Is Child Sexual Abuse Harmful by Itself? V3

Rind, B., & Tromovitch, P. (1997). A meta‐analytic review of findings from national samples on psychological correlates of child sexual abuse. Journal of Sex Research, 34(3), 237–255.

Laumann et al. (1994) found that, although SA respondents consistently reported more sexuality-related problems than control respondents, they were also consistently more sexually active and had consistently experienced more diverse types of sex than control respondents. This confounding variable of extent and type of sexual experience renders the difference in adjustment between the SA and control respondents uninterpretable in terms of cause and effect. Laumann et al. argued that greater sexual activity may have subjected SA respondents to more untoward outcomes, which may then have led to poorer adjustment.

The findings from another study using a national sample, not included in the current review because it did not report psychological correlates of CSA and because of its exclusive focus on female respondents, are particularly relevant for interpreting causation in national samples (Ageton, 1985,1988). Ageton reported the results of longitudinal data collected on U.S. respondents aged 11 to 17 at the beginning of the study and found that girls experiencing unwanted sexual contacts differed from those who did not in terms of family, school, and social factors. The family environments of SA girls compared with control girls were characterized by more disruption and instability. SA girls had substantially more involvement with delinquent friends and received more support from these peers for delinquent and antisocial acts. SA girls also displayed far more tolerant attitudes toward delinquent behavior. Compared with controls, SA girls were less well integrated into their families and schools. We computed effect sizes for these measures for the last year for which data were taken to obtain estimates of the magnitude of confounding between CSA and social environment. Effect sizes ranged from small-medium to large. Some examples were these: disruptive events in home (r = .21), school-related delinquency (r = .30), exposure to delinquent peers (r = .48), support from delinquent peers for deviance (r = .30), delinquent behavior (r = .30), peer pressure for drinking and drugs (r = .47), attitudes toward deviance (r = .28), and nonsexual victimization (r = .34). These results suggest that the small differences in adjustment between CSA and control respondents observed in other national samples may be attributable to larger differences in social environment, rather than to the CSA. . . .

Briere, J., & Elliott, D. M. (2003). Prevalence and psychological sequelae of self-reported childhood physical and sexual abuse in a general population sample of men and women. Child Abuse & Neglect, 27 , 1205-22. Link: https://www.sciencedirect.com/science/article/abs/pii/S0145213403001856?via%3Dihub DOI: https://doi.org/10.1016/j.chiabu.2003.09.008

Overlapping abuse histories. Cross-tabulation of subjects’ physical and sexual abuse histories indicated that individuals with one form of abuse were statistically more likely to have experienced the other as well (χ2(1) = 23.2, p<.001). In this regard, of all subjects with some form of child abuse history (n = 345), 72 (20.9%) had experienced both physical and sexual abuse.

Whiffen, V. E., & MacIntosh, H. B. (2005). Mediators of the Link between Childhood Sexual Abuse and Emotional Distress. Trauma, Violence, & Abuse, 6(1), 24–39. doi:10.1177/1524838004272543

Family context in which CSA typically occurs has been characterized as disorganized, conflicted, inflexible, violent, and strained by parental mental illness (Fromuth, 1986; Harter et al., 1988).

Rind, B., & Tromovitch, P. (1997). A meta‐analytic review of findings from national samples on psychological correlates of child sexual abuse. Journal of Sex Research, 34(3), 237–255.

To address the issue of whether CSA was the result or cause of negative social factors, Ageton (1988) analyzed the longitudinal data prospectively. She investigated whether any social factors measured in earlier years of the study were predictive of CSAthat occurred in later years of the study and found that a number of factors were predictive. We computed effect sizes for the significant predictors, averaged them over the two years reported for each predictor, and obtained the following: family normlessness (r = .18), school normlessness (r = .15), peer support for delinquent behavior (r = .22), exposure to delinquent peers (r = .25), and attitudes toward deviance (r = .22). These results, with effect sizes of small to medium magnitude, imply that negative social factors predispose children and adolescents to CSA, rather than the reverse. These results are consistent with the possibility that negative social factors lead to poorer adjustment and to CSA and that the relation between CSA and adjustment in the general population is either spurious or of lower magnitude than we estimated.

Boney-McCoy, S., & Finkelhor, D. (1996). Is youth victimization related to trauma symptoms and depression after controlling for prior symptoms and family relationships? A longitudinal, prospective study. Journal of Consulting and Clinical Psychology, 64(6), 1406–1416.

In a review of the medical records of children treated at a hospital in the aftermath of sexual abuse, Paradise et al. (1994) found that victimized children were more likely to have been seen by a psychiatrist (for reasons unrelated to the abuse) before that hospital visit than were children admitted to the hospital for nonabuse-related causes. These data suggest that the abused children may have been symptomatic at the time of the abuse, and raises the possibility that symptomatology may contribute to victimization.

Whiffen, V. E., & MacIntosh, H. B. (2005). Mediators of the Link between Childhood Sexual Abuse and Emotional Distress. Trauma, Violence, & Abuse, 6(1), 24–39. doi:10.1177/1524838004272543

It is not at all clear that CSA precedes family dysfunction; in fact, the empirical evi- dence suggests that the reverse is true: that chil- dren from problematic families are at risk for CSA (Finkelhor & Baron, 1986; Mian, Marton, LeBaron, & Birtwistle, 1994; Rowland, Zabin, & Emerson, 2000).

Wylted said: "I am watching interviews with the writer of the "Trauma Myth" and she thinks that child sexual abuse is very harmful. If I limited my response to Susan Clancy quotes it would be enough to win this debate. She is concerned about the myths of how sexual abuse effects victims prevents victims from being recognized and coming forward."

"In my study—no differently from other research— the exact amount of time it took for victims to reconceptualize what had happened to them varied. It depended on the individual victims, on how old they were when abused, what educational and life experiences had taught them about sex, and what kinds of cues had triggered their thinking about what had happened and recognizing it as abuse. Victims described the point of realization in different ways: “A light went on.” “It was like, aha!” “I said, ‘Oh my God.’” For more than a few it was “like a bomb went off. . . . Holy shit! I was abused!” For many, the realization was a “long, drawn-out process” that slowly built up to a new perception of the abuse. One thing did not vary: only at this point—when victims understood the abuse as such, once they had reconceptualized these formerly ambiguous and confusing events—did the experience become psychologically traumatic and begin to exert its negative effects. . . . It is the retrospective interpretation of the event that mediates subsequent impact . . . . there is almost always a period in which the victim reports a lack of awareness that they were abused and then subsequently reconceptualizes the experience . . . ."

"As I discussed at length in chapter 2, according to victims, they did not experience the abuse as awful when it happened because most simply did not understand clearly the meaning or significance of the sexual behaviors they were engaging in. That being said, at some point later on in life, they do. Over time, the “cloak of innocence lifted,” as one victim described it. Victims reconceptualized the formerly “confusing and weird experiences” and understood them for what they were—sexual in nature and clearly wrong. Only at this point—when the sexual abuse is fully apprehended— does it begin to damage victims. . . ."

"If you experience psychological distress after sexual abuse, then the sexual abuse must be the cause[, right?]. But it is not actually that simple. What, specifically, about the abuse has triggered the distress? Does it have to do with objective characteristics of the abuse (for example, how many times it happened or whether penetration was involved)? Does it have to do with subjective characteristics about the abuse (how painful, frightening, or shocking it was)? Perhaps it has less to do with the actual abuse and more to do with, say, the particular child (how old he or she was and how genetically predisposed to long-term psychological problems) or the environment. the abuse occurred in (one characterized by poverty, physical abuse, or neglect). Maybe it has to do with the cognitive or social consequences of the abuse (how the victim’s family or health professionals handled it or how the victim understood or conceptualized it later on in life). There are numerous ways to understand how and why sexual abuse damages victims. [In other words there are many different theories that claim to know why when a child has sex with an adult the child is harmed in the short term or in the long term.] For decades, however, the main focus has centered on one—the incident itself. . . .

Lucy Berliner and Jon Conte in their 1990 study noted that a majority of the children they interviewed reported not knowing initially that they were being sexually abused. Berliner and Conte quoted victims as saying such things as . . . . “I didn’t know there was any- thing wrong with it, because I didn’t know it was abuse until later. I thought he was showing me affection.”10

More recently, two cognitive psychologists, Michelle Epstein and Bette Bottoms, specifically hypothesized that due to the confusing and secretive nature of the abuse, many victims may fail to understand the meaning of the sexual acts committed (and subsequently forget them for periods), but then, at a later point, come to “relabel” the experiences as “traumatic.”11

In my study—no differently from other research— the exact amount of time it took for victims to reconceptualize what had happened to them varied. It depended on the individual victims, on how old they were when abused, what educational and life experiences had taught them about sex, and what kinds of cues had triggered their thinking about what had happened and recognizing it as abuse. Victims described the point of realization in different ways: “A light went on.” “It was like, aha!” “I said, ‘Oh my God.’” For more than a few it was “like a bomb went off. . . . Holy shit! I was abused!” For many, the realization was a “long, drawn-out process” that slowly built up to a new perception of the abuse. One thing did not vary: only at this point—when victims understood the abuse as such, once they had reconceptualized these formerly ambiguous and confusing events—did the experience become psychologically traumatic and begin to exert its negative effects. . . . It is the retrospective interpretation of the event that mediates subsequent impact . . . . there is almost always a period in which the victim reports a lack of awareness that they were abused and then subsequently reconceptualizes the experience . . . ."

"Only 2 of 27 subjects remembered the experience as terrifying, overwhelming, or traumatic. The other subjects remembered it as weird, confusing, or uncomfortable. Moreover, only 2 subjects understood the experience as sexual at the time it occurred. [...] However, after recalling their experience during adulthood, and viewing it through the eyes of an adult as sexual abuse, many subjects became highly distressed. In fact, 7 met symptomatic criteria for current PTSD, and all the participants believed that the abuse had multiple adverse effects on their lives. Retrospective reappraisal of the abuse as a trauma, after subjects recall it during adulthood, may render the memory pathogenic later in life."

The trauma conceptualization of child sexual abuse (meaning the traumano-genic model of child-sexual abuse) emerged in the early 1980s. What professional theories and approaches to child sexual abuse had existed before then? Having come of age during a time when most professionals in the mental health field acknowledged that sexual abuse is a common and harmful form of victimization, I was shocked by what I found in the historical literature lead- ing up to this point. For most of the twentieth century, many mental health professionals believed otherwise.

Although some health professionals acknowledged that sexual abuse existed and was perhaps more common than many thought, they were quick to dismiss the cases as harmless to the victims . . . . because . . . . victims reported that force or violence were rarely involved and that it was rare for any medically significant physical trauma to occur. As John Gagnon, one of the foremost experts, put it in 1965, “The bulk of sexual abuse cases will be minimal in character. . . . The amount of damage—if any, is limited.”13 A text coauthored by C. Henry Kempe, a world-renowned child abuse expert, argued in 1978 that “most sexual molestation appears to do little harm to normal chil- dren.”14 The consensus among most professionals was that the majority of these offenses were essentially “nuisance experiences” and rarely involved the use or threat of physical force.15 As the scholar Philip Jenkins puts it, “The perception of child molestation was as innocuous as the modern image is threatening.”16

Definitions of CSA

Using the original Kinsey sample, enjoyment and emotionally negative reactions to first postpubescent coitus were examined in relation to whether the coitus occurred as a legal minor (aged under 18) with an adult (5 or more years older), a minor with a peer (within 4 years of age), or an adult with an adult (both 18 or older). . . . In addition to these three main divisions, we subdivided the minor–adult and adult–adult categories into 5 subcategories, as follows: (1) Minor (14 and under)–adult: participant was 14 or under and partner was at least 5 years older7 ; (2) Minor (15–17)–adult: participant was 15–17 and partner was at least 5 years older; (3) Adult–younger adult: both participant and partner were adults (at least 18) and participant was at least 5 years older than partner; (4) Adult–peer adult: both participant and partner were adults (at least 18), and partner was within 4 years of participant’s age; (5) Adult–older adult: both participant and partner were adults (at least 18), and participant was at least 5 years younger than partner. . . .

[This studies sample] consisted of 6,621 males and 6,337 females who were interviewed between 1938 and 1953. . . . For males and females combined, the numbers in the minor– peer, minor–adult, and adult–adult categories were, respectively, ns=1,560, 834, and 5,444. An additional 4,318 participants had had no first coitus and were not analyzed in the present study. . . .

The data were collected in face-to-face interviews conducted by researchers from multiple scientific disciplines, who were trained to elicit sexual histories, regardless of their nature, nonjudgmentally. . . .

Questionaire: Reasons for enjoying it

Participants, who had had coitus, were asked whether they enjoyed their first coitus, with these response options: 1 = no; 2 = little; 3 = some; 4 = much. . . .

Quetionaire: Reasons for not enjoying it

Participants were also asked the main reason for why they did not enjoy their first coitus, if they had any such reasons. For males, 35 specific reasons were coded (Albright, 2006, pp. 99–100) and, for females, the number was 37 (Albright, 2006, p. 90). Reasons included problems that the participant or partner may have had, such as incompetence (e.g., male impotent), physical (e.g., painful), psychological (e.g., disgusted), and alcohol (e.g., male drunk). . . .

Participants were coded as not enjoying their first coitus for emotionally negative reasons if they endorsed, or the interviewer recorded, any one of the following options: (1) painful and embarrassed (frightened, scared, upset, nervous, uneasy, shocked); (2) painful and shame (guilt, regret); (3) embarrassed (frightened, scared, upset, nervous, uneasy, shocked);(4)disgusted (revolted, offended);(5)moral (inhibited, conflict); or (6)shame (regret, guilt).4 For females, one additional option was: pain plus moral(inhibit, conflict). If any of these applied, a participant was given a ‘‘1’’ for emotionally negative reactions, otherwise a‘‘0.’’. . . . 4 Thewordingforseveralitemsdifferedinminorwaysinpresentationto male versus female participants. For male participants,‘‘emotional’’was added to the list of descriptors for painful and embarrassed and for embarrassed; ‘‘annoyed’’ was added to the list of descriptors for disgusted; and‘‘conscience’’was added to the list of descriptors for moral. . . .

Age difference

Notably, in the minor–adult groups, the chief focus here, the mean age of first postpubescent coitus for boys was 15.56 (SD = 1.41), the mean age of their female partners was 24.99 (SD = 3.38), and the mean age difference was 9.44 years (SD = 3.51). The mean age for girls with men was 15.51 (SD = 1.49), the mean age of their male partners was 26.36 (SD = 6.76), and the mean age difference was 10.85 years (SD = 6.83).