Sexual Abuse

Any sexual act or sexual exposure that is not consensual or that occurs between a child and an older individual.

Sexual abuse includes any sexual act or experience which is forced upon a person or which occurs as a result of coercion. In general, any sexual experience or exposure that occurs between a child and an older child, an adolescent, or an adult, for the gratification of the older individual, is considered to be sexual abuse. Sexual abuse includes rape, incest, inappropriate touching, exhibitionism, and physical or verbal harassment. Exposing children to pornographic material or using children in the production of pornography also constitutes sexual abuse.

Since many or even most cases of sexual abuse are not reported to the authorities, it has been difficult to determine the extent of sexual abuse in our society. The victims of sexual abuse can be males or females of any age, from infants to the elderly. The perpetrators of sexual abuse are predominantly male, but include some females, and come from all socioeconomic classes and racial and ethnic groups. They may be educated professionals, working people, or unemployed. They may or may not be under the influence of alcohol or drugs. Many abusers were themselves abused as children. Although the abuser may be a stranger to the victim, most often it is a family member, friend or acquaintance, or a caregiver. In recent years, an increased public awareness of sexual abuse has resulted in more abuse reports and prosecutions, as well as increasing the development of recovery programs for victims and treatment programs for abusers. Furthermore, there have been major initiatives aimed at preventing the sexual abuse of both children and adults. Unfortunately, in a few cases this heightened awareness of the problem of sexual abuse has resulted in false accusations, overzealous prosecution of innocent people, or manipulation of victims by unqualified therapists.

Victims of sexual abuse often feel guilty and believe that they are at fault for the abuse. Sexual assault on an adult often involves violence or the threat of violence. Although violence may be involved in the sexual abuse of children, most often the coercion is based upon the inherent power that the adult has over the child. An infant or very young child has no defense against an abuser. Although an older child may be bribed or threatened, the child usually has been taught to acquiesce to adult demands. The abuser usually insists that the child keep "their secret," and the shame and guilt felt by the child reinforces the need for secrecy.

Historical perspectives

The definition of sexual abuse varies among cultures and has changed over time. Feminist movements have promoted broader definitions of what constitutes sexual abuse. Although most societies view sex between children and adults as inappropriate, mores concerning appropriate ages and age differences for sexual partners vary. Even today, there are individuals and organizations that promote sex between children and adults and argue for the elimination of laws against incest and statutory rape.

The early work of psychoanalyst Sigmund Freud suggested that, for many of his patients, repressed memories of childhood incest lay at the root of neuroses. However, many of Freud's colleagues argued that the early sexual encounters described by patients in psychoanalysis were actually memories of childhood sexual fantasies. Freud himself later adopted this position, although his colleague, Sandor Ferenczi, confirmed the involvement of childhood sexual abuse in many psychological disorders. As a result of Freud's influence, reports of sexual abuse often were discounted as the products of a child's imagination. When the evidence of abuse was undeniable, the child was viewed as having allowed or encouraged the abuse. To some extent, these attitudes survive today.

In the 1940s and 1950s, Alfred Kinsey and his coworkers first documented the extent of childhood sexual abuse. However, they did not view these early sexual experiences as particularly significant. It was not until the women's movement of the 1970s that the extent and significance of sexual abuse began to be appreciated.

Immediate effects of sexual abuse

The victim's initial response to sexual abuse is usually horror and disbelief. This may be followed by a false sense of calm, brought on by fear. Many victims report that they mentally leave their bodies, to dissociate themselves from the physical event. This passivity may be misinterpreted as consent by both the abuser and the victim. Sexual abuse may or may not result in physical injury.

Following the experience, the victim of sexual abuse may be confused, frightened, furious, resentful, and depressed. These emotions can continue for a very long time. Child victims may become withdrawn, may regress to earlier developmental stages, or may display precocious sexualized behavior. Non-abusive parents of abused children, as well as the innocent partners of adult victims, may experience many of these same emotions. This is called "secondary victimization."

Many victims of sexual abuse blame themselves. They may be overwhelmed by guilt and shame. Some victims repress all memories of the experience or rationalize it in a way that makes it seem insignificant.

Long-term effects of sexual abuse

Victims of sexual abuse may develop many of the symptoms of post-traumatic stress disorders. For children, the guilt, fear, shame, and anger brought on by sexual abuse, if untreated, can last into adulthood. Longterm effects of sexual abuse can include chronic anxiety, low self-esteem, and problems with intimacy and sexuality. Victims may become severely depressed, even suicidal, or develop psychotic symptoms. They may suffer from alcohol or drug abuse or eating disorders. Many victims experience marital and family difficulties. In severe cases, a victim's efforts to dissociate from the experience can lead to the development of multiple personality disorder.

Many factors influence the effects of sexual abuse on the victim. These include the type of abuse, the age of the victim, the frequency of abuse, and the relationship of the victim to the abuser. Children who are victimized by a trusted adult experience the betrayal of this trust. Victims who obtain support from family, friends, and trained professionals following the abuse are less likely to experience long-term effects. In general, abused children who have been coerced into maintaining secrecy suffer from the most serious long-term effects.

Recovery from sexual abuse

Recovery from sexual abuse occurs in recognizable stages. These stages are analogous to those of the grieving or mourning process. Often, the first stage is a denial, which may involve the suppression or even total repression of memories of the abuse. In therapy or self-help groups, adults who were sexually abused as children may begin to recover these memories. However, in a few cases, overzealous counselors and therapists have elicited memories of childhood sexual abuse from patients who apparently were never abused. In the popular press, this has become known as "false memory syndrome."

Once the abuse is recognized, the victim may try to excuse it, rationalize it, or minimize it by suggesting that it was not really significant. Eventually, recovering victims come to accept that the abuse had major consequences in their lives and that it was not their fault. The later stages of recovery include anger, sadness, and finally, acceptance. Many law enforcement agencies provide support services to victims of sexual abuse. Trained therapists and self-help groups, including 12-step programs, may be indispensable for the recovery process. Individuals who have recovered from the effects of sexual abuse often are referred to as survivors.

The sexual offender

Many sexual offenders abuse multiple victims. The perpetrators of sexual abuse are usually angry individuals who are driven by a need to dominate or control others. They may be psychotic or have personality disorders. Some sexual abuse is perpetrated by pedophiles who are sexually attracted to prepubescent children. Other sexual abuse appears to be situational. For example, incest may occur only when the parent is intoxicated or under stress.

Most sexual offenders deny that the abuse occurred. If they do admit to it, they usually blame it on the victim or the circumstances. They also may blame alcohol or drugs. A limited number of treatment programs are available for sexual offenders, both inside and outside of prisons. Recidivism is usually high for chronic sexual abusers.