DIVISION OF CHILD ABUSE AND DOMESTIC
Department for Human Support Services
Cabinet for Health and Family Services
CHILD SEXUAL ABUSE: A MENTAL HEALTH ISSUE?
Child sexual abuse is one of the most pervasive social problems faced by this society. Its impact is profound because of the sheer frequency with which it occurs and because of the trauma brought to the lives of children and adults who have experienced this crime. Historically, however, the sexual abuse of children was dismissed as a "family problem". Within the past decade, it has been addressed by a sometimes reluctant criminal justice system. It is only in more recent years that the profession of mental health has begun to understand child sexual abuse not only as a criminal justice problem, but also as a mental health concern. This realization has been unavoidable as clinicians have repeatedly seen the manifestation of sexual abuse in the lives of their clients.
Research findings related to the incidence of sexual abuse and assault against women report that between 15 to 28 percent of females will be sexually victimized at some point in their lives. Research data related to male victimization is less available, and is undoubtedly underrepresented by the currently reported figure of 8.7 percent. The application of national studies to Kentucky population figures reveals that over 580,000 females will be directly impacted by sexual abuse during their child or adult years, and that over 43,000 male children in this Commonwealth will be sexually abused before the age of eighteen. The research clearly indicates that for far too many women and men, their first experience of sex occurs in the context of violence and manipulation rather than love and trust.
In addition to compelling statistics related to the incidence of sexual abuse and assault, there is mounting evidence that early victimization places persons at risk of subsequent psychological problems. Studies related to the impact of sexual abuse in childhood, for example, indicate an association of the experience with significant mental health problems in adulthood. High incidence rates of child sexual abuse history have been documented among inpatient and outpatient populations, including findings that 70% of females in a psychiatric emergency room sample were abuse survivors, that 43% of inpatients had confirmed histories of physical and sexual abuse, and findings that 51% of state hospital patients were sexually abused during childhood or adolescence. Similarly, studies have found a child molestation rate of 44% among female outpatients and a rate of 33% within a general outpatient caseload. Notably, these incidence figures within mental health populations compare to an incidence rate within the general population of 19 to 28 %.
The specific types of long-term effects of childhood sexual abuse have also been documented in clinical and non-clinical populations. High rates of depression, anxiety, substance abuse, dissociative disorders, interpersonal dysfunction, sexual problems, and suicidality have all been identified to varying degrees among women and men who survive sexual abuse. The severity of psychological and psychosocial problems experienced by adult survivors of childhood victimization has been found to vary based on the age of the victim, the relationship between the victim and the offender, the violent or coercive nature of the crime, the length of time during which the molestation occurred, and other factors. Researchers conservatively report, however, that approximately 20% of sexual abuse victims will suffer significant long-term effects. Extrapolating from the incidence of sexual abuse in the general population, this estimate reveals that approximately 5% of the female population within the United States experiences major mental health problems in their adult lives as a direct result of childhood sexual abuse.
The existence of long-term effects of child sexual abuse may well result because of the influence which this early trauma has on children. The experience of sexual abuse for a child distorts her or his self-concept, orientation to the world, and affective capabilities. The child's sexuality is shaped in a developmentally inappropriate manner as children are placed in an adult relationship for which they are cognitively unprepared, and because sex is associated in the mind of the child with fear, pain, manipulation and secrecy. Children faced with incestuous abuse experience the ultimate sense of betrayal in that they are harmed most by the person upon whom they are most dependent. Sexually abused children may also feel betrayed by nonoffending family members who offered no protection or disbelieved or blamed the child when the abuse was first disclosed. The experience of sexual abuse is also a disempowering process for children whose will, desires, decision-making and sense of efficacy or contravened. Children who face sexual trauma most often incorporate into their self image negative connotations of guilt, shame or "badness" which are communicated intentionally by the offender or by cultural and societal attitudes which view victims in such a negative light.
For some children, the path to recovery from sexual abuse is completed with short-term support and intervention. Studies show that other children, however, continue to re-experience the trauma with symptoms of fear, anxiety, nightmares, phobias, clinging behavior, depression, suicidality, alcohol or drug abuse, self-destructive behavior, and in vulnerability to future victimization. The high percentage of sexually abused children within psychiatric hospitals and residential facilities within this Commonwealth, and the significant percentage of children with a serious emotional disturbance who have memories of sexual abuse speaks to the formidable impact which victimization can bear.
While the incidence of sexual victimization nationally and within the Commonwealth is dramatic, the history of sexual abuse frequently goes undetected by therapists. Studies of client records, in fact, reveal that abuse is rarely detected by mental health professionals. In a 1989 study of outpatients in which 68% were found to have experienced prior abuse, almost 3/4 of prior victims had never revealed the abuse experience to therapists. When asked by researchers why the prior victimization had never been disclosed, a significant number responded simply that they were never asked. A lack of detection of abuse history may have significant implications in that the clinician is at risk of treating symptoms without addressing one of the major causes of mental health or emotional problems for a client.
The significant impact of childhood sexual abuse is unquestionable. This impact, however, speaks not only to the individual child victim of the crime, but also to the mental health community. There is no longer a question of whether child sexual abuse is a criminal justice problem or a social services problem or a mental health problem, for its power pervades the territory of each. The question must now lie in the resolve of all professionals to overcome skepticism with acknowledgement, disbelief with understanding, indifference and indignance, and reluctance to intervene with an unswayable intolerance of the victimization of all children.