child sexual abuse

PREPARED BY:
M.VIJAYARANI.BSC(N).R.N.R.M

CHILD SEXUAL ABUSE

DEFINITION:

ABUSE:

Abuse refers to harmful or injurious treatment of another human being that may include physical, sexual, verbal, psychological/emotional, intellectual, or spiritual maltreatment. Abuse may coexist.

SEXUAL ABUSE:

Sexual abuse refers to inappropriate sexual contact between a child or an adult and someone who has some kind of family or professional authority over them. Sexual abuse may include verbal remarks, fondling or kissing, or attempted or completed intercourse. Sexual contact between a child and a biological relative is known as incest, although some therapists extend the term to cover sexual contact between a child and any trusted caregiver, including relatives by marriage. Girls are more likely than boys to be abused sexually; according to a conservative estimate, 38% of girls and 16% of boys are sexually abused before their eighteenth birthday.

CHILD SEXUAL ABUSE:

Is an umbrella term describing criminal and civil offenses in which an adult engages in sexual activity with a minor or exploits a minor for the purpose of sexual gratification

NEGLECT:

Which is defined as failure to meet a dependent person's basic physical and medical needs, emotional deprivation, and/or desertion. Neglect is sometimes described as passive abuse.

TYPES OF SEXUAL ABUSE:

This term includes a variety of sexual offenses, including:
· Sexual assault – a term defining offenses in which an adult touches a minor for the purpose of sexual gratification; for example, rape (including sodomy), and sexual penetration with an object.
· Sexual molestation – a term defining offenses in which an adult engages in non-penetrative activity with a minor for the purpose of sexual gratification; for example, exposing a minor to pornography or to the sexual acts of others.
· Sexual exploitation – a term defining offenses in which an adult victimizes a minor for advancement, sexual gratification, or profit; for example, prostituting a child, and creating or trafficking in child pornography.
· Sexual grooming - defines the social conduct of a potential child sex offender who seeks to make a minor more accepting of their advances, for example in an online

CHILD SEXUAL OFFENDER:
Refers to a person who has been convicted for one or more child sexual abuse offenses.

INCIDENCE:
Over 20.83% of the populations suffer some forum of sexual abuse before the age of 18 years old. They come from all walks of life; about 25% of children who are abused or neglected are younger than two years of age. It is estimated that before the age of 18 at least 1 in 4 females and 1 in 6 males will have suffered from some form of sexual abuse. That is over 20.83% of the population!!With over 50,000,000 people in the UK, that means that there are more than 10,400,000 people in the UK alone who are, or will become, survivors of sexual abuse. Assuming that people live 70 years that’s over148, 571 NEW victims of childhood sexual abuse per year! And this does NOT include adults who have been raped. Children who suffer from birth defects, developmental delays, or chronic illnesses have a higher risk of being abused by parents or other caregivers.

POPULATION:
They come from all walks of life, all backgrounds, and happens to both females and males, rich and poor, white, black, or pink. Child sexual abuse can take place within the family, by a parent, stepparent, sibling or other relative; or outside the home, for example, by a friend, neighbor, child care person, teacher, or stranger.

COPING MECHANISM IN CHILDREN TO ABUSE:

When sexual abuse has occurred, a child can develop a variety of distressing feelings, thoughts and behaviors.No child is psychologically prepared to cope with repeated sexual stimulation. Even a two or three year old, who cannot know the sexual activity is wrong, will develop problems resulting from the inability to cope with the overstimulation. When sexual abuse occurs within the family, the child may fear the anger, jealousy or shame of other family members, or be afraid the family will break up if the secret is told. A child who is the victim of prolonged sexual abuse usually develops low self-esteem, a feeling of worthlessness and an abnormal or distorted view of marriage and sex. The child may become withdrawn and mistrustful of adults, and can become suicidal. Some sexually abused children become child abusers or prostitutes, or have other serious problems when they reach adulthood. Child sexual abusers can make the child extremely fearful of telling, and only when a special effort has helped the child to feel safe, can the child talk freely. If a child says that he or she has been molested, parents should try to remain calm and reassure the child that what happened was not their fault. Parents should seek a medical examination and psychiatric consultation.

CHILD SEXUAL OFFENDER CAN BE:

Many victims of childhood sexual abuse will have been abused by someone in the family or a close family friend, and the abuser can be either male or female, rich or poor, teacher, step dad, mother, babysitter, vicar, brother or anyone. Some will have been abused by a stranger, and although that is what becomes reported in the news far more often, abuse happens far more often by someone known to the child that they should have been able to trust to protect them.

CAUSES OF ABUSE:
· Early learning experiences
· Ignorance of developmental timetables
· Economic stress
· Lack of social support or social resources.
· Substance abuse: (Alcohol and mood-altering drugs)
· Mental disorders.
· Belief systems

AFTER EFFECTS:

Abuse affects all dimensions of human development and existence.Abused children often display
1. Retarded physical growth and poor coordination

2. In both children and adults, repeated trauma produces changes in the neurochemistry of the brain that affect memory formation.

3.Instead of memories being formed in the normal way, which allows them to be modified by later experiences and integrated into the person's ongoing life, traumatic memories are stored as chaotic fragments of emotion and sensation that are sealed off from ordinary consciousness.

4.These traumatic memories may then erupt from time to time in the form of flashbacks.

5.Abused children develop stress

6.They often misinterpret other people's behavior and refuse to trust them.

7.Emotional distortions include such patterns as being unable to handle strong feelings, or being unusually tolerant of behavior from others that most people would protest.

8.Children who are abused are often in physical and emotional pain at school.

9.cannot concentrate on schoolwork, and consequently fall behind in their grades

10.They often find it hard to make or keep friends, and may be victimized by bullies or become bullies themselves

11.Even though a survivor may consciously want to avoid re-abuse, the individual is often unconsciously attracted to people who remind him or her of the family of origin.

12.Abused adults are also likely to fail to complete their education, or they accept employment that is significantly below their actual level of ability.

COMMON SYMPTOMS OF ADULT SURVIVORS OF CHILDHOOD SEXUAL ABUSE
· Low self-esteem, feeling worthless.
· Fear of abandonment and other abandonment issues.
· Acting out behavior. Not knowing how to identify, process and or express intense feelings in more productive ways.
· Unexplained fears of being alone at night, nightmares and/or night terrors . . .passing urine in bed during night after elder years like after 12 years
· Feeling overly grateful/appreciative from small favors by others.
· Boundary issues: lack of, needing to be in control, power issues, fear of losing control...
· Eating disorders including: anorexia, bulimia, compulsive over-eating etc.. .
· Headaches, arthritis and/or joint pain, gynecological disorders, stomachaches and other somatic symptom logy.
· Unexplained anxiety/panic, when with individuals from childhood.
· Extreme guilt/shame.
· Obsessive/compulsive behaviors (not necessarily Obsessive/Compulsive Disorder).
· History of being involved in emotionally, psychological and/or physically violent relationships (emotionally, physically).
· Memories of domestic violence in childhood.
· Sexual acting out, "sexaholism", history of prostitution, performing in porn films . . .
· Distorted body image/poor body image.
· Hyper vigilance. (Too much sensitivity)
· History of ambivalent (both loves and hurts the same person) or intensely conflictive relationships.
· Depersonalization. Feeling one to be unreal and everyone else to be real (or vice versa).
· Blocking out periods of one's life (usually ages 1-12) or a specific person or place.
· History of multi-victimizations in other forms.
· Extremely high or low risk taking.
· Obsession with suicide at various times of the year or after triggering events.
· Wearing layers of clothing, even in the summer - caused by body image issues.
· Intense anxiety and/or avoidance of gynecological exams.
· Unexplained fears of suffocation.
· Unusual interest in or avoidance of all things of a sexual nature
· Depression or withdrawal from friends or family
· Seductiveness
· Statements that their bodies are dirty or damaged, or fear that there is something wrong with them in the genital area
· Refusal to go to school
· Delinquency/conduct problems
· Secretiveness
· Aspects of sexual molestation in drawings, games, fantasies
· Unusual aggressiveness, or suicidal behavior

LONG TERM EFFECTS OF CHILD SEXUAL ABUSE:

There are many possible long-term effects that childhood sexual abuse can have on a person, and among any group of abuse survivors there are always people who will react in totally different ways, that, at first can seem to contradict each other. I cannot list all of the effects due to there being so many possibilities.
#Intense nightmares
#Flashbacks
#Guilt
#Depression and Bad Days
#Shame
#Self hate
#Feeling a failure
#Fear of fear
#Seeing no way forward
#Fear of men
#Fear of women
#Low self-esteem
#Fear of authority
#Often feeling "used"
#Need to feel in control
#Jealousy
#Fear of other people's motives
#Anger (or fear of your own)
#Agoraphobia
#Fear of the dark
#Unable to say "no"
#Sleep problems
#Self harm & cutting
#Eating disorders
#Unreasonable self blame
#Feeling suicidal
#Drug abuse
#Drink problems
#Lack of emotions
#Isolation
#Fear of sex
#Prostitution
#Masturbation problems
#Feeling lost
#Sexual identity problems
#Relationship problems
#Trust problems
#Feeling different
#Unable to cry
#Always crying
#Inability to plan ahead
#Financial problems
#Panic attacks
#Sexual dysfunction
#Unable to take compliments
#Fear of hurting other people
#Always asking WHY ME?
#Need to be perfect
#The need to please other people, for fear of losing their friendship.
#Need to find some way to push away those that become too close, or mean something, to you before they get a chance to reject you.
#Feeling "if people really knew me, they would reject me".
Additional Behavioral Signs in Pre-teens and Adolescents
· Self-mutilation (the child may repeatedly pick at scabs, cut him/herself with a razor blade, bite his/her finger or arm, burn him/herself with a cigarette)
· Threatening or attempting suicide
· Using drugs or alcohol
· Becoming promiscuous (a child is sexually active without discrimination, or just has that reputation)
· Being prudish (the child avoids any sexuality, does not see him/herself as a sexual being in any way)
· Prostitution
· Fire-setting
· Lying, stealing
· Running away
· Isolating self or dropping friends
· Pre-occupation with death (the child may write poems about death, may ask a lot of questions about death, such as "What does it feel like and where do people go?")

MEDICAL AND PSYCHIATRIC:

In addition to requiring immediate treatment for physical injuries, abused children and adults often need long-term psychotherapy in order to recover from specific mental disorders and to learn new ways of dealing with distorted thoughts and feelings. This approach to therapy is known as cognitive restructuring. Specific mental disorders that have been linked to childhood abuse include
Major depression, (always sad)
Bulimia nervosa, (eating more)
Social phobia,(unable to socialize with others)
Generalized anxiety disorder, (fear of every thing)
Post-traumatic stress disorder, (after a stress developing symptoms)
Borderline personality disorder(acting out in situations badly with out thinking of the consequences)
Dissociative amnesia, (forgetting) and
Dissociative identity disorder. (Forgetting about own identity like whom am I)
Abused adults may develop post-traumatic stress disorder, major depression, or substance (Alcohol and drug) abuse disorders. Sexually abused children and their families need immediate professional evaluation and treatment. Child and adolescent psychiatrists can help abused children regain a sense of self-esteem, cope with feelings of guilt about the abuse, and begin the process of overcoming the trauma. Such treatment can help reduce the risk that the child will develop serious problems as an adult.

WHEN MANY OF US GO INTO THERAPY:

we do so in the hope of getting some quick release from the distress that we are experiencing at the time. We are very aware that therapy is costing us a lot in terms of time, money, and energy, and understandably we want to see some immediate results, especially when we are in emotional pain. No therapist, however, has a magic wand to instantly take away our pain, nor do they have a crystal ball and are able to know our exact needs without us saying. Therapy is not like a doctor that can set a broken leg; therapy takes time to heal the mind.It is important that you talk with your therapist about what your expectations are, and about what your needs are from therapy. Just like any other relationship, the more you know and can communicate what you want and need from that relationship, the better chance you will have of receiving that. For some people, it may be easier, at first, for you to write down your needs than to say them aloud. It may well be that you are entering therapy for the first time and not have any sense of what needs to happen other than you want to feel better than you currently do feel. It is very important that you express this also. Therapy should be a two way process of communication.

RESPONDING TO CHILD SEXUAL ABUSE:

When a child tells an adult that he or she has been sexually abused, the adult may feel uncomfortable and may not know what to say or do. The following guidelines should be used when responding to children who say they have been sexually abused:
What to SayIf a child even hints in a vague way that sexual abuse has occurred, encourage him or her to talk freely. Don't make judgmental comments.
· Show that you understand and take seriously what the child is saying. Child and adolescent psychiatrists have found that children who are listened to and understood do much better than those who are not. The response to the disclosure of sexual abuse is critical to the child's ability to resolve and heal the trauma of sexual abuse.
· Assure the child that they did the right thing in telling. A child who is close to the abuser may feel guilty about revealing the secret. The child may feel frightened if the abuser has threatened to harm the child or other family members as punishment for telling the secret.
· Tell the child that he or she is not to blame for the sexual abuse. Most children in attempting to make sense out of the abuse will believe that somehow they caused it or may even view it as a form of punishment for imagined or real wrongdoings.
· Finally, offer the child protection, and promise that you will promptly take steps to see that the abuse stops.
What to DoReport any suspicion of child abuse. If the abuse is within the family, report it to the local Child Protection Agency. If the abuse is outside of the family, report it to the police or district attorney's office. Individuals reporting in good faith are immune from prosecution. The agency receiving the report will conduct an evaluation and will take action to protect the child.
Parents should consult with their pediatrician or family physician, who may refer them to a physician who specializes in evaluating and treating sexual abuse. The examining doctor will evaluate the child's condition and treat any physical problem related to the abuse, gather evidence to help protect the child, and reassure the child that he or she is all right.
Children who have been sexually abused should have an evaluation by a child and adolescent psychiatrist or other qualified mental health professional to find out how the sexual abuse has affected them, and to determine whether ongoing professional help is necessary for the child to deal with the trauma of the abuse. The child and adolescent psychiatrist can also provide support to other family members who may be upset by the abuse.
While most allegations of sexual abuse made by children are true, some false accusations may arise in custody disputes and in other situations. Occasionally, the court will ask a child and adolescent psychiatrist to help determine whether the child is telling the truth, or whether it will hurt the child to speak in court about the abuse.
When a child is asked as to testify, special considerations--such as videotaping, frequent breaks, exclusion of spectators, and the option not to look at the accused--make the experience much less stressful.
Adults, because of their maturity and knowledge, are always the ones to blame when they abuse children. The abused children should never be blamed.
When a child tells someone about sexual abuse, a supportive, caring response is the first step in getting help for the child and reestablishing their trust in adults.

CHILD ABUSE - THE HIDDEN BRUISES:

The statistics on physical child abuse are alarming. It is estimated hundreds of thousands of children are physically abused each year by a parent or close relative. Thousands die. For those who survive, the emotional trauma remains long after the external bruises have healed. Communities and the courts recognize that these emotional “hidden bruises” can be treated. Early recognition and treatment is important to minimize the long term effect of physical abuse. Whenever a child says he or she has been abused, it must be taken seriously and immediately evaluated.
Children who have been abused may display:
· A poor self image
· Sexual acting out
· Inability to trust or love others
· Aggressive, disruptive, and sometimes illegal behavior
· Anger and rage
· Self destructive or self abusive behavior, suicidal thoughts
· Passive, withdrawn or clingy behavior
· Fear of entering into new relationships or activities
· Anxiety and fears
· School problems or failure
· Feelings of sadness or other symptoms of depression
· Flashbacks, nightmares
· Drug and alcohol abuse
· Sleep problems
Often the severe emotional damage to abused children does not surface until adolescence or later, when many abused children become abusing parents. An adult who was abused as a child often has trouble establishing intimate personal relationships. These men and women may have trouble with physical closeness, touching, intimacy, and trust as adults. They are also at higher risk for anxiety, depression, substance abuse, medical illness, and problems at school or work. Without proper treatment, physically abused children can be damaged for life. Early identification and treatment is important to minimize the long-term consequences of abuse. Qualified mental health professionals should conduct a comprehensive evaluation and provide treatment for children who have been abused. Through treatment, the abused child begins to regain a sense of self-confidence and trust. The family can also be helped to learn new ways of support and communicating with one another. Parents may also benefit from support, parent training and anger management. Physical abuse is not the only kind of child abuse. Many children are also victims of neglect, or sexual abuse, or emotional abuse. In all kinds of child abuse, the child and the family can benefit from evaluation and treatment from a qualified mental health professional

GUIDE LINES TO COPE UP:

1. Relaxation exercises can help to reduce the stress levels.

2. Do something Physical. If you are sitting and feeling agitated, try to do some physical exercise, such as walking about, hovering, go out jogging or for a brisk walk.

3. Engage in a simple repetitive activity. If you are in a supermarket and feeling anxious you could count the number of people in a queue, count the money in your purse or repeat a statement over and over again.

4. A lot of people find that keeping some cards with coping statements on them in a bag or coat pocket helpful. Bring them out when panic symptom start to come on and repeat the statements over to yourself.

5. Express anger by pounding a pillow or cushion. Throw soft thing around, or dig the garden and pound the soil with a spade.

6. Practice muscle relaxation.

7. Do something that requires your concentration to be focused such as playing cards, crosswords or knitting.

8. Practice deep abdominal breathing

REFERENCS:

1. http://www.healthline.com/galecontent/abuse-1/4
2. http://www.theawarenesscenter.org/symptoms.html
3. http://www.aest.org.uk/survivors
4. http://www.aacap.org/page.ww?name=Child+Sexual+Abuse&section=Facts+for+Families
5. http://www.aacap.org/cs/root/facts_for_families/responding_to_child_sexual_abuse



prepared by vijayarani.M