Improving policy and practice responses for men sexually abused in childhood

ACSSA Wrap No. 12 – November 2012

Male child sexual abuse

Prevalence and effects

Basic statistics

In 2002, Davies identified that research into the sexual assault of males and its subsequent impacts was over 20 years behind research that examined the sexual assault of females, however there is now a developing body of knowledge that can be drawn upon to inform service provision. Research suggests that:

  • between 1 in 6-10 males are sexually abused whilst under the age of 16 years (Dube et al., 2005; Dunne, Purdie, Cook, Boyle, & Najman, 2003);
  • over 30% of confirmed reports of child sexual abuse involve male victims (Fergusson & Mullen, 1999);
  • most sexual abuse of males happens when adolescent or pre-adolescent (Gonsiorek, Bera, & Le Tourneau, 1994);
  • 80% of childhood sexual abuse of males is perpetrated by males (Dube et al., 2005);
  • males are more likely than females to be subjected to clergy abuse as children and prison based sexual violence as adults (Heilpern, 1998; John Jay College of Criminal Justice, 2004; Mariner, 2001; Parkinson, Oates, & Jayakody, 2009; Yap et al., 2011); and
  • the risk of sexual assault declines for adult men relative to adult women (Australian Bureau of Statistics [ABS], 2006; Dal Grande et al., 1999).

Although there are no exclusive circumstances in which boys are abused, research indicates that boys are more likely than girls to be abused outside the home, subjected to extra-familial abuse (Ogloff, Cutajar, Mann, & Mullen, 2012), abused around witnesses, and be abused by strangers (ABS, 2006; Crome, 2006). The developing body of knowledge emphasises the situational and contextual nature of sexual abuse where some boys and men, more than others, are targets of sexual abuse or sexual assault. Vulnerability is situational, it should not just be seen as a personal characteristic. Risk of sexual abuse escalates if a boy is homeless, has a learning or physical disability, is subjected to other forms of maltreatment in the home, comes from an impoverished and/or single-parent family, is same-sex attracted, or has spent time in a hospital or institutional setting (Crome, 2006; Mitra, Mouradian, & Diamand, 2011).

Effects

Sexual abuse is something done to someone, not a diagnosis, characteristic, essence or something a person is. (Anderson, 2008, p. 56)

There is no prescribed way that people are affected by sexual abuse or assault; everyone is different. However, we do know childhood sexual abuse can have profound effects. In comparison with men in general, men who have experienced childhood sexual abuse disproportionately report:

  • depression/anxiety;
  • intense emotions/anger;
  • flashbacks/nightmares;
  • overwhelming shame/guilt;
  • decreased appetite and weight loss;
  • suicidality/self harm;
  • sexual difficulties;
  • relationship difficulties;
  • sleep difficulties; and
  • mental health problems (Banyard, Williams, & Siegel, 2004; Tewkesburg, 2007).

There is a growing consensus that the effects of childhood sexual abuse are best understood as characteristic of complex trauma. Identifying the impacts of childhood sexual abuse as complex trauma is important, because, whilst having many similarities to acute trauma (e.g., natural disasters), the occurrence of trauma at a critical developmental period can significantly impact on sense of self, safety, and trust in adult life - especially when perpetrated by a trusted caregiver or family member (Curtois & Ford 2009, van der Kolk 2005). Understanding the complexity of the effects of this trauma is important to enable professionals to respond appropriately.

The most comprehensive Australian study to date (O'Leary, 2009; O'Leary & Gould, 2009) identified that men who have been subjected to child sexual abuse are vulnerable to a range of mental health difficulties, increased substance abuse, and suicidality. When compared to a community comparison group, men sexually abused in childhood are four times more likely to qualify for a clinical diagnosis, and some 10 times more likely to qualify for a diagnosis of post-traumatic stress disorder (PTSD). These findings are consistent with numerous studies showing a significant over-representation of adults with histories of childhood sexual abuse amongst clinical mental health populations (Nurcombe, 2000; Olgoff & Cutajar, 2009). In addition, in amongst clinical populations, there is some evidence to suggest that men subjected to sexual abuse exhibit a greater propensity for externalising behaviours (e.g., aggression and excessive risk taking), whereas women who have been sexually abused exhibit internalising behaviours (e.g., guilt and depression) (Romano & De Luca, 2001).

Suicide

We know that whilst Australian men are significantly more likely than women to commit suicide, both women and men who have been subjected to childhood sexual abuse report higher rates of suicidality than the general population (Spokas, Wenzel, Stirman, Brown, & Beck. 2009). Evidence suggests that men sexually abused in childhood are particularly vulnerable to suicide, reporting suicidal ideation at 10 times the rate of a community sample of Australian men; 46% of these men reporting at least one attempted suicide (O'Leary, 2009; O'Leary & Gould, 2009). Recent publicity (McKenzie, Baker, & Lee, 2012) detailing the death by suicide of 34 men sexually abused as schoolboys by two men in Victoria, graphically highlights the impact of sexual abuse on men's lives, as does the below comment from a 25 year old man:

I tried to knock myself off about three times … OD'd twice, slashed my wrists once, yeah, woke up in hospital and all that sort of sh_t … f_ck, can't even get that right! So it's the first thing I thought - can't even do this f_ckin' right - so that was a bit of a spin-out. (O'Leary, 2010, p. 959)

Although steps are being taken to address the problem of men and suicide - with initiatives such as Promoting Good Practice in Suicide Prevention: Activities Targeting Men (Department of Health and Ageing [DoHA], 2008) - men sexually abused in childhood are not recognised as a group requiring specifically targeted interventions (Department of Health, 2010). Factors that have been shown to increase the suicidality of these men and that can inform development of future targeted initiatives are: feeling isolated and alone; acting violently and aggressively; blaming themselves for the abuse; using alcohol and drugs; feeling fearful and anxious; along with a loss of hope (O'Leary & Gould, 2009; Spokas et al., 2009).

Barriers to men's disclosure

Considerable efforts are required in Australia to educate men to come forward after sexual assault, with "more publicity is needed to dispel the myths about male sexual assault". (KPMG, 2009, p. 37)

A particular challenge in seeking to provide helpful information to men and support more helpful ways of coping is that men are very reluctant to disclose child sexual abuse (or adult sexual assault). Research indicates that:

  • a majority of men who have experienced childhood sexual abuse have not told anyone (Holmes & Slap, 1998);
  • boys are less likely to disclose at the time sexual abuse occurs than girls (O'Leary & Barber, 2008; Paine & Hansen, 2002);
  • men typically disclose being sexually abused in childhood 10 years later than women - on average 22 years after the assault (Holmes & Slap, 1998; O'Leary & Barber, 2008; O'Leary & Gould, 2009);
  • men are one-and-a-half times less likely than women to report adult sexual assault to police (Pino & Meier, 1999); and
  • men make fewer and more selective disclosures than women (Hunter, 2011).

In seeking to better understand and address men's limited disclosure and help seeking we are required to look beyond the stigma associated with sexual abuse itself and the power exercised through threats, coercion, blame etc., and the "silencing" effects of fear, confusion and shame (Dorahi & Clearwater 2012). Interviews with men identify a reluctance to disclose sexual abuse out of concern that they will be treated differently, and will receive limited or inadequate responses (O'Leary & Barber, 2008). Men report that their disclosure of abuse is heavily influenced by dominant masculine stereotypes, questions related to sexuality, and uncritical acceptance of the idea that male victims will become perpetrators of abuse (Sorsoli, Kia-Keating, & Grossman, 2008; Washington, 1999).

Masculinities

I'm not telling nobody that it happened to me, because that makes me weak. That makes me less than a man. (Sorsoli et al., 2008, p. 341)

We know that dissonance between male role expectation and the experience of victimisation impacts significantly on men's understanding and can have men questioning their whole gender identity (O'Leary, 2001, p. 84). Limited ideals of manhood compound problems for men, in that men both blame themselves for not stopping the abuse from happening and for struggling with the aftermath, because "as men they should be able to cope". The sense of "failure as a man" that sexual abuse can feed into makes men less likely seek help, leading to increased isolation and its accompanying problems (Lisak, 2005).

Men may (often correctly) assume that to disclose sexual abuse would be to open him to ridicule or stigmatisation (Yarrow & Churchill, 2009). In this scenario, keeping quiet becomes configured as a way of looking after oneself. It also fits with the gender training men receive growing up to put up with discomfort and wait until difficulties impact on day-to-day functioning before acting (White & Johnson, 2000; Wilhelm, 2009). Our experience working with men sexually abused in childhood, and evidence from Kia-Keating, Grossman, Sorsoli, and Epstein (2005), suggests that in order to come forward and speak up about sexual abuse, men need reassurance that they will be believed, taken seriously, and not evaluated against normative masculine expectations. Unless these expectations are actively challenged, men have little reason to think they will receive a supportive response.

Sexuality

Homophobia (personal and public) acts as a major inhibitor of men disclosing child sexual abuse and seeking any form of assistance (KPMG, 2009). Questions relating to sexual identity produce unnecessary confusion and move attention away from the use of violence, manipulation, coercion and the offensive nature of the crime of sexual abuse. If a man was sexually abused by a man he may be concerned that people will think he is gay, and discriminate against him, or if he was abused by a woman that people will not take his complaints seriously, and think he should be okay about it (Teram, Stalker, Hovey, Schachter, & Lasiuk 2006). Personal concerns with questions of sexuality often trouble men, even if they have never previously experienced sexual interest in another man (Foster, 2005). Individual men themselves may not have negative attitudes towards homosexuality, but are aware that men identified as anything other than heterosexual, face discrimination, harassment and abuse.

Gay-identifying and same-sex attracted men face the doubly silencing effects of stigma surrounding child sexual abuse and homophobia (Lew, 2004). Here, difficulties become compounded by societal denigration of same-sex relationships. Personal distress and reluctance to speak about abuse is only added to by suggestion of a supposed link between sexual abuse and "damaged" sexuality (O'Dell, 2003). Unfortunately, there is insufficient room to detail in anything but a cursory way, the extent to which questions of sexuality produce distress and silence men subjected to sexual abuse.

Uncritical promotion of the idea that male sexual victimisation leads automatically to perpetration

A significant barrier to men seeking support and accessing services is the suggestion that a boy who experiences child sexual abuse is likely to go on to perpetrate abuse. Unfortunately the "automatic" route from victim to perpetrator is often uncritically reproduced in the media cited in the context of working to prevent sexual abuse. Whilst recognising it is always important to intervene to stop abuse, it is also important to be aware that research has found that most males sexually abused in childhood (95%) do not become sexual offenders (Ogloff et al., 2012), but particular experiences and patterns of childhood behaviour additional to sexual abuse are associated with an increased risk of offending (Richards, 2011; Salter et al., 2003).

Despite the fact that there is no straight forward, causal pathway from victimisation to offending, the "cycle myth" continues to circulate and has a profound impact on men's lives, leading to men monitoring and viewing themselves in negative ways, stopping men from participating in relationships, parenting or working with children (Ouellette, 2009). Greater education would assist service providers to put this concern into perspective and help remove this complex barrier to disclosure and help seeking (See Boyd & Bromfield, 2006; Living Well, 2012).

Methods of coping

Men are tough. Men are macho. Men don't need help. All we have to do is "get over it - be a man!" You know, men don't cry, men don't eat quiche either! [laughs] It's sad, very sad. (Teram et al., 2006, p. 509)

Men adopt a variety of methods of coping with sexual abuse, some of which have been identified as helpful, some unhelpful. Coping is best understood as a dynamic, often complex process, not simply a static pathway from not coping through to coping well (O'Leary & Gould, 2010). The following quote from a gay-identifying man highlights the complexity of this process:

I don't always use protection, and that's just like, oh well, I want to feel the whole thing and I don't give a damn what the repercussions are. But in actual fact, if I'm not in that frame of mind, I do give a damn, but because of the abuse … It almost feels like I'm a bit of a perpetrator on myself in a way - who gives a f_ck about me? … And I relate this to the abuse, definitely. (O'Leary & Gould, 2010, p. 2674).

The problems men experience can manifest in all areas of their lives, in interpersonal relationships, parenting, employment, social and leisure activities and at different points throughout the life span (Alaggia & Millington, 2008; O'Leary & Gould, 2009). Consequently, it is important that knowledge about men's experiences of sexual abuse and ways of responding is available in a range of service settings, not just mental health and sexual assault services. For example, it is useful that human service professionals are aware that drug and alcohol misuse is the most preferred method of coping amongst men sexually abused in childhood, in order to develop appropriate referral processes and support strategies (O'Leary, 2009).

Factors that have been found to impact on men's coping is the severity of sexual abuse (physical injuries, number of incidents, duration, number of perpetrators, and relationship to perpetrator) and how disclosure is handled by family or friends (O'Leary, Coohey, & Easton, 2010; O'Leary & Gould, 2009). Although we might hypothesise that disclosure is more likely to be associated with a better outcome, if the response is inappropriate or not protective it can result in increased difficulties (O'Leary et al., 2010). Coping strategies that have been identified as unhelpful and predictive of clinical diagnosis are suppression, withdrawal, anger, denial and acceptance (that "this is my lot in life") (O'Leary, 2009). Factors that are correlated with men's enhanced wellbeing are:

  • Practical information and assistance. Working to develop concrete life skills that address the impact of sexual abuse, exploring feelings and learning to tolerate emotional distress (O'Leary & Gould, 2010).
  • Talking with someone who is supportive. This may be a work colleague, partner or friend (O'Leary & Gould, 2010).
  • Talking with someone who encountered a similar event. Men's wellbeing is enhanced not just through receiving support but through having the opportunity to support and help others (Grossman, Sorsoli, & Kia-Keating, 2006; Kia-Keating, Sorsoli, & Grossman, 2010; O'Leary, 2009).
  • Developing a sense of hope, positive re-interpretation and growth. Practicing optimism, self-understanding, viewing survival and life accomplishments in a positive manner (O'Leary & Gould, 2010; Wolin & Wolin, 1993).