issues with boundaries, control,
abandonment
- Pattern of re-victimization,
not able to say "no"
- Blocking of memories, especially
between age one and 12
- Feeling crazy, different,
marked
- Sexual issues and extremes
- Signs of posttraumatic stress
disorder
Certain issues
appear repeatedly. For example, victims typically
blame themselves for the abuse, even if they were
two or three years old at the time of the event.
Guilt and shame are expressed, along with intense
feelings of rage8
If the rape or
molestation was committed by an individual of
the same sex (i.e., a man abusing a boy), questions
regarding sexual orientation tend to arise in
the patient ("I must be gay; after all, a
man raped me!"). Female victims will frequently
develop sexually promiscuous lifestyles in an
effort to "conquer" the situation and
bring it under their control. In other instances
individuals will largely withdraw from any social
or sexual interactions in order to avoid the feared
stimuli, and turn toward extremely isolated lives.
The connection
that is made for victims between sex and pain
(love and humiliation, closeness and betrayal)
is a particularly disastrous one. Frequently patients
will express and/or demonstrate the belief that
the only way to be loved or cared for is if they
are also being abused ("I knew if I didn't
let him keep beating me, I'd always be alone").
Often, in the extreme, physical and sexual abuse
are even viewed as a normal part of everyday life.
Healthy boundaries do not exist for these individuals,
and therefore, healthy relationships are impossible.
Victims will actually respond to feelings of loneliness
or sadness by abusing themselves (e.g., self-mutilation)
if the "significant other" is not available
to do so.
One of the more
difficult issues that arise is the recollection,
by some individuals, of experiencing a certain
amount of physical pleasure during a molestation
or incest. This adds enormously to the sense of
being at fault and "dirty." Thus, one
of the aims of treatment is to educate survivors
as to normal physiological responsiveness. The
realization that their feelings are/were normal
helps tremendously toward alleviating the sense
of shame.
Even when individuals
have spoken of their abuse prior to group treatment,
any pleasurable aspects have typically been denied.
The opportunity to relate to others who have shared
these feelings, as well as the experience, is
part of the healing power of this form of therapy.
The sense of isolation, of being "different
from the whole world," quickly begins to
subside. It is only in revealing the secrets and
dealing with the pain that survivors of sexual
abuse can and do go on with their lives.
References
1. Incest Survivors'
Resource Network, International. (1990). Manual.
N.Y. Yearly Meeting, Hicksville, NY.
2. Calam, R.M.,
(1989) Sexual experience and eating problems
in female undergraduates. International Journal
of Eating Disorders, 8, 391-399.
3. Blume, E.
Sue, (1989). Secret Survivors: Uncovering
incest and its aftereffects. John Wiley
& Sons, NJ.
4. Koopmans,
M., (1990). Yeshiva University/Einstein College.
Personal Communication.
5. Op. Cit.,
Incest Survivors Resource Network.
6. Heiman, M.,
(1988). Untangling incestuous bonds: The treatment
of sibling incest. In M. Kahn & K. Lewis
(Eds.), Siblings in Therapy, Norton &
Co., N.Y.
7. Ibid.
8. Hartman,
M., Finn, S.E., & Leon, G.R., (1987). Sexual
abuse experiences in a clinical population:
Comparisons of familial and non-familial abuse.
Psychotherapy, 24, 154-159.
©1998
by The American Academy of Experts in Traumatic
Stress, Inc. |
