Chapter 4
Child Sexual Abuse

What is Child Sexual Abuse?
How Frequent is Child Sexual Abuse?
What Makes a Victim Disclose?
Victims
Perpetrators
Sexual Predators on the Internet
Effects of Child Sexual Abuse
The Repressed Memory Controversy
False Memories

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 in which 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 (CAPTA) of 1974 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

The federal government has established a broad definition of child sexual abuse, but 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 sixteen and eighteen. Sexual activity with children below the age of consent is considered statutory rape and is against the law. Table 4.1 summarizes current state laws regulating the age of consent.

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, and the compiled information is released by the Administration for Children, Youth, and Families (ACYF) 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 August 2008, 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 reauthorized CAPTA and authorized an additional $285 million for child abuse and neglect prevention programs. The act also directed the collection of data for NIS-4, which was expected to be available by the end of 2008. A third source of sexual abuse data are retrospective studies, which are surveys of adults about their childhood experience of sexual abuse.

According to the ACYF, in Child Maltreatment 2006 (2008, http://www.acf.hhs.gov/programs/cb/pubs/cm06/cm06.pdf), the number of sexual abuse cases reported by CPS agencies in the United States in 2006 was 78,120. (See Table 2.2 in Chapter 2.) It is important to note that these numbers represent only cases that were reported and substantiated (confirmed); 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, vol. 10, no. 1, February 2005), a study of a nationally representative sample of one thousand children and youth aged 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 of the University of New Hampshire 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, vol. 4, no. 2, 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 in 1978 by the sociologist Diana E. H. Russell of Mills College. 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. Whereas 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 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.) The ACYF indicates that substantiated child abuse cases dropped even further to 78,120 victims in 2006.

Lisa M. Jones and David Finkelhor of the University of New Hampshire examine in “The Decline in Child Sexual Abuse Cases” (Juvenile Justice Bulletin, January 2001) 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 to 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.

According to Jones and Finkelhor, several factors may have influenced the decline in substantiated cases of child sexual abuse. (See Figure 4.2.) 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 such as Amy M. Smith Slep and Susan G. O'Leary, in “Parent and Partner Violence in Families with Young Children: Rates, Patterns, and Connections” (Journal of Consulting and Clinical Psychology, vol. 73, no. 3, June 2005), and Emiko A Tajima of the University of Washington, in “Correlates of the Co-occurrence of Wife Abuse and Child Abuse among a Representative Sample” (Journal of Family Violence, vol. 19, no. 6, December 2004), show a 30% to 60% overlap in the victimization of children and the victimization of their mothers.

Jones and Finkelhor suggest several possible factors that could account for the drop in reports of child sexual abuse from 1991 to 1998. People might be reluctant 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. CPS agencies might have stopped screening certain cases, such as sexual abuse by nonfamily members, and agencies with large caseloads may have investigated only cases they deemed serious enough to warrant their time.

In “Explanations for the Decline in Child Sexual Abuse Cases” (Juvenile Justice Bulletin, January 2004),

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.

Even though 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 that show the decline in sexual abuse cases. One piece of evidence includes the results of two self-reports of sexual assault (by nonfamily members) and sexual abuse (by family members). The second piece of evidence consists of the National Crime Victimization Survey (NCVS) and the Minnesota Student Survey. The NCVS, an annual survey of eighty thousand people over age twelve, 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 4.3.) The Minnesota Student Survey, which was administered five times between 1989 and 2001 to over one hundred thousand students in grades six, nine, and twelve, 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 4.4.)

What Makes a Victim Disclose?

Rochelle F. Hanson et al. report in “Correlates of Adolescent Reports of Sexual Assault: Findings from the National Survey of Adolescents” (Child Maltreatment, vol. 8, no. 4, 2003) on the factors that contribute to the likelihood that an adolescent will disclose sexual abuse. The researchers also examine whether, among the different ethnic and racial groups, adolescents differ in the 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 aged twelve to seventeen. The sample was made up of 51.3% males and 48.7% females. A majority (70.2%) were white, non-Hispanics. 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 (8.1%) adolescents indicated that they had experienced child sexual abuse. Approximately four out of five (78.1%) of those reporting child sexual abuse 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, 30.7% had been raped, 26.8% reported fearing for their life during the assault, and 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 a 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 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 life during the assault were especially likely to disclose the abuse (80.7%). Other factors that were related to high levels of disclosure were having experienced a penetration assault (72%), having suffered physical injury (70.6%), having used substances (68.2%), or having been assaulted once (67.9%). 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 (87.7%) of the victims who were sexually abused by a relative disclosed the incident, compared to those abused by a stranger (70.7%), an unrelated acquaintance (62.2%), or a father (57.1%).

Hanson et al. note that for some groups the gender of the adolescent is related to disclosure of sexual abuse, with girls more likely to do so. In this study African-American females were seven times more likely than their male counterparts to tell someone they had experienced sexual abuse, though white adolescents did not differ in disclosure of abuse based on gender. The researchers reiterate previous findings that males might fear being thought of as gay if the abuser was male. They also note that other studies show that African-American females are reluctant to disclose sexual abuse because of fear of not being believed. Even though 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.

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. (See Chapter 2 for a definition of these standards.)

In “Childhood Sexual Abuse among Black Women and White Women from Two-Parent Families” (Child Maltreatment, vol. 11, no. 3, August 2006), a retrospective study, Maryann Amodeo et al. of Boston University examine 290 African-American and white women to determine differences in prevalence of child sexual abuse. 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 of the University of Illinois find in “Ethnicity and Child Sexual Abuse Experiences of Female College Students” (Journal of Child Sexual Abuse, vol. 14, no. 3, 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 Asian-Americans.

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, vol. 280, no. 21, December 2, 1998), the researchers 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. The researchers 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

In 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 of the National Center for Juvenile Justice finds that 20.1% 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. (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.)

Patricia Tjaden and Nancy Thoennes of the Center for Policy Research in Denver, Colorado, find 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, that 21.6% of female rape or sexual abuse victims and 48% of male rape or sexual abuse victims were under the age of twelve when they were first raped. (See Figure 4.5.) Another 32.4% of females and 23% of males were between ages twelve and seventeen. Therefore, more than half of all female rape victims and seven out of ten male rape victims had been raped while children.

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 aged six to eleven (42.4%), and further decreased for victims aged twelve to seventeen (24.3%). More female victims (51.1% of those aged five years and younger and 43.8% of those aged six to eleven) were abused by family members, compared to their male counterparts (42.4% of those aged five years and younger and 37.7% of those aged six to eleven). (See Table 4.2.)

Fathers

Linda Meyer Williams and David Finkelhor indicate in The Characteristics of Incestuous Fathers (1992) that, generally, incestuous fathers had lonely childhoods (82%). Almost half (47%) had not lived with their own father and had changed living arrangements (43%), perhaps as a result of parental divorce or remarriage. However, their own parents’ alcohol problem 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. According to Craig M. Allen, in A Comparative Analysis of Women Who Sexually Abuse Children (1990), when women were involved in abuse, it was thought to be a situation in which a either a man had forced the woman to commit the abuse or the woman had a severe psychiatric disturbance. 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 men tie their feelings of self-worth to their sexual experiences, women are supposedly less concerned with sexual prowess and tend to be more empathetic toward others.

Comparing male and female offenders, Allen finds that the women reported more severe incidents of physical and emotional abuse in their past, 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. The organization Making Daughters Safe Again explains in “Female-Perpetrated Sexual Abuse: Redefining the Construct of Sexual Abuse and Challenging Beliefs about Human Sexuality” (2008, http://mdsasupport.homestead.com/ra.html) that 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 to the man who acts out his anger in sexually criminal behavior. Women's sexually abusive behavior toward their children may be disguised under the pretense of caretaking for their children.

Siblings

Sibling incest is another form of abuse that has not been well studied. However, some experts believe sibling sexual abuse is more common than father-daughter incest. Vernon R. Wiehe indicates in “Sibling Abuse” (Understanding Family Violence: Treating and Preventing Partner, Child, Sibling, and Elder Abuse, 1998) 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.

In “Intrafamilial Sexual Abuse: Brother-Sister Incest Does Not Differ from Father-Daughter and Stepfather-Stepdaughter Incest” (Child Abuse and Neglect: The International Journal, vol. 26, no. 9, September 2002), Mireille Cir et al. find 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 indicate 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 the Washington teacher Mary Kay Letourneau (1962–), who was charged with child rape of a twelve-year-old student and served a seven-and-a-half-year sentence, other cases have not received much attention. Some experts observe 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 the Superior Court judge Bruce A. Gaeta (1942–2008) refused to sentence Pamela Diehl-Moore (1959–) 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 S. Shakeshaft of Hofstra University reported that no national study of public school educators who have abused students had ever 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 2001 involving 3,695 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 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, have 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. (See Table 4.3.) Principals accounted for 6%, and school counselors made up 5%. Shakeshaft 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.

Sexual Abusers of Boys

Holmes and Slap find that more than 90% of the abusers of 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. Whereas male perpetrators used physical force, with threats of physical harm increasing with victim age, female perpetrators used persuasion and promises of special favors.

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. Thomas F. Reilly (1942–), the attorney general of Massachusetts, explains in The Sexual Abuse of Children in the Roman Catholic Archdiocese of Boston: A Report by the Attorney General (July 23, 2003, news.findlaw.com/hdocs/docs/abuse/maag72303abuserpt.pdf) 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.”

Reilly started the investigation in March 2002, soon after John Geoghan (1935–2003), 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 Geoghan 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. However, Reilly believes 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.

The Nature and Scope of the Problem of Sexual Abuse of Minors by Catholic Priests and Deacons in the United States (2004, 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 period, 4,392 (4%) allegedly abused children under age eighteen. Most (55.7%) of these priests 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 (50.7%) were between the ages of eleven and fourteen. More than a quarter (26.7%) were fifteen to seventeen years old, 16.5% were aged eight to ten, and 6.1% were aged seven or younger. (See Table 4.4.) The number of allegations rose steadily between 1950 and 1980 before dropping off sharply. (See Figure 4.6.)

At the time of the allegations, most of the priests were serving in the capacity of associate pastor (42.3%) or pastor (25.1%). One out of ten (10.4%) were serving as

resident priests. 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%). (See Table 4.5.) Nearly half (49.6%) of the priests socialized with the alleged victim's family, mostly (79.6%) in the family's home.

In “Stained Glass: The Nature and Scope of Child Sexual Abuse in the Catholic Church” (Criminal Justice and Behavior, vol. 35, no. 5, May 2008), a follow-up study, Karen J. Terry of the John Jay College of Criminal Justice finds that many victims of abuse by priests were groomed for the abuse—7.8% of children were given gifts and 17% of children were given other enticements, such as alcohol, drugs, money, or trips. Only 7.8% of victims were threatened, usually psychologically rather than physically.

Sexual Predators on the Internet

The Internet gives pedophiles easy access to children. According to the U.S. Department of Justice's Office for Victims of Crime, in Internet Crimes against Children (May 2001, http://www.ojp.usdoj.gov/ovc/publications/ bulletins/internet_2_2001/welcome.html), 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. Predators 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 Computer and Internet Use in the United States: 2003 (October 2005, http://www.census.gov/prod/2005 pubs/p23-208.pdf, Jennifer Cheeseman Day, Alex Janus, and Jessica Davis of the U.S. Census Bureau explain that in 2003, 80% of adolescents aged fifteen to seventeen used the Internet at some location. More than two-thirds (68.9%) of children aged ten to fourteen, 44.8% of children aged six to nine, and 23.4% of children aged three to five used the Internet. Females were slightly more likely than males to use the Internet (57% and 55.1%, respectively).

Julian Fantino notes in “Child Pornography on the Internet: New Challenges Require New Ideas” (Police Chief, vol. 70, no. 12, 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 identity. 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 of Youth: Five Years Later (2006, http://www.unh.edu/ccrc/pdf/CV138.pdf), a national survey on the risks children face on the Internet, Janis Wolak, Kimberly Mitchell, and David Finkelhor of the University of New Hampshire find that nearly one out of seven (13%) youths using the Internet in the last year had received an unwanted sexual solicitation or approach. Sexual solicitations involved requests to do sexual things the children did not want to do, and 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, 34% 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 of the University of New Hampshire indicate in “Exposure to Internet Pornography among Children and Adolescents: A National Survey” (CyberPsychology and Behavior, vol. 8, no. 5, 2005) 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.

In a follow-up study, Kimberly J. Mitchell, Janis Wolak, and David Finkelhor of the University of New Hampshire state in “Trends in Youth Reports of Sexual Solicitations, Harassment, and Unwanted Exposure to Pornography on the Internet” (Journal of Adolescent Health, vol. 40, 2007) that the proportion of youth who reported online sexual solicitations declined between 2000 and

2005, although online harassment and unwanted exposure to pornography actually rose. The researchers find that in 2005 approximately 13% of youth were sexually solicited online, meaning that they were requested online to talk about sex—although many of these requests probably came from other youth. (See Figure 4.7.) Many of these solicitations were not intended to lure children into sexual activity. Mitchell, Wolak, and Finkelhor's best guess is that about 4% of youth were aggressively sexually solicited online, including attempts to contact the youth offline—up from 3% in 2000. (See Figure 4.8.)

However, according to Kimberly J. Mitchell, David Finkelhor, and Janis Wolak of the University of New Hampshire, in “The Internet and Family and Acquaintance Sexual Abuse” (Child Maltreatment, vol. 10, no. 1, 2005), nearly as many acquaintances and family members used the Internet to commit sex crimes against children as did adults who used the Internet to actually meet children. The follow-up study actually found that even though the percentage of youth who used the Internet rose between 2000 and 2006, the percentage of youth who spoke to people they knew only online dropped from 40% to 34%. (See Table 4.6.) This decline might be due to a heightened awareness of pedophiles on the Internet.

When youth were sexually solicited online, most were able to deal with the problem by blocking solicitors

or leaving sites. Most did not report feeling distressed by the experience, but about 4% of youth did report feeling upset or distressed as a result of the online solicitation. (See Figure 4.7.) In “Online ‘Predators’ and Their Victims: Myths, Realities, and Implications for Prevention and Treatment” (American Psychologist, vol. 63, 2008), Janis Wolak et al. of the University of New Hampshire indicate that when predatory offenders were charged with a crime, the pattern most often involved nonforcible sexual activity between young victims and adult men.

However, 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.

In “The Relative Importance of Online Victimization in Understanding Depression, Delinquency, and Substance Use” (Child Maltreatment, vol. 12, no. 4, November 2007), Kimberly J. Mitchell, Michele L. Ybarra, and David Finkelhor of the University of New Hampshire find that 23% of 1,501 youth surveyed reported being the victim of either sexual solicitation or harassment online. Nearly three-quarters of these youth reported an offline victimization as well. However, youth who had been sexually solicited online were nearly twice as likely as others to report depression and substance use, indicating the serious nature of this type of victimization.

Effects of Child Sexual Abuse

According to the American Psychological Association (APA), in “What Are the Effects of Child Sexual Abuse?” (October 31, 2006, http://www.apa.org/releases/sexabuse/effects.html), children who have been sexually abused exhibit a range of symptoms. A child may show inappropriate sexual knowledge or exhibit sexual acting out behaviors. Other immediate effects may include regressive behaviors, such as 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 child sexual abuse. Adult victims 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, vol. 12, no. 2, 2003), a study of sexual at-risk behaviors of 125 female adolescents aged 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. Afterward, 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.

Over 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 abuse 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

A number of studies, such as Christiane Brems et al.'s “Childhood Abuse History and Substance Use among Men and Women Receiving Detoxification Services” (American Journal of Drug and Alcohol Abuse, vol. 30, no. 4, November 2004), Patricia B. Moran, Sam Vuchinich, and Nancy K. Hall's “Associations between Types of Maltreatment and Substance Use during Adolescence” (Child Abuse and Neglect: The International Journal, vol. 28, no. 5, May 2004), and Cathy Spatz Widom et al.'s “Long-Term Effects of Child Abuse and Neglect on Alcohol Use and Excessive Drinking in Middle Adulthood” (Journal of Studies on Alcohol and Drugs, vol. 68, no. 3, May 2007), show that child sexual abuse increases the risk for substance abuse later in life. 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, vol. 27, no. 1–2, January 2002), Carl M. Anderson et al. of Harvard Medical School uncover 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 aged eighteen to twenty-two, including eight with a history of repeated sexual abuse in childhood 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 sexual abuse had diminished blood flow. Anderson et al. suggest the stress experienced with repeated sexual abuse 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 child sexual abuse 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 sexual abuse survivors. 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.

Robert C. Freeman, Karyn Collier, and Kathleen M. Parillo of NOVA Research Company of Bethesda, Maryland, examine 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, vol. 28, no. 1, February 2002) a total of 1,478 noninjecting female sexual partners of male intravenous drug users. Nearly two-thirds (63.7%) of the women reported having used crack cocaine. The researchers find that an equal proportion of the 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 child sexual abuse and lifetime crack use, they find no direct link between sexual abuse during adolescence and lifetime crack use. However, they do find 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, vol. 18, no. 12, December 2003), Jennie G. Noll et al. report on a longitudinal study (a study of the same group over a period of time) that examines the effects of child sexual abuse 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 study consisted of eighty-four abused children and a comparison group of eighty-two nonabused 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 researchers find 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 1.6 times more physical victimization, such as domestic violence. Compared to 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 (e.g., having family or friends move away or die), emotional abuse and/or rejection by family, natural disasters, and witnessing violence.

Henrietta H. Filipas and Sarah E. Ullman of the University of Illinois, Chicago, explore in “Child Sexual Abuse, Coping Responses, Self-Blame, Posttraumatic Stress Disorder, and Adult Sexual Revictimization” (Journal of Interpersonal Violence, vol. 21, no. 5, 2006) what factors make child sexual abuse survivors more vulnerable to revictimization as adults. They hypothesize that self-blame, maladaptive coping responses, and posttraumatic stress disorder (PTSD) would all make survivors more likely to be revictimized. However, Filipas and Ullman find that only the extent to which adult female victims of child sexual abuse used maladaptive coping responses such as alcohol and drug use, withdrawal from people, and sexual acting out was correlated with their vulnerability to revictimization as adults.

In “Substance Use and PTSD Symptoms Impact the Likelihood of Rape and Revictimization in College Women” (Journal of Interpersonal Violence, May 2008), Terri L. Messman-Moore, Rose Marie Ward, and Amy L. Brown find that substance use and PTSD increase the likelihood that college women will be raped or otherwise revictimized. They argue that PTSD sufferers use drugs and alcohol or maladaptive sexual behavior to cope with PTSD symptoms and that these coping behaviors increase their risk of further victimization.

Noll et al. observe that child sexual abuse 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 re-experience feelings of shame in an attempt to resolve it.

Effects of Sexual Abuse by Women

In “The Long-Term Effects of Child Sexual Abuse by Female Perpetrators: A Qualitative Study of Male and Female Victims” (Journal of Interpersonal Violence, vol. 19, no. 10, October 2004), Myriam S. Denov of the University of Ottawa conducted a qualitative study on the long-term effects of child sexual abuse 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 (e.g., 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 CHILD SEXUAL ABUSE AND CLINICAL FINDINGS. In their review of nearly 150 studies of male sexual abuse, 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, to cases in which the perpetrator was much older than the victim, or to 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 PTSD, major depression, paranoia, aggressive behavior, poor self-image, poor school performance, substance abuse, and running away from home. 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: abused males may believe they have failed to protect themselves as society expects them to do, or, if they had experienced pleasure while being abused, they may be confused by their feelings about it.

Sharon M. Valente of the Research and Education Department of Veteran Affairs in Los Angeles, California, finds in “Sexual Abuse of Boys” (Journal of Child and Adolescent Psychiatric Nursing,vol. 18, no. 1, January–March 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. According to Susan Rick of Louisiana State University Health Science Center, in “Sexually Abused Boys: A Vulnerable Population” (Journal of Multicultural Nursing and Health, winter 2003), sexually abused boys have “prominent symptoms such as fear, depression, guilt, self destructive behavior and hypersexuality.”

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: The International Journal, vol. 28, no. 5, May 2004), Ron Roberts et al. seek to determine the effects of child sexual abuse on adult mental health, parenting relationships, and the adjustment of the children of mothers who had been victims of child sexual abuse. They investigated 8,292 families, a subsample of the Avon Longitudinal Study of Parents and Children, which is 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 a father 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.

The Repressed Memory Controversy

In the early 1900s the Austrian psychoanalyst Sigmund Freud (1856–1939) 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 memory repression explains why a victim of a traumatic experience, such as CSA, may forget the horrible incident. Some also believe forgotten traumatic experiences can be eventually recovered.

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, explaining 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

The earliest psychiatrists recognized that memory of child sexual abuse could be “split off” from consciousness. In the late 1900s Pierre Marie Felix Janet (1859–1947) connected the new diagnosis of hysteria with traumatic experiences that were separated from consciousness. Freud also studied lost traumatic memories in relation to female patients diagnosed with hysteria. In 1896 Freud theorized in The Aetiology of Hysteria that sexual abuse was the cause of hysteria. Under pressure from his psychiatric colleagues, he later recanted his theory, instead arguing that women were fantasizing rather than remembering sexual abuse. However, all of these early psychiatrists recognized that memory of traumatic experience in childhood could be lost to conscious awareness.

According to James A. Chu et al. of the Harvard Medical School, in “Memories of Childhood Abuse: Dissociation, Amnesia, and Corroboration” (American Journal of Psychiatry, vol. 156, no. 5, May 1999), even though 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 aged eighteen to sixty undergoing treatment in a psychiatric hospital.

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 dissociative amnesia (a type of dissociative disorder). The occurrence of physical and sexual abuse at an early age accounted for a higher level of amnesia.

Chu et al. note that 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 for 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 memory 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.

Some studies look at participants with documented history of child sexual abuse to see whether any individuals have lost conscious awareness of the abuse for any period of time. In one such study, Robin S. Edelstein et al. find in “Individual Differences in Emotional Memory: Adult Attachment and Long-Term Memory for Child Sexual Abuse” (Personality and Social Psychology Bulletin, vol. 31, no. 11, 2005) that whether and how well an individual “remembered” sexual abuse was mediated by the extent to which he or she was attached to others. In fact, the more severe the abuse, the less accurately individuals who were insecurely attached to others could recall its details. Therefore, children who had received emotional support from their mother in the aftermath of child sexual abuse were better able to remember the experience in their adult life. By contrast, children who were insecurely attached to their parents because their parents were the abusers would be more likely to lose conscious awareness of the abuse.

In “‘True’ and ‘False’ Child Sexual Abuse Memories and Casey's Phenomenological View of Remembering” (American Behavioral Scientist, vol. 48, no. 10, 2005), Joanne M. Hall and Lori L. Kondora review the literature on dissociative memory and find ample evidence that it is common for sexually abused children to lose conscious awareness of the abuse. The researchers point out, as have other researchers, that studies of soldiers returning from combat and World War II (1939–1945) concentration camp survivors show that people can and do fragment traumatic memory, splitting it off from daily life. They connect the debate about the authenticity of delayed sexual abuse memories with a cultural denial that sexual abuse of children occurs, because “its existence fractures cultural values about family.” Hall and Kondora argue that false memories of child sexual abuse are rare, but not impossible.

Betrayal Trauma Theory

Jennifer J. Freyd proposes in Betrayal Trauma: The Logic of Forgetting Childhood Abuse (1996) 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. However, children 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 report in “Self-Reported Memory for Abuse Depends upon Victim-Perpetrator Relationship” (Journal of Trauma and Dissociation, vol. 2, no. 3, 2001) 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 to 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 CSA

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, aged twenty-five to sixty-four, during a twelve-year period. The women consisted of 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 that lasted 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 in life? Twenty-five women were amnesic and had no awareness of the abuse until recently, twenty-one were nonamnesic and 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 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

As of August 2008, the best study 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, vol. 62, no. 6, 1994), Williams reports on 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), Elizabeth Loftus and Katherine Ketcham claim that repression is not normal memory and that it is empirically unproven. The researchers do not believe that the mind can block out experiences of recurrent traumas, with the person unaware of them, and then recover them years later. Their explanation for recovered memories is that they are false memories. Loftus and Ketcham and other critics of recovered memories believe therapy to “recover” repressed memories can lead people to believe they remember things that never actually happened.

Loftus and Ketcham show that false memories can be implanted fairly easily in the laboratory. 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 suppos-edly 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, vol. 58, no. 11, November 2003), Loftus notes that memories can be influenced by people's imagination. She states that “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.” 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.

The False Memory Syndrome Foundation was founded in 1992. It is a network of people who have been accused of CSA by their adult children. They claim 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.