Mental health articles

Current conceptualization of child sexual abuse Moving forward to the current period, the empirical knowledge base presented in this book provides a very different perspective of child sexual abuse. Child sexual abuse is a sociological problem of immense proportions. Approximately one-third of girls are sexually abused before their 18th birthdays, as are approximately one-seventh of boys (Bolen & Scannapieco, 1999). While 95% of offenders are male, 70% of victims are female (Finkelhor, Hotaling, Lewis, & Smith, 1990; Russell, 1983; Wyatt, 1985), suggesting that child sexual abuse is primarily a gendered problem. Studies suggest that factors placing males at risk to abuse males are different than factors placing males at risk to abuse females. Males who abuse other males may do so at least in part because of their own childhood histories of sexual abuse, especially if they experienced multiple childhood victimizations. These findings are supported in retrospective studies of identified offenders (Hanson & Slater, 1988) as well as in populations of “normal” college students (Bagley, Wood, & Young, 1994). Because seven girls are abused for every three boys, however, another explanation is required for why primarily male offenders, most of whom are not sexually abused in childhood (Bagley et al., 1994; Hanson & Slater, 1988), abuse primarily female victims. It was suggested in Chapter 8 that one of the primary reasons males sexually abuse children is because they are socialized within a patriarchal society to a sense of entitlement to the world around them, including entitlement to sex. Conversely, females develop a sense of their subordination to the more powerful male members of society. The primary mechanism for these worldviews is through socialization processes that occur within schools, homes, and communities. Once these worldviews become inculcated into the individual, however, they become largely unavailable to conscious thought. Instead, they are a part of what the individual considers normal, just as cultural values become inculcated into one’s belief system. If the socialization of male entitlement is implicated in the abuse of females by males, then it would stand to reason that males are the primary offenders and females are the primary victims. It would also stand to reason that child sexual abuse is endemic to a patriarchal society. Thus, not only would a large number of girls be sexually abused, but a large number of males would also sexually abuse. While hypotheses deriving from this conceptualization have not been evaluated directly, compelling support in the empirical knowledge base exists for them. As noted earlier, girls are indeed victimized more frequently, whereas males account for the vast majority of all offenders. Further, 6% to 21% of adult males self-report that they have either sexually abused a child or are sexually attracted to children (Bagley et al., 1994; Briere & Runtz, 1989; Finkelhor & Lewis, 1988). Thus, a significant minority of males self-identify as having risk factors that place them at risk to offend. Another group of males, however, may not necessarily self-identify as having a sexual attraction to younger children but might also be at increased risk to sexually offend, although for other reasons (Bolen, 2000a). These mostly adolescent and young adult males appear to be acting out sexual scripts of male dominance as they abuse their victims simply for sport, as conquests, or because of an enduring sense of entitlement to sexual access. This group may constitute as much as 25% of all extrafamilial abuse. Thus, not only is the risk of being sexually abused endemic within society, but the risk of abusing may be endemic for males. Because child sexual abuse is endemic within society, it is far more than just a family problem. Indeed, approximately 70% of all abuse is extrafamilial (Table 6- 1). These offenders approach their victims in numerous locations, most of which are considered safe (i.e., within the child’s home or neighborhood) (Bolen, 2000a; Wyatt, 1985). Risk of abuse also varies by age of the child. Younger children are at greatest risk of abuse in their homes or neighborhoods, and are at greatest risk by strangers, neighbors, and friends of the family (Bolen, 2000a). Older children are at greatest risk of abuse by acquaintances, friends, or family friends, and are at greatest risk at the perpetrator’s home or while walking. Adolescents are at greatest risk of abuse outside the neighborhood or in a car, and are at greatest risk of abuse by friends, family friends, or dates. Approaches of these offenders are also multifaceted, defying attempts at categorization. Thus, extrafamilial sexual abuse remains a generalized risk for all children in all locations by mostly male perpetrators using numerous methods of approach. The remaining 30% of sexual abuse is intrafamilial (Table 7-1), and again more than 95% of this abuse is committed by males (Finkelhor et al., 1990; Russell, 1983; Wyatt, 1985). Of relatives who abuse, uncles abuse most frequently, although father figures and cousins abuse at close to the same levels (Tables 7-1 and 7-2). Intrafamilial abuse is similar to other types of abuse, with older males typically abusing younger females. Dynamics within these families also appear to express implicit societal values of power and control over women and children, including all types of gendered violence (Herman, 1981; Laviola, 1992; Wiehe, 1990). One of the less frequent types of abuse is father-daughter incest, accounting for only 7% to 8% of all sexual abuse (Russell, 1984; Wyatt, 1985). While family dynamics are somewhat dysfunctional in families in which father-daughter incest or other types of intrafamilial abuse occur, these dynamics are not unique to families in which incest occurs and are found to a lesser extent in families with victims of extrafamilial abuse (Alexander & Lupfer, 1987; Ray, Jackson, & Townsley, 1991). Thus, family dynamics cannot be considered causal to this type of abuse. Instead, fathers may abuse the power they wield in these families by not only sexually abusing the child, but often victimizing the mother (Sirles & Franke, 1989; Finkelhor & Williams, 1990), other siblings (Phelan, 1986; Sirles, Smith, & Kusama, 1989), and even unrelated children (Ballard et al., 1990). Mothers in these families, while having higher rates of childhood sexual abuse, do not stand out on other psychological characteristics from mothers in normal populations (Nakhle Tamraz, 1996; Smith & Saunders, 1995). Further, 75% to 95% of mothers are unaware of the ongoing abuse by the father (Faller, 1990; Myer, 1985). When they find out about the abuse, 65% to 85% believe that the abuse is occurring, and 81% offer some or full support to their child (Bolen, 2000b). The primary points of this empirically supported conceptualization of child sexual abuse are as follows. • Child sexual abuse is endemic within society and may be a result of the unequal power of males over females. In support, Females are at much greater risk of abuse than males. Males are at much greater risk to offend than females. Children are at high risk of abuse by filial and nonfilial males. Child sexual abuse is primarily heterosexual, almost all of which is perpetrated by males against females. Extrafamilial abuse is more prevalent than intrafamilial abuse. Fathers abuse at approximately the same frequency as other intrafamilial abuse offenders, but less frequently than most extrafamilial abuse offenders. • Neither intrafamilial abuse nor father-daughter incest is unique but instead shares many dynamics with extrafamilial abuse. • Child sexual abuse is difficult to prevent because of the multiple types of offenders and their varied approaches in multiple locations. • Most mothers react appropriately to the abuse of their child. This conceptualization of child sexual abuse is very different than the one presented in the previous section. Differences between conceptualizations occur in the prevalence of father-daughter incest and its notions of causality, as well as in the focus on intrafamilial abuse instead of extrafamilial abuse. The most important difference between these two conceptualizations, however, is that the empirically supported conceptualization suggests that child sexual abuse is a sociocultural problem of immense proportions, whereas the historical and theoretical conceptualization suggests that sexual abuse is a problem unique to dysfunctional families. Thus, the primary unit of analysis supported in the empirical literature is at the level of society, whereas the primary unit of analysis supported in the historical conceptualization is at the level of the family and individual. Finally, it is important to note that many of the tenets of the psychoanalytic interpretation of child sexual abuse and the early conceptualization of family systems theory are not supported in the empirical literature. Thus, these early theories presented a myth-based conceptualization of child sexual abuse.

Tags: child, sexual abuse