Sexual Abuse in Children: Before, During, and After

In 1978, the Children’s Division of American Humane Association reported that an estimate of around 100,000 children were sexually abused each year. That was forty-one years ago, and as of now, the number has skyrocketed. Government officials state that this number has risen up to 700 million children worldwide. One out of ten children have gone through some type of sexual abuse. As much as that number is alarming, it unfortunately is the reality for many children in the United States. These acts of violation can heavily affect a child’s brain; biologically and psychologically. This stunts their development, as well as hinders future mental thought processes as one gets older.

    Sexual assault may seem relatively easy to detect, but to this day, it still isn’t understood completely. When anyone intentionally hurts of harms a person psychologically, sexually, physically, or with acts of neglect, this is known as abuse. Child sexual abuse is the exact same thing, just with a minor (typically seventeen and under) involved. A child under no circumstances can consent to doing anything sexual with anyone of consenting age. When an adult engages in any inappropriate acts with a minor, they are knowingly exposing the child to irreversible damage; obstructing one’s vulnerability. One thing to note is that child sexual abuse isn’t just always physical contact, although that is the case in many situations. RAINN, the Rape, Abuse, and Incest National Network, says some of these acts are, and certainly not limited to:

• Exhibitionism, a mental condition in which a person is compelled to display one’s genitals in public.

• Fondling (stroke or caress erotically)

• Masturbation in the presence of a child

• Forcing a child to masterbate in front of them

• Obscene phone calls, text messages, online chat rooms, or any digital interaction

• Producing, owning, or sharing child pornography

• Sexual harassment

    The people who commonly inflict these acts of violation are people that these minor may know and see on a regular basis, which makes it a lot easier to manipulate the person; teachers, coaches, instructors, caretaker, an older sibling, parent, step-parent, parent of a friend, and even their friends. As many as ninety three percent of children know the perpetrator. This drives a wedge into a person’s trust, creating those issues and letting them manifest into their behaviors later on in life.

    There are a few tell-tell signs of sexual assault in children; both physical and biological like stated earlier. The signs may be easier to discern depending on the age of the child. For instance, the average age for menstruation in young women is around twelve, so if a twelve year old is bleeding from ill-suited activity, sexual abuse might not be the first thing that comes to mind. Now, if a person is examining a four year old with vaginal bleeding, that may raise a few red flags. Bleeding is a common sign, but so is sudden bruising or swelling in the genital region. Torn articles of clothing, difficulty walking or sitting, frequent urination, urinary tract infections, yeast infections, or peeling, burning, and or agitation in or around the vagina, penis, or buttocks.

    The brain is one of the most complex and fragile organs inside the human body. It is made up of over billions of different nerves; communicating in the trillions by connecting in sequences called synapses. This typically occurs around three years of age. In the early stages of brain development, neural connections and skills form first, followed by more complex thought processes, circuits, and abilities (Harvard). A child’s mind is impressionable; like a sponge, absorbing every experience that they come across. In Piaget’s Theory of Development, he states that human beings build up mental structures to adapt to the world around them. Children constantly construct their own “cognitive worlds.” At the beginning of the sensorimotor stage, mental changes begin to occur. Infants construct their understanding of the world by their own senses. After the sensorimotor stage comes the preoperational stage, a stage that begins from the age of two and ends at the age of seven. During this age range, Vygotsky says that children begin to develop their own way of thinking, and this is shaped primarily through social interaction. Children’s minds are shaped my cultural context. Imagine a child who has been molested, how do you think they are going to internalize that? What does this do to their cognitive developments and functions?

    The stages of brain development are quite extensive. When a young child experiences trauma, the effects are much more profound and much more internally damaging. No new neurons are made after birth, but once the brain is developed, the neurons that are already there begin to rewire. Old connections disconnect and become no more, while new experiences attach to one another. This is an example of the brain’s plasticity, the brain’s ability to be shaped and molded. Trauma that occurs during childhood can change the development of the brain as well as the structure of it. The amygdala (an almond shaped set of neurons located deep in the temporal lobe that has control over processing emotions), hippocampus (a small curved formation in the brain that is involved in the shaping of new memories), and prefrontal cortex (the cerebral cortex covering the front part of the frontal lobe, said to plan complex cognitive behavior, personality expression, decision making and moderating social behavior) are areas of the brain implicated in the stress response. Traumatic stress can be associated with increased amounts of cortisol and norepinephrine responses to subsequent stressors (Bremner). Cortisol is a steroid hormone that regulates a wide range of processes throughout the body. These processes include metabolism and the immune system response. When cortisol levels are at such high amounts for prolonged periods of time, things such as weight gain, high blood pressure, disrupted sleep, negative moods, and a reduction in energy can occur. In a 2011 study conducted by Concordia University, many children who have behavioral issues have been shown to have an abnormally higher levels of cortisol than more well-behaving children.

    This goes into behavioral signs of abuse. According to RAINN, some children after being molested refuse to bathe or execute proper hygiene. They may not take much initiative in their clothes or their hair, refusing to brush it or comb it, and not washing the things that they wear or not putting much thought into how their clothes look. Parents and teachers should notice lowering or failing grades, as well as kids just not showing up to school to begin with. It’s pretty telling when a straight A student is suddenly getting D’s and F’s on their report cards. They may also run away from places that may be deemed as “safe” like school or home. They also say that children may also:

• Develop some sort of phobia

• Become overly protective over siblings and friends

• Have more knowledge about sex or sexual activities than the average child

• Nightmares

• Bed wetting

• Returns to regressive behaviors like thumb sucking for comfort

• Feels threatened by any physical contact

• Self harm

• Exhibits signs of depression and PTSD (post traumatic stress disorder)

    Within the psychological field, many professionals are still puzzled as to why people feel the need to take advantage of minors. The debate between sex and power is heavily argued. What is the nature of the problem? Child sexual abuse is classified as a sexual problem, while some textbooks on human sexuality consider it a sexual variation. When treating a child predator, professionals orient their treatments toward sexual aberration; loosening sexual tension and temporarily quenching their sexual desires and thirst. Some sexual offenders are given antilibidinal drugs to try and suppress their sexual libido. There are two types of medications that physicians prescribe; those that decrease testosterone (e.g. progestogens, antiandrogens, and gonadotropin releasing hormones) and those that reduce sexual drives (antipsychotics and serotonergic antidepressants). Six studies examined if three of the drugs listed previously were successful in lowering testosterone. The study showed that there was no re-offence within the two year follow-up. Secondary outcomes have shown that these perverted fantasies were brought down in people being treated, however, the offences did not cease. The testosterone levels correlated with the amount of sexual activity (Khan, Ferriter, Huband, Powney, Dennis, Duggan).

    Of course, the most important thing is the betterment of the child that has been affected. The child is innocent in this situation, and therapy is to help stifle trauma from progressing. Allison N. Sinanan, a social work professor at Stockton University, says that psychotherapy aids as the first model of a healthy relationship. The goal for this treatment is to jumpstart healing, nurture themselves through positive relationships, and so on and so forth. The goal for the psychologist or the person who is evaluating the child is to develop a sturdy relationship with that child. Psychotherapy helps rework trauma into a healthier sense of self. PTSD is a huge reality for children who have gone through abuse, and counseling is supposed to teach them how to “identify, reframe, and evaluate the dysfunctional cognitions related to the specific trauma and its sequelae that contribute to the intense negative emotions and behavioral reactions.” One of the methods that’s used in therapy is CBT (cognitive behavioral therapy). In a 2011 study, this way of therapy was effective in improving participant symptomatology, with the eight session condition including the trauma narrative being the most effective when it comes to abuse specific distress and child abuse related fear and general anxiety. EDMR, or eye desensitization and reprocessing is another treatment method. It allows clients to process an emotional experience that the survivor does not feel comfortable talking about as of yet. Directive questioning is used to desensitize the client through brief imagined exposure to the memory that proves traumatic. This method was originally created for adults who suffer from PTSD, but the use of this type of therapy is now an option for children and adolescents. Using an eight phase approach, the therapist will have the survivor recollect distressing images while receiving one of several types of bilateral sensory input like side to side eye movement. Another popular option is group therapy. This is considered the treatment of choice when working with sexually abused adolescents (Lindon). This is an environment in which children can interact with one another; giving them a sense that they aren’t alone; promoting a sense of support. Group therapy provides benefits beyond what individual therapy is able to achieve by providing increased empowerment and psychological well being (Yalom and Lezczc). People have said that it is easier to express their feelings knowing that what they’ve gone through others in the room have gone through at well. Group therapy has shown to reduce feelings of depression and anxiety by significant amounts (Westbury and Tutty). Many ways of healing come with counseling and work socially, but medication can also be given to a child sexual abuse survivor, however, it is not discussed as much as the different modes of therapy listed above. There has always been a debate in terms of medicating children and whether it is necessary; stating that it masks the problem instead of solving it. There is only minimal evidence that shows implementing sertraline, a selective serotonin reuptake inhibitor, caused any clinical improvement for children with comorbid depression. However, there was a significant improvement in people with post-traumatic stress disorder.

In a case study done by Christiana Balan, a faculty member of Psychology and Educational Sciences within Spiru Haret University, she examines Daria, an eleven year old girl born in Rupea, a town in Transylvania, Romania who was sexually abused by her Uncle. During her psychological evaluation, Balan discovered that Daria was exposed to numerous traumatic situations, as well as being neglected by her Mother. In the past, the young girl has also been hospitalized and institutionalized. Due to the circumstances that Daria was in and the actions that were inflicted towards her, she was moved to a safer environment and was forced to undergo an intensive program of psychological counseling. Balan then broke down the process of assessment of this little girl. In the beginning of her treatment, Daria exhibited some of the signs that were mentioned before such as depressive moods and heightened emotions, but towards the end of the assessment, Balan was able to see a change. Over time, Daria was able to establish a healthy relationship with her assessor built on trust and unconditional acceptance. Unfortunately, the young girl exhibited mixed emotional disorder with anxiety-depressive and maladaptive components. She showed emotional lability, low resistance to frustration, excessive crying, and being quite malleable. Psychologically, she was not reaching the maturity levels that most eleven year olds are at. Daria is apart of the concrete operational stage of cognitive development. During this time, Daria and her peers would be able to accurately imagine the consequences of something occurring without it really needing to. Children within the concrete operational stage, they think of “what if” scenarios.

In the case of Daria and people who have been through what she’s been through, in recovery, short term and long term goals are established. For short term goals, mental health professionals want to be able to get the full story of the abuse that took place in the client’s life; the frequency, duration, and the nature of the abuse that took place. Next would be expressing and identifying feelings that stem from the abuse; breaking away from keeping certain information secretive. After that would possibly be telling someone that they trust about the things that have happened. The main thing initially is being honest; with themselves, with their family members, and being honest with their therapist, counselor, psychologist, or psychiatrist. Getting rid of shame and guilt would be another goal, as well as reminding them that what took place was nowhere near their fault. Trying to reduce emotional intensity and stabilize unbalanced moods and mindsets. The child needs to learn to build their self-esteem, improve positive social skills, and work on boundaries. Long term goals include stopping sexual victimization in children; controlling emotions and behaviors that come with sexual abuse. Working on acceptance and forgiveness can be hard, but once it is done, the client has unlocked a huge key in healing. Over time, the child should want to overcome the traumatic event, eliminating denial of what has happened. Being able to see themselves in a positive light would be a step towards the right direction.

    The long term effects on child sexual abuse survivors depends on the person, as well as the amount of treatment they do or do not get. Some people may exhibit higher levels of depression, guilt, self-blame, shame, somatic concerns, anxiety, dissociative patterns, denial, repression, as well as future relationship problems and sexual problems. Depression is the most common trait that an adult may have after being abused as a child. The survivors may have a habit of thinking negatively about themselves an internalizing their abuse (Hartman). They tend to display more destructive actions years after the abuse, sometimes even blaming themselves for what has happened (Browne and Finklehor). Physical image issues and body dysmorphia can relate to feeling dirty and not whole; picking up disorders such as bulimia nervosa and anorexia (Ratican). Survivors may even resort to physical harm like cutting or body mutilation. Interpersonal relationships can be a difficult task, as the abuse may make the survivor afraid of getting to know new people. This can grow into trust issues, skewed boundaries, passive behaviors, and getting involved in abusive relationships. Abuse survivors may deflect from physical touch all together; fearing intimacy and any sense of commitment. If they are able to go further with sexual experiences, they may not be able to reach orgasm. Sexual abuse survivors were more likely to have erectile dysfunction, premature ejaculation, or vaginal pain during sex. This can lead to an array of arousal disorders.

    When an adult who has suffered through sexual abuse is trying to resolve the issues that have come with it, there are a series of different therapy methods that a mental health professional may introduce. Wendy Maltz in 2001 says that the best way to resolve internal conflict is to locate where the sexual and intimacy issues stem from. Client empowerment; making the person feel safe and worthy of validation. They must gain skills to be immersed into a normal way of life. Sometimes the client may hinder from disclosing information about the attack, whether it be from embarrassment or pride. The mental health professional may help the person engage in beginning healthy relationships with others; platonically and romantically. According to Feinauer in a 1996 study, people who were able to better adjust to relationships has a drop in depression. If the survivor is already in a long term relationship, the professional now takes on the role of teacher; educating their partner on the long term effects of child sexual abuse so that they can actively be apart of the healing process. Counselors can help couples integrate positive and effective communication, trust, respect, and equality in their partnership (Maltz). Sometimes however, the complete opposite occurs. Some people may show extreme sexual pleasures like compulsive sexual behavior, inappropriate seduction, sexualizing every relationship that they make, promiscuity, and sadistic and masochistic fantasies. The survivors must learn to develop a positive sexual self concept, lowering negative sexual tendencies.

    Every ninety-two seconds someone is sexually assaulted. Every nine minutes the person is a child. From 2009 to the year 2013, Child Protective Services states that around 64,000 kids a year are molested in the United States; a majority of them being between the ages of twelve and seventeen. 18.34% of children are underneath the age of twelve. These children are thrust into a life that they did not ask for; a life that they did not deserve. Out of one thousand attackers, only five of them are reprimanded…only five. With psychology and science, people are making more efforts to aid people into recovery, while preventing attacks from repeating. More and more people are speaking out; letting their voices be heard and advocating for survivors to speak as well.

Bibliography

Maltz, W. (2002). Treating the sexual intimacy concerns of sexual abuse survivors. Sexual and Relationship Therapy, 17(4), 321-327.

Feinauer, L., Callahan, E. & Hilton, H. G. (1996). Positive intimate relationships decrease depression in sexually abused women. American Journal of Family Therapy, 24(2), 99-106.

Ratican, K. (1992). Sexual abuse survivors: Identifying symptoms and special treatment considerations. Journal of Counseling & Development, 71(1), 33-38.

Browne, A., & Finkelhor, D. (1986), Impact of child sexual abuse: A review of the research. Psychological Bulletin, 99, 66-77.

Hartman, M., Finn, S., & Leon, G. (1987). Sexual-abuse experiences in a clinical population: Comparisons of familial and nonfamilial abuse. Psychotherapy: Theory, Research, Practice, Training, 24(2), 154-159.

Hall, M., & Hall, J. (2011). The long-term effects of childhood sexual abuse: Counseling implications. Retrieved from http://counselingoutfitters.com/vistas/vistas11/Article_19.pdf

“Cognitive Development: Piaget’s Concrete Operations.” MentalHealth.net. https://www.mentalhelp.net/cognitive-development/piagets-concrete-operations/

Staron, V. Perel, JM. Mannarino, AP. Cohen, JA. (2007)  “A pilot randomized controlled trial of combined trauma-focused CBT and sertraline for childhood PTSD symptoms.”

https://www.ncbi.nlm.nih.gov/pubmed/17581445

Westbury E, Tutty LM (1999) The efficacy of group treatment for survivors of childhood abuse.Child Abuse Negl 23: 31-44.

Yalom and Leszcz (2005) The Theory and Practice of Group Psychotherapy.(5thedn) Basic Books.

Lindon J, Nourse CA (1994) A multi-dimensional model of groupwork for adolescent girls who have been sexually abused.Child Abuse Negl 18: 341-348.

Steer, RA. Runyon, MK. Cohen, JA. Mannarino, AP. Deblinger, E. (2011) “ Trauma-focused cognitive behavioral therapy for children: impact of the trauma narrative and treatment length.” https://www.ncbi.nlm.nih.gov/pubmed/20830695

Khan O, Ferriter M, Huband N, Powney MJ, Dennis JA, Duggan, C. “Drug treatments for sexual offenders or those at risk of offending.” https://www.cochrane.org/CD007989/BEHAV_drug-treatments-for-sexual-offenders-or-those-at-risk-of-offending

S, Sgroi. “Handbook of Clinical Intervention in Child Sexual Abuse.” Simon and Schuster. (https://books.google.com/books?hl=en&lr=&id=XfBX3y5O8WcC&oi=fnd&pg=PR11&dq=child+sexual+abuse+therapy&ots=8k_5MrnnMo&sig=0bRARM9MBjUqydhTW6rt4numD2w#v=onepage&q=child%20sexual%20abuse%20therapy&f=false

(2011) C, Balan.“Child Abuse: Case Study.”  Spiru Haret University. https://pdfs.semanticscholar.org/75db/2726f183504dee81f296685bb3a73122d62b.pdf

“Behavioral Problems Linked to Cortisol Levels” (2011) Concordia University.  http://www.concordia.ca/cunews/main/releases/2011/02/09/behavioral-problems-linked-to-cortisol-levels.html

K, Singer. “Myths and Facts about Male Sexual Abuse and Assault.” 1 in 6.org. https://1in6.org/get-information/myths/

(2019) “Cortisol” YouandYourHormones.org. https://www.yourhormones.info/hormones/cortisol/

J, Douglas Bremner. (2006) “Traumatic Stress: Effects on the Brain.” NCBI.NLM.NIH.gov. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181836/

(2016) “Timeline: brain development from birth.” Queensland Government. https://www.earlyyearscount.earlychildhood.qld.gov.au/age-spaces/timeline-brain-development-birth/

“Brain Architecture.” Harvard University. https://developingchild.harvard.edu/science/key-concepts/brain-architecture/

(2019) “A look at child abuse on a global level.” The Protection of Minors in the Church. https://www.pbc2019.org/protection-of-minors/child-abuse-on-the-global-level

E. Olafson. (2011) “Child Sexual Abuse: Demography, Impact, and Interventions.” Journal of Child and Adolescent Trauma. https://www.tandfonline.com/doi/full/10.1080/19361521.2011.545811   

A, Wilbert Burgess. “Sexual Assault of Children and Adolescence.” Lexington Books. https://books.google.com/books?hl=en&lr=&id=h2uIOTSvoRUC&oi=fnd&pg=PR9&dq=sexual+assault+in+children&ots=1z7RXDYn6f&sig=d-ThZM6tiS9WpCIkABH_8ryeqkc#v=onepage&q=sexual%20assault%20in%20children&f=false

“Child Sexual Abuse-Guidelines for Medico-Legal Care For Victims of Sexual Violence.” MedLeg. https://www.who.int/violence_injury_prevention/resources/publications/en/guidelines_chap7.pdf