Sexual abuse

Type of psychology: Clinical; Counseling; Psychopathology, Psychotherapy

Sexual abuse is any kind of nonconsensual sexual activity using force, threats, or coercion to take advantage of another. While both men and women can be victims, the vast majority are female. Sexual abuse includes unwanted touching, inflicting unwanted physical pain during sex, deliberately spreading sexual infections, using objects without consent, forcing sexual activity with others, forcing prostitution, refusing to use contraception, withholding sex, ridiculing others, and humiliating others. Immediate reactions to sexual abuse include shock, fear, or disbelief.

Introduction

Sexual abuse is a form of interpersonal violence that involves all forms of forced sexual activity on one person by another. Sexual abuse may include sexual acts that are consensual but illegal such as sex with minors, people with disabilities, or mentally incompetent individuals. It involves unwanted sexual contact between two or more adults, two or more minors, an adult and a minor, two minors with a significant age difference between them, or sexual contact initiated by a youth toward an adult.

Nonphysical sexual abuse includes indecent exposure, voyeurism, exhibitionism, exposure to pornographic material, a viewing of sexual intercourse, or masturbation in front of a victim. Physical sexual abuse involves direct contact and includes vaginal, anal, or oral sex, fondling, groping, touching genitalia, unwanted kissing, violent sex, rape, or sex with someone who is under the influence of drugs or alcohol.

To gain sexual control, abusers use intimidation, fraud, humiliation, verbal pressure, false promises to gain trust, nonphysical threats, threats of physical harm to cause pregnancy or transmit sexual infections, threats to reveal immigration status or sexual orientation, substances, disability exploitation, misuse of authority, bartering of sexual favors for basic needs, or the providing of drugs, alcohol, or other substances.

Many sexual abuse laws distinguish between sexual contact and penetration. Abuse laws in some states focus on nonphysical sexual abuse. Some states specifically address nonconsensual or illegal sexual penetration under state rape or assault laws. Though sexual abuse between partners and married couples is considered by some to be a form of domestic violence, for centuries, the law did not recognize sexual abuse or rape between partners and married couples because women were the property of male partners/husbands who had sexual rights to their female partners. However, the concept of ownership has changed so that nonconsensual sexual activities are recognized as crimes even between partners and married couples.

According to the Bureau of Justice Statistics, only 23 percent of rape or sexual assault cases were reported in 2016. The 2017 National Intimate Partner and Sexual Violence Survey of the Centers for Disease Control and Prevention (CDC) reported that between 2010 and 2012, 81 percent of rape, stalking, or physical violence female victims reported short or long-term effects. In the United States, approximately one in five women and one in seventy-one men will be raped during their lifetime. Almost 28 percent of male rape victims were first raped at ten years of age or younger, while the majority of female rape victims, almost 80 percent, experienced their first rape before the age of twenty-five. Approximately 35 percent of women who were raped when they were young were also raped as adults. According to 2015 surveys, about 23 percent of female undergraduate students experience sexual assault while in college.

Risk Factors

The risks for being a victim of sexual abuse include being female, young, physically attractive, educated or economically empowered, and intellectually disabled as well as having experiences of substance abuse, multiple sex partners, previous rape or sexual abuse, poverty, institutionalization, or incarceration. Among children, domestic violence, parents with low education, mental illness, substance abuse, social isolation, history of abuse, and poverty are risk factors.

The risk factors for becoming an abuser include being male, liking impersonal sex, or feeling hostile toward women as well as having experiences of a physically or sexually abusive family environment, impulsive antisocial personality, coercive sexual fantasies, peer associations, community tolerance for sexual violence, and lack of support.

Signs and Symptoms

Physical signs and symptoms of sexual abuse include bruising or bleeding around genitalia, breasts, or mouth, vaginal or anal bleeding, stained or bloody undergarments, sexually transmitted infection, pregnancy, difficulty walking or sitting, or reporting being sexually assaulted.

Psychological signs and symptoms of sexual abuse include anxiety, fear, depression, disassociation, and post-traumatic stress disorder (PTSD). Anxiety is often associated with depression. Its symptoms include excessive worry and negativity, hyper-alertness, apprehension, feeling unsafe, out of control, and an urgent need to escape. Depression symptoms include prolonged feelings of sadness, hopelessness, crying, changes in appetite, lack of energy, sleep disturbances, loss of interest in activities, and suicidal ideations. Fear is a psychological symptom of anxiety. It can manifest by social withdrawal, avoidance of reminders of a situation, person, or place, depersonalization, heightened restlessness, crying, lack of energy, shock, guilt, anxiety, loneliness, yearning, confusion, sadness, and hallucinations. Dissociation causes victims to feel detached from life. Symptoms include sleep disorders, depression, headaches, amnesia, dramatic mood swings, hallucinations, acting in socially inappropriate ways or insisting to be called by another name, a sense of lost time, self-harm, and suicidal ideations. PTSD results in response to a traumatic event. Its symptoms include anxiety, fear, flashbacks, and uncontrollable thoughts about an incident.

Children may exhibit inappropriate sexual behavior and/or sexual abuse toward other children. Sexually abused children may also exhibit changes in behavior. Children up to three years of age may fail to thrive, cry excessively, have extreme fear or sleep disturbances, and may have bowel, feeding, and vomiting issues. Children two to nine years of age may feel shame or guilt, be fearful of specific people or strangers, places, and activities, live in fear that the incident will recur, experience eating problems, nightmares, or sleep disturbances, revert to bedwetting, masturbate excessively, become withdrawn, or sexually abuse others. Preadolescent and adolescents may become depressed, promiscuous, aggressive, or angry and may experience powerlessness, eating issues, nightmares or sleep disturbances, fear that the incident will recur, or poor academic performance. They may also run away, become pregnant, get married, abuse substances, act older than their age, or attempt suicide.

The psychological effects of child sexual abuse last into adulthood. Survivors may feel stigmatized and experience low self-esteem, depression, grief, guilt, shame, self-blame, rage, anxiety, fear, and panic attacks. They are often distrustful, have difficulty developing and maintaining relationships, have poor support systems, tend to be revictimized, self-mutilate, or attempt suicide.

Consequences

Not everyone who is sexually abused experiences negative effects. However, those who are negatively affected by sexual abuse suffer with feelings of distrust, guilt, depression, identity confusion, low self-esteem, and emotional and relationship issues. They may exhibit self-abuse and antisocial behavior. Some behaviors are consequences of sexual abuse at the same time that they are risk factors for revictimization. Such behaviors include high-risk sexual activities like unprotected sex, multiple sexual partners, prostitution, substance abuse, and diet extremes like fasting, purging, and vomiting.

Prevention and Treatment

Victims are often reluctant to report sexual abuse because they are afraid they will be harmed by their abuser again, do not want it to become public, feel ashamed, guilty or embarrassed, or fear they will be blamed or not believed. As of 2016, the CDC uses a four-step approach to address sexual violence. It includes defining the problem, identifying the risk and protective factors, developing and testing prevention strategies, and assuring widespread adoption. The goal is to stop sexual violence before it begins.

There are also psychological and pharmacological treatments available for victims of abuse. Stress management, emotional expression, exposure therapy, group therapy, and antidepressants are available to assist in the recovery of victims. Victims should be provided information about the resources available to them so that they can be treated appropriately and effectively.

Children should be taught appropriate sexual behavior and to say “no” to touch in ways that make them uncomfortable. Child victims of sexual abuse need to be reassured that they are not responsible for what happened and that they should not feel shame or guilt. Awareness of sexual abuse should be provided to others through community programs. Any suspected abuse should be reported to local police and/or child protective agencies so that a child who is being sexually abused can be helped.

Actions taken by individuals that can lessen the chance of being sexually assaulted include knowing alcohol limits and not leaving drinks unattended, not taking drugs, parking in well-lit areas, keeping car and house doors locked, having keys ready when approaching the door, setting sexual limits, and becoming educated about sexual abuse and assault by attending community, campus, or facility crime prevention programs.

Convicted sex offenders may be sentenced to correction or rehabilitation facilities. Afterward they are placed on probation or parole, based on their risk for sexually abusing again. They must report to their supervisor in addition to following restrictions that may include no contact with victims, no or limited contact with minors, and restricted geographic movement, internet, workplace, and living access.

Bibliography

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