Child sex­ual abuse

Part One of Three – In­tro­duc­tion

The Jerusalem Post - The Jerusalem Post Magazine - - PSYCHOLOGY - • DR. MIKE GROPPER The writer is a mar­i­tal, child and adult cog­ni­tive-be­hav­ioral psy­chother­a­pist with of­fices in Jerusalem and Ra’anana.­mikegrop­per; dr­mikegrop­[email protected]

In the 1970s, I was a se­nior drug re­ha­bil­i­ta­tion coun­selor at a spe­cial heroin drug re­ha­bil­i­ta­tion pro­gram in the Bronx (NYC). My caseload con­sisted of about 30 hard­core drug ad­dicts, many of them ex-con­victs. As a be­gin­ning coun­selor, I re­mem­ber meet­ing one of my first clients, a young His­panic woman in her early 20s. She had been us­ing heroin since her teens and was strug­gling to put her life to­gether. In one of our ses­sions, she told me that her un­cle had mo­lested her through­out her early child­hood. Her un­cle babysat for her to help his sis­ter, the girl’s mom, who was a sin­gle par­ent. Very of­ten, the un­cle forced her to give him oral sex. This went on for many years. Never caught, he moved far away and the sex­ual abuse stopped. She never spoke about it with her mother, some­thing that the sci­en­tific lit­er­a­ture states is very com­mon.

Defin­ing Child Sex­ual Abuse (CSA)

CSA is a uni­ver­sal prob­lem with grave life­long con­se­quences. The World Health Or­ga­ni­za­tion (2003) de­fines CSA as “the in­volve­ment of a child in sex­ual ac­tiv­ity that he or she does not fully com­pre­hend, is un­able to give in­formed con­sent to, or for which the child is not de­vel­op­men­tally pre­pared and can­not give con­sent, or that vi­o­lates the laws or so­cial taboos of so­ci­ety. Child sex­ual abuse is ev­i­denced by this ac­tiv­ity be­tween a child and an adult or an­other child who by age or devel­op­ment is in a re­la­tion­ship of re­spon­si­bil­ity, trust or power, the ac­tiv­ity be­ing in­tended to grat­ify or sat­isfy the needs of the other per­son.”

Erin K. Martin and Peter H. Sil­ver­stone (2013) list four types of child sex­ual abuse. They are 1) non-con­tact (e.g., the per­pe­tra­tor ex­pos­ing him­self), 2) gen­i­tal touch­ing (e.g., where an in­di­vid­ual touches the gen­i­tals of the child with his/her hands or mouth, or where the child is made to touch the gen­i­tals of the per­pe­tra­tor with his/her hands or mouth), 3) at­tempted vagi­nal and anal pen­e­tra­tive acts, and/or 4) vagi­nal and anal pen­e­tra­tive acts.

How wide­spread is CSA?

The World Health Or­ga­ni­za­tion re­ports (2010) that glob­ally, one in five women (20%) and one in 13 (7.7%) men ex­pe­ri­enced sex­ual abuse as chil­dren. There are some preva­lence vari­a­tions in dif­fer­ent coun­tries, but over­all these fig­ures are con­sis­tent world­wide. The preva­lence of CSA is higher for fe­males, chil­dren who live in poverty, and chil­dren with phys­i­cal and men­tal dis­abil­ity. Chil­dren in foster homes, adopted chil­dren, sin­gle par­ent homes, and homes with high dys­func­tion in­clud­ing other forms of vi­o­lence and sub­stance abuse are more at risk for CSA. Nev­er­the­less, CSA crosses all so­cioe­co­nomic groups and ed­u­ca­tional lev­els. How­ever, ex­perts cau­tion that the true preva­lence of CSA is not known be­cause CSA thrives in si­lence and is com­monly not re­ported. These kids live their lives in silent suf­fer­ing, be­ing afraid or ashamed to tell some­one.

An­other star­tling statis­tic is that in 90% of the cases, the child knows the per­pe­tra­tor (e.g., par­ent, step­par­ent, un­cle, sib­ling, teacher, coach, neigh­bor or baby-sitter).

Is­rael study

A for­mer col­league of mine at Haifa Univer­sity School of So­cial Work, Zvi Eisikovits and his fel­low in­ves­ti­ga­tor Rachel Lev-Wiesel con­ducted a na­tional epi­demi­o­log­i­cal study from 2010 to 2015 on the preva­lence of child mal­treat­ment in Is­rael un­der the su­per­vi­sion of the Is­rael Min­istry of Ed­u­ca­tion (Jour­nal of Child & Ado­les­cent Trauma, June 2018). They stud­ied more than 12,000 Jewish and Arab chil­dren. They found that 18.7% of this large sam­ple of chil­dren from age of 12 to 17 were ex­posed to some type of CSA. How­ever, in con­trast to global preva­lence data, Is­raeli boys re­ported higher rates of sex­ual abuse, com­pared to girls.

Im­pact of CSA

Child sex­ual abuse ex­poses vic­tims to im­me­di­ate phys­i­cal trauma as well as se­vere and dis­abling emo­tional con­se­quences. Rachel Lev-Wiesel iden­ti­fies some of the detri­men­tal men­tal health con­se­quences as­so­ci­ated with CSA in her pa­per “Child­hood Sex­ual Abuse: From Con­cep­tu­al­iza­tion to Treat­ment,” pub­lished in The Jour­nal of Trauma and Treat­ment (2015). These in­clude post-trau­matic symp­toms, de­pres­sion, sub­stance abuse, help­less­ness, neg­a­tive at­tri­bu­tions, ag­gres­sive be­hav­iors, anx­i­ety, con­duct dis­or­ders, eat­ing dis­or­ders, per­son­al­ity dis­or­ders, dis­so­cia­tive dis­or­ders, self-harm such as self-mu­ti­lat­ing by cut­ting one­self and in some cases psy­chotic episodes. Al­though it is be­yond the scope of this ar­ti­cle to dis­cuss at length the com­plex­ity of the emo­tional fall­out re­sponses of a CSA vic­tim, I have cho­sen to high­light a cen­tral and po­tent con­se­quence of CSA. Rachel Lev-Wiesel de­scribes how the brain of a sex­u­ally abused young child or teen at­tempts to cope with the trauma. She writes, “The brain re­sponds to the trau­matic event through var­i­ous mech­a­nisms, such as psy­cho­log­i­cal numb­ing, shut­ting down nor­mal emo­tional re­sponses or ac­ti­vat­ing dis­so­ci­a­tion: the sub­ject ‘splits’ off part of it­self from the ex­pe­ri­ence.” In other words, the emo­tional ex­pe­ri­ence is so over­whelm­ing that in or­der to sur­vive, one has to lock up and re­press the fear and ter­ror that he/she goes through when vic­tim­ized. This se­vere sense of help­less­ness re­sults in many of the vic­tims de­vel­op­ing some of the mal­adap­tive be­hav­iors and emo­tional re­ac­tions men­tioned above.

Psy­chother­apy is es­sen­tial to help this per­son over­come the emo­tional trauma as well as dys­func­tional be­hav­iors that he/she has re­sorted to in or­der to deal with his/ her own vic­tim­iza­tion. The heal­ing process is hard and long, but there is hope for vic­tims of CSA. I will write about treat­ment in Part Two. In Part Three, I will ad­dress the is­sue of pre­ven­tion.

The World Health Or­ga­ni­za­tion re­ports (2010) that glob­ally, one in five women (20%) and one in 13 (7.7%) men ex­pe­ri­enced sex­ual abuse as chil­dren


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