It is no surprise that child sexual abuse is rampant in today’s world. A recent poll suggested that one in ten children are abused before age eighteen. While it is more reported today, we are no closer to solving the problem than we were decades ago. To get a magnitude of the problem, Townsend and Rheingold suggest thinking of it as 400,000 children are born each year who will be a target of abuse [1]. This is nothing to sneeze at.

WHAT IS ABUSE?

For the purposes of our discussion, we will be confining ourselves to defining abuse as only sexual abuse. Sexual abuse is any sexual contact between a child and an adult, or even using a child to gratify one’s sexual needs. A child here is any person less than eighteen years of age. Contrary to popular belief, most acts of sexual abuse or violence are committed by someone related to or close to the child. Another aspect is sexual exploitation where a child may be enticed into sexual acts with the promise of money, drugs or any other thing the child may deem needful.

It is estimated one in three girls and one in six boys are affected by sexual abuse in America [2]. Most cases go unreported [3]. The reasons for not reporting may vary from shame, guilt or even fear towards the person involved as he mostly will be a close family friend or relative.

So why is this important to our discussion? It was found in a recent survey that of the people who receive mental health services, about 50% of women and 25% of men have undergone sexual abuse as a child [4] .

Though rampant, child abuse is not random. Those perpetrating it are well aware of the consequences and stigma and make sure their tracks are well covered. Thus, abuse is much more likely to be found in children with learning disorders, mental illnesses and physical disabilities, ones that are less likely to report abuse.

IS IT LEGAL?

Definitely not! Most countries have outlawed this form of practice with strict punishments enacted upon those who engage. Most societies frown upon such practices.

HOW DOES IT PRESENT IN ADULTHOOD

Here comes the crux of our entire discussion. Children who are sexually abused tend to have mental illnesses in adulthood. This is due a wide range of unsolved issues. Most of the times, the child is forced to live in close proximity to the perpetrator after the incident due to the closeness of the families. In other cases, they are threatened by the perpetrators to either hurt or humiliate the parents in some way. Whatever the modus operandi, a kind of barrier is made between the child and the parents. Once this barrier is made, it is difficult for the child to ever attain closure or even confront and discuss other problems with their parents. They will look for some other form of emotional stability and end up finding this in outlets like drugs. This also leads to trust issues which reflect in the future family life of the adult victim.

Some common mental health issues noted in adulthood due to child sexual abuse are:

• Depression: In a study published in the British Medical Journal, researchers screened 1189 women and found a strong correlation between women who were sexually abused (attempted or actual penetration) and depression [5].
• Eating Disorders: In a study conducted in Melbourne, researchers found that those who were abused twice or more as a child had a 4.9 percent increased chance of eating disorders compared to those who were abused once at 2.5 times rate [5] [6].
• Dissociative Disorders: Dissociation is a condition where the mind “separates” itself from reality in order to protect itself from painful incidents. Patients often report witnessing the incident as if in third person [7].
• Personality Disorders: The personality of a person is formed during the formative years. Severe emotional trauma will affect the shaping of personalities. Impulsive natures may be noted amongst individuals abused in childhood [8] [9].
• Trust Issues: People who have been abused tend to have problems trusting people. This often leads to unstable relationships when starting one’s own family. This is increasingly so if you have had a close relationship with the perpetrator [10].
• Substance Abuse: Adults who have been sexually abused as a child are more prone to substance abuse [11].

In addition to mental health problems, organic problems have also been reported to be caused as a result of child sexual abuse. These are:

• Diabetes Mellitus Type II: It was found that there was a greater incidence of Diabetes Mellitus amongst child abuse victims.
• Inflammatory Bowel Disease: It is found to be more prevalent in victims of child abuse

REVICTIMIZATION

If a person is abused as a child, chances of repeated abuse throughout life is much higher. People often complain of being targets for abuse. It is not uncommon for a victim to be involved in an abusive relationship where the spouse or significant other physically, verbally or emotionally traumatizes the victim. It is a sad phenomenon, but victims of repeated abuse even come to the point where they say they deserve the treatment meted out to them [12].

Why does this happen? The prime reason is the personality forged during the initial abuse attempt. Those who have not been able to differentiate appropriate behaviour with inappropriate ones fail to form protective barriers or safe boundaries when approaching individuals, a fact not lost on potential abusers. Victims often assume the routine violence to be a part of normality. Some people even try to repeat the circumstances subconsciously hoping for a better outcome [13]. Traumatic bonding is another aspect, where the victim tends to prefer the company of the perpetrator, even defending him on occasion. This pathologically arises from the lack of social support from one’s own family structure. Indeed, the study published by Widom et al clearly states the need for early intervention amongst children subjected to child abuse to prevent revictimization [14].

HOW THE MIND OF AN ABUSED CHILD WORKS

Once again, it has to be emphasized that the description I give here is highly generalized. Of course, there are a lot of strong people out there who have not only come over their traumatic experiences but have made it into their strengths. Some have even gone ahead to speak about it and definitely deserve mention. However, it does not change the fact that there is a startling majority of victims, who have either suppressed their memories or refuse to speak about it.

The reasons why people keep silent about abuse are quite individual but go on to shape the person’s character and define future relationships. It is thus, necessary to identify and help treat them. Some common thoughts that lead to silence are:

• I deserve it: it may be frightening how common this thought is. The perpetrators form a cocoon or deceit around the victim convincing the victim for need of such violation. Judith Herman, in her thesis suggests the need for victims to conclude that their inner badness is responsible for the mistreatment, in order to sustain attachments [15].
• Keeping the family order: When the perpetrator is a close relative of the family, children are often pressured into silence in order for the family to stay together.
• The need for love: This mainly occurs in families that are not close to each other. If there is little love shared between the family members, children are bound to look elsewhere. Perpetrators often make the child believe that they are ‘special’ to them and that this ‘special’ relationship will only last if silence is maintained.
• The notion or reality that parents will not support them: It is harsh, but there are a number of families that prefer to hush up any such incidents so that family honor may be maintained. This puts enormous strain on children whose prime defence against personal invasion are supposed to be the parents.
• Love involves Pain: This is something that is often seen even leading to defining personal relationships later in life. Many victims have reported a certain closeness to the partner when abused during coitus. Though not exactly masochistic, as they do not actually like the pain, it creates a sense of dependency and in extension, a sense of attachment to the partner [12].
• Misconceptions about sex: Some victims report, growing up, thinking that sex was supposed to be degrading and humiliating.

 

RECOGNIZING SYMPTOMS OF CHILD ABUSE

Recognizing abuse is not as easy as it sounds. One cannot expect a child to be forthcoming about such a traumatic experience. The greatest interventions are constant vigilance and proactiveness  on the part of the parent. That being said, there are a number of things to be watchful for. They may be broadly classified as Behavioural and Physical signs.

Behavioural signs:

• Have you noticed your child having increased anxiety lately?
• Have you noticed your child being exceptionally moody or withdrawn lately?
• Is your child having difficulty concentrating?
• Is your child getting increasingly involved in conflicts?
• Is your child suffering academically suddenly?
• Have you had any complaints from the school regarding your child’s behaviour?
• Is your child increasingly hypervigilant?
• Is your child having difficulty sleeping?
• Is your child having any habit disorders? (sucking, biting nails, rocking back and forth, tics)
• Have you noticed the child avoiding or having any fear towards one individual (that was not there before)?
• Have you noticed any promiscuity or sexual behaviours?
• Have you noticed the child wearing extra layers of clothing recently?
• Have you noticed any age-inappropriate interest in sexual matters?
• Does your child have increased occurrence of nightmares?

Physical Signs:

• Have you noticed frequent and unexplained sore throats or urinary infections?
• Has your child complained about itching or irritation in the genital areas?
• Has your child had bruising or bleeding in the genital or anal regions?
• Have you noticed any difficulty in the child walking?
• Have you noticed any venereal disease especially in the pre-teens?

If any of these signs are noticed, it is only prudent to investigate further.

 

HOW TO PROTECT YOUR CHILD

As mentioned before, the most important thing to do is constant vigilance. This may not be easy but as the old saying goes, “It may be easy to become a parent, but it is difficult to be a parent”. Our children depend on us and it is up to us to protect the innocent flowers in their hearts. There are a lot of ways this can be achieved. Some of these are:

• TALK TO YOUR CHILDREN DAILY. Take some time out of the day when the child can talk to you in the safety and confines of your house without anyone else present. Let them open up to you. Make them feel comfortable in discussing any and every aspect of their life.
• Also, while talking tell them about your day and ask them opinions in daily life matters. This ensures proper two-way communication and helps more in opening up.
• Do not leave the child in the care of an adult or non- immediate family (father, mother, siblings or grandparents) for too long. Let them not mentally replace your role with theirs.
• Preferably change babysitters often making sure no one person is too attached or has unnecessary freedoms with the child.
• Be very careful while sending children on slumber parties or sleepovers as this is a very common place for abuse to occur. It does not matter how close you are to the family. Remember, your child always comes first.
• Be a good example. Behave with others the way you want your children to behave. This will help them understand right relationship behaviours from wrong and help them to set up their own personal space when around others.
• DO NOT LEAVE YOUR CHILDREN ALONE AT HOME. If in need, ask the help from grandparents or other reliable individuals.
• Learn to recognize signs of abuse.

Remember! The child will not come up to you and report the incident. It is up to you to find it and help the child.

TEACHING YOUR CHILD THE DANGERS

Every child has to be educated from a very young age on the right and wrong kinds of personal interactions. Dolls may be used by parents to point out to children the areas of the body that are OK to be touched by others and those that are not. An early education and pre-emptive intervention helps the child not to be confused when actually approached by a predator. The child should also be taught what to do when such a situation arises. Basic self-defence and appropriateness of crying out loud for help if the situation arises must be inculcated at a very young age.  The child should also be taught whom to rely on or call for help in such situations. 9-1-1 and other emergency phone numbers should be memorized.

 

REFERENCES

1. Dial-A-Law. (2010, March). Reporting Suspected Child Abuse [fact sheet]. Vancouver, BC: Canadian Bar Association, BC Branch. www.cba.org/bc/public_media/family/156.aspx. 
2. BC Ministry of Children and Family Development. (2007). BC Handbook for Action on Child Abuse and Neglect (For service providers), Victoria, BC: Author. www.mcf.gov.bc.ca/child_protection/pdf/handbook_action_child_abuse.pdf. 
3. Hirakata, P. (2009). Narratives of Dissociation: Insights into the Treatment of Dissociation in Individuals Who Were Sexually Abused as Children. Journal of Trauma and Dissociation, 10, 297-314.
4. Beattie, K. Family violence against children and youth. In AuCoin, K. (Ed). (2005). Family Violence in Canada: A Statistical Profile 2005. Ottawa, ON: Canadian Centre for Justice Statistics, Statistics Canada. www.statcan.gc.ca/pub/85-224-x/85-224-x2005000-eng.pdf. 
5. http://www.medicaldaily.com/effects-child-sexual-abuse-depression-and-other-mental-health-conditions-247591
6. Pearlstein, T. (2002). Eating disorders and comorbidity. Archives of Women’s Mental Health, 4, 67-87. – See more at: http://www.heretohelp.bc.ca/factsheet/childhood-sexual-abuse-a-mental-health-issue#sthash.bky7r0eO.dpuf
7. Lynch, S.M. et al. (2008). Attending to Dissociation: Assessing Change in Dissociation and Predicting Treatment Outcome. Journal of Trauma and Dissociation, 9(3), 301-319. 
8. (2009, February 13). Child Abuse and Neglect: What happens [fact sheet]. Victoria, BC: HealthLinkBC. http://www.healthlinkbc.ca/kb/content/special/tm4865.html#tm5164.  
9. Spataro, J. et al. (2004). Impact of child sexual abuse on mental health: Prospective study in males and females. British Journal of Psychiatry, 184, 416-421. 
10. Mullen, P.E. and Fleming, J. (1998, Autumn). Long-term Effects of Child Sexual Abuse. Issues in Child Abuse Prevention, 9. http://www.aifs.gov.au/nch/pubs/issues/issues9/issues9.html 
11. Arellano, C.M. (1996). Child maltreatment and substance use: A review of the literature. Substance Use & Misuse, 31(7), 927-935. 
12. http://www.pandys.org/articles/revictimization.html
13. Van der Kolk, Bessel A. MD. “The Compulsion to Repeat the Trauma: Re-enactment, Revictimization, and Masochism”, Psychiatric Clinics of North America, Volume 12, Number 2, Pages 389-411, June 1989http://www.cirp.org/library/psych/vanderkolk/
14. Cathy Spatz Widom, Sally J. Czaja, Mary Ann Dutton.Childhood victimization and lifetime revictimization. Child Abuse Negl. Author manuscript; available in PMC 2009 August 1.Published in final edited form as: Child Abuse Negl. 2008 August; 32(8): 785–796. Published online 2008 August 28. doi: 10.1016/j.chiabu.2007.12.006
15. Herman, J. Trauma and Recovery: From domestic abuse to political terror, BasicBooks, USA, 1992