Chapter 4
Child Sexual Abuse

Many experts believe that sexual abuse is the most underreported type of child maltreatment. A victim, especially a young child, may not know what he or she is experiencing. In many cases the child was threatened to keep it secret. Adults who may be aware of the abuse sometimes get involved in a conspiracy of silence.

Child sexual abuse is the ultimate misuse of an adult's trust and power over a child. When the abuser is particularly close to the victim, the child feels betrayed and trapped in a situation where an adult who claims to care for the child is assaulting him or her. Familial abuse, or incest, involves the use of a child for sexual satisfaction by a family member—a blood relative who is too close to marry legally. Extrafamilial abuse involves a person outside the family. Extrafamilial predators may be strangers, but they may also be people in a position of trust, such as family friends, teachers, and spiritual advisers.

WHAT IS CHILD SEXUAL ABUSE?

Federal Definition

The Child Abuse Prevention and Treatment Act of 1974 (CAPTA) specifically identified parents and caretakers as the perpetrators of sexual abuse. Sexual molestation by other individuals was considered sexual assault. The 1996 amendments to this law, however, included a more comprehensive definition, one that also included sexually abusive behavior by individuals other than parents and caregivers.

The CAPTA Amendments of 1996 defined child sexual abuse as:

• The employment, use, persuasion, inducement, enticement, or coercion of any child to engage in, or assist any other person to engage in, any sexually explicit conduct or simulation of such conduct for the purpose of producing a visual depiction of such conduct
• The rape, and in cases of caretaker or interfamilial relationships, statutory rape, molestation, prostitution, or other form of sexual exploitation of children, or incest with children

State Definitions Vary

Whereas the federal government has established a broad definition of child sexual abuse, it leaves it up to state child abuse laws to specify detailed provisions. All states have laws prohibiting child sexual molestation and generally consider incest illegal. States also specify the age of consent, or the age at which a person can consent to sexual activity with an adult—generally between the ages of fourteen and eighteen. Sexual activity with children below the age of consent is considered statutory rape and is against the law. (See Table 4.1.)

HOW FREQUENT IS CHILD SEXUAL ABUSE?

Each year the National Child Abuse and Neglect Data System of the U.S. Department of Health and Human Services (HHS) collects child maltreatment data from child protective services (CPS) agencies in the fifty states and the District of Columbia, releasing the compiled information as Child Maltreatment. The federally mandated National Incidence Study of Child Abuse and Neglect (NIS) is another source that shows the extent of child sexual abuse. As of this writing, three national incidence studies had been conducted: NIS-1 (1980), NIS-2 (1986), and NIS-3 (1993). In 2003 the Keeping Children and Families Safe Act, which reauthorized CAPTA and authorized an additional $285 million for child abuse and neglect prevention programs, directed the collection of data for NIS-4, which was expected to be available by February 2008. A third source of sexual abuse data are retrospective studies, which are surveys

of adults about their childhood experience of sexual abuse. Within this source type are periodic federal government surveys of jail inmates and prisoners regarding their experience of child sexual abuse.

According to the HHS, in 2000 the number of sexual abuse cases reported by CPS agencies in the United States was 87,770. In 2004 the number of sexual abuse cases was down to 84,398. (See Table 4.2.)

It is important to note that these numbers represent only cases that were reported and substantiated; unknown numbers of child sexual abuse cases are undiscovered. The secrecy surrounding child abuse makes it virtually impossible to count the cases perpetrated in the family. However, retrospective studies of adults are one attempt to get a true picture of the prevalence of child sexual abuse.

In "The Victimization of Children and Youth: A Comprehensive, National Survey" (Child Maltreatment, February 2005), a study of a nationally representative sample of one thousand children and youth ages two to seventeen, David Finkelhor et al. find that more than half of the children had been victimized in the previous year, either by a physical assault, a property offense, a form of child maltreatment, a sexual victimization, or a form of indirect victimization, such as witnessing an act of violence. One youth out of twelve had been sexually victimized in the study year.

Determining the Extent of Child Sexual Abuse through Retrospective Studies

David Finkelhor is a national authority on child sexual abuse. In "Current Information on the Scope and Nature of Child Sexual Abuse" (The Future of Children: Sexual Abuse of Children, Summer-Fall 1994), Finkelhor notes that surveys of adults regarding their childhood experiences (called retrospective studies) probably give the most complete estimates of the actual extent of child sexual abuse. He reviews nineteen adult retrospective surveys and finds that the proportion of adults who indicated sexual abuse during childhood ranged widely, from 2% to 62% for females and from 3% to 16% for males.

Finkelhor observes that the surveys that reported higher levels of abuse were those that asked multiple questions about the possibility of abuse. Multiple questions are more effective because they provide respondents various "cues" about the different kinds of experiences the researchers are asking about. Multiple questions also give the respondents ample time to overcome their embarrassment. Many experts accept the estimate that one out of five (20%) American women and one out of ten (10%) American men have experienced some form of childhood sexual abuse (CSA).

One of the early landmark studies of child sexual abuse was conducted by the sociologist Diana E. H. Russell in 1978. Russell surveyed 930 adult women in San Francisco about their early sexual experiences and reported her findings in The Secret Trauma: Incest in the Lives of Girls and Women (1986). Russell noted that 38% of the women had suffered incestuous and extrafamilial sexual abuse before their eighteenth birthday. About 16% had been abused by a family member.

Russell's study is still frequently cited by experts who believe that much more abuse occurs than is officially reported by government studies. They suggest the high results recorded in her study reflect the thoroughness of her preparation. While other studies ask one question concerning CSA, she asked fourteen different questions, any one of which might have set off a memory of sexual abuse.

In The Epidemic of Rape and Child Sexual Abuse in the United States (2000), Diana E. H. Russell and Rebecca M. Bolen revisit the prevalence rates reported in Russell's 1978 survey. Russell and Bolen believe those rates are underestimated. The 1978 survey subjects did not include two groups regarded to be highly probable victims of child sexual abuse: females in institutions and those not living at home. Russell and Bolen also find that some women were reluctant to reveal experiences of abuse to survey interviewers, whereas others did not recall these experiences.

Are Child Sexual Abuse Cases Declining?

According to CPS agencies across the United States, reported and substantiated cases of child sexual abuse have declined since 1992. Substantiated, or confirmed, cases of sexual abuse of children dropped from a peak of 150,000 in 1992 to less than 90,000 in 2000, a decrease of 40%. (See Figure 4.1.) Substantiated child abuse cases dropped to 84,398 victims in 2004, according to the HHS. (See Table 4.2.)

Lisa M. Jones and David Finkelhor examine in The Decline in Child Sexual Abuse Cases (January 2001, http://www.ncjrs.gov/html/ojjdp/jjbul2001_1_1/contents.html) the possible factors responsible for this decline. They find that between 1990 and 1992 just three states experienced a decrease in cases of substantiated child sexual abuse, compared with fourteen states reporting increases of 20% or more. The decreasing trend started between 1992 and 1994, with twenty-two states reporting a decline of 20% or more, followed by eighteen states reporting declines between 1994 and 1996. From 1996 to 1998 thirteen states showed decreases of substantiated child sexual abuse cases. (See Figure 4.2.)

According to Jones and Finkelhor, several factors may have influenced the decline in substantiated cases of child sexual abuse. (See Figure 4.3.) Since the 1990s the incidence of child sexual abuse may have been reduced by factors such as child victimization prevention programs, incarceration of sexual offenders, treatment programs for sex offenders, and other variables. These variables include female victimization by intimate partners and poverty. In other words, declining trends in these causal variables may play a role in the decreasing cases of child sexual abuse. Experts show a 30% to 60% overlap in the victimization of children and the victimization of their mothers (Amy M. Slep and Susan G. O'Leary, "Parent and Partner Violence in Families with Young Children: Rates, Patterns, and Connections," Journal of Consulting and Clinical Psychology, June 2005; and Emiko A Tajima, "Correlates of the Co-occurrence of Wife Abuse and Child Abuse among a Representative Sample," Journal of Family Violence, December 2004).

Jones and Finkelhor suggest that the drop in reports of child sexual abuse from 1991 to 1998 might also be because of people's reluctance to report their suspicions because of widely publicized cases of false accusations. The public and mandated reporters, such as health care professionals, may also have learned accurate identification of the signs of abuse. In addition, the large numbers of sexual abuse cases that had surfaced as a result of increased vigilance starting in the 1980s may have been exhausted.

The investigation of child sexual abuse may have changed in scope. Jones and Finkelhor note that some CPS agencies may not be screening certain cases, such as sexual abuse by nonfamily members. Agencies with large caseloads may be investigating only cases they deem serious enough to warrant their time. These factors also affect the sexual abuse count. Changes in agency criteria of which investigated cases are substantiated may also affect the final count of substantiated cases.

Jones and Finkelhor point out that if declining numbers of child sexual abuse resulted from intimidation of child abuse reporters or changes in CPS investigative and substantiating policies, more research is needed. They suggest better training of professionals in identifying abuse. They also recommend exploring the cases that had not been investigated or substantiated and the changes in CPS procedures that may have caused the decline.

In the report Explanations for the Decline in Child Sexual Abuse Cases (January 2004, http://www.ncjrs.gov/pdffiles1/ojjdp/199298.pdf), Finkelhor and Jones revisit the factors possibly influencing the decline. They examine, among other things, four states (Illinois, Minnesota, Oregon, and Pennsylvania) with large decreases in substantiated child sexual abuse, as well as extensive information from the 1990s. Finkelhor and Jones find little or no evidence that the decline resulted from CPS agencies not investigating certain cases or the diminishing number of older cases. They cannot determine whether or not fear of repercussions, such as lawsuits, had contributed to the decline in mandated reporting by physicians because the states had mixed results in physician reports.

Although Finkelhor and Jones find "no solid and convincing explanation" for the decline of child sexual abuse in the 1990s, they offer two pieces of evidence for some true decline in sexual abuse cases. One piece of evidence was the results of two self-reports of sexual assault (by nonfamily members) and sexual abuse (by family members). The other piece of evidence cited by Finkelhor and Jones was the National Crime Victimization Survey (NCVS), an annual survey of eighty thousand people over age twelve, which found an overall 56% decline in self-reported sexual assault against twelve- to seventeen-year-old juveniles between 1993 and 2000, with a 72% decline by family members. (See Figure 4.4.) The Minnesota Student Survey, administered five times between 1989 and 2001 to students in grades six, nine, and twelve (to more than one hundred thousand individuals), found a slight increase in the sexual abuse trend from 1989 to 1992, then a 22% decline for sexual abuse by family and nonfamily members. (See Figure 4.5.)

WHAT MAKES A VICTIM DISCLOSE?

Rochelle F. Hanson et al., in "Correlates of Adolescent Reports of Sexual Assault: Findings from the National Survey of Adolescents" (Child Maltreatment, November 2003), report on the factors that contribute to the likelihood that an adolescent will disclose sexual abuse. They also examine whether, among the different ethnic/racial groups, adolescents differ in rates of disclosure and in the factors contributing to that disclosure.

Participants in the National Survey of Adolescents were a random sample of 4,023 U.S. adolescents ages twelve to seventeen. The sample was made up of 51.3% males and 48.7% females. A majority (70.2%) were white non-Hispanic. The children were grouped into several age cohorts. Interviews were conducted by telephone, with the consent of the parent or guardian.

A total of 326 adolescents (8.1%) indicated that they had experienced child sexual abuse. Approximately four out of five of those reporting child sexual abuse (78.1%) were female, and one out of five (21.9%) were male. Most (58.2%) were white, 23.6% were African-American, and 9.4% were Hispanic. Other ethnic groups made up the remaining 8.8% of child sexual abuse victims.

Of the 326 victims almost one-third (30.7%) had been raped, more than one-quarter (26.8%) reported fearing for their life during the assault, and about 10% had suffered physical injuries. Alcohol or drugs were involved in 6.7% of the incidents. Single incidents were reported by about two-thirds (64.1%) of the victims. Three-quarters (76.4%) knew the perpetrator. Specifically, 4.3% identified their father or stepfather as the abuser, 17.5% named another relative, 52.8% reported an unrelated acquaintance, and 1.8% knew the perpetrator but did not identify the person. Nearly one-quarter (23%) said the perpetrator was a stranger, and two victims did not name the perpetrator.

About two-thirds (68.1%) of the victims told interviewers they disclosed their sexual abuse to someone. Just 4.5% of those who disclosed first told a police officer or social worker. One-third (34.3%) told their mother or stepmother, and more than a third (39.3%) told a close friend. The other victims told another relative (6.1%), a teacher (1.8%), a father or stepfather (1.7%), or a doctor or other health professional (1.3%). About 3.4% indicated they disclosed the abuse to someone but did not say who it was. Another 3.9% would not say who they told of the abuse or could not remember who they first told. Overall, just one-third (33.6%) indicated they ever reported the abuse to police or other authorities.

More females (74%) than males (46.5%) disclosed to someone that they had been sexually abused. White victims (75.1%) were more likely than Hispanics (67.7%) and African-Americans (55.8%) to tell someone of their abuse. Those who feared for their lives during the assault were especially likely to disclose the abuse (80.7%). Other factors that were related to high levels of disclosure were having suffered physical injury (70.6%), having used substances (68.2%), having been assaulted once (67.9%), or having experienced a penetration assault (72%). The likelihood of telling someone of the abuse was also influenced by the relationship between the victim and the perpetrator. Nearly nine out of ten victims (87.7%) who were sexually abused by a relative disclosed the incident, compared with those abused by a stranger (70.7%), an unrelated acquaintance (62.2%), or a father (57.1%).

The study shows that the gender of the adolescent is related to disclosure of sexual abuse, with girls more likely to do so. Hanson et al. reiterate previous findings that males might fear being thought of as gay if the abuser was male. Hanson et al. also note that other studies show that African-American females are reluctant to disclose sexual abuse because of fear of not being believed. Although no similar studies have been done of their male counterparts, Hanson et al. think the same reason might keep African-American male adolescents from reporting child sexual abuse. In this study African-American females were seven times more likely than their male counterparts to tell someone they had experienced sexual abuse. White adolescents did not differ in disclosure of abuse based on gender.

VICTIMS

Who Is Sexually Abused?

Most studies indicate that girls are far more likely than boys to suffer sexual abuse. Under the Harm and Endangerment Standards discussed by Andrea J. Sedlak and Diane D. Broadhurst in NIS-3, girls were sexually abused about three times more often than boys.

In "Childhood Sexual Abuse among Black Women and White Women from Two-Parent Families" (Child Maltreatment, August 2006), a retrospective study, Maryann Amodeo et al. examine 290 African-American and white women to determine differences in prevalence of CSA. Amodeo et al. used questionnaires and face-to-face interviews, as well as interviews with siblings, to determine whether child sexual abuse had occurred. African-American women showed a higher prevalence of child sexual abuse than did white women (34.1% and 22.8%, respectively).

Sarah E. Ullman and Henrietta Filipas find in "Ethnicity and Child Sexual Abuse Experiences of Female College Students" (Journal of Child Sexual Abuse, 2005) racial and ethnic differences in their retrospective study using a sample of 461 female college students. Analysis of their survey reveals that African-Americans reported more sexual abuse than other groups, followed by Hispanics, whites, and Asians.

Is Sexual Abuse of Boys Underreported?

William C. Holmes and Gail B. Slap claim that sexual abuse of boys is not only common but also underreported and undertreated. In "Sexual Abuse of Boys: Definition, Prevalence, Correlates, Sequelae, and Management" (Journal of the American Medical Association, December 2, 1998), they review 149 studies of male sexual abuse. These studies, conducted between 1985 and 1997, included face-to-face interviews, telephone surveys, medical chart reviews, and computerized and paper questionnaires. The respondents included adolescents (ninth-through twelfth-graders, runaways, non-sex-offending delinquents, and detainees), college students, psychiatric patients, Native Americans, sex offenders (including serial rapists), substance-abusing patients, and homeless men. Holmes and Slap find that, overall, one out of five boys had been sexually abused.

Holmes and Slap note that boys younger than thirteen years of age, nonwhite, of low socioeconomic status, and not living with their fathers were at a higher risk for sexual abuse. Boys whose parents had abused alcohol, had criminal records, and were divorced, separated, or remarried were more likely to experience sexual abuse. Sexually abused boys were fifteen times more likely than boys who had never been sexually abused to live in families in which some members had also been sexually abused.

Start and Duration of Abuse

Kathleen A. Kendall-Tackett and Roberta Marshall, in "Sexual Victimization of Children: Incest and Child Sexual Abuse" (Raquel Kennedy Bergen, ed., Issues in Intimate Violence, 1998), report that studies find that the age of victims at the start of the abuse could be anywhere between seven and thirteen, although there had been cases of sexual abuse among children six years of age or younger. The sexual abuse may be a one-time occurrence or it may last for several years. Kendall-Tackett and Marshall find durations of abuse ranging from two and a half to eight years.

In the report Sexual Assault of Young Children as Reported to Law Enforcement: Victim, Incident, and Offender Characteristics (July 2000, http://www.ojp.usdoj.gov/bjs/pub/pdf/saycrle.pdf), Howard N. Snyder finds that 34.1% of all victims of sexual assault reported to law enforcement from 1991 to 1996 were under age twelve, with 14% under six years of age. (See Table 4.3.) (Some researchers distinguish between child sexual abuse as perpetrated by parents or caregivers and sexual assault as committed by other individuals. In this report, the term sexual assault included child sexual abuse.)

In Extent, Nature, and Consequences of Rape Victimization: Findings from the National Violence against Women Survey (January 2006, http://www.ncjrs.gov/pdffiles1/nij/210346.pdf), a study of rape using data from the National Violence against Women Survey, Patricia Tjaden and Nancy Thoennes find that 21.6% of women and 48% of men were under the age of twelve when they were first raped. Another 32.4% of women

and 23% of men were between ages twelve and seventeen. Therefore, more than half of all female rape victims and seven of ten male rape victims had been raped while children. (See Figure 4.6.)

In their research on male child victims, Holmes and Slap find that sexual abuse generally began before puberty. About 17% to 53% of the respondents reported repeated abuse, with some victimization continuing over periods of less than six months and some victimization enduring for eighteen to forty-eight months.

PERPETRATORS

Snyder finds that the abusers of young victims were more likely than the abusers of older victims to be family members. Sexual abusers whose victims were children five years old and younger were family members nearly half the time (48.6%), a number that decreased for those ages six to eleven (42.4%), and further decreased for victims ages twelve to seventeen (24.3%). (See Table 4.4.) More female victims (51.1% of those age five years and younger and 43.8% of those ages six to eleven) were abused by family members, compared with their male counterparts (42.4% of those age five years and younger and 37.7% of those ages six to eleven). (See Table 4.5.)

Fathers

Linda Meyer Williams and David Finkelhor, in The Characteristics of Incestuous Fathers (1992, http://eric.ed.gov/ERICDocs/data/ericdocs2/content_storage_01/0000000b/80/25/10/cb.pdf), find that, generally, incestuous fathers had lonely childhoods (82%). Almost half (47%) had not lived with their own fathers and had changed living arrangements (43%), perhaps as a result of parental divorce or remarriage. Their own parents' alcohol problem, however, was no different from that of the nonabused comparison group. Incestuous fathers were far more likely to have been juvenile delinquents and to have been rejected by their parents. Williams and Finkelhor also find that the sex education of incestuous fathers while growing up did not come from friends or peers, but from being victims of sexual abuse. About 70% had a history of sexual abuse, with 45% having multiple abusers. Nearly three out of five were sexually abused by nonfamily adults.

Women Who Abuse

For many years, experts thought female sex abusers were uncommon. When women were involved in abuse, it was thought to be a situation in which a man had forced the woman to commit the abuse. Some experts postulate that women are more maternal and, therefore, less likely to abuse a child. Women are also thought to have different attitudes toward sex. While a man ties his feelings of self-worth to his sexual experiences, a woman is supposedly less concerned with sexual prowess and tends to be more empathetic toward others.

Some researchers propose that the abusive behavior of women is influenced by severe psychiatric disturbance, mental retardation, brain damage, or male coercion. In A Comparative Analysis of Women Who Sexually Abuse Children (1990), C. Allen studies female offenders and finds that their lives involved particularly harsh childhoods marked by instability and abuse.

Comparing male and female offenders, Allen finds that the women reported more severe incidents of physical and emotional abuse in their pasts, had run away from home more often, were more sexually promiscuous than male offenders, and had more frequent incidents of being paid for sex. Because they perceived child sexual abuse as a great social deviance, female offenders were less likely to admit guilt. They were less cooperative than men during the investigations and were angrier with informants and investigators. Following disclosure, they also appeared to experience less guilt and sorrow than male offenders.

MOTHERS

Sexual abuse by mothers may remain undetected because it occurs at home and is either denied or never reported. Mothers generally have more intimate contact with their children, and the lines between maternal love and care and sexual abuse are not as clear-cut as they are for fathers. Furthermore, society is reluctant to see a woman as a perpetrator of incest, portraying the woman as someone likely to turn her pain inward into depression, compared with the man who acts out his anger in sexually criminal behavior.

Siblings

Sibling incest is another form of abuse that has not been well studied. Some experts, however, believe that sibling sexual abuse is more common than father-daughter incest. Vernon R. Wiehe, in "Sibling Abuse" (Understanding Family Violence: Treating and Preventing Partner, Child, Sibling, and Elder Abuse, 1998), believes that the problem of sibling incest has not received much attention because of the families' reluctance to report to authorities that such abuse is happening at home, the parents' playing down the fact that "it" is indeed a problem, and the perception that it is normal for brothers and sisters to explore their sexuality. Wiehe believes that sexual abuse by a sibling should be considered a crime of rape because the perpetrator uses aggression, force, or threats. Moreover, the consequences to the victim are the same whether the sexual abuse takes the form of fondling or intercourse.

Mireille Cir et al. find in "Intrafamilial Sexual Abuse: Brother-Sister Incest Does Not Differ from Father-Daughter and Stepfather-Stepdaughter Incest" (Child Abuse and Neglect, September 2002) that there were few differences between sexual abuse perpetrated by fathers, stepfathers, or brothers in their survey of seventy-two sexually abused girls between the ages of five and sixteen. They find that penetration was much more frequent in the brother-sister incest group (70.8%) than in the stepfather-stepdaughter incest group (27.3%) or the father-daughter incest group (34.8%). They also find that nine out of ten girls abused by their brothers showed clinically significant traumatic stress. These findings show that sexual abuse perpetrated by a sibling should be taken seriously.

Educators

Sex between educators and students is nothing new. However, except for sensational cases, such as that of Washington teacher Mary Kay Letourneau who was charged with child rape of her twelve-year-old student and served a seven-and-a-half-year prison term, other cases have not received much attention. Some experts observe that there seems to be a double standard in cases involving a female teacher and a male student. They point to an example in New Jersey. In 2002 Superior Court judge Bruce A. Gaeta refused to sentence Pamela Diehl-Moore to prison for pleading guilty to sexual assault and instead ordered probation. The teacher admitted having sex for six months with a thirteen-year-old student. The judge claimed he saw no harm done to the student and that the relationship might have been a way for the boy to satisfy his sexual needs. Gaeta received public reprimand for his comments. Diehl-Moore was sentenced to three years in prison on appeal.

In 2004 Charol Shakeshaft reported that no national study of public school educators who have abused students had even been done. In compliance with the No Child Left Behind Act of 2001, the U.S. Department of Education commissioned Shakeshaft to conduct a national study of sexual abuse in schools. After identifying about nine hundred literature citations that discussed educator sexual misconduct and contacting over one thousand researchers, educators, and policy makers on the issue, Shakeshaft found just fourteen U.S. and five Canadian/British empirical studies on educator sexual misconduct. (Empirical studies are based on practical observations and not theory.) With scant empirical studies on hand, she based her conclusion on two American Association of University Women Hostile Hallways surveys conducted in 1993 and 2000 involving about 2,065 public school students in eighth and eleventh grades. Both were Shakeshaft's own work. In addition, Shake-shaft used her 2003 reanalysis of the surveys for additional data on educator sexual misconduct.

In the report Educator Sexual Misconduct: A Synthesis of Existing Literature (2004, http://www.ed.gov/rschstat/research/pubs/misconductreview/report.pdf), Shakeshaft projects the numbers in her surveys to the whole public school system. She concludes that 9.6% of public school children, accounting for 4.5 million students, experienced sexual misconduct—ranging from being told sexual jokes, to being shown pictures of a sexual nature, to sexual intercourse—by educators. Educators included teachers and other school officials, such as principals, coaches, counselors, substitute teachers, teacher's aides, security guards, bus drivers, and other employees.

The studies Shakeshaft analyzes do not reveal the number or proportion of educators who were perpetrators of sexual misconduct. However, Shakeshaft's surveys show that perpetrators of sexual misconduct against students in schools were 18% teachers, 15% coaches, and 13% substitute teachers. Principals accounted for 6%, and school counselors made up 5%. (See Table 4.6.) Shake-shaft observes that teachers whose jobs involve dealing with individual students, such as coaches and music teachers, are more likely than other educators to sexually abuse students. With regard to the gender of the perpetrators, the different studies Shakeshaft surveys show a range of 4% to 42.8% for female educators and a range of 57.2% to 96% for male educators.

Babysitters

As more and more working parents depend on outside help to care for their children, the possibility of abuse by babysitters has grown. In Crimes against Children by Babysitters (September 2001, http://www.ncjrs.gov/pdffiles1/ojjdp/189102.pdf), David Finkelhor and Richard K. Ormrod examined 1,427 victimizations of children by babysitters. They used information from jurisdictions in seventeen states reported to the Federal Bureau of Investigation (FBI) in 1995 through 1998. (Nationwide data on babysitter abuse was not available.) In this study, "babysitter" referred to people who were paid to care for children on a temporary basis in their own home or in the home of the child. This definition purposely excluded family members and school or other day care programs.

Finkelhor and Ormrod report that about two-thirds (65%) of the babysitter offenses studied were sex offenses. Forcible fondling comprised 41% of the offenses, followed by 11% of sodomy and 9% of rape. Another 3% represented sexual assault with an object. (See Figure 4.7.) In comparison, simple assault accounted for approximately 25% of babysitter offenses, and aggravated assault accounted for another 9%. Finkelhor and Ormrod note that minor forms of abuse are less likely to have been reported to the police (and included in their data), and that older children are less likely to be cared for by babysitters.

Overall, 63% of babysitters reported for offenses against children were male and 37% were female. The high representation of male abusers is particularly noteworthy when the fact that male babysitters are less common than female babysitters is considered. Males were especially likely to be involved in sexual offenses, accounting for 77% of these cases. A majority (71%) of male sex offenders victimized females and more than half (54%) victimized children under six years of age. Female sex offenders, however, nearly equally victimized female (46%) and male (54%) children, and more than two-thirds (68%) of their victims were younger children under age six. (See Figure 4.8.) Female sex offenders were most likely to be adolescents ages thirteen to fifteen (67%), male sex offenders tended to be adults (58%). Overall, more than 40% of all sexual abuse was perpetrated by babysitters between ages twelve and seventeen.

Sexual Abusers of Boys

Holmes and Slap find that more than 90% of the abusers of the sexually abused boys and young male adolescents in their study were male. Male abusers of older male teenagers and young male adults, however, made up 22% to 73% of perpetrators. This older age group also experienced abuse by females, ranging from 27% to 78%. Adolescent babysitters accounted for up to half of female sexual abusers of younger boys.

More than half of those who sexually abused male children were not family members but were known to the victims. Boys younger than six years old were more likely to be sexually abused by family and acquaintances, whereas those older than twelve were more likely to be victims of strangers. While male perpetrators used phys-ical force, with threats of physical harm increasing with victim age, female perpetrators used persuasion and promises of special favors. One study reviewed by Holmes and Slap found that up to one-third of boys participated in the abuse out of curiosity.

Priests

Public concern about sexual abuse by priests skyrocketed in the early twenty-first century as a result of a scandal surrounding abuse and cover-ups within the Catholic Church. On July 23, 2003, Massachusetts Attorney General Thomas F. Reilly released the report The Sexual Abuse of Children in the Roman Catholic Archdiocese of Boston: A Report by the Attorney General (http://www.ago.state.ma.us/filelibrary/archdiocese.pdf), describing the culture of secrecy involving the sexual abuse of an estimated one thousand minors in the archdiocese of Boston since 1940. Reilly's eighteen-month investigation finds that "there is overwhelming evidence that for many years Cardinal [Bernard] Law and his senior managers had direct, actual knowledge that substantial numbers of children in the Archdiocese had been sexually abused by substantial numbers of its priests."

Attorney General Reilly started the investigation in March 2002 soon after John Geoghan, a former priest in the Archdiocese of Boston, was sentenced to nine to ten years in prison for sexually abusing a ten-year-old boy. Reilly's investigators found that starting in 1979 the archdiocese had received complaints of child sexual abuse against Geoghan. Church documents, which had previously been sealed, revealed that the church not only moved him from parish to parish but had also paid settlements amounting to $15 million to the victims' families. Reilly reported that the archdiocese's own files showed that 789 people had brought sexual complaints against the Boston clergy. The attorney general believed the actual number of victims is higher. There were 237 priests and church workers who had been accused of rape and sexual assault.

EXTENT OF CHILD SEXUAL ABUSE BY PRIESTS

Responding to emerging allegations of sexual abuse by priests, in June 2002 the U.S. Conference of Catholic Bishops commissioned a study of the nature and scope of the problem of child sexual abuse in the Catholic Church. The John Jay College of Criminal Justice of the City University of New York conducted the study based on information provided by 195 dioceses, representing 98% of all diocesan priests in the United States. The researchers also collected data from 140 religious communities, accounting for about 60% of religious communities and 80% of all priests in the religious communities.

A report of the study was released in 2002. The Nature and Scope of the Problem of Sexual Abuse of Minors by Catholic Priests and Deacons in the United States (June 2002, http://www.usccb.org/nrb/johnjaystudy) covers the period from 1950 to 2002. Of the 109,694 priests and deacons (collectively referred to as priests) who served during this time period, 4,392 (4%) allegedly abused children under age eighteen. Most of these priests (55.7%) had a single allegation of abuse. Nearly 27% had two to three allegations, 13.9% had four to nine allegations, and 3.5% had ten or more allegations.

The report shows that 10,667 individuals made allegations of child sexual abuse by priests between 1950 and 2002. About 81% of the victims were male and 19% were female. About half (50.9%) were between the ages of eleven and fourteen. More than a quarter (27.3%) were fifteen to seventeen years old, 16% were ages eight to ten, and 6% were younger than seven. One survey question asked whether or not a sibling was also allegedly abused. Of the 6,350 individuals who provided this information, 1,842 answered "yes."

The largest number of allegations were made in the 1970s (35.3%) and the 1960s (26.1%). At the time of the allegations, most of the priests were serving in the capacity of pastors (25.1%), associate pastors (42.3%), and resident priests (10.4%). About 7.2% of the priests were teachers, 2.7% were chaplains, and 1.8% were seminary administrators or faculty members. The remaining 10.5% were bishops, vicars, cardinals, chancellors, deacons, seminarians, priests performing other functions, and priests who were relatives of the victims.

Most of the abuse occurred in the priest's home or parish residence (40.9%), in church (16.3%), and in the victim's home (12.4%). Nearly half (49.6%) of the priests socialized with the alleged victim's family, mostly (79.6%) in the family's home.

SEXUAL PREDATORS ON THE INTERNET

Many pedophiles find that the Internet gives them easy access to children. According to the report Internet Crimes against Children (February 2001, http://www.ojp.usdoj.gov/ovc/publications/bulletins/internet_2_2001/welcome.html) by the U.S. Department of Justice's Office for Victims of Crime, child predators who look for victims in places where children typically congregate, such as schoolyards, playgrounds, and shopping malls, now have cyberspace to commit their criminal acts. The Internet presents an even more attractive venue because predators can commit their crime anonymously and are able to contact the same child regularly. They may groom children online for the production of child pornography. They have been known to prey on vulnerable children, gaining their confidence online, and then meeting up with them for the purpose of engaging them in sex acts.

In October 2003 more than three-fourths (78.8%) of adolescents ages fourteen to seventeen used the Internet at some location. More than two-thirds (67.3%) of children ages ten to thirteen, 42% of children ages five to nine, and 19.9% of children ages three to four used the Internet. (See Table 4.7.)

Julian Fantino notes in "Child Pornography on the Internet: New Challenges Require New Ideas" (The Police Chief, December 2003) that more and more younger children are being used in child pornography, with a large proportion being infants and preschool children. Offenders form secret clubs, sharing modes of operation and protecting one another's identities. According to Fantino, in 2003 more than one hundred thousand Web sites contained child pornography.

National Survey on the Online Victimization of Children

In Online Victimization: A Report on the Nation's Youth (June 2000, http://www.missingkids.com/en_US/publications/NC62.pdf), the first national survey on the risks children face on the Internet, David Finkelhor, Kimberly J. Mitchell, and Janis Wolak find that nearly one out of five youths (19%) using the Internet in the past year had received an unwanted sexual solicitation or approach. Sexual solicitations involved requests to do sexual things

the children did not want to do, while sexual approaches involved incidents in which people tried to get children to talk about sex when they did not want to or asked them intimate questions. In addition, one out of four children (25%) reported at least one unwanted exposure to sexual material (pictures of naked people or people having sex) while surfing the Internet the past year. Michele L. Ybarra and Kimberly J. Mitchell, in "Exposure to Internet Pornography among Children and Adolescents: A National Survey" (CyberPsychology & Behavior, 2005, http://www.unh.edu/ccrc/pdf/jvq/CV76.pdf), show that 20% of youth between the ages of fourteen and seventeen and 8% of youth between the ages of ten and thirteen, primarily male, intentionally sought out pornographic materials on the Internet.

Teens Communicate with Strangers Online

In the report Teenage Life Online: The Rise of the Instant-Message Generation and the Internet's Impact on Friendships and Family Relationships (June 2001, http://www.pewinternet.org/pdfs/PIP_Teens_Report.pdf), Amanda Lenhart, Lee Rainie, and Oliver Lewis find that adolescents who have Internet access do communicate with strangers they meet online. About three out of five (60%) of online teens (ages twelve to seventeen) reported that they had received e-mails or instant messages from strangers. About 63% of those who had received e-mails or instant messages from strangers had answered such messages. Teens also said that they had lied about their age to get on a pornographic Web site. Boys (19%) were more likely than girls (11%) to have done so.

In 2006 parents, educators, and law enforcement officials sent out a warning about MySpace.com, a huge Web site designed to be an Internet chat room and hangout for teens and young adults, but which police say is attracting sexual predators. As many as fifty-eight million users post personal information on the site, including photos and Web logs (so-called blogs, containing journal-like postings from the user), sometimes with home addresses and phone numbers included. According to Jane Gordon, in "MySpace Draws a Questionable Crowd" (New York Times, February 26, 2006), in Connecticut police investigated several reports of sexual assaults of young girls between the ages of thirteen and fifteen that occurred after they met adult male suspects on the site. Anick Jesdanun reports in "MySpace Plans Adult Restrictions to Protect Teen Users" (Washington Post, June 21, 2006) that by June 2006 MySpace planned new restrictions on the interactions of adults over age eighteen and children under age sixteen on the site in response to criticisms.

EFFECTS OF CHILD SEXUAL ABUSE

According to the report Understanding Child Sexual Abuse: Education, Prevention, and Recovery (October 1999, http://www.apa.org/releases/sexabuse/), the American Psychological Association (APA) notes that children who have been sexually abused exhibit a range of symptoms. The immediate effects may include thumb sucking and/or bed wetting; sleep disturbances; eating problems; and school problems, including misconduct, problems with performing schoolwork, and failure to participate in activities.

The APA also details long-term effects of CSA. Adult victims of CSA may suffer from depression, sexual dysfunction, and anxiety. Anxiety may manifest itself in behaviors such as anxiety attacks, insomnia, and alcohol and drug abuse. Adult survivors of CSA also report revictimization, as rape victims or as victims of intimate physical abuse.

High-Risk Sexual Behaviors in Adolescent Girls

In "Sexual At-Risk Behaviors of Sexually Abused Adolescent Girls" (Journal of Child Sexual Abuse, 2003), a study of sexual at-risk behaviors of 125 female adolescents ages twelve to seventeen who had experienced sexual abuse, Caroline Cinq-Mars et al. administered a self-report questionnaire that asked about the subjects' sexual activities, not including sexual abuse experiences. Then the subjects were interviewed regarding their sexual abuse experiences, including information about the perpetrator (both family and nonfamily members), frequency and duration of abuse, severity of the abuse, and whether or not they told someone of the abuse.

Among offending family members, fathers were the perpetrators in 30.4% of incidents. Stepfathers and extended family members each were responsible for 28.8% of the sexual abuse, and brothers accounted for another 9.6% of abuse. The victims experienced more than one incident of sexual abuse, with the mean (average) number of perpetrators per victim being 1.8. The mean age for the start of abuse was 9.3 years. More than one-third (36.8%) of the victims experienced sexual abuse before age eleven.

More than half (55.3%) of the participants reported being sexually active. More than half (54.5%) had their first consensual intercourse before the age of fifteen. The rate of pregnancy was 15%. Cinq-Mars et al. find three sexual abuse characteristics that were associated with the adolescents' sexual at-risk behavior. Adolescents who experienced CSA involving penetration were more than thirteen times as likely to have been pregnant and twice as likely to have more than one consensual partner in the past year. Having been abused by more than one perpetrator (in one or more incidents) was also closely associated with at-risk behaviors—pregnancy (eight times as likely), more than one consensual sexual partner (four times as likely), and irregular condom use (three times as likely). Finally, physical coercion during abuse increased the odds of pregnancy (four times as likely), more than one consensual sexual partner (five times as likely), and irregular condom use (three times as likely).

Substance Abuse

Studies show that childhood abuse increases the risk for substance abuse later in life (see Christiane Brems et al., "Childhood Abuse History and Substance Use among Men and Women Receiving Detoxification Services," American Journal of Drug and Alcohol Abuse, November 2004; and Patricia B. Moran et al., "Associations between Types of Maltreatment and Substance Use during Adolescence," Child Abuse and Neglect, May 2004). Carl M. Anderson et al., in "Abnormal T2 Relaxation Time in the Cerebellar Vermis of Adults Sexually Abused in Childhood: Potential Role of the Vermis in Stress-Enhanced Risk for Drug Abuse" (Psychoneuroen-docrinology, January 2002), uncovered how this occurs. They find that the vermis, the region flanked by the cerebellar hemispheres of the brain, may play a key role in the risk for substance abuse among adults who have experienced child abuse. The vermis develops gradually and continues to produce neurons, or nerve cells, after birth. It is known to be sensitive to stress, so that stress can influence its development.

Anderson et al. compared young adults ages eighteen to twenty-two, including eight with a history of repeated CSA and sixteen others as the control group. Using functional magnetic resonance imaging technology, they measured the resting blood flow in the vermis. They find that the subjects who had been victims of CSA had diminished blood flow. Anderson et al. suggest that the stress experienced with repeated CSA may have caused damage to the vermis, which in turn could not perform its job of controlling irritability in the limbic system. The limbic system in the center of the brain, a collection of connected clusters of nerve cells, is responsible for, among other things, regulating emotions and memory. Therefore, the damaged vermis induces a person to use drugs or alcohol to suppress the irritability.

Because the CSA subjects had no history of alcohol or substance abuse, Anderson et al. wanted to confirm their findings, which linked an impaired cerebellar vermis and the potential for substance abuse in CSA victims. After analyzing test data collected from the 537 college students recruited for the study, they find that students who reported frequent substance abuse showed higher irritability in the limbic system. They also exhibited symptoms usually associated with drug use, including depression and anger.

A total of 1,478 noninjecting female sexual partners of male intravenous drug users were the subjects of a study by Robert C. Freeman, Karyn Collier, and Kathleen M. Parillo, in "Early Life Sexual Abuse as a Risk Factor for Crack Cocaine Use in a Sample of Community-Recruited Women at High Risk for Illicit Drug Use" (American Journal of Drug and Alcohol Abuse, February 2002). Nearly two-thirds (63.7%) of the women reported having used crack cocaine. Freeman, Collier, and Parillo find that an equal proportion of all women had suffered sexual abuse before age twelve (39.5%) and during adolescence (38.8%). Overall, nearly 22% were sexually abused during both childhood and adolescence.

While Freeman, Collier, and Parillo find a relationship between CSA and lifetime crack use, they find no direct link between sexual abuse during adolescence and lifetime crack use. They do find, however, some indirect connections between the two. Female teens who were victims of sexual abuse were more likely to run away, and these runaways were more likely to use crack because of the type of people with whom they associated.

Sexual Revictimization and Self-Harming Behaviors

In "Revictimization and Self-Harm in Females Who Experienced Childhood Sexual Abuse: Results from a Prospective Study" (Journal of Interpersonal Violence, December 2003), Jennie G. Noll et al. report on a longitudinal study that examines the impact of CSA on female development. This was the first prospective study that followed children from the time sexual abuse was reported through adolescence and into early adulthood. Referred by CPS agencies, the participants experienced sexual abuse by a family member before the age of fourteen. The median age at the start of sexual abuse was seven to eight years, and the median duration of abuse was two years. The group consisted of eighty-four abused children and a comparison group of eighty-two children. Two yearly interviews followed the first assessment of the group. A fourth interview was conducted four to five years after the third interview.

Noll et al. note that this study was the first to provide information about the revictimization of child sexual abuse survivors not long after their abuse (seven years after the abuse when the participants were in their adolescence and early adulthood). The study finds that participants who had been sexually abused during childhood were twice as likely as the comparison group to have experienced sexual revictimization, such as rape or sexual assault, and almost four times as likely to harm themselves through suicide attempts or self-mutilation. They also suffered about 1.6 times more physical victimization, such as domestic violence. Compared with the nonabused group, the abused group reported 20% more significant lifetime traumas subsequent to being sexually abused. Significant lifetime traumas reported by the participants included separation and losses (for example, having family or friends move away or die), emotional abuse and/or rejection by family, natural disasters, and witnessing violence.

Noll et al. observe that CSA is the "strongest predictor of self-harm," even when other types of abuse are present. They surmise that the victims may have negative feelings toward their own body and want to hurt it. Noll et al. write that some researchers believe victims may want to reveal internal pains through outward manifestation of self-harm. Others wish to reexperience feelings of shame in an attempt to resolve it.

Effects of Sexual Abuse by Women

Myriam S. Denov, in "The Long-Term Effects of Child Sexual Abuse by Female Perpetrators: A Qualitative Study of Male and Female Victims" (Journal of Interpersonal Violence, October 2004), conducted a qualitative study of the long-term effects of CSA by women. Unlike quantitative research, which involves collecting samples of quantitative data and performing some form of statistical analysis, qualitative research is based on a smaller sample of individuals and does not represent the general population. However, according to Denov, the qualitative approach "is particularly appropriate for a study of this nature as it can give depth and detail of phenomena that are difficult to convey with quantitative methods."

The study sample consisted of seven males and seven females, who ranged in age from twenty-three to fifty-nine years. The sexual abuse occurred when they were fourteen years old or younger. All participants reported at least one incident of sexual abuse by a lone female perpetrator. Five participants reported having been sexually abused by more than one lone perpetrator. Nine participants were abused by a female relative—six by their mother, two by their mother and grandmother, and one by his mother and sister. Four participants were abused by an unrelated person—three by a babysitter and one by a nun at a local church. While the study concerns abuse perpetrated by women, half (or seven) of the participants reported having also been sexually abused by a man (in a separate incident from the abuse by women)—four by their father, two by an unrelated male babysitter, and one by his older half-brother.

The sexual abuse started, on average, at age five and ended, on average, at age twelve. It lasted about six years. Five participants were abused more than once per week, three were abused once per week, and four were abused once per month. Two participants reported a single episode of abuse. All participants reported mild abuse (for example, kissing in a sexual way and sexual invitations). In addition, ten reported moderate abuse (genital contact or fondling [without penetration] and simulated intercourse). Nine participants experienced severe abuse (such as intercourse and penetration with fingers or objects).

Denov observes that while many effects of sexual abuse by females seem similar to that by males, female sexual abuse has long-term effects that are unique. Of the fourteen study participants, just one (a male) indicated he did not feel damaged by the sexual abuse by a woman. The other thirteen said they felt damaged by the abuse. All seven participants who were also abused by males reported that the sexual abuse by women was more damaging. The effects of child sexual abuse included substance abuse (used to "silence their rage and numb the pain"), self-injury, thoughts of suicide, depression, and rage. All victims reported a great mistrust of women and a discomfort with sexual intimacy. Most of the female victims were confused about their sense of identity and self-concept. Five out of seven said that, as young girls, they did not want to grow up to be women. Four women confessed that they continued to deny their femininity, one victim admitting that she dressed in an unwomanly fashion because she would be safest to herself and to others. Twelve participants feared they might sexually abuse their own children. In fact, two men and two women reported having sexually abused children. One man and three women decided not to have children.

Effects on Boys

MALE VICTIMS' PERCEPTION OF CSA AND CLINICAL FINDINGS

In their review of nearly 150 studies of male sexual abuse mentioned previously, Holmes and Slap find that only 15% to 39% of victims who responded to the studies thought that they were adversely affected by the sexual abuse. The victims stressed that the adverse effects were linked to the use of force, cases in which the perpetrator was much older than the victim, or cases where the victim was very young. Holmes and Slap note, however, that negative clinical results (in contrast to what the studies' subjects reported) included posttraumatic stress disorder, major depression, paranoia, aggressive behavior, poor self-image, poor school performance, and running away from home.

Holmes and Slap also find a connection between sexual abuse and subsequent substance abuse among male victims. Sexually abused males were more likely to have sex-related problems, including sexual dysfunction, hypersexuality, and the tendency to force sex on others. They surmise that the discrepancy between the respondents' perceptions of the negative consequences of their sexual victimization and those discovered in clinical outcomes may be because of several factors. Holmes and Slap observe that perhaps abused males believe they have failed to protect themselves as society expects them to do. Instead of owning up to their failure, they resort to not giving much gravity to their experiences. Moreover, if the victims had experienced pleasure while being abused, they may be confused by their feelings about it.

Sharon M. Valente finds in "Sexual Abuse of Boys" (Journal of Child and Adolescent Psychiatric Nursing, January 2005) that boys who have been sexually abused display a range of psychological consequences to the traumatic experience. She finds that common responses include anxiety, denial, dissociation, and self-mutilation. Boys who have been sexually abused are at risk for running away. Susan Rick, in "Sexually Abused Boys: A Vulnerable Population" (Journal of Multicultural Nursing and Health, Winter 2003), finds that sexually abused boys "had prominent symptoms such as fear, depression, guilt, self destructive behavior and hypersexuality."

Relationship between Male Child Sexual Abuse and Teen Pregnancy

Robert F. Anda et al., in "Abused Boys, Battered Mothers, and Male Involvement in Teen Pregnancy" (Pediatrics, February 2001), report on more than 4,100 men in a primary care setting who were interviewed regarding whether or not they had ever impregnated an adolescent girl. The study finds that men with a history of childhood sexual or physical abuse or of witnessing physical abuse of their mother were more likely to have been involved in teenage pregnancy. About 19% of the men reported ever getting a girl pregnant during adolescence and adulthood. The girls were between twelve and nineteen years old. About 59% of the men were age twenty or older at the time they impregnated the girls.

One-fourth (25.5%) of men who experienced CSA indicated having impregnated teen girls, compared with 17.8% of those who had not been sexually abused as children. Those whose sexual abuse was characterized by physical force or threat of harm were about twice as likely to have impregnated a teenage girl. Those who were abused at age ten and under showed an 80% increased risk of getting a teenage girl pregnant.

A Longitudinal Study of the Effects of Child Sexual Abuse

In "The Effects of Child Sexual Abuse in Later Family Life: Mental Health, Parenting, and Adjustment of Offspring" (Child Abuse and Neglect, May 2004), Ron Roberts et al. seek to determine the impact of child sexual abuse on adult mental health, parenting relationships, and the adjustment of the children of mothers who had been victims of CSA. They investigated 8,292 families, a subsample of the Avon Longitudinal Study of Parents and Children, a continuing study of women and their families in Avon, England. The participating women had self-reported experiences of sexual assault before adolescence. Four family groups were included:

• Single-mother families (9% of the study sample)—Consist of a nonmarried woman with no partner and her children
• Biological families (79.5%)—Consist of two parents and their biological children with no other children from previous relationships
• Stepmother/complex stepfamilies (4.6%)—Consist of fathers with at least one biological child (living in the household or visiting regularly) who is not the biological offspring of the mother
• Stepfather families (6.9%)—Consist of a mother and at least one biological child (living in the household or visiting regularly) who is not the biological offspring of the father

The study reveals that more than a quarter (26%) of survivors of child sexual abuse had teen pregnancies. These women were disproportionately likely to be currently living in a nontraditional family—single-mother families (3%) and stepfather families (2.9%)—than to be living in biological families (1.3%). Roberts et al. did not have a similar finding when it came to stepmother/complex stepfamilies. In this group just 0.8% reported child sexual abuse. They surmise that a woman who has experienced child sexual abuse tends to choose a partner without children because she might feel inadequate to take care of more children.

Child sexual abuse also has consequences on the adult survivors' mental health. Mothers who reported child sexual abuse were likely to report more depression and anxiety and lower self-esteem. These mental problems in turn affect the mothers' relationship with their children and the children's adjustment. Mothers with a history of child sexual abuse reported less self-confidence and less positive relationships with their children. The children were hyperactive and had emotional, peer, and conduct problems.

REPRESSED MEMORIES OF CHILD SEXUAL ABUSE

In the early 1900s the Austrian psychoanalyst Sigmund Freud first proposed the theory of repression, which hypothesizes that the mind can reject unpleasant ideas, desires, and memories by banishing them into the unconscious. Some clinicians believe that memory repression explains why a victim of a traumatic experience, such as childhood sexual abuse, may forget the horrible incident. Some also believe that forgotten traumatic experiences can be recovered later.

In 1988 Ellen Bass and Laura Davis published The Courage to Heal: A Guide for Women Survivors of Child Sexual Abuse. This book became controversial because it suggested that some women may not remember incidences of childhood abuse. Bass and Davis explain that in situations of overwhelming pain and betrayal, a child might dissociate, or separate, the memory of the experiences from conscious knowledge.

Some memory researchers do not agree, saying that children who have suffered serious psychological trauma do not repress the memory; rather, they can never forget it. They cite the examples of survivors of concentration camps or children who have witnessed the murder of a parent who never forget. Their explanation for recovered memories is that they are inaccurate. They point to studies that have demonstrated that memory is unreliable, and that it can be manipulated to "remember" events that never happened.

In the middle of this controversy are clinicians and memory researchers who believe that the workings of the mind have yet to be fully understood. They agree that, while it is possible for a trauma victim to forget and then remember a horrible experience, it is also possible for a person to have false memories.

Dissociative Amnesia for Childhood Abuse Memories

According to James A. Chu et al. in "Memories of Childhood Abuse: Dissociation, Amnesia, and Corroboration" (American Journal of Psychiatry, May 1999), although research shows that memories can be inaccurate and influenced by outside factors such as overt suggestions, most studies show that memory tends to be accurate when it comes to remembering the core elements of important events. Chu et al. conducted a study of ninety female patients ages eighteen to sixty who were undergoing treatment in a psychiatric hospital. Dissociative amnesia, which was discussed in this study, is a type of dissociation, or dissociative disorder.

A large proportion of patients reported childhood abuse: 83% experienced physical abuse, 82% were victims of sexual abuse, and 71% witnessed domestic violence. Those who had a history of any kind of abuse reported experiencing partial or complete amnesia. The occurrence of physical and sexual abuse at an early age accounted for a higher level of amnesia.

Contrary to the popular belief that recovered memory of childhood abuse typically occurs under psychotherapy or hypnosis, most of the patients who suffered complete amnesia of their physical and sexual abuse indicated first recalling the abuse when they were at home and alone. Most patients did not recover memory of childhood abuse as a result of suggestions during therapy. Just one or two participants (for each of the three types of abuse) reported first memory of abuse while in a therapy session. Nearly half (48% for physical abuse and 45% for sexual abuse) were not undergoing psychological counseling or treatment when they first remembered the abuse.

Critics of recovered memories note the lack of corroboration (confirmation that the abuse really occurred) in many instances of recovered memories. In this study Chu et al. find that, among patients who tried to corroborate their abuse, more than half found physical evidence such as medical records. Nearly nine out of ten of those who suffered sexual abuse found verbal validation of such abuse.

Betrayal Trauma Theory

In Betrayal Trauma: The Logic of Forgetting Childhood Abuse (1996), Jennifer J. Freyd proposes the betrayal trauma theory to explain how children who had experienced abuse may process that betrayal of trust by mentally blocking information about it. Freyd explains that people typically respond to betrayal by distancing themselves from the betrayer. Children, however, who have suffered abuse at the hands of a parent or a caregiver, might not be able to distance themselves from the betrayer. Children need the caregiver for their survival so they "cannot afford not to trust" the betrayer. Consequently, the children develop a "blindness" to the betrayal.

Jennifer J. Freyd, Anne P. DePrince, and Eileen L. Zurbriggen, in "Self-Reported Memory for Abuse Depends upon Victim-Perpetrator Relationship" (Journal of Trauma and Dissociation, 2001), report on their preliminary findings relating to the betrayal trauma theory. They find that people who had been abused by a trusted caregiver reported greater amnesia, compared with those whose abusers were not their caregivers. Greater amnesia was also more likely to be associated with the fact that the perpetrator was a caregiver than with the repeated trauma of abuse.

A Longitudinal Study of Memory and Childhood Sexual Abuse

In Resolving Childhood Trauma: A Long-Term Study of Abuse Survivors (2000), Catherine Cameron discusses a long-term study of child sexual abuse survivors she conducted between 1986 and 1998. Cameron interviewed seventy-two women, ages twenty-five to sixty-four, during a twelve-year period. The women comprised a group of sexual abuse survivors who sought therapy for the first time in the 1980s. On average, it had been thirty years since their first abuse occurred (thirty-six years for those who suffered amnesia). The women were in private therapy, were better educated, and were more financially well off than most survivors. Twelve imprisoned women were included in the survey. They came from a low socioeconomic background, were serving long sentences, and had participated only in brief group therapy sessions, lasting less than a year.

Cameron sought to study amnesia as both an effect and a cause—what was it about the abuse that resulted in amnesia and how did the amnesia affect the victim later on in life? Twenty-five women were amnesic, having no awareness of the abuse until recently. Twenty-one were nonamnesic, unable to forget their abuse, and fourteen were partially amnesic about their abuse. The imprisoned women were not assigned a specific category because they were part of a therapy group.

About eight out of ten of the amnesic and partially amnesic women believed that they did not remember the sexual abuse because the memories were too painful to live with (82%) and they felt a sense of guilt or shame (79%). More than half of each group believed the amnesia served as a defense mechanism resulting from their desire to protect the family (58%) and love for, or dependence on, the perpetrator (53%). About three-quarters (74%) thought the amnesia occurred because they felt no one would believe them or help them. More than one-third (37%) thought the amnesia had come about because they needed to believe in a "safe" world.

During the years between the abuse and the recall of the abuse, the amnesics reported experiencing the same problems as the nonamnesics, including problems with relationships, revictimization, self-abuse, and dependency on alcohol. Because the amnesics, however, had no conscious knowledge of their childhood abuse, they could not find an explanation for their problems. Cameron theorizes that the conflict between the amnesia and memories that needed release left the amnesic victims depressed and confused.

Cameron addresses the allegations that some therapists implant false memories of sexual abuse in their clients. She notes that 72% of the amnesic women in her study had begun to recall their abuse before seeking therapy. Once the survivors in her study confronted their traumatic past, they took charge of how they wanted their therapy handled. Cameron also observes that, because it is evident that recovered memories of childhood abuse are common, they should not be labeled as "false memories" nor accepted as "flawless truth," but should instead be explored by proponents of the opposing views.

Research Supporting the Repression of Memory

The best study to date on amnesia for childhood abuse was conducted by Linda Meyer Williams. The strength of this study lies in the fact that she interviewed adults whose sexual abuse in childhood had been documented at the time that it happened. In "Recall of Childhood Trauma: A Prospective Study of Women's Memories of Child Sexual Abuse" (Journal of Consulting and Clinical Psychology, 1994), Williams reports on the detailed interviews she conducted with 129 women who, seventeen years previously, had been taken to the emergency room after being sexually abused. Williams finds that more than one out of three women did not report the sexual abuse during the interview. She concludes that most or all of these women did not remember the documented abuse. She also finds that the younger the child was at the time of the abuse, and the closer the relationship the child had with the perpetrator, the greater the likelihood that the abuse would not be remembered.

FALSE MEMORIES

In The Myth of Repressed Memory: False Memories and Allegations of Sexual Abuse (1994), psychologist Elizabeth F. Loftus, a leading opponent of the recovered-memory movement, claims that repression is not normal memory and that it is empirically unproven. She does not believe that the mind can block out experiences of recurrent traumas, with the person unaware of them, and then recover them years later. Her explanation for recovered memories is that they are false memories. While the people who experience them genuinely believe them, they did not actually happen. She and other critics of recovered memories believe that therapy to "recover" repressed memories can lead people to believe they remember things that never actually happened.

Loftus and other researchers have shown that false memories can be implanted fairly easily in the laboratory. In the Myth of Repressed Memory, Loftus recounts assigning a term project to students in her cognitive psychology class. The project involved implanting a false memory in someone's mind. One of the students chose his fourteen-year-old brother as his test subject. The student wrote about four events his brother had supposedly experienced. Three of the experiences really happened, but the fourth one was a fake event of his brother getting lost at the mall at age five. For the next five days the younger brother was asked to read about his experiences (written by his older brother) and then write down details that he could remember about them. The younger brother "remembered" his shopping mall experience quite well, describing details elaborately.

In "Make-Believe Memories" (American Psychologist, November 2003), Loftus notes that memories can be influenced by our imagination. "Imagination can not only make people believe they have done simple things that they have not done but can also lead people to believe that they have experienced more complex events," writes Loftus. She describes a study in which participants were told to imagine performing a common task with certain objects, such as flipping a coin. The second meeting consisted of imagining doing a task without using any object. In a subsequent meeting, participants were tested on their memory of the first day's task performance. Some participants "remembered" not only tasks they had not done but also unusual ones they had not performed.

In 1992 an organization called the False Memory Syndrome Foundation (FMSF) was formed. It is a network of people who have been accused of childhood sexual abuse by their adult children. They claim that the accusations of abuse, and their children's recovered memories, are false. The group coined the term False Memory Syndrome (not a recognized psychological disorder) and has worked to publicize the concept of false memories of childhood abuse.