Theoretical perspectives of male sexual abuse: conceptualization of a case study

The purpose of this article is to demonstrate the traumatic impact that sexual abuse can have on a young male's development by addressing mediating dispositions that can render a child vulnerable to the effects of sexual abuse. Consideration is given to three different theoretical perspectives that are not exclusive to male victims but shed light on the impact that sexual abuse can have on the development of a young boy. These perspectives include early family relationships and attachment theory, developmental psychopathology, and trauma theory. These theoretical lenses provide a conceptual understanding into why some victims are vulnerable to the effects of sexual abuse. Each theoretical view is applied to a case study of an adolescent male with a history of early trauma and sexual abuse. Clinical implications are discussed.     

Introduction: Queering Later Life

Summary

The field of sexual trauma developed from the sociopolitical movements of the feminist, rape, and child protection movements. As thinking in the field developed, however, it has been difficult to integrate the perspective of the male survivor of sexual trauma into these perspectives. Gay men, in particular, have been notably absent from the literature, except when their abuse history is discussed as an etiology for their sexuality. It is clear that gay men suffer violence and oppression in the form of homophobia—an abuse with a sexual focus. Integrating the experience of gay men who have suffered trauma into perspectives regarding sexual trauma offers a possibility to enhance understanding about, as well as prevention efforts against, the sexual abuse of children. This includes expanding definitions and vocabulary regarding sexual trauma, as well as recognizing the impact on mental health professionals of working with survivors of sexual trauma.     

Male victims of child sexual abuse

Despite the increased attention the subject of child sexual abuse has received in recent years, rarely has much consideration been given to the boys and adolescent males who are the victims of such abuse. That young girls are consistently the clear majority of sexual abuse victims is not disputed, however the extent to which they are the majority is in question. A review of existing literature has indicated that one of the leading factors for this inadvertent negligence in presenting a truer picture of the magnitude of the problem for male victims concerns the area of under-reporting of the incidence of abuse of young males. Under-reporting has served to give a false sense of the scope of child sexual abuse, particularly for male children. Many societal and methodological factors contribute to under-reporting. Reasons for the discrepancy in reporting abuse will be presented and implications for practice will be discussed.     

Who is advocating for children under six? Uncovering unmet needs in child advocacy centers

Evidence suggests that children under the age of 6 years are affected by trauma, yet there are few studies available to determine how well their needs are addressed in the mental health system. Child Advocacy Centers (CACs) offer a promising avenue for expanding the system of care for very young children exposed to sexual and/or physical abuse. This study used a mixed-methods approach to examine the type and extent of CAC services for very young children in one state. Quantitative results revealed that the youngest children were less likely to be referred for counseling and less likely to already be engaged in counseling when an investigation is initiated. Qualitative results from interviews with CAC advocates suggest that advocates have variable perceptions regarding the effects of trauma on young children, and they do not consistently receive training in the mental health needs of traumatized children under 6. Our results confirm the need for an expanded system of service delivery for the youngest and most vulnerable child maltreatment victims.     

Childhood victimization and subsequent adult revictimization assessed in a nationally representative sample of women and men

The purpose of this study was to identify whether experiences of childhood physical and/or sexual victimization would increase women's and men's risk for victimization in adulthood by different perpetrators (any perpetrator regardless of the relationship to the victim; intimate partner perpetrator; non-intimate perpetrator) using a nationally representative sample. Results of hierarchical logistic regression analyses indicated that childhood victimization increased the risk for adulthood victimization by any perpetrator for men and women, and by an intimate partner for women but not men. Female and male victims of physical and/or sexual child abuse are at higher risk for adult victimization by non-intimate perpetrators. These results suggest the appropriateness of interventions among adults or young adults who have been victims of child abuse, to prevent any future victimization in adulthood. To guide the development of such prevention programs, research is needed to identify factors that affect the probability of adulthood victimization among child abuse victims.     

The fate of the sexually abused child

This article emphasizes the importance of understanding the specific meaning of sexual abuse to the particular child in his/her particular developmental stage. A critique of the research is presented, along with discussion of the psychodynamic impact of sexual abuse on the developing ego of the child. The primary means of adaptation following the trauma are (1) identification with the aggressor and (2) the repetition compulsion. It is also suggested that Freud's seduction theory can coexist with his later fantasy theory. Two case vignettes are presented to highlight the theoretical discussion.     

Impact Evaluation of a Cognitive Behavioral Group Therapy Model in Brazilian Sexually Abused Girls

This study evaluated the impact of a cognitive behavioral group therapy model in Brazilian girls who had experienced sexual abuse. The effect of the waiting period before treatment and the enduring effectiveness of the treatment after six and 12 months were also evaluated. Forty-nine female sexual abuse victims between the ages of 9 and 16 completed instruments measuring depression, anxiety, stress, and post-traumatic stress disorder before, during, and after the group therapy. The group therapy had a positive impact on their psychological functioning, significantly reducing symptoms of anxiety, stress, and post-traumatic stress disorder. The therapeutic effects lasted six to 12 months after the treatment ended. The model proved effective for treating young female victims of sexual abuse.     

Predatory Priests: Sexually Abusing Fathers

The media, the public, and the Church have spotlighted the effects of the scandals on the Church rather than the effects of priest abuse on its victims. Child sexual abuse has ominous relational implications for its victims. It often results in distrust of authority; seeing relationships in hierarchical, exploitative terms; distance and isolation; and fear of relating. Dissociation, an adaptive response to trauma, can become a characteristic, dysfunctional response to stress. Boys often have particular problems because of socialized masculine-gender norms that men are not victims and concerns about the implications of same-sex abuse for their sexual orientation. To these aftereffects, sexual abuse by a priest adds betrayal of spirituality, unconscious feelings that incest has occurred, and a crisis of faith arising from a sense that one has betrayed God. Examples from film, clinical practice, and an interview with a mental health professional sexually abused as a boy illustrate these points.     

Sexual trauma, spirituality, and psychopathology

This study assessed the association between spirituality and psychopathology in a group of sexual abuse victims and controls with a focus on whether spirituality moderated the association between sexual trauma and psychopathology. Seventy-one sexual trauma victims were compared to 25 control subjects on spiritual well-being, the Eating Disorder Examination, the PTSD Symptom Scale, and the SCID-I/P. The data showed that the two groups did not differ in terms of spiritual well-being. Sexual trauma status was associated with most of the psychopathology outcomes, but its impact on psychopathology was largely unmoderated by spirituality. Among sexual trauma victims, the level of spiritual well-being did not alter the probability of current psychopathology. However, increased spiritual well-being was generally associated with lower psychopathology for the entire sample.     

Maladaptive Schemas as Mediators in the Relationship Between Child Sexual Abuse and Displaced Aggression

Child sexual abuse is one of the most serious forms of abuse due to the psychological consequences that persist even into adulthood. Expressions of anger among child sexual abuse survivors remain common even years after the event. While child sexual abuse has been extensively studied, the expression of displaced aggression has been studied less. Some factors, such as the maladaptive early schemas, might account for this deficiency. The objective of this study was to analyze the relationships between child sexual abuse, displaced aggression, and these schemas according to gender and determine if these early schemas mediate the relationship between child sexual abuse and displaced aggression. A total of 168 Spanish subjects who were victims of child sexual abuse completed measures of childhood trauma, displaced aggression, and early maladaptive schemas. The results depict the relationship between child sexual abuse, displaced aggression, and early maladaptive schemas. Women scored higher than men in child sexual abuse, emotional abuse, disconnection or rejection and impaired autonomy. Mediational analysis found a significant mediation effect of disconnection or rejection on the relationship between child sexual abuse and displaced aggression; however, impaired autonomy did not mediate significantly.     

Therapeutic management of preschool cases of alleged but unsubstantiated sexual abuse

Alleged sexual abuse among preschoolers is often difficult to substantiate, and is rarely criminally prosecuted. Yet very young children are vulnerable when abuse is suspected but cannot be proven. These cases call for a special form of structured therapeutic management that seeks to inhibit the possibility of abuse while buying time for these very young children so that potential later abuse can be reported more accurately.     

Conversations of Care: A Narrative Review of Collaborative Care Systems for Foster and Kinship Care

This paper reviews the literature on human relational factors and their impact on complex care systems for a highly vulnerable population of children and young people in out‐of‐home care (OOHC). Factors contributing to the functioning of collaborative OOHC systems are reviewed from theoretical and contextual perspectives. The authors posit that secondary traumatic stress and vicarious trauma are central to understanding the impact of relational trauma and the experience of individuals, families, teams, and the wider ecology of collaborative care systems. Given the challenges of working collaboratively across interpersonal, family, and systems boundaries to support traumatised children in OOHC, further research is required.     

When the levee breaks: treating adolescents and families in the aftermath of hurricane katrina

Hurricane Katrina brought to the surface serious questions about the capacity of the public health system to respond to community-wide disaster. The storm and its aftermath severed developmentally protective family and community ties; thus its consequences are expected to be particularly acute for vulnerable adolescents. Research confirms that teens are at risk for a range of negative outcomes under conditions of life stress and family disorganization. Specifically, the multiple interacting risk factors for substance abuse in adolescence may be compounded when families and communities have experienced a major trauma. Further, existing service structures and treatments for working with young disaster victims may not address their risk for co-occurring substance abuse and traumatic stress reactions because they tend to be individually or peer group focused, and fail to consider the multi-systemic aspects of disaster recovery. This article proposes an innovative family-based intervention for young disaster victims, based on an empirically supported model for adolescent substance abuse, Multidimensional Family Therapy (MDFT; Liddle, 2002). Outcomes and mechanisms of the model's effects are being investigated in a randomized clinical trial with clinically referred substance-abusing teens in a New Orleans area community impacted by Hurricane Katrina.     

A relational understanding of the needs of siblings of children who have been sexually abused

This participatory research project highlighted the views and experiences of young people who are the brothers and sisters of children and young people who have experienced child sexual abuse. By working with young people who had experienced sexual abuse and their siblings, this practitioner research sought to give these young people a voice. The research involved a group process with young people who have experienced sexual abuse and have siblings, and one-to-one online consultations with the brothers and sisters of young people who have experienced abuse. All the young people spoke of their sibling and family relationships as unique and requiring unique responses to these relationships by services and health-care professionals. Siblings’ needs in the aftermath of a child sexual abuse discovery are often overlooked. This research describes how just as children who have experienced sexual abuse may feel anger, fear, guilt, shame, anxiety, and confusion, so do their siblings. Brothers and sisters of young people who have experienced sexual abuse describe significant relational trauma with intense emotional experiences of isolation, confusion, sadness, and anger. There is a real need to support young people and families to find words and develop capacities to talk about child sexual abuse -- a need to find supportive ways to speak about what has occurred and understand its impact on all. The study clearly demonstrated the significant level of need and impact on brothers and sisters of young people who have experienced sexual abuse.     

Victim to Victimizer: The Psychology of Isomorphism in a Case of a Recidivist Pedophile in Finland

ABSTRACT

An extreme case of a six victim, 38-year-old recidivist sex offender was selected for examining the isomorphic relationships between child sexual abuse trauma and adult sex offenses. This sex offender had victimized children of both sexes and an adult woman. Life history, letter, file, and the Adult Attachment Interview information were analyzed to seek the relations between childhood abuse experiences and adult offending. Both subjective reports and file data revealed that the man had experienced severe physical, psychological, and sexual abuse in childhood. His pattern of sexual offending against children was similar to his own experiences of sexual abuse by his father. The age of the child victims fell in the range of his age at the time of the childhood sexual abuse. Moreover, the use of coercion to gain victim compliance resembled the way his father had acted towards him. The pedophile's offending behavior was interpreted using the isomorphic and attachment perspectives.     

Elder Sexual Abuse in Britian:

Ninety cases of suspected elder sexual abuse were identified by professionals working with vulnerable elderly people in Britain. A female to male victim ratio of 6:1 was indicated and some 85% of all victims were aged 75 years and over. In all but two cases, the abuser was male. Almost 90% of the victims were dependent on their abusers for care. Preliminary findings of the study are presented and the implications of the research are considered.     

Family Responses to Young People Who have Sexually Abused: Anger,Ambivalence and Acceptance

Data on 117 British young people who had sexually abused others were examined in order to investigate the nature and impact of family responses on the management of young sexual abusers. Parental responses were varied, ranging from being entirely supportive of the child, through to ambivalence and uncertainty and, at the other end of the continuum, to outright rejection. Parents were more likely to be supportive when their child's victims were extra‐familial and condemnatory when the victims were intra‐familial. Sibling responses were complex and strongly influenced by whether that sibling was the victim of the young person's abuse or not. Policy and practice implications are discussed.     

Study of Cases of Child Sexual Abuse Referred for Medico-Legal Examination in Cairo and Giza,Egypt,2007–2011

ABSTRACT

Child sexual abuse is a complex problem that results in detrimental effects on its victims. This study aimed to investigate the pattern of child sexual abuse in cases referred for medico-legal examination in Cairo and Giza governorates in the period between 2007–2011. The study included 813 cases of child sexual abuse. Female gender was more predominant than male gender (52.8%, 4.29 cases), and adolescents were the most frequent age group identified as victims of sexual abuse (43.8%, 356 cases). All perpetrators were male and most of them were persons outside the victims’ families (89.9%, 731 cases). It was recommended to teach and encourage children to tell their caregivers if they have been assaulted and to educate parents and caregivers on how to respond when the child discloses sexual abuse.     

The Place of Culture and Religion in Patterns of Disclosure and Reporting Sexual Abuse of Males: A Case Study of Ultra Orthodox Male Victims

ABSTRACT

This article deals with reporting patterns of sexual abuse in males in a religious-cultural context through a case study of ultra-Orthodox Jewish (Haredi) men who were young victims of sexual abuse. The study is based on in-depth interviews with 40 Haredi men. The results indicate that sexual abuse involving ultra-Orthodox boys was and is underreported. Moreover, the results indicate that even when such incidents were reported, the avenues for disclosure were parents, educational-religious figures, and friends. It was also found that silencing in matters related to sexuality, viewing sexual abuse in boys as a serious sin and taboo, and encouraging blind obedience—all of which characterize Haredi society—were factors in the underreporting. The results also show a strong tendency to cover up incidents of sexual abuse on an individual level, on a family level, and at the community level. The findings indicate a linkage between the religious and cultural background of male victims of sexual abuse and their reporting patterns.     

Understanding child sexual abuse by Catholic priests from a situational perspective

Most sexual offense research focuses on offender motivation and individual risk factors rather than the criminal events themselves. This article provides an analysis of data from two studies on child sexual abuse by Catholic priests to help understand the opportunities clergy had or created to abuse youth. Findings show that situational factors played a role in victim choice among a heterogeneous group of abusers. Priests abused more male than female victims and had significantly greater access to male youth historically. When access to female youth increased in the 1990s, abuse of females as a percentage of victims also increased. The article concludes with a discussion about how ecological information can be used to craft intervention policies to prevent sexual offenses.