Child sexual abuse

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Child sexual abuse is a form of child abuse and 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. This term 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, sodomy, and sexual penetration with an object. 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.
• 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.
• sexual exploitation – a term defining offenses in which an adult victimizes a minor for advancement, sexual gratification, or profit; for example, prostituting a child, and creating or trafficking in child pornography.
• 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

Child sexual abuse can cause physical injury to the child and both short and long term emotional and psychological harm, including depression, post-traumatic stress disorder, anxiety, propensity to re-victimization in adulthood, and other symptoms.

The legal term child sexual offender refers to a person who has been convicted for one or more child sexual abuse offenses. The term therefore describes a person who has committed child sexual abuse, without regard to the perpetrator’s motivation.

The term "pedophile" is used colloquially to refer to child sexual offenders. However, pedophilia, is generally defined as a sexual preference for prepubescent or preadolescent children, and is currently defined as a psychiatric disorder by the medical community. Neither definition requires the pedophile to have sexually offended, with the latter specifying additional requirements such as distress. Indeed, not all child sexual offenders meet the diagnostic criteria of pedophilia, and not all pedophiles act on their fantasies or urges to engage in sexual activity with children. Law enforcement and legal professionals have begun to use the term predatory pedophile, a phrase coined by children's attorney Andrew Vachss to refer specifically to pedophiles who engage in sexual activity with minors. The term emphasizes that child sexual abuse consists of conduct chosen by the perpetrator.

List of activities considered CSA

In countries and jurisdictions where child/adult sexual behavior is illegal, it is a criminal offense, although the list (range) of activities that are prosecuted varies between countries. Activities which are often defined as abuse only when children are involved include the following:

• penetrative intercourse (oral, anal or vaginal) between a child below a predefined age of consent (generally between 12 and 18 years) and an adult (or a much older child),
• asking a child to give consent to any kind of penetrative intercourse,
• fondling a child's genitals,
• asking, forcing, or inducing a child to fondle genitals (either his or her own, an adult's, or another child's),
• acting as a pimp for child prostitution (including a parent acting as a pimp),
• inducing a child to behave sexually in a performance, or to appear in child pornography,
• asking, forcing, or inducing a child to watch any kind of sexual behavior (including masturbation),
• asking, forcing, or inducing a child to look at adult genitals (in many countries if a child is not intentionally directed to look at adult genitals in public baths or nudistic settings, the mere presence of them is not considered CSA),
• lewd action towards children, including disseminating pornography to a minor,
• asking, forcing, or inducing a child to undress for any reason other than to help a child who is too young or otherwise unable to wash, dress exclusively to keep hygiene for himself or herself,
• observing a child's genitals for any reason other than for examining existing health problems.
• any sexual interaction of a child with an adult or other child where coercion or a power differential is present
• purposefully undressing in front of or being seen nude around one's children after they have reached the age of awareness (often estimated as early as four or five and as late as ten years of age)
• bathing a child who is old enough and capable enough to bathe himself/herself

Signs of child sexual abuse

Both girls and boys can be victims of sexual abuse and, for many reasons, this type of abuse is difficult to identify. It is likely to happen in private and child abusers go to incredible lengths to prevent discovery, including threatening the child to keep silent. Many children feel such a strong sense of guilt and shame that they are reluctant to speak about what has happened to them.

The National Society for the Prevention of Cruelty to Children (NSPCC) in the UK has identified these signs as requiring further professional investigation.

Physical signs

• pain, itching, bruising or bleeding in the genital or anal areas
• any sexually transmitted disease
• recurrent genital discharge or urinary tract infections without apparent cause
• stomach pains or discomfort when the child is walking or sitting down.

Behavioural signs

• sudden or unexplained changes in behaviour
• an apparent fear of someone
• running away from home
• nightmares or bedwetting
• self-harm, self-mutilation or attemptsed suicide
• drug, alcohol or substance abuse
• eating disorders such as anorexia or bulimia
• sexualised behaviour or knowledge in young children
• sexual drawings or language
• possession of unexplained amounts of money
• taking a parental role at home and functioning beyond their age level
• not being allowed to have friends (particularly in adolescence)
• alluding to secrets which they cannot reveal
• telling other children or adults about the abuse.

Effects of sexual abuse on children

The widely-accepted view of adult-child sex among both legal experts and lay people is that it is an inherently abusive practice by the adult against the child. Supported by evidence from several studies of child sexual abuse victims, psychologists argue that the inability of children to provide full and informed consent to sexual acts necessarily makes all such acts abusive in regards to the child.

The American Psychiatric Association maintains the position that "children cannot consent to sexual activity with adults", and condemns the action of the adult in strong terms: "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."

The majority of experts believe that CSA is innately harmful to children. A wide range of psychological, emotional, physical, and social effects has been attributed to child sexual abuse, including anxiety, depression, obsession, compulsion, grief, Complex post traumatic stress disorder, post-traumatic stress disorder symptoms such as flashbacks, emotional numbing, pseudo-maturity symptoms, and other more general dysfunctions such as sexual dysfunction, social dysfunction, dysfunction of relationships, poor education and employment records, eating disorders, self-mutilation, and a range of physical symptoms common to some other forms of PTSD, such as sensual numbness, loss of appetite (see Smith et al., 1995). Additionally, young girls who are victims of abuse may encounter additional trauma by pregnancy and birth complications. See Pregnancy after childhood sexual abuse.

Two studies have reached other conclusions about CSA. For example, a 1982 meta-analysis by Mary DeYoung reported that 20% of her "victims" appeared to be "virtually indifferent to their molestation" and instead tended to be traumatized by the reaction of adults to its discovery. [2] However, it is likely that the lack of reaction is a manifestation of one element of PTSD, splitting off.

Most notably, a controversial and largely discredited meta-analytic study of other various studies of CSA, Rind et al. (1998), found only a weak correlation between sex abuse in childhood and the later stability of the child's adult psyche, noted that a not insignificant percentage reported their reactions to sex abuse as positive in the short term, and found the confounding variable of poor family environment as a plausible cause for the majority of negative effects. Although the study stated in its conclusion that "the findings of the current review do not imply that moral or legal definitions of or views on behaviors currently classified as CSA should be abandoned or even altered," (Rind et al., 1998, p. 47), it on one hand drew widespread outrage from conservative activists, and on the other hand was often cited as supporting evidence by pedophile advocates. The authors' defense of it can be found here[3]. This study was discredited by the American Psychological Association.

The percentage of adults suffering from long-term effects is unknown. Smith quotes a British study that showed that 13% of adults sexually abused as children suffered from long-term consequences.

Wakefield and Underwager (1991) note the difference between CSA experiences of boys and girls, where more boys than girls report the experience as neutral or positive, saying that "It may be that women perceive such experiences as sexual violation, while men perceive them as sexual initiation." Much of this has been challenged, the effects of sexual abuse on men being seen by some researchers as similar to the effects on women, "initiation" being considered part of the myth of male socialisation that men are the initiators of sex and cannot be abused (Draucker 1992). However, even accepting that the notion that males cannot be abused is a myth does not prove that there is no difference between early sexual initiation and sexual abuse for males (or for females for that matter.)

Forty to 71 percent of Borderline Personality Disorder patients report having been sexually abused.

More recent studies conducted in the new mellenium indicate that sexual abuse in children can lead to the overexitation of an undeveloped limbic system; causing damage [4]. This could explain the problems sexual abuse victims have with regulation of mood and other limbic functions. Other studies also indicate sexual abuse can lead to temporal lobe epilepsy, damage to the cerebellar vermis, along with reduced size of the corpus callosum [5]

Offenders

Most offenders are situational offenders (pseudopedophiles) rather than pedophiles. They are rarely strangers, but relatives or acquaintances like trainers or playmates. Most offenders are male, the number of female perpetrators is usually reported to be between 10% and 20%, however in some studies it was found to be as high as 70%.

Pedophilia

Main article: Pedophilia

The American Psychiatric Association and the World Health Organization both define pedophilia as attraction by adults and older adolescents toward prepubescent children, whether the attraction is acted upon or not. According to researcher Howard E. Barbaree, "not all child molesters are pedophiles, and some pedophiles may not have molested children (ie there may be men who prefer sex with prepubescent children but who have not acted on their desires)".

The term "pedophile" is used colloquially to refer to child sexual offenders. However, pedophilia is generally defined as a sexual preference for prepubescent or preadolescent children, and is currently defined as a psychiatric disorder by the medical community. Neither definition requires the pedophile to have sexually offended, with the latter specifying additional requirements such as distress. Indeed, not all child sexual offenders meet the diagnostic criteria of pedophilia, and not all pedophiles act on their fantasies or urges to engage in sexual activity with children. Law enforcement and legal professionals have begun to use the term predatory pedophile, a phrase coined by children's attorney Andrew Vachss, to refer specifically to pedophiles who engage in sexual activity with minors. The term emphasizes that child sexual abuse consists of conduct chosen by the perpetrator.

Typology

There are three categorizations of child sex offenders studied in the field of criminal psychology. The first two are major while the third is minor.

Regressed offenders

Regressed offenders are primarily attracted to their own age group but are passively aroused by minors (pseudo-pedophiles).

• The sexual attraction in children is not manifested until adulthood.
• Their sexual conduct until adulthood is aligned with that of their own age group.
• Their interest in children is either not cognitively realized until well into adulthood or it was recognized early on and simply suppressed due to social taboo.

Other scenarios may include:

• Not associating their attractions as pedosexual in nature due to cultural differences.
• Age of consent laws were raised in their jurisdiction but mainstream views toward sex with that age group remained the same, were acted upon, then they were charged with a crime.
• The person's passive interest in children is manifested temporarily upon the consumption of alcohol and acted upon while inhibitions were low.

Some view regressed offenders as people who are unable to maintain adult sexual relationships and so the offender substitutes an adult with a child. This appears to be a flawed concept since it would suggest the offender was primarily pedosexual and they would thus fit into the fixated category.

Fixated offenders

Fixated offenders are most often adult pedophiles who are maladaptive to accepted social norms. They develop compatibility and self-esteem issues, stunting their social growth. This is commonly characterized amongst psychologists as a "lack of maturity".

"This offender identifies with children, in other words considers him or herself to be like a child and thus seeks sexual relationships with what the offender perceives to be other children".^[6]

Such offenders often resort to collecting personal articles related to minors (clothing, children's books) as an outlet for their repressed desires. Most fixated offenders prefer members of the same sex. There is a difference of opinion as to whether this may be classified as homosexuality due to the nature of the individual's attractions. The sexual acts are typically preconceived and are not alcohol or drug related.

Sadistic offenders

Sadistic offenders are very rare and inherently violent criminals. They primarily use sexuality as a tool of sadistic suppression and not for sexual satisfaction. For this reason they do not fit within the classification of pedophilia.

Categorization

The great majority of offenders fit into the regressed category. Only between 2-10% percent of all offenders are fixated.

These categories, (primarily the first two), are based on the assumption that the offender suffers from an irreversible mental illness. A few have noted that the primary division between "regressed" or "fixated" offenders seems to rest on two criteria: the offending person's ability to successfully live a socially acceptable lifestyle before committing the crime and the person's primary sexual preference. These categorizations also assume the act is a crime in the jurisdiction they reside in.

These terms generally do not encompass the full range of possible scenarios and merely attempt to label easily identifiable situations. A growing number of pedosexuals feel that the two main classifications are a direct result from the lack of understanding and/or bias in the mainstream regarding pedosexuality in western society and thus are categorically flawed.

"Children who molest"

Some therapists noticed that many adult sex offenders already showed what they considered deviant sexual behavior during childhood. So they promoted early treatment of deviant minors as a preventive measure. However there is still little known about normal as opposed to deviant child sexuality. It is also unknown whether so called deviant minors have a higher risk of becoming an adult sex offenders than anybody else.

The US started to focus on juvenile sex offenders or even children for therapy or detention perhaps in the early 1990s. The label "juvenile sex offender" is controversial because it is not only used to describe acts of violence, but also consensual acts that violate statutory rape laws; critics of this trend view many such children as simply engaging in sexual experimentation. They also criticize the law for forcing arbitrary classification of such pairs of offenders into victim and perpetrator.

Therapies used on children have included controversial methods historically used in the "treatment" of homosexuals such as aversion therapy, where children are, for example, forced to smell ammonia while looking at nude pictures or to listen to audio tapes describing sexual situations. In order to measure sexual response, devices like penile plethysmographs and vaginal photoplethysmographs are sometimes used on these children.

Variation in cultural practices, norms and research findings

Between cultural relativists and cultural universalists there is no consensus whether and which among different past or present cultural practices in Western or non-Western societies can be defined as abusing either general universalistic human rights or special universalistic rights of children due to which there is no generally accepted definition which of them can be listed as CSA.

In different cultures the practices sanctioned by cultural norms involve for example cutting and bleeding of the genitals, female circumcision, circumcision (of males), castration, infibulation, sexual relationships between adolescent boys and adult men sanctioned by the state and sanctified by religion in ancient Greece and feudal Japan, child prostitution tolerated in some societies as a way for children to support their families, groping of schoolgirls in Japanese trains, in the Western societies now abolished remedies against masturbation (once named 'self-abuse'), and nudity in public baths and nudistic settings etc.

In some South Pacific island cultures, such as the Sambia of Papua New Guinea, one of the primary rituals of initiation for boys involves having them ingest semen, which they consider to be the literal essence of manhood. The boys obtain semen by fellating older boys who have already passed through the initiation. Upon initiation into higher stages, the roles are reversed, making the fellator the fellated. Ritual fellatio is somewhat common throughout southeastern Papua New Guinea but has been studied the most in the Sambia (Herdt 1982). [7] [8] [9]

Because of the lack of the universal definition the research on CSA is open both to personal biases of the researchers and of their critics.

Epidemiology

Goldman (2000) notes that "the absolute number of children being sexually abused each year has been almost impossible to ascertain" and that "there does not seem to be agreement on the rate of children being sexually abused". A meta-analytic study by Rind, Tromovitch, and Bauserman (1998) found that reported prevalence of abuse for males ranged from 3% to 37%, and for females from 8% to 71% with mean rates of 17% and 28% respectively. A study by Fromuth and Burkhart (1987) found that depending upon the definition of CSA used, prevalence among men varied from 4% to 24%.

Sexual abuse, consent, minors, age gap and culture

The simple definition of child sexual abuse is when an adult forces or coerces sex on a prepubescent minor. There is an ongoing controversy surrounding this definition. The controversy lies within the argument as to whether children can or cannot give cognitive consent. The mainstream opinion in countries such as the U.S. and U.K. is that any minor under the legal age of consent is deemed mentally incapable of consenting to sexual activity with people older than they are, thus any and all contact is automatically considered abuse.

Also, in cases of multi-generational relationships where both parties are legal adults, such relationships are still often widely considered immoral and taboo, even though legal. Such relationships often result in humorous anecdotes or parodies, and in some more severe cases, social abolishment.

In most cases involving minors, the combination of these two elements results in the passing of laws which prohibit minors from giving legal informed consent, even if they are indeed a willing partner to the best of their own knowledge. Thus, if such acts are discovered, the adult may be charged with a criminal offense.

Definition based on moral objection; relativity

The mainstream view is that any and all contact between minors and adults is immoral and automatically abuse in all cases. In more severe opinions it is considered inherently evil, and in their own words, "the perpetrators must be held liable to the utmost extent of the law."

Innocence of children

On one hand, moral opponents also strive to maintain preservation of the perceived innocence in children.

On the other hand, proponents claim this argument based on innocence is inherently flawed in that it is ignorance, not innocence, which is wrought by not allowing children to be exposed to sex at an earlier age.

This debate is a separate one in and of itself, and lends to ideals which both sides of the argument deem worthy enough for strong objection. Both sides routinely refer to the "preponderance" of psychological, sociological, and historical evidence to back their claims.

Both sides agree that genuine cases of force and coercion are indeed true abuse.

Objection to homosexuality

In cases of same-sex relations between adults and minors in western civilisation, there is also the stigma based on the homosexual nature of the actions. There are other societies, however, in which adult/adult homosexuality is considered criminally and morally offensive behavior, but child/adult heterosexual relations are viewed as acceptable.

Criticism of the definitions

Views on sexual relations between adults and prepubescent minors in western society remains a deep controversy.

Critics disagree with labeling all child sexual activity involving adults as partners or observers as abuse based on the concept of informed consent, arguing that simple consent should suffice to exclude consensual acts from the definition of child sexual abuse (CSA). Those critics, including some sociologists, psychologists, educators, and some pedophilia advocates, also object to the use of the terms victim and perpetrator when describing consensual acts. Many doubt that there is scientific evidence that consensual sexual activity causes harm to minors and argue that some sexual activity of or with minors is considered a crime solely because of sexual morality. Some researchers contend that categorizing all sexual activity with minors as abuse makes it difficult to study the effects of abuse on children. Others claim that a distinction should be made between, on the one hand, severe sexual abuse that is often associated with severe symptoms such as suicidal tendencies, sexual aggression, and self-mutilation (Kisiel and Lyons, 2001), and on the other hand, milder types of CSA that do not necessarily cause harm. Rind et al. (1998) argued that "CSA does not cause intense harm on a pervasive basis," although anecdotal evidence documents harmful effects of early sexual activity (see Bass, Ellen et al, The Courage to Heal, 3rd edition, 1994)

Medical responses to child sexual abuse

The American Psychological Association defines child sexual abuse as contact between a child and an adult or other person significantly older or in a position of power or control over the child, where the child is being used for sexual stimulation of the adult or another person. Studies of the effects of child sexual abuse often define it as including invitations or requests to do anything sexual, sexual kissing or hugging, touching or fondling of the genitals, indecent exposure, and attempted or completed sexual intercourse.

Effects of child sexual abuse

Depending on the age and size of the child, and the degree of force used, child sexual abuse may cause infections, sexually transmitted diseases, or internal lacerations. In severe cases, damage to internal organs may occur, which, in some cases, may cause death. 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 old. Causes of death included trauma to the genitalia or rectum and sexual mutilation.

Psychological damage may occur even when physical effects are absent. Long term negative effects on development, leading to re-victimization in adulthood, can also occur. Child sexual abuse has been identified as a predictor of future psychopathology, though it has no characteristic pattern of symptoms.

Kendall-Tackett et al. (1993) and other studies found that a wide range of psychological, emotional, physical, and social effects are associated with child sexual abuse, including depression, post-traumatic stress disorder, anxiety, poor self-esteem, somatoform disorders, complex post-traumatic stress disorder, emotional dysregulation, neurosis, and other more general dysfunctions such as sexualized behavior, school/learning problems, behavior problems and destructive behavior. A review of studies by Kendell-Tackett et al. found that two-thirds of the children who were sexually abused showed symptoms, but in comparison with children in treatment who were not sexually abused, the sexually abused children were less symptomatic for all measured symptoms except sexualized behavior.

Caffaro-Rouget et al. (1989) found that 51% of their sample was symptomatic; in Mannarino and Cohen (1986), 69% of forty-five assessed children were symptomatic; 64% of Tong, Oates, and McDowell's (1987) forty-nine child sample were not within the normal range on the child behavior checklist; and in Conte and Schuerman (1987), whose assessment included both very specific and broad items such as 'fearful of abuse stimuli' and 'emotional upset,' 79% of the sample was symptomatic. A minority of abused children have been found to be healthy and asymptomatic, and the level of harm associated with the abuse may correlate with other factors. Prescott and Kendler (2001) found that the risk of psychopathology increased if the perpetrator was a relative, if the abuse involved intercourse or attempted intercourse, or if threats or force were used. The age at which an individual was first abused did not appear to be related. Other studies have found that the risk of adverse outcomes is reduced for abused children who have supportive family environments.

Because child sexual abuse often occurs alongside other possibly confounding variables, such as poor family environment and physical abuse, some scholars argue it is important to control for those variables in studies which measure the effects of sexual abuse and some have hypothesized "that abuse effects are at least in part the results of dysfunctional family dynamics that support sexual abuse and produce psychological disturbance (Fromuth, 1986) and that concomitant physical or psychological abuse may account for some of the difficulties otherwise attributed to sexual abuse (Briere & Runtz, 1990)." Martin and Fleming, however, argue 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." Rind et al.'s 1998 meta-analysis of studies using college student samples concluded that the relationship between poorer adjustment and child sexual abuse is generally found nonsignificant in studies which control for variables such as family environment and other forms of abuse. Other studies have found an independent association of child sexual abuse with adverse psychological outcomes.

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. After controlling for possible confounding variables, Widom (1999) found that child sexual abuse independently predicts the number of symptoms for PTSD a person displays. 37.5% of their sexually abused subjects, 32.7% of their physically abused subjects, and 20.4% of their control group met the criteria for a diagnosis of PTSD. The authors concluded, "Victims of child abuse (sexual and physical) and neglect are at increased risk for developing PTSD, but childhood victimization is not a sufficient condition. Family, individual, and lifestyle variables also place individuals at risk and contribute to the symptoms of PTSD." Mullen and Fleming, argue 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."

It has been suggested that 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. 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.

Neurological differences in clinical research

Research has shown that traumatic stress, including stress caused by sexual abuse, causes notable changes in brain functioning and development.

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;" Teicher et al. (1993) found that an increased likelihood of "ictal temporal lobe epilepsy-like symptoms" in abused subjects; Anderson et al. (2002) recorded abnormal transverse relaxation time in the cerebellar vermis of adults sexually abused in childhood; 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; and Ito et al. (1993) found increased electrophysiological abnormalities in sexually abused children.

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

A study by Gilbertson found that individuals with a smaller hippocampal volume are more disposed to the development of PTSD. This is supported by studies which show that those who have shown damage also have a history of neurocognitive abnormalities. McNally gave his view on the recent research into this area in his book Remembering Trauma:

Another myth debunked by recent research is the notion that elevated cortisol in PTSD has damaged the hippocampi of survivors. Not only is cortisol seldom elevated in PTSD, but smaller hippocampi in those with the disorder are best tributed to genetic factors, not traumatic stress. A smaller hippocampus may constitute a vulnerability for the disorder among those exposed to trauma.

King et al. (2001), studying 5 to 7 year old girls who had been abused within the last two months, found victims of early sexual abuse had significantly lower cortisol levels than control subjects. However, other studies have found an increase in cortisol levels among victims of child sexual abuse and trauma and damage to various parts of the brain. "Fear literally arises from the core of the brain, affecting all brain areas and their functions in rapidly expanding waves of neurchemical acticity...also important is a stress hormone called cortisol.", p. 64.

A short-term longitudinal study of hippocampal volume in thirty-seven trauma survivors by Bonne et al. found no progressive reduction of the hippocampus between 1 week and 6 months after the traumatic incident. Regarding this, they speculated that structural changes to the hippocampus may only occur if the victim's exposure to traumatization is prolonged; that it may take longer than 6 months for any change in volume to manifest; or that a change in volume may have taken place in the period between the incident and the first assessment. They also found that there was no significant difference between the hippocampal volume of survivors of trauma who developed PTSD and those who did not. Because of these findings, they concluded that "smaller hippocampal volume is not a necessary risk factor for developing PTSD and does not occur within 6 months of expressing the disorder." This study did not specifically focus on child sexual abuse victims.

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," which, they say, "could be a consequence of reduced corpus callosal area." 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. The authors hypothesized that the development of brain regions which myelinate over decades (such as the corpus callosum and hippocampus) may be disturbed by stress, because stress hormones such as cortisol suppress the final mitosis of granule cells and thereby the production of the oligodendrocytes and Schwann cells that form the myelin sheath.

Epidemiology

Estimate of the prevalence of child sexual abuse varies

Main article: Epidemiology of child sexual abuse

Therapy and child sexual abuse

• Assessment in child sexual abuse
• Therapy with sexually abused children
• Therapy with adult surviviour os childhood sexual abuse
• Offender profiles in childhood sexual abuse

See also

• Rind et al. (1998)
• Incest
• Child grooming
• Child-on-child sexual abuse
• Child pornography
• Child prostitution
• Dyadic Developmental Psychotherapy
• Commercial sexual exploitation of children
• Reflex anal dilatation
• Roman Catholic Church sex abuse scandal
• Complex Post Traumatic Stress Disorder

References

1. Committee on Child Abuse and Neglect "American Academy of Pediatrics: Guidelines for the Evaluation of Sexual Abuse of Children: Subject Review" Pediatrics 103 (1) January 1999, pp. 186-191
2. Draucker , Claire. Counselling Survivors of Childhood Sexual Abuse. SAGE Publications 1992 ISBN: 0803985711
3. Herdt, Gilbert H. (ed.) "Fetish and fantasy in Sambia initiation". In Rituals of Manhood: Male Initiation in Papua New Guinea. Pp. 44-98. Berkeley: University of California Press 1982. ISBN: 0520044487
4. Smith D., Pearce L., Pringle M., Caplan R., "Adults with a history of child sexual abuse: evaluation of a pilot therapy service" BMJ 1995;310:1175-1178
5. Kisiel, C. L. and Lyons, J. S., "Dissociation as a Mediator of Psychopathology Among Sexually Abused Children and Adolescents" Am. J. of Psychiatry 158:1034-1039, July 2001
6. Underwager, Ralph and Wakefield, Hollida, "Antisexuality and Child Sexual Abuse" IPT Volume 5 - 1993
7. Eric Vern L. Bullough and Bonnie Bullough, "Problems of Research into Adult/Child Sexual Interaction" IPT Volume 8 - 1996
8. Pedophilia: Biosocial Dimensions (). Edited by Feierman JR. New York, Springer-Verlag, 1990
9. Juliette D. G. Goldman and Usha, K. Padayachi, "Some Methodological Problems in Estimating Incidence and Prevalence in Child Sexual Abuse Research". Journal of Sex Research, Nov, 2000 [10]
10. Fromuth, M.E. and Burkhart, B.R., "Childhood sexual victimization among college men: definitional and methodological issues". Violence and Victims 1987; 2:241-253

Further reading

• Vigil, J. M., Geary, D. C., & Byrd-Craven, J. (2005). A life history assessment of early childhood sexual abuse in women. Developmental Psychology, 41, 553-561. Full text
• Drauker, Clare & Martsolf, Donna (2006). Counselling Surviviours of Childhood Sexual Abuse. London:Sage ISBN 1412922399

External links

• American Academy of Child and Adolescent Psychiatry on Child Sexual Abuse.
• Child Sexual Abuse: Evaluation and Outcomes - a review from the Penn State College of Medicine and the Child Advocate Network.
• Ethical Treatment for All Youth by Geoff Birky; a website which protests and documents trends in the area of "children who molest".
• Child Sexual Abuse: What It Is and How To Prevent It.
• The Role of Schools in Sexual Abuse Prevention and Intervention
• Male Survivor - "Overcoming sexual victimization of boys and men"
• National Sex Offender Public Registry
• When Are We Crossing A Child's Sexual Boundaries?
• The Difference Between "Sick" and "Evil" by Andrew Vachss, originally published in Parade magazine, July 2002.