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
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
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
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
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
- Frequent accidents or self-injurious behaviors
- Refusal to go to school, or to the doctor,
- Secretiveness or unusual aggressiveness
- Sexual components to drawings and games
- Neurotic reactions (obsessions, compulsiveness,
- Habit disorders (biting, rocking)
- Wears long sleeves in hot weather (to
- 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
- Pregnancy or sexually transmitted diseases,
especially in preteens
- Repeated urinary infections or genital
Identifying Adults Abused
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:
1. Damaged goods: Low
self-esteem, depression, self-destructiveness
(suicide and self-mutilation), guilt, shame,
self-blame, constant search for approval and
2. Betrayal: Impaired
ability to trust, blurred boundaries and role
confusion, rage and grief, difficulty forming
3. Helplessness: Anxiety,
fear, tendency towards re-victimization, panic
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,
- Difficulties with anger/rage
- Splitting/ de-personalization, shutdown
- 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
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
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,
3. Blume, E. Sue, (1989).
Secret Survivors: Uncovering incest and
its aftereffects. John Wiley & Sons,
4. Koopmans, M., (1990).
Yeshiva University/Einstein College. Personal
5. Op. Cit., Incest Survivors
6. Heiman, M., (1988). Untangling
incestuous bonds: The treatment of sibling
incest. In M. Kahn & K. Lewis (Eds.),
Siblings in Therapy, Norton & Co.,
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,
The American Academy of Experts in Traumatic