Child sexual abuse and incest: community-based intervention

OBJECTIVE: The primary aim of this article is to determine the effectiveness of community intervention in the case of child sexual abuse. The article describes and analyses an actual case in a small urban community in Israel. METHOD: After several incidents of child sexual abuse, much of it incestuous, were brought to light in the community, they were discussed openly, contained, and punished. A community campaign, in which community activists as well as all the service providers were involved, was organized by community social workers. Individual, group, and community interventions were used. RESULTS: The continuation of the abuse has been checked, and, so far, there is no evidence to suggest its resurgence. Community apathy to child sexual abuse seems to have been halted and reversed. The involvement of community residents, particularly the activists, has increased, and this appears to be the major factor in changed community norms toward child sexual abuse. CONCLUSION: Implications of the individual, group, and community interventions are discussed. An integrated program of intervention practices is advocated to contain and prevent the incidence of child sexual abuse and incest.     

Attributing responsibility in cases of father-daughter sexual abuse

This study examined the effects of social workers' attributions of responsibility on their strategies in cases of father-daughter sexual abuse. Social workers read three vignettes illustrating such abuse. Following each vignette, they rated the degree of responsibility they attributed to the father, mother, and daughter described in each vignette, and the likelihood that they would recommend the incarceration of the father or the placement of the daughter into foster care. The more responsibility workers attributed to the father and daughter and the less they attributed to the mother, the more likely they were to recommend the father's incarceration. The more responsibility they attributed to the father, the more likely they were to recommend that the daughter be placed into foster care.     

Brother-sister incest - father-daughter incest: a comparison of characteristics and consequences.

OBJECTIVE: One group of women who were sexually abused by brothers and a second group who were sexually abused by fathers are compared with the intent to identify the differing characteristics of each type of abuse and the effects of the abuse on their adult functioning. Our hypothesis was that there would indeed be differences in the characteristics of the abuse and its effects, and that this would necessitate differing treatment strategies. METHOD: Surveys were distributed to women attending support groups for incest survivors. Of the 62 women completing questionnaires, 14 women (23%) had been sexually abused by a brother. A similar number of women (15) who had been sexually abused by their fathers were chosen from the overall sample for comparison. RESULTS: The absence of the father as a vital force in family life played a key role in the sexual abuse of women by their brothers in every case. The duration of the sexual abuse for brother-abused women and father-abused women was lengthy. The characteristics, including use of force, are equally as serious for sisters as for daughters. The family circumstances surrounding the abuse were examined for both groups and the results yielded a fuller understanding of the incestuous family. Despite an appearance of normalcy, the level of family-wide disturbances, for example substance abuse, mental illness and pervasive family-wide violence were profound for both groups. In this study, we also examine the effects in adulthood of the serious disruption of childhood developmental phases for both brother-abused and father-abused women, taking into account the incidence of substance abuse, depression, suicidality, and eating disorders. CONCLUSIONS: The authors conclude that the characteristics and consequences of brother-sister incest are of equal seriousness to those of father-daughter incest. This would suggest that brother-sister incest is one of the current blind spots in incest research, and one that we cannot afford to ignore. In-depth knowledge of the dynamics and effects of brother-sister incest suggest specific treatment strategies are indeed necessary and these are discussed in this paper.     

Attitudes of health professionals to child sexual abuse and incest

While there has been increasing interest in the topic of child sexual abuse, few studies have focused on attitudes or the determinants of such attitudes held by professionals. To what extent concern is based on stereotyping or factual knowledge is not clear. The present study uses a combination of experimental and survey methodologies to address these issues. Sample case histories were issued to subjects who were then asked to complete a questionnaire on topics relating to the case and to incest in general. Results showed that the type of sexual activity involved influenced responses: type of relationship between adult and child, less so. Estimates of incest were low, but incest was considered, especially by female respondents, to be harmful to the victim.     

An exploration of family and individual profiles following father-daughter incest

This paper presents the results of a range of psychometric assessments which attempted to identify family and individual variables associated with father-daughter incest. Psychometric self-report measures were used to examine differences between families in which incest had been confirmed and a matched comparison group. Significant differences between the members of the incest and the comparison groups included behavioral and self-esteem problems in the daughters and differences in the familial environments of the two groups. Daughters who had been sexually abused reported lower levels of self-esteem about their intellectual and school status. Mothers in the incest group reported that their daughters had more conduct problems than the comparison mothers. The incest families were generally reported to be higher in conflict and organization and lower in cohesion, expressiveness, and active recreation. No differences between groups were found for levels of marital adjustment, self-esteem in mothers, or overall level of psychopathology in the perpetrators.     

Mutual influence and interlocking professional-family process in the treatment of child sexual abuse and incest

Three different types of professional intervention are described for families where father-daughter incest and stepfather-stepdaughter child sexual abuse have occurred. Their possible bearing on the development of the family process and the family network process is outlined. It will be demonstrated how the particular form of the professional intervention influences the relationship between family members and how, in turn, different family members attempt to channel professional intervention along lines they designate. The notion of an overall professional-family system, which describes the mutual influence and interlocking effects each sub-system has on the other, is proposed. The interlocking effects between the two sub-systems are demonstrated by means of a detailed clinical example.     

Attribution of causal and moral responsibility to victims of father-daughter incest: An exploratory examination of five factors

This study was designed to assess the extent to which victim characteristics, assault characteristics, and respondents' sex would affect attributions of causal and moral responsibility to an incest victim. The victim was either a 7- or 15-year-old child who responded in either a passive or resisting manner. The incestuous abuse involved either sexual intercourse or fondling, and either high or low levels of coercion. The subjects were undergraduate students (male = 240; female = 240) who responded to a vignette describing a sexual interaction between a father and daughter. The results indicate that significantly more causal and moral responsibility was attributed to the victim in cases where the victim responded passively. A breakdown of the significant form of responsibility x victim age x coerciveness interaction revealed a significant main effect for form of responsibility; significantly more causal (as opposed to moral) responsibility was attributed to the victim. The simple main effects for victim age were significant in all cases except for the moral responsibility, high coercion condition; and the simple main effects for coercion were significant in all cases except for the moral responsibility, 7-year-old victim condition. These findings are discussed in terms of their implications for public education and future research.     

Therapy of incest survivors: abuse or support?

A preliminary study examined the self-reports of 30 adult incest survivors related to professional help received for personal concerns and incest-related problems. Subjects rated the helpfulness of services received from 12 categories of professionals or groups commonly sought for counsel. Subjects utilized 113 professionals (53 male, 60 female) and spent an average of 36 sessions (9 months) in helping relationships. Chi-square analysis indicated a significant relation (p less than .001) between sex of professional or helper and rating of helpfulness of individual sessions. The trend indicated by this data suggests that male helpers were seen longer and rated lower than females. Additional information provided indicated that the most helpful categories of interventions included (1) validation; (2) advocacy; (3) empathic understanding; and (4) absence of derision or contempt. Practices or attitudes considered harmful were (1) blaming the victim; (2) lack of validation; (3) negative or rejecting responses; and (4) exploitation or victimization of the client. Sexual involvement with the person in the helping role was reported by 23% of the sample; an additional 23% reported other forms of exploitation or victimization. Results of the study are discussed using the conceptual framework of trauma-based disturbances. Reliving experiences, revictimization dynamics, and dissociative processes are speculated to be involved in the high incidence of exploitation of adult incest survivors by persons in helping roles.     

Childhood disclosure of sexual abuse: Necessary but not necessarily sufficient

Prevention programs often encourage sexually abused children to disclose without fully considering the potential for adverse consequences. This study examined the impact of disclosure on abuse cessation and later adult symptomatology. A clinical sample of 301 adult survivors completed the Impact of Event Scale (IES/IES-R), and the Beck Depression Inventory (BDI-II). Participants were divided into 3 groups: Nondisclosure (n = 221), Disclosure/Abuse Ended (n = 25), and Disclosure/Abuse Continued (n = 55). Multivariate analyses of covariance, adjusting for abuse characteristics (age of onset, penetration, and number of perpetrators) and other trauma exposure, revealed significant differences in psychiatric symptom severity among the three groups, Wilks’ λ = 0. 95, F (6, 584) = 2.69, p = 0.014, η_p² = 0.03. Specifically, those in the Disclosure/Abuse Continued group scored significantly higher on the IES/IES-R Intrusion subscale (p = 0.04) and the BDI-II (p = 0.01), as compared to the Nondisclosure group. The Disclosure/Abuse Ended group did not differ significantly from the other groups. Results suggest that disclosure may be detrimental unless adequate steps are taken to ensure abuse cessation and appropriate treatment.     

Long-term effects of incest: life events triggering mental disorders in female patients with sexual abuse in childhood.

The authors studied several psychosocial, psychosomatic, and psychodynamic factors in 33 female psychiatric patients who had been victims of incest. Abuse was almost exclusively severe and prolonged. Three quarters of the female patients had been abused by their biological fathers or stepfathers. Sexual abuse experiences in childhood are connected with feelings of anxiety, helplessness, and powerlessness. Together with a lack of support on the part of the mother, these experiences lead to ego weakness, an autoplastic mode of coping with aggression and to patterns of objectal relationships which predispose them to object loss. The links between a girl's traumatic experiences in relationships and her vulnerability to separation in later life and their importance for the incidence of mental disorders will be discussed on the basis of Bowlby's attachment theory.     

Effects of mother-son incest and positive perceptions of sexual abuse experiences on the psychosocial adjustment of clinic-referred men

OBJECTIVE: The primary objective was to examine the long-term impact of mother-son incest and positive initial perceptions of sexual abuse experiences on adult male psychosocial functioning. METHOD: Sixty-seven clinic-referred men with a history of sexual abuse participated. The participants completed self-report measures regarding their current psychosocial functioning and described the nature of their sexual and physical abuse experiences during childhood. RESULTS: Seventeen men reported mother-son incest, and these men endorsed more trauma symptoms than did other sexually abused men, even after controlling for a history of multiple perpetrators and physical abuse. Mother-son incest was likely to be subtle, involving behaviors that may be difficult to distinguish from normal caregiving (e.g., genital touching), despite the potentially serious long-term consequences. Twenty-seven men recalled positive or mixed initial perceptions of the abuse, including about half of the men who had been abused by their mothers. These men reported more adjustment problems than did men who recalled purely negative initial perceptions. CONCLUSIONS: Mother-son incest and positive initial perceptions of sexual abuse experiences both appear to be risk factors for more severe psychosocial adjustment problems among clinic-referred men.     

Child sexual abuse: factors affecting victims' removal from home

This study was conducted to examine factors associated with children's protective service workers' decision to remove sexually abused children from the family home. The decision to remove was analyzed relative to the following six factors: (1) nature of the abuse, (2) severity of abuse, (3) frequency of abuse (4) mothers' employment status, (5) mothers' compliance with a recommended treatment plan, and (6) mothers' belief of the victim. Discriminant function analysis revealed that the discriminant function containing mothers' compliance, mothers' belief, severity of abuse, mothers' employment status, and frequency of abuse, in order of importance of contribution, was significantly related to victims' removal from the home.     

Children's disclosures of sexual abuse: learning from direct inquiry

Objectives

Published protocols for forensic interviewing for child sexual abuse do not include specific questions about what prompted children to tell about sexual abuse or what made them wait to tell. We, therefore, aimed to: (1) add direct inquiry about the process of a child's disclosure to a forensic interview protocol; (2) determine if children will, in fact, discuss the process that led them to tell about sexual abuse; and (3) describe the factors that children identify as either having led them to tell about sexual abuse or caused them to delay a disclosure.

Methods

Forensic interviewers were asked to incorporate questions about telling into an existing forensic interview protocol. Over a 1-year period, 191 consecutive forensic interviews of child sexual abuse victims aged 3-18 years old in which children spoke about the reasons they told about abuse or waited to tell about abuse were reviewed. Interview content related to the children's reasons for telling or for waiting to tell about abuse was extracted and analyzed using a qualitative methodology in order to capture themes directly from the children's words.

Results

Forensic interviewers asked children about how they came to tell about sexual abuse and if children waited to tell about abuse, and the children gave specific answers to these questions. The reasons children identified for why they chose to tell were classified into three domains: (1) disclosure as a result of internal stimuli (e.g., the child had nightmares), (2) disclosure facilitated by outside influences (e.g., the child was questioned), and (3) disclosure due to direct evidence of abuse (e.g., the child's abuse was witnessed). The barriers to disclosure identified by the children were categorized into five groups: (1) threats made by the perpetrator (e.g., the child was told (s)he would get in trouble if (s)he told), (2) fears (e.g., the child was afraid something bad would happen if (s)he told), (3) lack of opportunity (e.g., the child felt the opportunity to disclose never presented), (4) lack of understanding (e.g., the child failed to recognize abusive behavior as unacceptable), and (5) relationship with the perpetrator (e.g., the child thought the perpetrator was a friend).

Conclusions

Specific reasons that individual children identify for why they told and why they waited to tell about sexual abuse can be obtained by direct inquiry during forensic interviews for suspected child sexual abuse.

Practice implications

When asked, children identified the first person they told and offered varied and specific reasons for why they told and why they waited to tell about sexual abuse. Understanding why children disclose their abuse and why they wait to disclose will assist both professionals and families. Investigators and those who care for sexually abused children will gain insight into the specific barrier that the sexually abused child overcame to disclose. Prosecutors will be able to use this information to explain to juries why the child may have delayed his or her disclosure. Parents who struggle to understand why their child disclosed to someone else or waited to disclose will have a better understanding of their child's decisions.     

Child sexual abuse: relationship between sexual acts and genital findings

A comparison was made between the findings observed during the examination of female victims of sexual abuse with the sexual acts to which the perpetrator confessed to have performed. In Shelby County, TN, during the calendar years 1985-1987, 30 individuals confessed to have sexually assaulted 31 girls. The mean age of the girls was 9.1 years, and that of the offenders was 30 years. In 18 of the 31 cases the offender admitted to vaginal penetration. Specific findings were observed in 11 of these 18 (61%) girls, compared with only 3 of 13 (23%) girls when penetration was denied. Although specific findings were more commonly observed when the perpetrator admitted to vaginal penetration, in 7 of 18 girls (39%) the examiner described normal appearing genitalia (n = 2), or nonspecific abnormalities only (n = 5). The author concludes that all complaints of sexual abuse must be considered potentially valid and should be investigated further, even if the physical examination fails to detect any abnormalities.     

Anatomical doll play of preschoolers referred for sexual abuse and those not referred

Anatomical dolls are used to facilitate children's explanations of sexual abuse. The goal of this study was to identify whether children referred for evaluation of possible sexual abuse would react differently to dolls than would nonreferred controls matched on sex, race, and age. A sample of 35 two- through six-year-olds referred to a hospital child abuse clinic were compared to 35 controls. After a rapport-building exercise, each child played under four conditions in a specially prepared room. Two coders, unaware of the child's group membership, viewed each videotaped session and completed separate behavioral checklists. Six conclusions resulted: (1) anatomical dolls did not create undue anxiety; (2) careful interpretation of sexualized play with dolls is needed; (3) dolls did not overstimulate and cause demonstration of sexual activity; (4) sexual abuse could not be diagnosed solely on the basis of doll play; (5) children in both groups inserted their fingers into doll openings; and (6) practitioners must rely on supporting verbal and physical evidence when making the determination of possible sexual abuse. More training and comfort with anatomical dolls and knowledge of normal child development principles are needed by examiners.     

Pathways from childhood sexual abuse to trait anxiety

BackgroundChildren exposed to sexual abuse are at risk for developing several psychological and behavioral difficulties during adulthood. Here, direct and indirect effects of family conflict, insecurity within the family system (manifested as disengagement and/or preoccupation), and negative feelings provoked by childhood sexual abuse (CSA) on trait anxiety scores were analyzed with structural equation modeling. Both Finkelhor and Browne’s traumagenic dynamics model and Davies and Cummings Emotional Security Theory were applied.MethodsA total of 168 female college student survivors of CSA participated in this study. Information regarding each participant’s abuse was obtained from a self-reported questionnaires. Emotional security was assessed with the Security in the Family System scale. To assess negative feelings regarding abuse and trait anxiety, Children’s Impact of Traumatic Events Scale-Revised and State-Trait Anxiety Inventory were applied, respectively.ResultsLevel of family conflict was found to directly relate to emotional insecurity and trait anxiety. In addition, preoccupation strategies were found to be directly related to trait anxiety. Conversely, disengagement strategies were indirectly related to anxiety through the negative feelings provoked by abuse. Experience with other types of abuse and/or neglect was also related to emotional insecurity and feelings provoked by CSA. Meanwhile, continuity of abuse only correlated with feelings provoked by abuse.ConclusionsStrong relationships between family conflict, emotional insecurity, negative feelings provoked by CSA and trait anxiety were observed. These results suggest that treatment of CSA survivors should focus on improving security within the survivors’ family system and reducing negative feelings provoked by abuse.     

Child sexual abuse and bulimic symptomatology: relevance of specific abuse variables

OBJECTIVE: This study examined specific aspects of child sexual abuse in relation to symptom severity among hospitalized patients diagnosed with bulimia nervosa. METHOD: Participants were 45 hospitalized bulimic women who reported a history of child sexual abuse. Structured interviews were conducted in order to obtain detailed information regarding specific features of the abusive event(s). Participants also completed instruments that measured depression and eating pathology. RESULTS: There were no significant differences in severity of depression or eating disturbance among women reporting differing abusive experiences including intrafamilial versus extrafamilial abuse, abuse with or without the use of physical force, one versus multiple incidents, early abuse versus abuse occurring after age 14, contact versus noncontact abuse, disclosed versus undisclosed, and combined physical/sexual abuse versus sexual abuse alone. CONCLUSION: The specific characteristics of child sexual abuse are not related to the level of symptomatology for hospitalized bulimic patients. This study suggests that differences in the nature of the abuse may not be as important as the fact that the abuse occurred in the first place.