The Trauma of Sexual Abuse

Sexual abuse is a painful reality. Millions of children have suffered the shame, humiliation, anger and sadness that sexual abuse often causes. Fortunately, as we become better able to recognize the signs of sexual abuse and help children understand that it's safe to tell someone about it, more people are getting the help they need.

WHAT IS SEXUAL ABUSE?
Sometimes it is difficult to decide whether or not sexual abuse has occurred. Clearly, if an adult has sexual intercourse with a child, the child has been sexually abused. But this is certainly not the only sexual act that is classified as abuse. Even seemingly less serious sexual behaviors are damaging to children and are considered abusive. For instance:

  • Fondling or kissing a child in a sexual manner
  • Making a child watch pornographic movies or observe sexual activities
  • Exhibiting one's sexual organs to a child or making the child display his or her own genitals
  • Taking sexually explicit photographs of a child
  • Talking with a child in a sexual or seductive manner

Regardless of the severity, any form of sexual abuse is detrimental to the victim's well-being and requires serious attention.

WHO IS SEXUALLY ABUSED?
Confronting sexual abuse, your own or a child's, is often very difficult. It is not unusual to deny or try to cover up sexual abuse. Sometimes this is because the perpetrator, or abuser, has threatened harm if the abuse is disclosed. Other times it is because of the victim's feelings of shame, guilt, or embarrassment. Telling someone about the abuse can he especially difficult if the abuser is a trusted family member or family friend. In fact, over one-third of individuals who are sexually abused never reveal the abuse. Adults who have kept the secret of sexual abuse locked away for many years may find it too painful to re-open these wounds and acknowledge the abuse. For these reasons, it is difficult to determine how many people have actually been sexually abused. However, recent studies have found that:

  • Up to two-thirds of females and one-third of males may be sexually abused at some time in their lives.
  • Sexual abuse is present in all classes, races and religions.
  • Females are two to three times more likely than males to be sexually abused.
  • The majority of sexual abuse begins when children are under 6 years old.

WHO ARE THE SEXUAL ABUSERS?
Sexual abuse can occur both within and outside the family However, almost all sexual abuse victims know their abusers and oftentimes it is a male relative, such as a stepfather, uncle, grandfather or brother. Although less common, there are incidents in which the abuser is female.

It is difficult to understand what drives an individual to sexually abuse a child; it is even more difficult to understand when the abuser is a family member or someone you love. Although little is known about the characteristics of sexual abusers, we do know that many perpetrators, or abusers, have themselves been sexually abused as children. Also, many of these individuals suffer from alcoholism, drug abuse problems or a variety of other psychiatric disturbances. It is important that the perpetrators of sexual abuse seek help. Often, psychiatric treatment is beneficial.

POSSIBLE WARNING SIGNS OF SEXUAL ABUSE
If a child spontaneously reports or suggests sexual abuse, it is crucial to take it seriously; children rarely make false accusations of sexual abuse. Unfortunately, very few children directly report sexual abuse. Because of this, it is helpful to be aware of some of the subtle cues that might indicate abuse is occurring. Below are some of the common symptoms that sexually abused children and adolescents often display.

INDICATIONS OF SEXUAL ABUSE IN CHILDREN AND ADOLESCENTS
Behavioral Signs

  • Sexualized behavior, for instance, children engaging in sexual play with dolls, or adolescents engaging in indiscriminate sexual activity
  • Acting-out behaviors such as running away or temper tantrums
  • Regressive behaviors such as thumb sucking, baby talk or curling up in fetal position
  • Poor school performance
  • Drug and/or alcohol abuse
  • Self-mutilating behaviors, cutting self or hurting self in other ways
  • Radical behavior change in any direction. For example, suddenly becoming a model child or suddenly beginning to act rebellious or unruly
  • Eating disturbances
  • Sleep disturbances, especially nightmares or insomnia
  • Difficulty concentrating

Emotional Signs

  • Depressed or sad mood
  • Feeling anxious in general or having fears of specific settings or circumstances, often related to the abusive situation
  • Perfectionism
  • Aggression
  • Withdrawal
  • Low self-esteem
  • Guilt, self-blame

Dissociation which in its mild form may include excessive daydreaming or a disconnection of feelings and experiences. More severe forms of dissociation, such as multiple personality disorder, may include adopting different and distinct personalities. The presence of multiple personalities is often displayed by rapid changes in mood, lapses in time or memory, and variations in skills and abilities.

Physical Signs

  • Abdominal pain
  • Genital, urethral or rectal pain, bleeding or abrasions
  • Sexually transmitted diseases
  • Recurrent urinary tract infections
  • Bed-wetting
  • Bed-soiling
  • Pregnancy

Remember, the presence of any one of these symptoms does not necessarily mean a child has been sexually abused. However, the presence of a combination of these symptoms should alert an adult to the need to investigate the possibility of past or current sexual abuse. If you are concerned, arrange for a diagnostic evaluation with a licensed physician or psychologist.

THE LONG-TERM EFFECTS OF SEXUAL ABUSE
Unfortunately, children who have been sexually abused are not always able to tell someone or get help. Although the abuse may have stopped or perhaps was only a single occurrence, failure to recognize or treat a sexually abused child can lead to a variety of emotional problems later in life. Recently, greater attention has been given to the unique difficulties survivors of sexual abuse must confront. Although every person's experience is different, some common long-term effects include:

  • Low self-esteem, feelings of self-hatred or shame.
  • An inability to trust, often leading to difficulties in establishing relationships.
  • Sexual difficulties or a lack of ability to feel sexual with individuals other than those with whom there is no attachment.
  • Continuation of the sexual abuse cycle: marrying an abusive partner or abusing one's own children.
  • Increase in alcohol or drug use, sometimes leading to substance abuse disorders.
  • Chronic abdominal, urinary tract or gynecological problems.
  • Repressed anger and hostility.
  • Depression and thoughts of suicide.
  • Anxiety or panic.
  • Eating disorders such as anorexia nervosa, an obsessive concern about food, weight and body image that leads to self-starvation; or bulimia, the destructive cycle of binge eating and purging.
  • Dissociative disorders, the most severe form being multiple personality disorder

THE NEED FOR TREATMENT
If you, or someone you know, has been sexually abused, there are a variety of helpful treatments available. These range from self-help groups to individual or group therapy to a combination of these treatments. Although psychotherapy is the most common form of treatment used to help sexual abuse victims, there are times when medications, such as antidepressants, can be helpful. If psychiatric problems have resulted from the sexual abuse, treatment targeting these difficulties also might be necessary.

Treatment helps reduce the shame and isolation that often follows abuse as well as helps people understand the wide range of conflicting, and often confusing emotional reactions to sexual abuse. Most importantly, treatment can help people realize that the abuse was not their fault or responsibility. The first step toward preventing and treating sexual abuse is accepting the fact that the victim does not provoke sexual abuse.

WHAT DO YOU DO IF YOU HAVE BEEN ABUSED?
Tell someone. You do not have to suffer the nightmare of sexual abuse alone. There is help available. The pain does not have to continue indefinitely. You may be experiencing one or more of the symptoms we have discussed or other problems that seem unrelated to sexual abuse. Addressing the problems of the abuse is likely to help alleviate many of your emotional difficulties. Do not be ashamed; you are not to blame.

WHAT DO YOU DO IF YOU SUSPECT YOUR CHILD, OR ANOTHER CHILD, HAS BEEN SEXUALLY ABUSED
Report it. If the abuse has occurred within your family, contact your local child protection agency. If the abuse has occurred outside of the family, report it to the police. Your first responsibility is to protect the child.

If a child even hints that sexual abuse has occurred, it is important to take it seriously. Allow the child to !talk freely and to feel safe talking to you. Disclosing abuse is a frightening experience, especially for a child. Show that you understand and believe the child. Help the child realize that he or she did not cause the abuse and is not to blame for it. Don't let the child suffer alone.

HOPE LIES IN LEARNING MORE
We have developed this pamphlet, part of our Learn to Understand Mental Illness program, to help you realize that survivors of sexual abuse need and deserve compassionate help. Reading this information may be your first step toward recovery.

If you can recognize the signs and symptoms of sexual abuse it may help you or someone else live a more healthy and fulfilling life.

Reprinted with permission from NAMI (National Alliance for the Mentally Ill) of Wishigan. The information in this publication is meant to compliment the advice and guidance of your health care professional, not replace it. Please consult with a licensed health care provider for help with these issues. For information, for help, for options, call 1-888-PATHWAY (728-4929).