August 8, 2014

Sexual Abuse

Child sexual abuse is one of the most damaging forms of child abuse that can be enacted on a child. It leaves lasting scars on every facet of the developing child: physical, emotional, psychological.

Child Sexual Abuse has been defined as “… the misuse of power by someone who is in authority over a child, for the purposes of exploiting a child for sexual gratification. It includes incest, sexual molestation, sexual assault and the exploitation of the child for pornography or prostitution.”
(Source: Rix G. Rogers, Reaching for Solutions (Ottawa: Health and Welfare Canada, 1990), p. 19)

There are two categories of sexual abuse, contact and non-contact:

Non-Contact:
– flashing or exposing sexual body parts to a child;
– watching intrusively as a child changes or showers;
– speaking or communicating sexually/seductively with a child;
– showing pornographic films, magazines or photographs to a child;
– having to participate in the creation of pornographic materials;
– forcing a child to watch a sexual act performed by others;
– objectifying or ridiculing a child’s sexual body parts

Contact:
– kissing or holding a child in a sexual manner;
– touching a child’s sexual body parts or forcing someone to touch another person’s
sexual body parts;
– penetrating a child anally or vaginally, with objects or fingers;
– having vaginal, anal, or oral intercourse with a child.

Behavioural Signs in A Young Child
• sexual knowledge or language that is inappropriate for the child’s age or development
• an unusual interest in, or preoccupation with sexual matters
• hints about sexual activity through actions or comments that are inappropriate to the child’s age or developmental level
• inappropriate sexual play or behaviour with dolls/toys, other children or themselves
• art that shows abuse
• excessive masturbation
• persistent urinating or defecating in clothes
• regressive behaviour: baby talk, thumb sucking
• fear or avoidance of any aspect of sexuality

• fear or avoidance of a particular adult, place or event
• sexually suggestive behaviour with adults or older children
• consistent psychosomatic complaints or frequent depression
• poor social boundaries
• starting fires or fascination with fire

Behavioural Signs in an Older child
• sexual knowledge or language that is inappropriate for the child’s age or development
• hints about abusive sexual activity through actions or comments
• sexually suggestive behaviour with adults or older children
• consistent psychosomatic complaints or frequent depression
• difficulty concentrating, withdrawn, overly obedient
• seeming accident-prone
• starting fires or fascination with fire
• running away
• promiscuity or prostitution
• refusing to undress for gym, often wearing layers of clothing
• [creating] stories, poems, or artwork about abuse
• suicidal feelings or attempts
• destroying property, hurting or mutilating animals

Physical Signs of Sexual Abuse
• bruising, bleeding, swelling, tears or cuts of genitals or anus
• unusual vaginal odour or discharge
• torn, stained, or bloody clothing, especially underwear, or itching in genital area, difficulty going to the bathroom, walking or sitting
• Sexually transmitted disease, especially in a pre-adolescent child
• pregnancy

NOTE:
The presence of any one of these signs does not necessarily mean that a child is being abused. These indicators may relate to matters other than sexual abuse.

(From the Child Welfare Information Gateway)

Emotional Reactions to Sexual Abuse

Three common emotional consequences of sexual victimization are a sense of somehow being responsible and therefore feeling guilty, an altered sense of self and self-esteem because of involvement in sexual abuse, and fears and anxiety.

  • Feeling responsible. An offender may make the victim feel responsible for the sexual abuse, for the offender’s well-being, and/or for the consequences of disclosure. Victims may also feel guilty for not having stopped the sexual abuse as well as for any positive aspects of the abuse, such as physical pleasure, the special attention given by the offender, or an opportunity to have control over other family members because of “the secret.”

The role of the clinician is to help the child understand intellectually and accept emotionally that the child was not responsible. The adult sexually abused the child; the child did not sexually abuse the adult. It was the adult’s job – not the child’s – to stop or prevent the abuse.

  • Altered sense of self. Guilt feelings as well as the invasive and intrusive nature of the sexual activity impact negatively on the child’s sense of self and self-esteem. Victims may suffer from feeling that they are damaged or tainted. The effect is both physical, in that children have an altered sense of their bodies, and psychological, in that children may see themselves as markedly different from their peers.

The task of the therapist is to make victims feel whole and good about themselves again. Work that addresses the issue of self-blame is helpful. Interventions that help children view themselves as more than merely victims of sexual abuse is helpful in healing the effects of sexual abuse. Normalizing and ego-enhancing activities, such as doing well in school, participating in sports, getting involved in scouts, or helping a younger victim, can be very important in victim recovery.

  • Anxiety and fear are related to the traumatic impact of the abuse on the child. The victim can develop phobic reactions to the event, the offender, and to other aspects of the abuse. Experiences that evoke recollections of the abuse come to elicit anxiety. In some children this anxiety and/or phobias become pervasive and crippling because of the level of avoidance they engage in to reduce their stress.

Before treating the child’s fears and anxiety, the therapist must be sure the child is no longer being sexually abused and is safe from further abuse. Then the therapist engages the victim in a series of interventions that allow her/him to gradually deal with the abuse and related phobias and anxiety in ways that usually avoid excessive stress and allow mastery.These may include EMDR, talking, play therapy, or interventions in the child’s environment. For example, the victim may be encouraged to ventilate by talking about the abuse and accompanying feelings, thereby reducing the level of distress related to it. Similarly, a child who is phobic about being left with a babysitter may be left with a relative first for short and then longer time periods, then with a babysitter for brief and then longer periods and thereby be desensitized to babysitting situations.

  • Additional emotional reactions may be found. Depending on the circumstances of the victimization and the child’s personality, she/he may react with regression, anger, depression, revulsion, or posttraumatic stress disorder to sexual abuse. These emotional reactions are likely to manifest themselves in problematic behaviors. These behaviors will be discussed in the next section.
  • Other behavior problems. Other behavioral reactions to sexual abuse include such problems as aggression toward people and animals, running away, self-harm (cutting or burning), criminal activity, substance abuse, suicidal behavior, hyperactivity, sleep problems, eating problems, and toileting problems.

Some of these problems, for example, difficulties with sleep, eating, toileting, and being alone, may be acute after disclosure but diminish over time and eventually disappear. Short-term intervention, labeling the behavioral problems as common reactions, and helping the victim resolve the underlying emotional or cognitive issues is generally helpful. Parents are encouraged to be understanding.

Treatment strategies for all behavioral problems include helping the victim understand the relationship between the behaviors and the sexual abuse and emotional or cognitive reactions to it; helping the child develop insight into the self-destructive nature of some of these behaviors; assisting the victim in more appropriate expression of the emotions, for example, anger; and behavioral interventions to diminish and eliminate problematic behavior. With older children, group therapy is usually very useful in addressing these problems.

Cognitive Reactions to Sexual Abuse

An important part of treatment of victims of sexual abuse is to help them understand the meaning of the abuse. This includes learning what appropriate and inappropriate touching entails; what is wrong about sexual activity between adults and children, if they do not know this; why adults or a particular adult was sexual with them; and in some cases, why they were chosen as targets and what that means to them. How these issues are addressed will vary with the child’s developmental stage.

Moreover, an adequate explanation for a child at a young age may not be sufficient as she/he grows older. Thus, this particular issue will need to be addressed at a more sophisticated level as the child matures. This may be done by a parent but in some cases will need to be done by a therapist.

Treatment for sexually abused children:

Being a victim of sexual abuse can have a devastating effect on children’s ability to trust other people. In sexual abuse that has occured within the family, the impact may be profound; a caretaker, who should be a protector and a limit-setter, exploits the child and violates the boundaries of safe behavior. Furthermore, if he child discloses the abuse to an unsupportive non-offending adult, this damage may be exacerbated.

However, children sexually molested outside the home may also experience problems with trust. This may come about because the person who victimizes the child is someone to whom the child has been entrusted by the parents, as happens, for example, when the abuser is a child care provider. These victims frequently perceive their parents as having given permission for the exploitation. Alternatively, the offender may be a person in a position of authority over the child and she/he feels compelled to comply. Then children may have considerable difficulty trusting persons in positions of authority in the future.

The challenge to the therapist is to create circumstances in which the child has positive experiences with trustworthy adults in order to repair the damage to the child’s ability to trust. This may involve rehabilitating the parents and/or creating opportunities for appropriate relationships with adults, for example, with foster parents, mentors, or other relatives. Therapists must ensure that they are honest and dependable in order to create an atmosphere of trust.

Megan Hughes has worked with fragile and abused children for many years. She is experienced and knowledgeable about the wounds inflicted on children and how to treat them. If you are worried about a child you care about, or have questions about child sexual abuse, call Stillwater Studio at 604-734-2779.