The long-term effects of child sexual abuse
- Determining the association between child sexual abuse and later outcomes
- A range of outcomes
- The impact of child sexual abuse on mental health
- Behavioural aspects of mental health functioning
- Interpersonal outcomes
- Physical health and overall developmental outcomes
- Gender differences in the long-term impacts of child sexual abuse and gaps in understandings of male victims/survivors
- A complex interplay
Gender differences in the long-term impacts of child sexual abuse and gaps in understandings of male victims/survivors
Research continues to depict child sexual abuse as predominantly perpetrated against female children. In Australia, in 2003, 76% of recorded sexual assault victims aged under 15 years of age were female and 24% were male (ABS, 2004). However, it is clear that definitional differences may influence the rate of sexual assault identified in male and female populations (methodological differences are likely to do likewise). A recent review of the prevalence of child sexual assault reported in comprehensive contemporary Australian studies found that males had prevalence rates of 4-8% for penetrative abuse and 12-16% for non-penetrative abuse, while females had prevalence rates of 7-12% for penetrative abuse and 23-36% for non-penetrative abuse (Price-Robertson, Bromfield, & Vassallo, 2010). These findings are consistent with earlier research that has reported that severely intrusive forms of abuse, including attempted or completed vaginal, oral, or anal penetration, did not greatly differ between boys and girls, with the majority of studies reporting prevalence figures in the range of 5-10% for both males and females (Fergusson & Mullen, 1999).
Child sexual abuse is clearly an issue in need of a nuanced understanding of both male and female victims. Research suggests that the sexual abuse of boys is far more common than generally believed (Dorahy & Clearwater, 2012). This is emerging from studies of clergy-perpetrated sexual abuse and from studies of gay and bisexual men. The prevalence rates for both groups are significantly higher than the more commonly cited figures for males in the general population (Jinich et al., 1998; Wilson & Widom, 2010). In relation to clergy-perpetrated abuse, it is becoming clear, as outlined earlier, that boys are much more likely than girls to be the victims of this type of abuse, though it may not be formally reported to authorities for some time, if ever (John Jay College, 2004; Parkinson et al., 2010).
Difficulties in teasing out the effects of child sexual abuse on male victims are compounded not only by definitional and methodological variations in the research as noted above, but also by a paucity of research that specifically compares the psycho-social attributes of male victims in clinical and non-clinical samples with non-victims as well as with female victims of child sexual abuse. Moreover, the findings in this area may be complicated by factors such as the nature and characteristics of abuse, and the homosexual overlay in the sexual abuse of boys. For example, there is evidence that male victims are more likely than female victims to have experienced same-sex molestation, greater violence and physical harm during the abuse, and are more likely to have been victimised by multiple perpetrators (Steever, Follette, & Naugle, 2001).
Importantly, there is increasing research evidence that the disclosure rates of sexual abuse by boys and men are lower than those for girls and women. Earlier research such as Easteal's (1992) study found that 53% of male respondents compared with 37% of female respondents had never, prior to this study, disclosed their abuse to anyone. Similarly, Roesler and McKenzie (1994) for example, found that 61% of adult women had told someone as a child compared with 31% of men. More recent research also indicates that men are less likely to disclose child sexual abuse during childhood compared with women and to make fewer and more selective disclosures (Hunter, S. V., 2011; O'Leary & Barber, 2008). O'Leary and Barber, for example, reported that 64% of women but only 26% of men had told someone about the abuse when they were children. Men took significantly longer than women to discuss it with someone, and "it was not uncommon … for men to report taking in excess of 20 years to talk about their experiences" (p. 139).
Boys may be especially inhibited from disclosing sexual abuse for various reasons that are different to why girls generally delay in disclosing or never disclose such abuse (Foster, Boyd, & O'Leary, 2012). Price-Robertson (2012a), drawing on the findings of his recent research in the area, argued that cultural images of how "real men" should think, feel and act can create:
powerful barriers to male victim/survivors of child sexual abuse disclosing their experiences to others, accepting their experience as one that may have had a formative influence on their lives, and healing from the trauma of the abuse … [This] means that many in society have difficulty fully acknowledging and accepting the reality of the sexual abuse of males during childhood/adolescence, and the trauma it can inflict. (p. 5)
Spataro, Moss, and Wells (2001) have pointed to individual factors - including "the male ethos of self-reliance, the fear of homosexuality, and notions of youthful male sexuality" (p. 177) - as key factors that may perpetuate nondisclosure by boys, arguing that "boys are usually socialised with an ethos where self-reliance, independence, and sexual prowess are valued, and both a victim role and homosexuality are denigrated" (p. 177). Further, Spataro et al. argued that differences in adult expectations of children based on gender may also inhibit disclosure of child sexual abuse, as the "masculine stereotype does not sanction the expression of feelings of dependency, fear, vulnerability, or helplessness" (2001, p. 177) - feelings that are commonly associated with child sexual abuse.
Other researchers have similarly suggested that under-reporting of sexual abuse by boys may be linked to "community assumptions that have often labelled them as future perpetrators: as homosexual; or, because they fear being treated as social outcasts, liars, or as emotionally weak" (Mezey & King, 1989, cited in Neame & Heenan, 2003, p. 4; Stott, 2001, in Fergus & Keel, 2005).
Some researchers have suggested that the nature of the abuse situation for boys may also be a complicating factor that reduces the likelihood of disclosure since "boys are more likely than girls to be assaulted by siblings or other boys" and are then more likely to experience "confusion about whether the experience is an assault or is typical and appropriate for their gender" (Spataro et al., 2001, p. 178). Boys may also harbour greater fears about being perceived as the instigator of the abuse (Dorahy & Clearwater, 2012). Where the abuser is a sibling, this is likely to be even more confusing and difficult to deal with (Stathopoulos, 2012). Where the abuser is a priest or trusted authority figure, as is more often the case for boys than girls, this is also confronting and confusing, bringing in spiritual development concerns as well (Brady, 2008; Fogler, et al., 2008).
Importantly, research also indicates that even if boys disclose sexual abuse, they are less likely to receive counselling and other professional support compared with girls (Foster et al., 2012; Holmes, Offen, & Waller,1997). This may be a consequence of either male victims themselves and/or clinicians and other professionals minimising the abusive nature of the alleged sexual abuse and/or the effects of such abuse. In other words, "a history of childhood sexual abuse in adult males is both under-reported and under-identified" (Homes et al., 1997, p. 71), a situation that of itself is likely to impact on the long-term outcomes following child sexual abuse.
A continued focus on girls as the primary victims of child sexual abuse means that much of the research and literature in the field is heavily skewed towards investigating and understanding the long-term impacts of such abuse on women and much less so on men. More research is needed on the extent, nature and dynamics of sexual victimisation perpetrated against boys and the impact of such abuse on male survivors specifically. As noted above, there is a growing body of research that indicates that boys may not only be especially inhibited from disclosing sexual abuse but that the impacts of non-disclosure or disclosing and getting an unsatisfactory response, as well as the characteristics of the sexual abuse itself, are different for boys compared with girls and may be particularly severe for male survivors, at least in some respects.
Table 2 summarises the findings from a number of studies on the impact of child sexual abuse on males and a comparison between male survivors of child sexual abuse and female survivors and non-abused men. Overall, research on the effects of child sexual abuse amongst male victims indicates that male survivors often "experience the event as traumatic and that psychological distress is a common long-term correlate" of such abuse (Steever et al., 2001). Despite a less robust body of research on the effects of child sexual abuse on adult male survivors there is "ample evidence that male CSA is associated with a broad spectrum of detrimental sequelae" (Schraufnagel, Davis, George, & Norris, 2010, p. 370). More specifically, research indicates that male survivors of child sexual abuse are at a substantially increased risk for depression, PTSD, personality disorders, poor self-image, substance abuse problems, suicidality, and sexual disorders (Romano & De Luca, 1996). Compared with women survivors, research seems to indicate that male survivors are particularly at risk of anxiety related symptoms and disorders (Hunter, J., 1991) and may be particularly susceptible to internalising effects (Dorahy & Clearwater, 2012; Romano & De Luca, 2001).
|Study||Type||Child sexual abuse vs non-abused||Males vs females|
|National US probability sample of children aged 11-14 who were investigated by protective services for child maltreatment with child sexual abuse as most serious or only type of maltreatment (n = 127 girls and 31 boys).||N/A||Twice as many boys (52%) as girls (24%) were in the clinical range on internalising behaviour problems. The effect for gender was not altered when the following factors were controlled: abuse characteristics, multiple victimisation, efficacy, relatedness, and autonomy.|
|Colman & Spatz Widom (2004)
|Comparison of 676 abused and neglected adults abused as children (substantiated cases 1967-71) with matched controls on gender, age, race, and approx family SES - prospective study interviewed 1989-95 with standardised rating scales.||Male and female abuse and neglect victims reported higher rates of cohabitation, walking out, and divorce than controls.||Females less likely to have positive perceptions of current romantic partners and to be sexually faithful.|
|Dorahy & Clearwater (2010)
|Study of seven adult males sexually abused as children attending a service for male sexual abuse. Measures completed for shame, guilt dissociation and childhood trauma. Focus group also conducted with participants.||N/A||Male victims in this study showed considerably higher levels of trait shame and guilt scores compared with college samples.|
|Dube et al. (2005)
|Retrospective large-scale cohort study of 17,337 adults.||After controlling for exposure to other forms of adverse childhood experiences that co-occur with child sexual abuse, history of suicide attempt was more than twice as likely among both men and women who experienced child sexual abuse, and a 40% increased risk of marrying an alcoholic, and 40% to 50% increased risk of reporting current marital problems.||Contact child sexual abuse was reported by 16% of males and 25% of females. Men reported female perpetration of child sexual abuse nearly 40% of the time, and women reported female perpetration of child sexual abuse 6% of the time.
Increased risk of adverse outcomes similar for men and women.
|Garnefski & Diekstra (1997)
|Large representative community sample of adolescents: see below.||Strong association between being sexually abused and the existence of a multiple problem pattern in both sexes.||Impact for boys worse and more complex than for girls.|
|Garnefski & Arends (1998)
|Large representative community sample of adolescents:
745 secondary school students, aged 12-19 with a self-reported history of sexual abuse (151 boys and 594 girls) and 745 matched students without such a history.
|More emotional problems, behavioural problems, suicidal thoughts and suicide attempts for both male and female.||More severe for boys than for girls:
(e.g., 3% cf. 27% for non-abused cf. abused boys [13 times higher]).
|Gold et al. (1999)
|162 women and 25 men entering an outpatient treatment program for adult survivors of childhood sexual abuse in a university-based community mental health centre.||N/A||Significantly more interpersonal sensitivity, depression, anxiety, and phobic anxiety for men than women.|
|Molnar, Berkman et al. (2001)
|Nationally representative sample of 5,877 Americans aged 15 to 54 years.||Among those sexually abused as children, odds of suicide attempts were 2-4 times higher among women and 4-11 times higher among men, compared with those not abused, after controlling for other adversities.||Prevalence for child rape or molestation for women of 14% and 3% for men. Reported suicide attempts slightly greater for men (31%) compared to women (27%).|
|Schraufnagel et al. (2010)
|N = 280 heterosexual men aged 21-35 recruited from the Greater Seattle area via newspaper ads and flyers circulated at community colleges, universities and other social environments.||N/A||Increased severity of child sexual abuse was associated with early age of drinking initiation. Child sexual abuse severity also directly associated with the number of partners participants reported.|
|Steever, et al. (2001)
|60 participants recruited from university undergrads aged 18-56. 20 were recruited for each group of: (i) men who reported no history of child sexual abuse; (ii) men who did not identify self as survivor of child sexual abuse but reported history of childhood or adolescent sexual experiences that were coercive/forced in nature; (iii) men who report a history of child sexual abuse.||N/A||Men who self-identified as child sexual abuse survivors reported significantly higher levels of psychological distress. No significant differences were found across the three groups in the following behavioural correlates: alcohol abuse, anger and aggression, compulsive sexuality, relationship stability.|
|van Roode et al. (2009)
|Large prospective birth cohort longitudinal study (Dunedin) 1972-73:
Contact child sexual abuse reported by 30% of 465 women and 9% of 471 men.
|Women: increased rates in number of sexual partners, unhappy pregnancies, abortion, and sexually transmitted infections from age 18 to 21 but then reduced
Men: greater number of partners from age 26-32 and more STD (herpes) age 21-32.
|Gender and age are critical when considering the effect of child sexual abuse. While the profound early impact of child sexual abuse demonstrated for women appears to lessen with age, abused men appear to carry increased risks into adulthood.|