Child sexual abuse

Child sexual abuse refers to sexual abuse of a child by an adult or some other person significantly older or in a position of power or control over the child, where the child is used for sexual stimulation of another person. In addition to overt sexual interactions, child sexual abuse also includes invitations or requests by an adult regarding sexual forms of kissing, hugging and any other sexual activities.

Child sexual abuse has been associated with depression, post-traumatic stress disorder, anxiety, propensity to re-victimization in adulthood, and physical injury to the child, among other things. There are several hypotheses on the causality of this association. A spectrum of responses are possible based on the circumstances of the abuse. Sexual abuse perpetrated by a family member is a form of incest, and is associated with more serious and long-term psychological trauma, especially in the case of parental incest.

In the USA as of 1994, approximately 20% of women and 5% to 15% of men had experienced some form of sexual abuse as children, according to professor of sociology David Finkelhor, director of the Crimes against Children Research Center.

Under the law, "child sexual abuse" is an umbrella term describing criminal and civil offenses in which an adult engages in sexual activity with a minor or exploits a minor for the purpose of sexual gratification. The American Psychiatric Association states that "children cannot consent to sexual activity with adults", and strongly condemns any such action: "An adult who engages in sexual activity with a child is performing a criminal and immoral act which never can be considered normal or socially acceptable behavior."

When an adult seeks or engages in sexual activity with a child, public sentiment usually considers these actions as a manifestation of pedophilia; however, some child sexual abuse is perpetrated by individuals who do not meet the criteria for the formal definition of that term.


Psychological and developmental

Psychological damage may occur even when physical effects are absent. Long term negative effects on development, leading to re-victimization in adulthood, can also occur. Child sexual abuse has been identified as a predictor of future psychopathology, though it has no characteristic pattern of symptoms.Brown states that the data from prospective studies establishes a causal relationship between childhood sexual abuse and certain specific areas of adult psychopathology, including suicidality, antisocial behavior, PTSD, anxiety and alcoholism.

Kendall-Tackett et al. (1993) and other studies found that a wide range of psychological, emotional, physical, and social effects are associated with child sexual abuse, including depression, post-traumatic stress disorder, anxiety, poor self-esteem, dissociative and anxiety disorders, and other more general dysfunctions such as neurosis, sexualized behavior, school/learning problems, and behavior problems including substance abuse, repeated victimization, destructive behavior, criminality in adulthood and suicide. A review of studies by Kendell-Tackett et al. found that two-thirds of the children who were sexually abused showed symptoms, and that "sexually abused children have more symptoms than non-abused children".A study by Baker and Duncan stated that "subjective reports of the effects of sexual abuse indicated that the majority (51%) felt harmed by the experience, while only 4% reported that it had improved the quality of their life." CSA does not appear to be connected to a higher risk of major depressive disorder, though adults with a history of CSA report considerably more depressive symptoms than non-abused peers.

Caffaro-Rouget et al. (1989) found that 51% of their sample was symptomatic; in Mannarino and Cohen (1986), 69% of forty-five assessed children were symptomatic; 64% of Tong, Oates, and McDowell's (1987) forty-nine child sample were not within the normal range on the child behavior checklist; and in Conte and Schuerman (1987), whose assessment included both very specific and broad items such as 'fearful of abuse stimuli' and 'emotional upset,' 79% of the sample was symptomatic. A minority of abused children have been found to be healthy and asymptomatic, and the level of harm associated with the abuse may correlate with other factors. Prescott and Kendler (2001) found that the risk of psychopathology increased if the perpetrator was a relative, if the abuse involved intercourse or attempted intercourse, or if threats or force were used. The age at which an individual was first abused did not appear to be related. Other studies have found that the risk of adverse outcomes is reduced for abused children who have supportive family environments.. In addition, Whiffen and MacIntosh (2005) found that negative psychological outcomes (emotional distress) may be mediated by shame or self-blame, interpersonal difficulties and avoidant coping strategies for survivors of childhood sexual abuse.

Because child sexual abuse often occurs alongside other possibly confounding variables, such as poor family environment and physical abuse, some scholars argue it is important to control for those variables in studies which measure the effects of sexual abuse. and some have hypothesized "that abuse effects are at least in part the results of dysfunctional family dynamics that support sexual abuse and produce psychological disturbance (Fromuth, 1986) and that concomitant physical or psychological abuse may account for some of the difficulties otherwise attributed to sexual abuse (Briere & Runtz, 1990)." In a 1998 review of related literature, Martin and Fleming, state "The hypothesis advanced in this paper is that, in most cases, the fundamental damage inflicted by child sexual abuse is due to the child's developing capacities for trust, intimacy, agency and sexuality, and that many of the mental health problems of adult life associated with histories of child sexual abuse are second-order effects." Other studies have found an independent association of child sexual abuse with adverse psychological outcomes.

Kendler et al. (2000) found that most of the relationship between severe forms of child sexual abuse and adult psychopathology in their sample could not be explained by family discord, because the effect size of this association decreased only slightly after they controlled for possible confounding variables. Their examination of a small sample of CSA-discordant twins also supported a causal link between child sexual abuse and adult psychopathology; the CSA-exposed subjects had a consistently higher risk for psychopathologic disorders than their CSA non-exposed twins. After controlling for possible confounding variables, Widom (1999) found that child sexual abuse independently predicts the number of symptoms for PTSD a person displays. 37.5% of their sexually abused subjects, 32.7% of their physically abused subjects, and 20.4% of their control group met the criteria for a diagnosis of PTSD. The authors concluded, "Victims of child abuse (sexual and physical) and neglect are at increased risk for developing PTSD, but childhood victimization is not a sufficient condition. Family, individual, and lifestyle variables also place individuals at risk and contribute to the symptoms of PTSD." The same study reported that "sexual abuse, perhaps more than other forms of childhood trauma, leads to dissociative problems" and that "these PTSD findings represent only part of the picture of the long-term psychiatric sequelae associated with early childhood victimization ... antisocial personality disorder, alcohol abuse, and other forms of psychopathology." Child abuse, including sexual abuse, especially chronic abuse starting at early ages, has been found to be related to the development of high levels of dissociative symptoms, which includes amnesia for abuse memories. The level of dissociation has been found to be related to reported overwhelming sexual and physical abuse. When severe sexual abuse (penetration, several perpetrators, lasting more than one year) had occurred, dissociative symptoms were even more prominent.

Child sexual abuse has also been repeatedly associated in adulthood with depression and chronic pain.People with a history of child abuse, especially sexual abuse, are more likely than people with no history of abuse to become frequent users of emergency and medical care services. A study comparing middle-aged women who were abused with non-abused counterparts found significantly higher health care costs for the former; 36% higher for women both physically and sexually abused, and 16% higher for women sexually, but not physically abused, and 22% higher for women only physically abused.

It has been suggested that young children who are abused sexually by adult females may incur double traumatization due to the widespread denial of female-perpetrated child sexual abuse by non-abusing parents, professional caregivers and the general public. Turner and Maryanski in Incest: Origins of the Taboo (2005), suggest that mother-son incest causes the most serious damage to children in comparison to mother-daughter, father-daughter and father-son child incest. Crawford asserts that our socially repressed view of female and maternal sexuality conceals both the reality of female sexual pathologies and the damage done by female sexual abuse to children.

The social stigma of child sexual abuse is hypothesized to be able to compound the psychological harm to children.


Depending on the age and size of the child, and the degree of force used, child sexual abuse may cause infections, sexually transmitted diseases, or internal lacerations. In severe cases, damage to internal organs may occur, which, in some cases, may cause death. Herman-Giddens found six certain and six probable cases of death due to child sexual abuse in North Carolina between 1985-1994. The victims ranged in age from 2 months to 10 years. Causes of death included trauma to the genitalia or rectum and sexual mutilation. Vaginitis has also been reported.


Research has shown that traumatic stress, including stress caused by sexual abuse, causes notable changes in brain functioning and development. Various studies have suggested that severe child sexual abuse may have a deleterious effect on brain development. Ito et al. (1998) found "reversed hemispheric asymmetry and greater left hemisphere coherence in abused subjects;" Teicher et al. (1993) found that an increased likelihood of "ictal temporal lobe epilepsy-like symptoms" in abused subjects; Anderson et al. (2002) recorded abnormal transverse relaxation time in the cerebellar vermis of adults sexually abused in childhood; Teicher et al. (1993) found that child sexual abuse was associated with a reduced corpus callosum area; various studies have found an association of reduced volume of the left hippocampus with child sexual abuse; and Ito et al. (1993) found increased electrophysiological abnormalities in sexually abused children.

Some studies indicate that sexual or physical abuse in children can lead to the overexcitation of an undeveloped limbic system. Teicher et al. (1993) used the "Limbic System Checklist-33" to measure ictal temporal lobe epilepsy-like symptoms in 253 adults. Reports of child sexual abuse were associated with a 49% increase to LSCL-33 scores, 11% higher than the associated increase of self-reported physical abuse. Reports of both physical and sexual abuse were associated with a 113% increase. Male and female victims were similarly affected.

King et al. (2001), studying 5 to 7 year old girls who had been abused within the last two months, found victims of early sexual abuse had significantly lower cortisol levels than control subjects. Victims of severe childhood abuse who suffer from PTSD have been found to have increased cortisol levels.

Navalta et al. (2006) found that the self-reported math Scholastic Aptitude Test scores of their sample of women with a history of repeated child sexual abuse were significantly lower than the self-reported math SAT scores of their non-abused sample. Because the abused subjects verbal SAT scores were high, they hypothesized that the low math SAT scores could "stem from a defect in hemispheric integration." They also found a strong association between short term memory impairments for all categories tested (verbal, visual, and global) and the duration of the abuse.


Dr. Gwen Adshead states that child sexual abuse occurs frequently in Western society. In research cited by Baker and Duncan, prevalence figures range between 10% in the UK or by other studies up to 62% for females and 16% for males in the United States. According to data from the Administration on Children and Families, of the US Department of Health and Human Services, in 2005 there were an estimated 3.6 million investigations by Child Protective Services in the USA; and of those, 899,000 were substantiated. Of the substantiated abuse reports, 9.3% of the cases showed 83,600 children were determined to have been sexually abused.

Based on a literature review of 23 studies, Goldman & Padayachi found that the prevalence of child sexual abuse varied between 7-62% for girls and 4-30% for boys. A meta-analytic study by Rind, Tromovitch, and Bauserman found that reported prevalence of abuse for males ranged from 3% to 37%, and for females from 8% to 71% with mean rates of 17% and 28% respectively. Berl Kutchinsky argues that most prevalence rates are overexaggerated and claim that the real prevalence of child sexual abuse may be as low as 1-2%. A 1992 survey studying father-daughter incest in Finland reported that of the 9,000 15-year old high school girls who filled out the questionnaires, of the girls living with their biological fathers, 0.2% reported father-daughter incest experiences; of the girls living with a stepfather, 3.7% reported sexual experiences with him. The reported counts included only father-daughter incest and did not include prevalence of other forms of child sexual abuse. The survey summary stated, "the feelings of the girls about their incestual experiences are overwhelmingly negative." Others argue that prevalence rates are much higher, and that many cases of child abuse are never reported. One study found that professionals failed to report approximately 40% of the child sexual abuse cases they encountered A study by Lawson & Chaffin indicated that many children who were sexually abused were "identified solely by a physical complaint that was later diagnosed as a venereal disease...Only 43% of the children who were diagnosed with venereal disease made a verbal disclosure of sexual abuse during the initial interview." It has been found in the epidemiological literature on CSA that there is no identifiable demographic or family characteristic of a child that can be used to bar the prospect that a child has been sexually abused.

In US schools, according to the US Department of Education., "nearly 9.6% of students are targets of educator sexual misconduct sometime during their school career." In studies of student sex abuse by male and female educators, male students were reported as targets in ranges from 23% to 44%. In U.S. school settings same-sex (female and male) sexual misconduct against students by educators "ranges from 18-28% or reported cases, depending on the study"

Significant underreporting of sexual abuse of boys by both women and men is believed to occur due to sex steoreotyping, social denial, the minimization of male victimization, and the relative lack of research on sexual abuse of boys. Sexual victimization of boys by their mothers or other female relatives is especially rarely researched or reported. Sexual abuse of girls by their mothers, and other related and/or unrelated adult females is beginning to be researched and reported despite the highly taboo nature of female-female child sex abuse. In studies where students are asked about sex offenses, they report higher levels of female sex offenders than found in adult reports. This under-reporting has been attributed to cultural denial of female-perpetrated child sex abuse, because "males have been socialized to believe they should be flattered or appreciative of sexual interest from a female" and because female sexual abuse of males is often seen as 'desirable' and/or beneficial by judges, mass media pundits and other authorities.

The prevalence of child sexual abuse in Africa is compounded by a belief that sexual intercourse with a virgin will cure a man of HIV or AIDS. This belief is especially common in South Africa, which has the highest number of HIV-positive citizens in the world. According to official figures, one in eight South Africans are infected with the virus. Eastern Cape social worker Edith Kriel notes that "child abusers are often relatives of their victims - even their fathers and providers." More than 67,000 cases of sexual assaults against children were reported in 2000 in South Africa. Child welfare groups believe that the number of unreported incidents could be up to 10 times that number. Researcher Suzanne Leclerc-Madlala states that the myth that sex with a virgin is a cure for AIDS is not confined to South Africa: "Fellow AIDS researchers in Zambia, Zimbabwe and Nigeria have told me that the myth also exists in these countries and that it is being blamed for the high rate of sexual abuse against young children."


70% of all perpetrators of sexual abuse are related to their victim. Child sexual abuse offenses where the perpetrator is related to the child, either by blood or marriage, is a form of incest described as intrafamilial child sexual abuse.

The most-often reported form of incest is father-daughter and stepfather-daughter incest, with most of the remaining reports consisting of mother/stepmother-daughter/son incest. Father-son incest is reported less often, however it is not known if the prevalence is less, because it is under-reported by a greater margin. Prevalence of parental child sexual abuse is difficult to assess due to secrecy and privacy; some estimates show 20 million Americans have been victimized by parental incest as children.

Types of child sexual assault

Child sexual abuse includes a variety of sexual offenses, including:

The legal term child sexual offender refers to a person who has been convicted for one or more child sexual abuse offenses. The term, therefore, describes a person who has committed child sexual abuse, without regard to the perpetrator's motivation.


Disclosure refers to when a victim of abuse tells someone that he or she has been abused. How one responds to disclosure is critical to the victim's short-term and long-term outcomes. Previous research has found that children who received supportive responses following disclosure had less traumatic symptoms and were abused for a shorter period of time than children who did not receive support In general, studies have found that children need support and stress-reducing resources after disclosure of sexual abuse Negative social reactions to disclosure have actually been found to be harmful to the survivor's wellbeing One study reported that children who received a bad reaction from the first person they told, especially if the person was a close family member, had worse scores as adults on general trauma symptoms, posttraumatic stress disorder symptoms, and dissociation Another study found that in most cases when children did disclose abuse, the person they talked to did not respond effectively, blamed or rejected the child, and took little or no action to stop the abuse Although hearing a victim's disclosure might be uncomfortable, for the sake of the victim's wellbeing, it is important to be able to respond effectively. Showing that you understand and take seriously what the child is saying is an important first step. The American Academy of Child and Adolescent Psychiatry provides guidelines for what to say to the victim and what to do following the disclosure


The American Psychiatric Association and the World Health Organization both define pedophilia as attraction by adults and older adolescents toward prepubescent children, whether the attraction is acted upon or not. According to researcher Howard E. Barbaree, "not all child molesters are pedophiles, and some pedophiles may not have molested children (ie there may be men who prefer sex with prepubescent children but who have not acted on their desires)".

The term "pedophile" is used colloquially to refer to child sexual offenders. However, pedophilia is generally defined as a sexual preference for prepubescent or preadolescent children, and is currently defined as a psychiatric disorder by the medical community. Neither definition requires the pedophile to have sexually offended, with the latter specifying additional requirements such as distress. Not all child sexual offenders meet the diagnostic criteria of pedophilia,. Law enforcement and legal professionals have begun to use the term predatory pedophile, a phrase coined by children's attorney Andrew Vachss, to refer specifically to pedophiles who engage in sexual activity with minors. The term emphasizes that child sexual abuse consists of conduct chosen by the perpetrator.

In papers by Paul Okami and Amy Goldberg (1992), and Kevin Howells (1981), the authors stated that most data they had reviewed suggests that pedophiles make up a minority of incarcerated child sex offenders. "Personality correlates of pedophilia: Are they reliable indicators?," Journal of Sex Research, 29, 297-328. "This is a particularly important point because most data suggest that only a relatively small portion of the population of incarcerated sexual offenders against minors consists of persons for whom minors (particularly children) represent the exclusive or even primary object of sexual interest or source of arousal." According to the Mayo Clinic, pedophilic child molestors commit ten times more sexual acts against children than non-pedophilic child molestors.


Offenders are more likely to be relatives or acquaintances of their victim than strangers. A 2006-2007 Idaho study of 430 cases found that 82% of juvenile sex offenders were known to the victims (acquaintances 46% or relatives 36%).

The percentage of incidents of sexual abuse by female perpetrators that come to the attention of the legal system is usually reported to be between 1% and 4%. Studies of sexual misconduct in US schools with female offenders have showed mixed results with rates between 4% to 43% of female offenders. Maletzky (1993) found that, of his sample of 4,402 convicted pedophilic offenders, 0.4% were female. Another study of a non-clinical population found that, among those in the their sample that had been molested, as much as a third were molested by women.

In U.S. schools, educators who offend range in age from "21 to 75 years old, with an average age of 28" with teachers, coaches, substitute teachers, bus drivers and teacher's aides (in that order) totaling 69% of the offenders.

International law

Child sexual abuse is outlawed in every developed country, generally with severe criminal penalties, including in some jurisdictions, life imprisonment or capital punishment. An adult's sexual intercourse with a child below the legal age of consent is defined as statutory rape, based on the principle that a child is not capable of consent and that any apparent consent by a child is not considered to be legal consent.

One hundred forty nations are signatories to the United Nations Convention on the Rights of the Child. This international treaty defines a set of protections which signatories agree to provide for the children of their respective countries. Articles 34 and 35 require that signatories protect their nations' children from all forms of sexual exploitation and sexual abuse. This includes outlawing the coercion of a child to perform sexual activity, the prostitution of children, and the exploitation of children in creating pornography. Signatories also agree to prevent abduction, sale, or trafficking of children.

Controversial research

Two analyses suggest that some people reporting experiences of childhood or adolescent sexual contact with adults had maintained some at least partially positive feelings about those experiences. The first was conducted in 1981 by Dr. Theo Sandfort, who interviewed 25 boys aged 10 to 16 who were currently involved in sexual relationships with adult men. The interviews took place in the homes of the men, although the men were not present in the interviews. According to the researcher, "The boys overwhelmingly experienced their sexual contact with the older partner as pleasant; such negative feelings as occurred had mainly to do with their social surroundings which they knew disapproved of such contacts." Dr. David Mrazek, co-editor of Sexually Abused Children and Their Families, attacked the Sandfort research as unethical, saying: "In this study, the researchers joined with members of the National Pedophile Workshop to 'study' the boys who were the sexual 'partners' of its members. There is no evidence that human subject safeguards were a paramount concern. However, there is ample evidence that the study was politically motivated to 'reform' legislation." Child sexual abuse researcher Dr. David Finkelhor also criticized the Sandfort research, pointing to the numerous studies which show adult-child sexual contact to be a predictor of later depression, suicidal behavior, dissociative disorders, alcohol and drug abuse, and sexual problems.

In 1998, Bruce Rind, PhD argued in his study known as Rind et al. that not all cases of "adult-child sex" should be termed child sexual abuse. This study was condemned by the United States Congress, an event which marked the first time in U.S. history that Congress officially condemned a study published in a major scientific journal. Rind's study was a meta-analysis of 15 studies using college students that found that boys reacted positively in 37% of the cases, while girls reacted positively in 11% of the cases. The methodology and conclusions drawn by this study has been criticized by many researchers, including Dallam et al., who stated "After a careful examination of the evidence, it is concluded that Rind et al. can best be described as an advocacy article that inappropriately uses science in an attempt to legitimize its findings." (2002). The study has also received some support for its scientific validity, though not necessarily its conclusions.

One study found that most men formerly involved in woman-boy sexual relations evaluate their experience as positive upon reflection. There is contrasting evidence that some children who initially report positive feelings will sometimes go on to reassess their abuse in a negative light. 38% of the 53 men studied by Urquiza (1987) said that they viewed their experience as positive at the time, but only 15% retained this attitude. One exploratory questionnaire-based study of 63 men and women who self-identified as maintaining at least a partial positive feeling about sexual abuse during their childhood or adolescence suggested a wide range of possible effects in adult life. Of the 63 subjects, 41% recalled feelings of guilt, 35% said they were frightened at the time, and 29% reported feelings of shame. Russell (1986) speculated that the perception of a sexually abusive event as 'positive' could stem from a mechanism for coping with traumatic experiences.

See also

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