Sexual abuse by itself is an uncomfortable subject. It often elicits silence. Child sexual abuse generally can be of two types: contact abuse and non contact abuse.

Contact abuse refers to such physical contact as penetration of the child’s vagina or anus with the perpetrator’s penis, fingers, or other object. It also extends to non contact abuse like child pornography and exhibitionism, which may not involve actual sexual activity between an adult and the child.

Pedophilia was formally introduced as a sexual deviation in 1968.The term sexual deviation was renamed Paraphilia in 1980. Paraphilia (previously known as sexual perversion and sexual deviation) refers to “recurrent, intense sexually arousing fantasies, sexual urges, or behaviors generally involving i) non-human objects (such as shoe fetish), ii) the suffering or humiliation of oneself or one’s partner (as in sexual sadism), or iii) children or other non-consenting persons that occur over a period of at least 6 months (which would include exhibitionism and pedophilia).

Child Molester: Who are they?

Those men or women who take their sexual satisfactions with prepubescent or early teenage girls come from nearly every walk of life. Rich and poor, intelligent and stupid, from urban and rural centres, they lust for the youthful and seek the immature as their sex partners. Some humberts are pedophiles, others are neurotics, and some fit no specific classification.

Study done on Incestual behavior in three generation of family found that incestual patterns can be learned from abusive parent and in turn transmitted to their children. Another study describes the pattern involved in the development of the incestuous relationship.Accordingly; there are many families in which child may function as a parent. Such a child, usually a girl, end up doing most of the cooking, cleaning, laundry and also looking after of children and adult. This process is called parentification .Child slowly assumes various responsibility out of her loyalty to her mother. As a father is neither resourceful nor confident to form outside relationships and his relationship with wife is already dried up, he starts to slide into inappropriate relationship with his already parentified daughter. Yet another study says that the man suffers from pedophilia, as a true deviation does not do so from excess of sensuality, but rather he has been unable to find sexual satisfaction in an adult relationship.

Freud talked about the sexually immature and animals as sexual object in his book, “Three essays on sexuality”. According to Freud, “only exceptionally are the children the exclusive sexual objects.” Children are seen as a substitute when an impulsive urgent desire cannot at the time secures the proper objects. 

Characteristics of Molesters

• They can have adult sex partners, but children are primary sex objects.
• They have lifestyle which gives them easy access to children.
• They target specific gender, age, hair, and eye color.
• They use to manipulate and control victims or bribe them with gifts, love.
• May commit first offense when in teens.
• They continue behavior even after conviction and treatment.
• They are mostly males, but females also molest.
• They make video or photograph sexual activity with children to exchange with other molesters.
• Some molester’s network with pornographers and their pictures are used for commercial child pornography. Pictures are also traded with others interested in sex with children and become part of the cottage child pornography industry.

Molesters gain access to children through volunteer and professional occupation as well as their own neighborhood.They are skilled at developing relationship with children, often supplying needs, which are not being met at home .Children are easily seduced into believing that it is okay for adults to have sex with children.It is a good way to learn about sex and it is normal for adults to show affection this way. Abductor preys upon children who are within their reach like home, take shortcut to school, look depressed, are loners, appear unkempt, neglected or unsupervised. Abductors also use uniform or badges of authority to convince a child to go with them. The most often used traps include asking for help in finding lost puppy, carrying books and groceries, or asking for directions. Young children are lured by money, toys, candy and older children by money, drugs, alcohol .Molesters take advantage of the fact that children are taught to look up to authority figures and respect and obey adults .A child is not prepared when a relative, neighbor or other acquaintances make sexual advances .The best way to deal with problem is before it occurs.In most case, Due to fear of rejection children do not say anything to parents or closed ones and silently allow the abuser to abuse him/her again and again. In that case, it is up to concerned adults to recognize signs of abuse.

Signs of abuse: behavioral and emotional indicators

• Regression in behavior, school performance or attaining developmental milestones
• Acute traumatic response such as clingy behavior and irritability in young children
• Sleep disturbances, bed wetting, and withdrawal from family, friends or usual activities   
• Hypersensitivity to touch, depressive state, anxious, use of sexual words, deep sense of     isolation,
• Inability to eat certain food that resemble the male organ, hostility or aggression, discipline problems, excessive bathing or poor hygiene, eating disorders, poor self esteem, inappropriate sexualized behavior.

Aftermath

For victims, the consequences of abuse can be devastating .The experience of abuse for a child can be very confusing. Victim may feel significant distress and display a wide range of psychological symptoms, both short and long term. They may feel powerless, guilty, ashamed, and distrustful of others.

One study found that several symptoms appeared consistently across studies related to child sexual abuse. These included symptoms of Post traumatic Stress Disorder (PTSD), especially fear and anxiety; depression; and problem sexual behavior

Four-Factor Traumagenics Model model suggests that CSA alters a child’s cognitive and emotional orientation to the world and causes trauma by distorting their self-concept and affective capacities. The four trauma-causing factors that victims may experience are traumatic sexualization, betrayal, powerlessness, and stigmatization.

Revictimization is prominent. For most of them, abusive experience arouses strong feelings and can lead to fixation, repeated appearances in fantasy and therefore, damage and perversion. There may also be feeling of fear ,self blame, self doubt ,fear of internal damage, feeling of being dirty ,spoilt ,severe conflicts about reproduction.

Affected mother can also unleash a bizarre range of medical perplexities upon their children; it is called Munchausen syndrome by proxy.

Interpersonal problems arise due to stigma, withdrawal from social contact and behavior seeking rejection; for example, physical or verbal aggression to create a barrier.

Abuse can also lead to fear of intimacy. There may be conscious or unconscious desire not to let anyone get close enough to hurt them again. Affection and sex may be split off from each other; therefore, there may be craving for affection without sex.

Judith Heman’s comprehensive framework for examining trauma allows her to offer an enriched diagnostic formulation for the complex effect of severe trauma. She has coined the term complex post traumatic stress disorder. Her description covers 7 categories of patient experience:

1)  A history of subjection to totalitarian control over a long period (survivors of domestic battering, survivors of childhood physical and sexual abuse).

2) Alteration in affect regulation (e.g. explosive anger).

3) Alterations in consciousness (especially dissociation phenomena and ruminative preoccupation).

4) Alterations in self perception (e.g. shame, guilt, sense of defilement).

5) Alterations in perception of perpetrator (e.g. preoccupation with relationship to persecutor).

6) Alteration in relation to others (e.g. isolation and withdrawal).

7) Alterations in systems of meaning (e.g. loss of sustaining faith).

The long term consequences of sexual abuse include sexual, emotional and behavioral problems

Prevention and Management

As concerned adults, we want to protect children from sexual abuse, but we can’t always be there to do that so, child sexual abuse should be dealt with at two levels: preventive level and therapeutic level.

Preventive level: We can teach children about sexual abuse in order to increase their awareness and coping skills. Without frightening children, we can provide personal safety information to children in a matter- of- fact way, with other routine safety discussions about fire, water, health etc. Children who are well prepared will be more likely to tell you if abuse has occurred. This is the child’s best defense.In order to protect children, teach them: to feel good about themselves and know they are valued, loved and deserved to be safe.Children should be made aware of the difference between safe and unsafe touch. Children should be taught proper names of all the body parts. Help the child to understand its right over its own body and nobody has right to touch or hurt it and child can say no to requests that make them feel uncomfortable even from close relatives or family member. Child should be taught that obedience to adult is good but blind obedience to anyone is not good. Give your child emergency telephone number. Sex education in school, followed by an intensive course in the first year of college, is imperative in today’s times. Indian children are also sexually maturing much faster than they ever did. They don’t know the difference between abuses and love so, it’s not their fault but parents should take the step to educate their children and tell them the difference.

Providing a safe environment where the child is allowed and encouraged to express his feelings is an important step in eventually teaching children to manage their angry feelings in constructive ways. If child trusts you enough to tell you about an incident of sexual abuse, you are in an important position to help the child. Listen to child and give positive messages such as “I know you couldn’t help it “, or “I am proud of you for telling”. Children are not emotionally equipped to deal with the trauma of sexual abuse, so, safe environment is necessary and along with it, psychological help is needed.

Therapeutic level: There are parents who notice behavioral changes in the child which compel them to show the child to the psychologist and counselors.

1)Analytic psychotherapy can help survivors of abuse express and process difficult emotions associated with the abuse, it helps to gain insight through various techniques for managing moments of emotional overwhelm, and to learn to trust again.

2)Cognitive behavior therapy (CBT) is goal-oriented psychotherapy treatment that helps to change patterns of thinking or behavior that are behind people’s difficulties. Cognitive behavioral strategies typically address the child’s thinking patterns, affective response, and behavioral reactions to the abuse. In particular, the child’s attributions of blame and responsibility for the abuse should be addressed.

3)Gradual exposure or discussion of abuse experiences helps to reduce the child’s anxiety and embarrassment and provides opportunities to modify inaccurate or self-defeating thinking processes and provides opportunities to modify inaccurate or self-defeating thinking processes.

4)Relaxation training further addresses the child’s fear or anxiety reaction to abuse-related cues and can facilitate more effective affect regulation.Educational approaches facilitate clarification of misperceptions developed in response to the abuse.

5)Skill training is used to teach the child coping strategies to manage negative emotions and to improve social/interpersonal functioning.

6)Group therapy is effective in providing social support to help survivors of abuse cope with and transform their feelings of shame, guilt, and alienation from others as they interact and bond with other people who have lived through similar experiences.

Pallavi

Psychologist

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