Child sexual abuse
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2008-07-15T17:24:03Z
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'''Child sexual abuse''' is a form of [[child abuse]] in which a child is abused for the sexual gratification of an adult or older adolescent.<ref name=medline2008>{{cite web |url=http://www.nlm.nih.gov/medlineplus/childsexualabuse.html |title=Child Sexual Abuse |work=Medline Plus|date = 2008-04-02 |publisher=U.S. National Library of Medicine,}}</ref><ref name="APA Guidelines">{{ cite journal | author = Committee on Professional Practice and Standards (COPPS), Board of Professional Affairs (BPA), American Psychological Association (APA) | authorlink = American Psychological Association | coauthors = Catherine Acuff, Ph.D.; Steven Bisbing, Ph.D.; Michael Gottlieb, Ph.D.; Lisa Grossman, Ph.D.; Jody Porter, Ph.D.; Richard Reichbart, Ph.D.; Steven Sparta, Ph.D.; and C. Eugene Walker, Ph.D | year = 1999 | month = August | title = Guidelines for Psychological Evaluations in Child Protection Matters | volume = 54 | issue = 8 | pages = 586–593 | doi = 10.1037/0003-066X.54.8.586 | journal = American Psychologist | url = http://www.apa.org/practice/childprotection.html | accessdate = 2008-05-07 | laysummary = http://psycnet.apa.org/index.cfm?fa=main.doiLanding&uid=1999-03403-007 | laysource = APA PsycNET | laydate = 2008-05-07 | quote = '''Abuse, sexual (child)''': generally defined as contacts between a child and an adult or other person significantly older or in a position of power or control over the child, where the child is being used for sexual stimulation of the adult or other person.}}</ref> In addition to direct [[sexual activity|sexual contact]], child sexual abuse also occurs when an adult exposes their genitals to a child, asks or pressures a child to engage in sexual activities, displays [[pornography]] to a child, or uses a child to produce child pornography.<ref>Martin, J., Anderson, J., Romans, S., et al (1993). ''[http://www.ncbi.nlm.nih.gov/pubmed/8330225 Asking about child sexual abuse: methodological implications of a two-stage survey],'' ''Child Abuse and Neglect'', 17, 383-392.</ref><ref name=medline2008/><ref name=nspcc/>
Effects of child sexual abuse include [[clinical depression|depression]],<ref name="Roosa"/> [[post-traumatic stress disorder]],<ref name="widom"/> [[anxiety]],<ref name="levitan"/> propensity to re-victimization in adulthood,<ref name="Messman-Moore"/> and physical injury to the child, among other problems.<ref name="dinw"/> Sexual abuse by a family member is a form of [[incest]], and can result in more serious and long-term psychological trauma, especially in the case of parental incest.<ref name= Courtois>{{cite book|title=Healing the Incest Wound: Adult Survivors in Therapy|last= Courtois|first=Christine A.|publisher=W. W. Norton & Company|pages=p208|year=1988|isbn= 0393313565}}</ref>
Approximately 20% to 25% of women and 5% to 15% of men were sexually abused when they were children.<ref name=Whealin/><ref name="Finkelhor1994">{{cite journal|author=David Finkelhor |title=Current Information on the Scope and Nature of Child Sexual Abuse |journal=The Future of Children |date=summer/fall 1994 |volume=(1994) 4(2): 31-53|url=http://www.unh.edu/ccrc/pdf/VS75.pdf}}</ref><ref>[http://www.unh.edu/ccrc Crimes against Children Research Center]</ref><ref>[http://www.unh.edu/frl Family Research Laboratory]</ref><ref>{{cite journal|title=The prevalence of child sexual abuse: Integrative review adjustment for potential response and measurement biases |journal=Child Abuse & Neglect |volume=Volume 21, Issue 4, April 1997 |pages=pp391–398 |doi=10.1016/S0145-2134(96)00180-9 |url=http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6V7N-3SWVJJ8-6&_user=10&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=3bf4125ab05f663f306a1ca792f43398 |publisher=Elsevier Science Ltd. |author=Kevin M. Gorey and Donald R. Leslie|year=1997}}</ref> Most sexual abuse offenders are acquainted with their victims; approximately 30% are relatives of the child, most often fathers, uncles or cousins; around 60% are other acquaintances such as friends of the family, babysitters, or neighbors; strangers are the offenders in approximately 10% of child sexual abuse cases. Most child sexual abuse is committed by men; women commit approximately 14% of offenses reported against boys and 6% of offenses reported against girls.<ref name=Whealin/> Most offenders who abuse pre-pubescent children are [[pedophile]]s,<ref name=mayoclinic/><ref name="ames"/> however a small percentage do not meet the diagnostic criteria for pedophilia.<ref name="barbaree-seto"/>
Under the law, "child sexual abuse" is an umbrella term describing criminal and civil offenses in which an adult engages in sexual activity with a [[Minor (law)|minor]] or exploits a minor for the purpose of sexual gratification.<ref> [http://www.sp2.upenn.edu/~restes/CSEC_Files/CSEC_Bib_August_2001.pdf The Sexual Exploitation of Children], ''Chart 1: Definitions of Terms Associated With the Sexual Exploitation (SEC) and Commercial Sexual Exploitation of Children (CSEC)'' (p. 4), [[University of Pennsylvania]] Center for Youth Policy Studies, U.S. [[National Institute of Justice]], August 2001.</ref><ref name=nspcc>[http://www.nspcc.org.uk/helpandadvice/whatchildabuse/sexualabuse/sexualabuse_wda36370.html Child sexual abuse definition from the [[NSPCC]]]</ref> The [[American Psychiatric Association]] states that "children cannot consent to sexual activity with adults",<ref name="apaposition">[http://www.leadershipcouncil.org/1/rind/apa.html Leadership Council - APA Statement on Child Sexual Abuse]</ref><ref name="delay">[http://www.apa.org/releases/delay.html APA Letter to the Honorable Rep. DeLay (R-Tx.)]</ref> and condemns any such action: "An adult who engages in sexual activity with a child is performing a criminal and immoral act which never can be considered normal or socially acceptable behavior."<ref name="apaposition"/>
==Effects==
===Psychological harm===
Child sexual abuse can result in both short-term and long-term harm, including [[psychopathology]] in later life.<ref name="dinw">Dinwiddie S, Heath AC, Dunne MP, et al (2000). "[http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=26191 Early sexual abuse and lifetime psychopathology: a co-twin-control study.]" ''Psychological Medicine'', 30:41–52</ref><ref name="twin">Nelson EC, Heath AC, Madden PA, et al (2002). "[http://archpsyc.ama-assn.org/cgi/content/full/59/2/139 Association between self-reported childhood sexual abuse and adverse psychosocial outcomes: results from a twin study.]," ''Archives of General Psychiatry'', 59:139–145</ref> Psychological, emotional, physical, and social effects include [[clinical depression|depression]],<ref name="Roosa">Roosa M.W., Reinholtz C., Angelini P.J. (1999). [http://findarticles.com/p/articles/mi_m0902/is_1_27/ai_54422556/print "The relation of child sexual abuse and depression in young women: comparisons across four ethnic groups,"] ''Journal of Abnormal Child Psychology'' 27(1):65-76.</ref><ref name=Widom2007>{{cite journal | author = Widom, S. | coauthors = Dumont K., Czaja, S. | year = 2007 | title = A Prospective Investigation of Major Depressive Disorder and Comorbidity in Abused and Neglected Children Grown Up | journal = Archives of General Psychiatry | volume = 64 | issue = 1 | pages = 49 | doi = 10.1001/archpsyc.64.1.49 | pmid = 17199054 }}; [http://www.sciencedaily.com/releases/2007/01/070102092229.htm lay summary]</ref><ref name=Arnow/> [[post-traumatic stress disorder]],<ref name="widom">Widom C.S. (1999). [http://ajp.psychiatryonline.org/cgi/content/full/156/8/1223 "Posttraumatic stress disorder in abused and neglected children grown up,"] American Journal of Psychiatry; 156(8):1223-1229.</ref><ref name=Treichel>{{cite journal |url=http://pn.psychiatryonline.org/cgi/content/full/40/15/34-a |title=Dissociation Often Precedes PTSD In Sexually Abused Childre |author=Joan Arehart-Treichel |journal=Psychiatric News |date=2005-08-05 |volume=Volume 40 Number 15 |pages=p. 34 |publisher=American Psychiatric Association}}</ref> [[anxiety]],<ref name="levitan">Levitan, R. D., N. A. Rector, Sheldon, T., & Goering, P. (2003). "[http://www3.interscience.wiley.com/cgi-bin/abstract/102529637/ABSTRACT?CRETRY=1&SRETRY=0 Childhood adversities associated with major depression and/or anxiety disorders in a community sample of Ontario: Issues of co-morbidity and specificity]," Depression & Anxiety; 17, 34-42.</ref>, [[eating disorders]], poor self-esteem, dissociative and anxiety disorders; general psychological distress and disorders such as [[somatization]], [[neurosis]], chronic pain,<ref name=Arnow>{{cite journal |last=Arnow |first=B. |year=2004 |month= |title=Relationships between childhood maltreatment, adult health and psychiatric outcomes, and medical utilization. |journal=Journal of Clinical Psychiatry |volume=65 |issue=Suppl 12:10-5. |pmid = 15315472}}</ref>sexualized behavior,<ref name=Faller>{{cite book |title=Child Sexual Abuse: Intervention and Treatment Issues |first=Kathleen C. |last=Faller |year=1993 |publisher=Diane Publishing |pages=p6 |isbn=078811669X}}</ref> school/learning problems; and behavior problems including [[substance abuse]],<ref name= Polusny/><ref name=NIDA17>{{cite web |url=http://www.nida.nih.gov/NIDA_Notes/NNVol17N1/Childhood.html
|title=Childhood Sex Abuse Increases Risk for Drug Dependence in Adult Women | work=NIDA Notes, National Institute of Drug Abuse, volume 17, no. 1 |publisher=National Institutes of Health |date=April, 2002}}</ref> destructive behavior, criminality in adulthood and suicide. <ref name="science-freyd">{{cite journal|title=The science of child sexual abuse|url=http://www.sciencemag.org/cgi/content/summary/308/5721/501 | doi = 10.1126/science.1108066 <!--Retrieved from url by DOI bot--> | author=Freyd, J.J., Putnam, F.W., Lyon, T.D., Becker-Blease, K. A., Cheit, R.E., Siegel, N.B., & Pezdek, K.|year=2005 |journal= Science |volume= 308|pages= p501|pmid=15845837}}</ref><ref name="Dozier">Dozier, M., Stovall, K.C., & Albus, K. (1999) Attachment and Psychopathology in Adulthood. In J. Cassidy & P. Shaver (Eds.). Handbook of Attachment (pp. 497-519). NY: Guilford Press, ISBN 1572308265</ref><ref name="Kendall">Kendall-Tacket, K. A., Williams, L. M., & Finkelhor. D. (1993). [http://www.eric.ed.gov/ERICWebPortal/custom/portlets/recordDetails/detailmini.jsp?_nfpb=true&_&ERICExtSearch_SearchValue_0=ED341908&ERICExtSearch_SearchType_0=eric_accno&accno=ED341908 Impact of Sexual Abuse on Children: A Review and Synthesis of Recent Empirical Studies]. Psychological Bulletin, 1993, Vol. 113, No. 1, 164-180. - also published in {{cite book |title=Annual progress in child psychiatry and child development 1994 |first=Margaret E. |last=Hertzig |coauthors=Ellen A. Farber |year=1994 |publisher=Psychology Press |pages=p321-356 |isbn=0876307446}}</ref><ref>Gauthier, L., Stollak, G., Messe, L., & Arnoff, J. (1996). [http://www.eric.ed.gov/ERICWebPortal/custom/portlets/recordDetails/detailmini.jsp?_nfpb=true&_&ERICExtSearch_SearchValue_0=EJ527636&ERICExtSearch_SearchType_0=eric_accno&accno=EJ527636 Recall of childhood neglect and physical abuse as differential predictors of current psychological functioning]. Child Abuse and Neglect 20, 549-559.</ref><ref name=Whealin>{{cite web |url=http://www.ncptsd.va.gov/ncmain/ncdocs/fact_shts/fs_child_sexual_abuse.html |title=Child Sexual Abuse |author=Julia Whealin, Ph.D. |publisher=National Center for Posttraumatic Stress Disorder, US Department of Veterans Affairs |date=2007-05-22}}</ref><ref name = "johnbriere">Briere, J. (1992). ''[http://www.johnbriere.com/methodological%20csa%20jccp%201992.pdf Methodological issues in the study of sexual abuse effects,]'' Journal of Consulting and Clinical Psychology, p. 199.</ref> A specific characteristic pattern of symptoms has not been identified<ref name="Fergusson">Fergusson, D.M. & Mullen, P.E. (1999). "Childhood sexual abuse: An evidence based perspective," Thousand Oaks, California: Sage Publications.</ref> and there are several hypotheses on the causality of these associations.<ref name="Roosa"/><ref name="kendler"/><ref>Briere, J., & Elliott, D.M. (1993). "Sexual abuse, family environment, and psychological symptoms: On the validity of statistical control," ''Journal of Consulting and Clinical Psychology'', 61, 284-288.</ref>
[[Image:NIH child sex abuse disorders graph.gif|right|400px|thumb|A study funded by the USA National Institute of Drug Abuse found that "Among more than 1,400 adult females, childhood sexual abuse was associated with increased likelihood of drug dependence, alcohol dependence, and psychiatric disorders. The associations are expressed as odds ratios: for example, women who experienced nongenital sexual abuse in childhood were 2.93 times more likely to suffer drug dependence as adults than were women who were not abused." <ref name=NIDA17/>]]
Long term negative effects on development leading to re-victimization in adulthood are also associated with child sexual abuse.<ref name="Messman-Moore">Terri L. Messman-Moore & Patricia J. Long, "[http://jiv.sagepub.com/cgi/content/abstract/15/5/489 Child Sexual Abuse and Revictimization in the Form of Adult Sexual Abuse, Adult Physical Abuse, and Adult Psychological Maltreatment]," ''15 Journal of Interpersonal Violence'' 489 (2000).</ref><ref name= Polusny>{{cite journal|title=Long-term correlates of child sexual abuse: Theory and review of the empirical literature |coauthors=Melissa A. Polusny and Victoria M. Follette |publisher=Elsevier Ltd.|journal=Applied and Preventive Psychology |volume=Volume 4, Issue 3, Summer 1995, Pages 143-166}}</ref> Studies have established a causal relationship between childhood sexual abuse and certain specific areas of adult psychopathology, including suicidality, antisocial behavior, PTSD, anxiety and alcoholism.<ref>{{cite journal |last=Brown |first=D. |year=2001 |title=(Mis)representation of the Long-Term Effects of Childhood Sexual Abuse in the Courts |journal=Journal of Child Sexual Abuse |volume=9 |issue=3/4 |pages=79–107 |url=http://www.eric.ed.gov/ERICWebPortal/custom/portlets/recordDetails/detailmini.jsp?_nfpb=true&_&ERICExtSearch_SearchValue_0=EJ672709&ERICExtSearch_SearchType_0=no&accno=EJ672709 |accessdate= 2008-01-28 |doi=10.1300/J070v09n03_05}}</ref> Adults with a history of abuse as a child, especially sexual abuse, are more likely than people with no history of abuse to become frequent users of emergency and medical care services<ref name=Arnow/> A study comparing middle-aged women who were abused as children with non-abused counterparts found significantly higher health care costs for the former.<ref name="pmid18204885">{{cite journal |author=Bonomi AE, Anderson ML, Rivara FP, ''et al'' |title=Health care utilization and costs associated with childhood abuse |journal=J Gen Intern Med |volume=23 |issue=3 |pages=294–9 |year=2008 |pmid=18204885 |doi=10.1007/s11606-008-0516-1 | url = http://www.springerlink.com/content/j54j767nx7026h66/fulltext.html | accessdate = 2008-04-03}} [url=http://www.eurekalert.org/pub_releases/2008-02/osu-wws021908.php lay-summary]</ref>
Sexually abused children suffer from more psychological symptoms than children who have not been abused; studies have found symptoms in 51% to 79% of sexually abused children.<ref>Caffaro-Rouget, A., Lang, R. A. & vanSanten, V. (1989). The impact of child sexual abuse. Annals of Sex Research, 2, 29-47.</ref><ref>Mannarino, A. P. & Cohen, J. A. (1986). A clinical-demographic study of sexually abused children. Child Abuse and Neglect, 10, 17-23.</ref><ref>Tong, L., Oates, K. & McDowell, M. (1987). [http://www.eric.ed.gov/ERICWebPortal/custom/portlets/recordDetails/detailmini.jsp?_nfpb=true&_&ERICExtSearch_SearchValue_0=EJ362256&ERICExtSearch_SearchType_0=eric_accno&accno=EJ362256 Personality development following sexual abuse]. Child Abuse and Neglect, 11, 371-383.</ref><ref>Conte, J. & Schuerman, J. (1987b). The effects of sexual abuse on children: A multidimensional view. Journal of Interpersonal Violence, 2, 380-390.</ref><ref name="Kendall" /> The risk of harm is greater if the abuser is a relative, if the abuse involves intercourse or attempted intercourse, or if threats or force are used.<ref>Bulick, C. M., Prescott, C. A., & Kendler, K. S. (2001). [http://bjp.rcpsych.org/cgi/content/abstract/179/5/444 "Features of childhood sexual abuse and the development of psychiatric and substance use disorders,"] ''[[British Journal of Psychiatry]]'', 179, 444-449.</ref> The level of harm may also be affected by various factors such as penetration, duration and frequency of abuse, and use of force.<ref name=Beitchman>{{cite journal |author=Beitchman JH, Zucker KJ, Hood JE, daCosta GA, Akman D, Cassavia E |title=A review of the long-term effects of child sexual abuse |journal=Child Abuse Negl |volume=16 |issue=1 |pages=101–18 |year=1992 |pmid=1544021 |doi=}}</ref><ref>Browne, A., & Finkelhor, D. (1986). "Impact of sexual abuse: A review of the research," ''Psychological Bulletin'', 99, 66-77.</ref><ref name="dinw" /><ref name="twin" /> The social stigma of child sexual abuse may compound the psychological harm to children,<ref>Browne, A., & Finkelhor, D. (1986). Impact of child sexual abuse: A review of the research. Psychological Bulletin, 99.</ref><ref>Holguin, G. & Hansen, D. J. (2002). The "[http://digitalcommons.unl.edu/cgi/viewcontent.cgi?article=1026&context=psychfacpub sexually abused child": potential mechanisms of adverse influences of such a label, ''Aggression and Violent Behavior]''</ref> and adverse outcomes are less likely for abused children who have supportive family environments.<ref>Romans, S., Martin, J., Anderson, J., et al (1995). "Factors that mediate between child sexual abuse and adult psychological outcome," ''Psychological Medicine'', 25, 127-142.</ref><ref>Spaccarelli, S. & Kim, S. (1995). "Resilience criteria and factors associated with resilience in sexually abused girls," ''Child Abuse and Neglect'', 19, 1171-1182.</ref>.
Young children who are abused sexually by adult females may incur double traumatization due to the widespread denial of female-perpetrated child sexual abuse by non-abusing parents, professional caregivers and the general public.<ref> Crawford, (1997) Forbidden Femininity: Child Sexual Abuse and Female Sexuality</ref> Turner and Maryanski in ''Incest: Origins of the Taboo'' (2005), suggest that mother-son incest causes the most serious damage to children in comparison to mother-daughter, father-daughter and father-son child incest. Crawford asserts that our socially repressed view of female and maternal sexuality conceals both the reality of female sexual pathologies and the damage done by female sexual abuse to children.<ref>Crawford, Colin, ''Forbidden Feminity: Child Sexual Abuse and Female Sexuality'', Ashgate, 1997.</ref>
====Dissociation and PTSD====
[[Child abuse]], including sexual abuse, especially chronic abuse starting at early ages, has been found to be related to the development of high levels of dissociative symptoms, which includes amnesia for abuse memories.<ref name=chu>{{cite journal |last=Chu |first=J |coauthors= Frey L, Ganzel B, Matthews J |year=1999 |month=May |title=Memories of childhood abuse: dissociation, amnesia, and corroboration. |journal=Anerican Journal of Psychiatry |volume=156 |issue=5 |pages=749–55 |pmid = 10327909 }}</ref> The level of dissociation has been found to be related to reported overwhelming sexual and physical abuse.<ref name=draijer>{{cite journal |last=Draijer |first=N |coauthors=Langeland W |year=1999 |month=March |title=Childhood trauma and perceived parental dysfunction in the etiology of dissociative symptoms in psychiatric inpatients |journal=Am J Psychiatry |volume=156 |issue=3 |pages=379–85 |pmid = 10080552 |doi=10.1016/j.biopsych.2003.08.018}}</ref> When severe sexual abuse (penetration, several perpetrators, lasting more than one year) had occurred, dissociative symptoms were even more prominent.<ref name=draijer/>
Child sexual abuse independently predicts the number of symptoms for [[PTSD]] a person displays, after controlling for possible confounding variables, according to Widom (1999), who wrote "sexual abuse, perhaps more than other forms of childhood trauma, leads to dissociative problems ... these PTSD findings represent only part of the picture of the long-term psychiatric sequelae associated with early childhood victimization ... antisocial personality disorder, alcohol abuse, and other forms of psychopathology."<ref name="widom" /> Children may develop symptoms of posttraumatic stress disorder resulting from child sexual abuse, even without actual or threatened injury or violence.<ref name=DSM4>{{cite book |author= |title=Diagnostic and statistical manual of mental disorders: DSM-IV |publisher=American Psychiatric Association |location=Washington, DC |year=1994 |pages= |isbn=0890420610 |oclc= |doi=}}</ref>
====Research factors====
Because child sexual abuse often occurs alongside other possibly confounding variables, such as poor family environment and physical abuse,<ref>{{cite journal |author=Mullen PE, Martin JL, Anderson JC, Romans SE, Herbison GP |title=The long-term impact of the physical, emotional, and sexual abuse of children: a community study |journal=Child Abuse Negl |volume=20 |issue=1 |pages=7–21 |year=1996 |pmid=8640429 |doi=}}</ref> some scholars argue it is important to control for those variables in studies which measure the effects of sexual abuse.<ref name="twin" /><ref name="kendler">Kendler, K. S., Bulik, C. M., Silberg, J., Hettema, J. M., Myers, J., & Prescott, C. A. (2000). "[http://archpsyc.ama-assn.org/cgi/reprint/57/10/953.pdf Childhood sexual abuse and adult psychiatric and substance use disorders in women: An epidemiological and cotwin control analysis]," ''Archives of General Psychiatry'', 57, 953-959.</ref><ref>Pope, H. G., & Hudson, J. I. (1995). "Does childhood sexual abuse cause adult psychiatric disorders? Essentials of methodology," ''The Journal of Psychiatry & Law'', 23, 363-381.</ref><ref>Levitt, E. E., & Pinnell, C. M. (1995). "Some additional light on the childhood sexual abuse-psychopathology axis," ''International Journal of Clinical and Experimental Hypnosis'', 43, 145-162.</ref> In a 1998 review of related literature, Martin and Fleming, state "The hypothesis advanced in this paper is that, in most cases, the fundamental damage inflicted by child sexual abuse is due to the child's developing capacities for trust, intimacy, agency and sexuality, and that many of the mental health problems of adult life associated with histories of child sexual abuse are second-order effects."<ref>Mullen, P. & Fleming, J. (1998). "[http://www.aifs.gov.au/nch/pubs/issues/issues9/issues9.html Long-term effects of child sexual abuse]," Issues in child abuse prevention (9). Australia: National Child Protection Clearing House.</ref> Other studies have found an independent association of child sexual abuse with adverse psychological outcomes.<ref name="kendler">Kendler, K. S., Bulik, C. M., Silberg, J., Hettema, J. M., Myers, J., & Prescott, C. A. (2000). "Childhood sexual abuse and adult psychiatric and substance use disorders in women: An epidemiological and cotwin control analysis," Archives of General Psychiatry, 57 , 953-959.</ref><ref name="twin" /><ref name="levitan" />
Kendler et al. (2000) found that most of the relationship between severe forms of child sexual abuse and adult psychopathology in their sample could not be explained by family discord, because the [[effect size]] of this association decreased only slightly after they controlled for possible confounding variables. Their examination of a small sample of CSA-discordant twins also supported a causal link between child sexual abuse and adult psychopathology; the CSA-exposed subjects had a consistently higher risk for psychopathologic disorders than their CSA non-exposed twins.<ref name="kendler" />
A 1998 meta-analysis by [[Rind et al]] generated controversy by suggesting that child sexual abuse does not always cause pervasive harm; that some college students reported such encounters as positive experiences; and that the extent of psychological damage depends on whether or not the child described the encounter as "consensual." <ref>Rind, B. & Tromovitch, P. (1997). "[http://www.findarticles.com/p/articles/mi_m2372/is_n3_v34/ai_20444907 A meta-analytic review of findings from national samples on psychological correlates of child sexual abuse]". ''Journal of Sex Research'', '''34''', 237-255.</ref> The study was criticized in published reviews by scientists for flawed methodology and conclusions,<ref name='LC Dallam">{{cite journal |author=Dallam SJ, Gleaves DH, Cepeda-Benito A, Silberg JL, Kraemer HC, Spiegel D |url=http://www.leadershipcouncil.org/1/res/dallam/5.html |title=The effects of child sexual abuse: Comment on Rind, Tromovitch, and Bauserman (1998) |journal=Psychol Bull |volume=127 |issue=6 |pages=715–33 |year=2001 |pmid=11726068 |doi=}}</ref><ref>{{cite book | last = Oltmanns | first = Thomas F. | coauthors = Emery, Robert E. | title = Abnormal Psychology | publisher = Prentice Hall | date = 2001 | location = Upper Saddle River, NJ | isbn = 0-13187-521-3}}</ref><ref name="LC Consent">{{cite web|url=http://www.leadershipcouncil.org/1/rind/consent.html|title=Consent? — Rind et al.'s Examination of Consent as a Moderator|author=Leadership Council on Child Abuse & Interpersonal Violence|accessdate=2008-05-16}}</ref><ref name="LC Rind">{{cite web|url=http://www.leadershipcouncil.org/1/rind/1.html|title=Examination of the Rind Meta-analysis|author=Leadership Council on Child Abuse & Interpersonal Violence|accessdate=2008-05-16}}</ref> though it's ''publication'' by [[peer-review]] has been tacitly or implicitly defended.<ref name=EditorsPerspective>{{cite journal |title=Publication of Rind et al. (1998): The editors' perspective. |author=Sher, Kenneth J.; Eisenberg, Nancy |year = 2002 |month = Mar |journal=[[American Psychologist]] |volume = 57 |issue = 3 |pages = 206–210 |publisher = American Psychological Association |location = |issn = 0003-066X |pmid=11905121 |eric=EJ646517 |psychnet=2002-10795-008 |format = Abstract |accessdate = 2008-05-20 |url=http://psycnet.apa.org/index.cfm?fa=search.displayRecord&id=0CB4AF74-D53F-168A-2DF9-52DC6612805C&resultID=1&page=1&dbTab=pa |quote = They go on to consider actions they could have taken to minimize the mischaracterizations of the study's findings and conclusions ... |doi=10.1037/0003-066X.57.3.206}}</ref><ref name=AAAS>{{cite journal | author = Hollida Wakefield | year = 2006 | title = The Effects of Child Sexual Abuse: Truth Versus Political Correctness | journal = Issues In Child Abuse Accusations | issn = 1043-8823 | volume = 16 | issue = 2 | publisher = Institute for Psychological Therapies | url = | accessdate = | quote = <small>We see no reason to second guess the process of peer review used by the APA journal in its decision to publish the article in question. While not without its imperfections, peer review is well established as a standard mechanism for maintaining the flow of scientific information that scientists can refer to, critique or build on. After examining all the materials available to the committee, we saw no clear evidence of improper application of methodology or other questionable practices on the part of the article's authors. [...] The Committee also wishes to express its grave concerns with the politicization of the debate over the article's methods and findings. In reviewing the set of background materials available to us, we found it deeply disconcerting that so many of the comments made by those in the political arena and in the media indicate a lack of understanding of the analysis presented by the authors or misrepresented the article's findings. All citizens, especially those in a position of public trust, have a responsibility to be accurate about the evidence that informs their public statements. We see little indication of that from the most vocal on this matter, behaviour that the Committee finds very distressing.</small>}}</ref><ref name=APAletters>[http://www.just-well.dk/lettersapa.htm Letters] to the [[American Psychological Association]] concerning its publication of the ''[[Rind et al]]'' study</ref> Following extensive publicity, the US Congress condemned the study for its conclusions and for providing material used by pedophile organizations to justify their activities.<ref name="congress">{{cite web|author=US Congress|year=1999|title=Whereas no segment of our society is more critical to the future of human survival than our children|format=PDF|work=106th Congress, Resolution 107|url=http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=106_cong_bills&docid=f:hc107enr.txt.pdf}}</ref> Russell (1999) speculated that the perception of a sexually abusive event as 'positive' could stem from a mechanism for coping with traumatic experiences, a form of [[rationalization (psychology)|rationalization]].<ref>Russell, D. (1999). The secret trauma: Incest in the lives of girls and women. New York: Basic Books. Cited in Stanley (2004).</ref>
===Physical harm===
====Infections and injury====
Depending on the age and size of the child, and the degree of force used, child sexual abuse may cause infections, [[sexually transmitted diseases]],<ref name="jong">De Jong, AR (1985). "Vaginitis due to Gardnerella vaginalis and to Candida albicans in sexual abuse," ''Child Abuse Negl'', 9, 27-29.</ref> or internal lacerations. In severe cases, damage to internal organs may occur, which, in some cases, may cause death.<ref>James F. Anderson; Nancie J. Mangels; Adam Langsam (2004) "Child Sexual Abuse: A Public Health Issue," Criminal Justice Studies, Volume 17, Issue 1 March 2004.</ref> Herman-Giddens et.al. found six certain and six probable cases of death due to child sexual abuse in North Carolina between 1985-1994. The victims ranged in age from 2 months to 10 years. Causes of death included trauma to the genitalia or rectum and sexual mutilation.<ref>Marcia E. Herman-Giddens, et.al., "[http://jama.ama-assn.org/cgi/reprint/282/5/463.pdf Underascertainment of Child Abuse Mortality in the United States]," Journal of the American Medical Association 1999;282:463-467 (1999)</ref> [[Vaginitis]] has also been reported.<ref name="jong" />
====Neurological damage====
Research has shown that traumatic stress, including stress caused by sexual abuse, causes notable changes in brain functioning and development.<ref>Developing Mind, Daniel Siegel, Guilford Press, 1999</ref><ref>Perry, Bruce (2007). ''The Boy Who Was Raised As a Dog.'' ISBN 0465056520</ref> Various studies have suggested that severe child sexual abuse may have a deleterious effect on brain development. Ito et al. (1998) found "reversed hemispheric asymmetry and greater left hemisphere coherence in abused subjects;"<ref>Ito Y, Teicher MH, Glod CA, et al: [http://neuro.psychiatryonline.org/cgi/content/full/10/3/298 "Preliminary evidence for aberrant cortical development in abused children: a quantitative EEG study,"] ''The Journal of Neuropsychiatry and Clinical Neurosciences'', 10:298–307</ref> Teicher et al. (1993) found that an increased likelihood of "ictal temporal lobe epilepsy-like symptoms" in abused subjects;<ref name="epi">Teicher MH, Glod CA, Surrey J, et al: Early childhood abuse and limbic system ratings in adult psychiatric outpatients. J Neuropsychiatry Clin. Neuroscience 1993; 5:301–306</ref> Anderson et al. (2002) recorded abnormal [[Relaxation (NMR)|transverse relaxation]] time in the cerebellar vermis of adults sexually abused in childhood;<ref>{{cite journal |author=Anderson CM, Teicher MH, Polcari A, Renshaw PF |title=Abnormal T2 relaxation time in the cerebellar vermis of adults sexually abused in childhood: potential role of the vermis in stress-enhanced risk for drug abuse |journal=Psychoneuroendocrinology |volume=27 |issue=1-2 |pages=231–44 |year=2002 |pmid=11750781 |doi=}}</ref> Teicher et al. (1993) found that child sexual abuse was associated with a reduced [[corpus callosum]] area; various studies have found an association of reduced volume of the left hippocampus with child sexual abuse;<ref name="scars">Teicher, Martin H. (2002). "[http://jillium.nfshost.com/scarsthatwontheal.pdf Scars That Won't Heal: The Neurobiology of Child Abuse]," Scientific American magazine.</ref> and Ito et al. (1993) found increased electrophysiological abnormalities in sexually abused children.<ref>Ito Y, Teicher MH, Glod CA, et al (1993). "Increased prevalence of electrophysiological abnormalities in children with psychological, physical, and sexual abuse," ''The Journal of Neuropsychiatry and Clinical Neurosciences'', 5:401–408</ref>
Some studies indicate that sexual or physical abuse in children can lead to the overexcitation of an undeveloped [[limbic system]].<ref name="scars" /> Teicher et al. (1993)<ref name="epi" /> used the "Limbic System Checklist-33" to measure ictal temporal lobe epilepsy-like symptoms in 253 adults. Reports of child sexual abuse were associated with a 49% increase to LSCL-33 scores, 11% higher than the associated increase of self-reported physical abuse. Reports of both physical and sexual abuse were associated with a 113% increase. Male and female victims were similarly affected.<ref name="epi" /><ref>Arehart-Treichel, Joan (2001). [http://pn.psychiatryonline.org/cgi/content/full/36/5/36 "Psychological Abuse May Cause Changes in Brain,"] Psychiatric News. March 2, 2001</ref>
Navalta et al. (2006) found that the self-reported math [[Scholastic Aptitude Test]] scores of their sample of women with a history of repeated child sexual abuse were significantly lower than the self-reported math SAT scores of their non-abused sample. Because the abused subjects verbal SAT scores were high, they hypothesized that the low math SAT scores could "stem from a defect in hemispheric integration." They also found a strong association between short term memory impairments for all categories tested (verbal, visual, and global) and the duration of the abuse.<ref name="navalta">Navalta, Carryl P., et al. (2006). "[http://neuro.psychiatryonline.org/cgi/content/full/18/1/45 Effects of Childhood Sexual Abuse on Neuropsychological and Cognitive Function in College Women]," ''The Journal of Neuropsychiatry and Clinical Neurosciences'', 18:45-53</ref>
==Prevalence==
===United States and Europe===
Child sexual abuse occurs frequently in Western society.<ref>{{Citation | last1 = Adshead | first1 = Gwen | contribution = Looking for clues - A review of the literature on false allegations of sexual abuse in childhood | pages = 57 –65 | year = 1994 }} in {{cite book |last= Sinason |first= Valerie |title= Treating Survivors of Satanist Abuse|year= 1994 |publisher= Routledge |location= New York |isbn= 0-415-10542-0}}</ref> Prevalence estimates range between 10% in the UK<ref name="Baker">{{cite journal |last= Baker |first= AW |coauthors= Duncan, SP |year= 1985 |title= Child sexual abuse: a study of prevalence in Great Britain. |journal= Child Abuse and Neglect |volume= 9| issue= 4 |pages= 457–67 |pmid = 4084825 |doi= 10.1016/0145-2134(85)90054-7}} </ref> and up to 62% for females and 16% for males in the United States.<ref name=Finklehor-epid>{{cite journal |last= Finkelhor |first= D. |year= 1993 |month= Jan - Feb |title= Epidemiological factors in the clinical identification of child sexual abuse. |journal= Child abuse and neglect |volume= 17 |issue= 1 |pages= 67–70 | pmid = 8435788 |doi= 10.1016/0145-2134(93)90009-T}} </ref><ref>{{cite journal |last= Kendall-Tacket |first= K. |coauthors= Meyer Williams, L. and Finklehor, D. |year= 1993 |title= Impact of child sexual abuse: a review | journal= Psychological Bulletin |volume= 113 |pages= 164–180 |doi= 10.1037/0033-2909.113.1.164}}</ref> The [[US Department of Health and Human Services]] reported 83,600 substantiated reports of sexually abused children in 2005.<ref>{{cite web |url=http://faq.acf.hhs.gov/cgi-bin/acfrightnow.cfg/php/enduser/std_adp.php?p_faqid=68&p_created=1001610478&p_sid=xmCO-dUi&p_accessibility=0&p_lva=&p_sp=cF9zcmNoPTEmcF9zb3J0X2J5PWRmbHQmcF9ncmlkc29ydD0mcF9yb3dfY250PTEzJnBfcHJvZHM9JnBfY2F0cz0xMCwzMCZwX3B2PSZwX2N2PTIuMzAmcF9zZWFyY2hfdHlwZT1hbnN3ZXJzLnNlYXJjaF9ubCZwX3BhZ2U9MQ**&p_li=&p_topview=1 |title=ACF Questions and Answers Support |work=Administration on Children and Families |accessmonthday=December 26 |accessyear=2007 |publisher=US Department of Health and Human Services}}</ref><ref>{{cite web |url=http://www.acf.dhhs.gov/programs/cb/pubs/cm05/chapterthree.htm |title=Child Maltreatment 2005 |work=Administration on Children and Families |accessmonthday=December 26 |accessyear=2007 |publisher=US Department of Health and Human Services}}</ref> The total number of incidents that were not reported is even larger.<ref name=aacap2008>{{cite web |url=http://www.aacap.org/cs/root/facts_for_families/child_sexual_abuse |title=Child Sexual Abuse |work=Facts for Families, No. 9|date = May 2008 |publisher=American Academy of Child and Adolescent Psychiatry}}</ref>
Surveys have shown that one fifth to one third of all women reported some sort of childhood sexual experience with a male adult.<ref name=Herman>{{cite book | last =Herman | first =Judith | title =Father-Daughter Incest | publisher =Harvard University Press | date =1981 | location = Cambridge, Massachusetts | pages =282 | isbn =0-674-29506-4}}</ref>
Based on a literature review of 23 studies, Goldman & Padayachi found that the prevalence of child sexual abuse varied between 7-62% for girls and 4-30% for boys.<ref>Juliette D. G. Goldman and Usha, K. Padayachi, "[http://findarticles.com/p/articles/mi_m2372/is_4_37/ai_72272302 Some Methodological Problems in Estimating Incidence and Prevalence in Child Sexual Abuse Research]". ''Journal of Sex Research'', Nov, 2000[http://www.findarticles.com/p/articles/mi_m2372/is_4_37/ai_72272302/pg_2]</ref> A 1992 survey studying father-daughter incest in Finland reported that of the 9,000 15-year old high school girls who filled out the questionnaires, of the girls living with their biological fathers, 0.2% reported father-daughter incest experiences; of the girls living with a stepfather, 3.7% reported sexual experiences with him. The reported counts included only father-daughter incest and did not include prevalence of other forms of child sexual abuse. The survey summary stated, "the feelings of the girls about their incestual experiences are overwhelmingly negative."<ref>Sariola, H. & Uutela, A. (1996). [http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6V7N-3VWPXYT-6&_user=10&_coverDate=09%2F30%2F1996&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=5591d31034978dfdea137836b73572a8 The prevalence and context of incest abuse in Finland.] Child Abuse & Neglect, Volume 20, Issue 9, September 1996, Pages 843-850.</ref> Others argue that prevalence rates are much higher, and that many cases of child abuse are never reported. One study found that professionals failed to report approximately 40% of the child sexual abuse cases they encountered<ref>Keuhnle, K., Assessing Allegations of Child Sexual Abuse, Professional Resources Press, Sarastota, FL, 1996</ref> A study by Lawson & Chaffin indicated that many children who were sexually abused were "identified solely by a physical complaint that was later diagnosed as a venereal disease...Only 43% of the children who were diagnosed with venereal disease made a verbal disclosure of sexual abuse during the initial interview."<ref>pg7., In. Keuhnle, K., Assessing Allegations of Child Sexual Abuse, Professional Resources Press, Sarastota, FL, 1996</ref> It has been found in the epidemiological literature on CSA that there is no identifiable demographic or family characteristic of a child that can be used to bar the prospect that a child has been sexually abused.<ref name=Finklehor-epid/>
====In schools====
In US schools, according to the US Department of Education.<ref name="shakeshaft2004">Shakeshaft, C, "[http://www.ed.gov/rschstat/research/pubs/misconductreview/report.pdf Educator Sexual Misconduct: A Synthesis of the Literature]", U.S. Department of Education, 2004</ref>, "nearly 9.6% of students are targets of educator sexual misconduct sometime during their school career." In studies of student sex abuse by male and female educators, male students were reported as targets in ranges from 23% to 44%.<ref name="shakeshaft2004" /> In U.S. school settings same-sex (female and male) sexual misconduct against students by educators "ranges from 18-28% or reported cases, depending on the study"<ref> Shakeshaft, C, "[http://www.ed.gov/rschstat/research/pubs/misconductreview/report.pdf Educator Sexual Misconduct: A Synthesis of the Literature]", U.S. Department of Education, 2004, p26.</ref>
====Underreported forms====
Significant underreporting of sexual abuse of boys by both women and men is believed to occur due to sex stereotyping, social denial, the minimization of male victimization, and the relative lack of research on sexual abuse of boys.<ref> Watkins, B. & Bentovim, A. (1992). The sexual abuse of male children and adolescents: a review of current research. Journal of Clinical Psychology & Psychiatry, 33(10), 197-248 [http://www.sasian.org/papers/boysngirls.htm]</ref> Sexual victimization of boys by their mothers or other female relatives is especially rarely researched or reported. Sexual abuse of girls by their mothers, and other related and/or unrelated adult females is beginning to be researched and reported despite the highly taboo nature of female-female child sex abuse. In studies where students are asked about sex offenses, they report higher levels of female sex offenders than found in adult reports.<ref>Shakeshaft, C, "[http://www.ed.gov/rschstat/research/pubs/misconductreview/report.pdf Educator Sexual Misconduct: A Synthesis of the Literature]", U.S. Department of Education, 2004, p22.</ref> This under-reporting has been attributed to cultural denial of female-perpetrated child sex abuse,<ref>Denov, Myriam S. (2004) "Perspectives on Female Sex Offending: A Culture of Denial"</ref> because "males have been socialized to believe they should be flattered or appreciative of sexual interest from a female"<ref name="Shakeshaft25" /> and because female sexual abuse of males is often seen as 'desirable' and/or beneficial by judges, mass media pundits and other authorities.<ref>Young, Cathy, "[http://www.rhfinc.org.au/docs/victims.pdf Double Standards: The Bias Against Male Victims of Sexual Abuse]", 2002, Reasononline</ref>
===Africa===
The prevalence of child sexual abuse in Africa is compounded by a belief that sexual intercourse with a virgin will cure a man of [[HIV]] or [[AIDS]]. This belief is especially common in South Africa, which has the highest number of HIV-positive citizens in the world. According to official figures, one in eight South Africans are infected with the virus.<ref>''United Nations HIV/AIDS Fact Sheet,'' United Nations Development Programme, 2002.</ref> [[Eastern Cape]] social worker Edith Kriel notes that "child abusers are often relatives of their victims - even their fathers and providers."<ref name="Flanagan">[http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2001/11/11/wrape11.xml '' South African Men Rape Babies as "Cure" for AIDS,''] Jane Flanagan, ''Daily Telegraph (UK),'' November 11, 2001.</ref> More than 67,000 cases of sexual assaults against children were reported in 2000 in [[South Africa]]. Child welfare groups believe that the number of unreported incidents could be up to 10 times that number.<ref name="Flanagan"/> Researcher Suzanne Leclerc-Madlala states that the myth that sex with a virgin is a cure for AIDS is not confined to South Africa: "Fellow AIDS researchers in [[Zambia]], [[Zimbabwe]] and [[Nigeria]] have told me that the myth also exists in these countries and that it is being blamed for the high rate of sexual abuse against young children."<ref>''[http://www.aegis.com/news/suntimes/1999/ST990401.html Child Rape: A Taboo within the AIDS Taboo: More and more girls are being raped by men who believe this will 'cleanse' them of the disease, but people don't want to confront the issue],'' by Prega Govender, ''Sunday Times (South Africa),'' April 4, 1999.</ref>
===Asia===
In one survey, 2.5% of Taiwenese adolescents report having experienced childhood sexual abuse.<ref>Yen, Cheng-Fang; Yang, Mei-Sang; Yang, Ming-Jen; Su, Yi-Ching; Wang, Mei-Hua; Lan, Chu-Mei (2008). "Childhood physical and sexual abuse: Prevalence and correlates among adolescents living in rural Taiwan," ''Child Abuse & Neglect'', 32(3), 429-438</ref>
====India====
Nineteen percent of the world's children live in India,<ref name=IndiaStudy2007>{{cite web |url=http://wcd.nic.in/childabuse.pdf |title=Study on Child Abuse: India 2007 |publisher=Published by the Government of India, (Ministry of Women and Child Development)}}</ref><ref name=India_01>{{cite web |url=http://www.law.georgetown.edu/humanrightsinstitute/contemporaryissues.4.18.html |title=Women's Rights by Amy Steiner | publisher=Georgetown University}}</ref> which constitutes 42 percent of India’s total population.<ref name=India_02>{{cite web |url=http://wcd.nic.in/BudgetingChildProtection.pdf | title=Budget Analysis for Child Protection | publisher=Published by the Government of India, (Ministry of Women and Child Development)}}</ref>
In 2007 the [[Ministry of Women and Child Development (India)|Ministry of Women and Child Development]] published the "Study on Child Abuse: India 2007."<ref name=IndiaStudy2007>{{cite web |url=http://wcd.nic.in/childabuse.pdf |title=Study on Child Abuse: India 2007 |publisher=Published by the Government of India, (Ministry of Women and Child Development)}}</ref> It sampled 12447 children, 2324 young adults and 2449 stakeholders across 13 states. It looked at different forms of child abuse: [[Physical abuse|Physical Abuse]], [[Sexual Abuse]] and [[Psychological abuse|Emotional Abuse]] and Girl Child Neglect in five evidence groups, namely, children in a family environment, children in school, children at work, children on the street and children in institutions.
The study's<ref name=IndiaStudy2007>{{cite web |url=http://wcd.nic.in/childabuse.pdf |title=Study on Child Abuse: India 2007 |publisher=Published by the Government of India, (Ministry of Women and Child Development)}}</ref> main findings included: 53.22% of children reported having faced sexual abuse. Among them 52.94% were boys and 47.06% girls. [[Andhra Pradesh]], [[Assam]], [[Bihar]] and [[Delhi]] reported the highest percentage of sexual abuse among both boys and girls, as well as the highest incidence of sexual assaults. 21.90% of child respondents faced severe forms of sexual abuse, 5.69% had been sexually assaulted and 50.76% reported other forms of sexual abuse. Children on the street, at work and in institutional care reported the highest incidence of sexual assault. It also reported that 50% of abusers are known to the child or are in a position of trust and responsibility and most children had not reported the matter to anyone.
==Incest==
{{main|Incest}}
Incest between a child or adolescent and a related adult has been identified as the most widespread form of child sexual abuse with a huge capacity for damage to a child.
<ref name= Courtois>{{cite book|title=Healing the Incest Wound: Adult Survivors in Therapy|last= Courtois|first=Christine A.|publisher=W. W. Norton & Company|pages=p208|year=1988|isbn= 0393313565}}</ref> 70% of all perpetrators of sexual abuse are related to their victim. <ref>{{cite web|url=http://www.aaets.org/article31.htm |title=Sexual Abuse: Surviving the Pain |author=Barabara E. Bogorad, Psy.D., A.B.P.P., Founder and Former Director, Sexual Abuse Recovery Program Unit
South Oaks Hospital, New York |publisher=The American Academy of Experts in Traumatic Stress, Inc.}}</ref> Child sexual abuse offenses where the perpetrator is related to the child, either by blood or marriage, is a form of [[incest]] described as ''intrafamilial child sexual abuse''.<ref>[http://cjp.sagepub.com/cgi/content/abstract/4/3/249 ''Decision-making of the District Attorney: Diverting or Prosecuting Intrafamilial Child Sexual Abuse Offenders,''] Lorie Fridell, ''Criminal Justice Policy Review,'' vol.4, 1990.</ref>
The most-often reported form of incest is father-daughter and stepfather-daughter incest, with most of the remaining reports consisting of mother/stepmother-daughter/son incest.<ref name=Turner>{{cite book|title=Encyclopedia of Relationships Across the Lifespan|last=Turner|first=Jeffrey S.|year=1996 |publisher=Greenwood Publishing Group |pages=p92|isbn=031329576X}}</ref> Father-son incest is reported less often, however it is not known if the prevalence is less, because it is under-reported by a greater margin.<ref>{{cite book|title=Don't Tell: The Sexual Abuse of Boys |first=Michel |last=Dorais|coauthors=Translated by Isabel Denholm Meyer|year=2002 |pages=p24 |publisher=McGill-Queen's Press |isbn=0773522611}}</ref><ref>{{cite book|title=Healing the Incest Wound: Adult Survivors in Therapy |first=Christine A.|last= Courtois |year= 1988 |publisher=W. W. Norton & Company |isbn=0393313565}}</ref> Prevalence of parental child sexual abuse is difficult to assess due to secrecy and privacy; some estimates show 20 million Americans have been victimized by parental incest as children.<ref name=Turner />
==Types of child sexual assault==
Child sexual abuse includes a variety of sexual offenses, including:
* ''[[rape|sexual assault]]'' – a term defining offenses in which an adult touches a minor for the purpose of sexual gratification; for example, [[rape]] (including [[sodomy]]), and sexual penetration with an object.<ref>[http://www.ncjrs.gov/pdffiles1/ojjdp/187238.pdf ''Child Abuse Reported to the Police,''] Juvenile Justice Bulletin, U.S. Office of Juvenile Justice and Delinquency Prevention, May 2001.</ref> Most U.S. states include, in their definitions of sexual assault, any penetrative contact of a minor’s body, however slight, if the contact is performed for the purpose of sexual gratification.<ref>[http://www.childwelfare.gov/systemwide/laws_policies/statutes/defineall.pdf ''Definitions of Child Abuse and Neglect, Summary of State Laws,''] National Clearinghouse on Child Abuse and Neglect Information, U.S. Department of Health and Human Services.</ref>
* ''sexual molestation'' – a term defining offenses in which an adult engages in non-penetrative activity with a minor for the purpose of sexual gratification; for example, exposing a minor to pornography or to the sexual acts of others.<ref>''Criminal Investigation of Child Sexual Abuse,'' U.S. Office of Juvenile Justice and Delinquency Prevention, March 2001.</ref>
* ''sexual exploitation'' – a term defining offenses in which an adult victimizes a minor for advancement, sexual gratification, or profit; for example, prostituting a child,<ref>[http://www.ncjrs.gov/html/ojjdp/203946/contents.html ''Prostitution of Juveniles,''] U.S. Office of Juvenile Justice and Delinquency Prevention, June, 2004.</ref> and creating or trafficking in child pornography.<ref>[http://www.ncjrs.gov/txtfiles/exploit.txt ''Child Sexual Exploitation: Improving Investigations and Protecting Victims,''] Massachusetts Child Exploitation Network, U.S. Office of Juvenile Justice and Delinquency Prevention, January, 1995.</ref>
*''[[Child grooming|sexual grooming]]'' - defines the social conduct of a potential child sex offender who seeks to make a minor more accepting of their advances, for example in an online [[chat room]]<ref>[http://www.zdnet.co.uk/tsearch/grooming+chatroom.htm grooming chatroom Content at ZDNet UK<!-- Bot generated title -->]</ref>
==Disclosure==
Children who received supportive responses following disclosure had less traumatic symptoms and were abused for a shorter period of time than children who did not receive support <ref> Gries, L., Goh, D., Andrews, M., Gilbert, J., Praver, F., & Stelzer, D. (2000). Positive reaction to disclosure and recovery from child sexual abuse. ''Journal Of Child Sexual Abuse'', 9(1), 29-51.</ref><ref> Kogan, S. (2005). The Role of Disclosing Child Sexual Abuse on Adolescent Adjustment and Revictimization. ''Journal Of Child Sexual Abuse'', 14(2), 25-47.</ref> In general, studies have found that children need support and stress-reducing resources after disclosure of sexual abuse <ref> Arata, C. (1998). To tell or not to tell: Current functioning of child sexual abuse survivors who disclosed their victimization. ''Child Maltreatment'', 3(1), 63.71.</ref> <ref name = "pwmjhq"> Palmer, S., Brown, R., Rae-Grant, N., & Loughlin, J. M., (1999). Responding to children's disclosure of familial abuse: what survivors tell us. ''Child Welfare'', 2(78), 259-282.</ref> Negative social reactions to disclosure have actually been found to be harmful to the survivor’s wellbeing <ref> Ullman, S.E. (2003). Social reactions to child abuse disclosure: A critical review. ''Journal of Child Sexual Abuse'', 12, 89-121.</ref> One study reported that children who received a bad reaction from the first person they told, especially if the person was a close family member, had worse scores as adults on general trauma symptoms, posttraumatic stress disorder symptoms, and dissociation <ref> Roesler, T.A. (1994). Reactions to disclosure of childhood sexual abuse: the effect on adult symptoms. ''Journal of Nervous and Mental Disease, '' 182, 618-624.</ref> Another study found that in most cases when children did disclose abuse, the person they talked to did not respond effectively, blamed or rejected the child, and took little or no action to stop the abuse <ref name = "pwmjhq"/> Although hearing a victim’s disclosure might be uncomfortable, for the sake of the victim’s wellbeing, it is important to be able to respond effectively. Showing that you understand and take seriously what the child is saying is an important first step.
The [[American Academy of Child and Adolescent Psychiatry]] provides guidelines for what to say to the victim and what to do following the disclosure <ref> Responding to Child Sexual Abuse [http://www.aacap.org/cs/root/facts_for_families/responding_to_child_sexual_abuse]
</ref>
==Treatment==
The initial approach to treating a person who has been a victim of sexual abuse is dependant upon several important factors:
*Age at the time of presentation
*Circumstances of presentation for treatment
*Co-morbid conditions
The goal of treatment is not only to treat current mental health issues, but to prevent future ones.
===Children and Adolescents===
Children often present for treatment in one of several circumstances, including criminal investigations, custody battles, problematic behaviors, and referrals from CPS.<ref name=NCCAN>{{cite book |author=Cynthia Winn; Anthony J. Urquiza |title=Treatment For Abused And Neglected Children: Infancy To Age 18 - User Manual Series |publisher=Diane Pub Co |location= |year=2004 |pages= |isbn=0-7881-1661-4 |oclc= |doi= |accessdate=}}</ref>
The three major modalities for therapy with children and teenagers are Family Therapy, Group Therapy, and Individual Therapy. Which course is used depends on a variety of factors that must be assessed on a case by case basis. For instance, treatment of young children generally requires strong parental involvement, and can benefit from family therapy. Adolescents tend to be more independent, can benefit from individual or group therapy. The modality also shifts during the course of treatment, for example group therapy is rarely used in the initial stages, as the subject matter is very personal and/or embarrassing.<ref name=NCCAN/>
Major factors that affect both the pathology and response to treatment include the type and severity of the sexual act, its frequency, the age at which it occurred, and the child’s family of origin.
===Adult Survivors===
Adults with a history of sexual abuse often present for treatment with a secondary mental health issue, which can include substance abuse, personality disorders, depression, and conflict in romantic or interpersonal relationships.
Generally the approach is to the present problem, rather than the abuse itself. Treatment is highly varied and depends on the person’s specific issues. For instance, a person with a history of sexual abuse suffering from severe depression would be treated for [[Major depressive disorder|depression]].
Sexual abuse is associated with many sub-clinical behavioral issues as well, including re-victimization in the teenage years, a bipolar-like switching between sexual compulsion and shut-down, and distorted thinking on the subject of sexual abuse (for instance, that it is common and happens to everyone). Frequently, victims do not make the connection between their abuse and their present pathology. Female victims who were abused before age 12 also will sometimes have a curious vocal inflection recognizable by clinicians, reminiscent of a child speaking, though at present this has not been studied or explained.
==Pedophilia==
{{Main|Pedophilia}}
The term "pedophilia" refers to persistent feelings of attraction in an adult or older adolescent toward [[prepubescent]] children, whether the attraction is acted upon or not.<ref>World Health Organization, International Statistical Classification of Diseases and Related Health Problems 10. § F65.4</ref><ref>American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders (fourth edition text revision), § 302.2</ref><ref name=americanheritage2> {{cite web |url=http://dictionary.reference.com/browse/pedophilia |title="pedophilia" (n.d.) |work=The American Heritage® Stedman's Medical Dictionary |date=2008-05-06 |quote=The act or fantasy on the part of an adult of engaging in sexual activity with a child or children.}}</ref> A person with this attraction is called a "pedophile".<ref name=americanheritage> {{cite web|url= http://dictionary.reference.com/browse/pedophile |title="pedophile" (n.d.) |work=The American Heritage® Dictionary of the English Language, Fourth Edition |date=2008-05-06}}</ref>
According to the [[Mayo Clinic]], approximately 95% of child sexual abuse incidents are committed by the 88% of child molestation offenders who meet the diagnostic criteria for pedophilia;<ref name=mayoclinic/> and pedophilic child molestors commit ten times more sexual acts against children than non-pedophilic child molestors.<ref name=mayoclinic>{{cite journal |url=http://www.mayoclinicproceedings.com/pdf%2F8204%2F8204sa.pdf |title=A Profile of Pedophilia: Definition, Characteristics of Offenders, Recidivism, Treatment Outcomes, and Forensic Issues |coauthors=RYAN C. W. HALL, MD, AND RICHARD C. W. HALL, MD, PA. |journal=Mayo Clin Proc |volume=82:457-471 2007 |publisher=MAYO FOUNDATION FOR MEDICAL EDUCATION AND RESEARCH}}</ref> This report was was confined to victims 12 and under with offenders over 18. On the other hand, when offenses against adolscents and teenagers were included, Okami and Goldberg (1992), and Kevin Howells (1981), state that most data they had reviewed suggest that pedophiles make up a minority of incarcerated child sex offenders.<ref>Okami, P. & Goldberg, A. (1992) "Personality correlates of pedophilia: Are they reliable indicators?," ''Journal of Sex Research'', 29, 297-328. "This is a particularly important point because most data suggest that only a relatively small portion of the population of incarcerated sexual offenders against minors consists of persons for whom minors (particularly children) represent the exclusive or even primary object of sexual interest or source of arousal."</ref><ref>Howells, K. (1981). "Adult sexual interest in children: Considerations relevant to theories of aetiology," in Cook, M. & Howells, K. (eds.), ''Adult sexual interest in children'', 55-94.</ref>
In [[Police|law enforcement]], the term "pedophile" is generally used to describe those accused or convicted of child sexual abuse under [[Minor (law)|sociolegal definitions of child]] (including both prepubescent [[children]] and adolescents younger than the local [[age of consent]]);<ref name="ames">Ames, A. & Houston, D. A. (1990). '']http://www.springerlink.com/content/g8g66p6370731x85/ Legal, social, and biological definitions of pedophilia.]'' ''Archives of Sexual Behavior''. '''19''' (4), 333-342.</ref> however, not all child sexual offenders are pedophiles and not all pedophiles engage in sexual abuse of children.<ref name=apaDSM>{{cite web |url=http://web.archive.org/web/20070629090023/http://www.psych.org/news_room/press_releases/diagnosticcriteriapedophilia.pdf |title=AMERICAN PSYCHIATRIC ASSOCIATION STATEMENT DIAGNOSTIC CRITERIA FOR PEDOPHILIA |date=2003-06-17 |publisher=American Psychiatric Association}}</ref><ref>''Self-Report of Crimes Committed by Sex Offenders,'' M. Weinrott and M. Saylor, ''Journal of Interpersonal Violence,'' vol.6 (1991). A study finding that child sexual offenders self-reported high degree of "crossover" sexual offenses, defined as rapes of adult women, as well as of both related and non-related children).</ref><ref name="barbaree-seto">{{cite book|last= Laws|first=Dr. Richard |coauthors= William T. O'Donohue|contributors=H. E.Barbaree, M. C.Seto |year=1997 |title=''Sexual Deviance: Theory, Assessment, and Treatment'' |pages= p175-193 |publisher=Guilford Press |isbn=1572302410 }}</ref> Law enforcement and legal professionals have begun to use the term ''predatory pedophile'',<ref>See, for example, [http://www.sconet.state.oh.us/rod/newpdf/6/2005/2005-ohio-3356.pdf State v. Frazier], 2005-Ohio-3356.</ref> a phrase coined by children's attorney [[Andrew Vachss]], to refer specifically to pedophiles who engage in sexual activity with minors.<ref>See, for example, ''Prosecuting Child Sex Tourists at Home,'' Margaret A. Healy, Fordham International Law Journal, vol.18, 1995.</ref> The term emphasizes that child sexual abuse consists of conduct chosen by the perpetrator.<ref>[http://www.vachss.com/av_dispatches/disp_8908_a.html ''How We Can Fight Child Abuse,''] [[Andrew Vachss]], ''Parade Magazine,'' August 20, 1989.</ref>
==Offenders==
===Adult offenders===
====Demographics====
Offenders are more likely to be relatives or acquaintances of their victim than strangers.<ref>[http://findarticles.com/p/articles/mi_hb179/is_199610/ai_n5572097 Childhood sexual abuse and psychiatric disorder in young adulthood: Prevalence of sexual abuse and factors associated with sexual abuse," Fergusson, D. M., Lynskey, M. T., and Horwood L. J. (1996) Journal of the American Academy of Child and Adolescent Psychiatry, 35(10), 1355-64.]</ref> A 2006-2007 Idaho study of 430 cases found that 82% of juvenile sex offenders were known to the victims (acquaintances 46% or relatives 36%).<ref>{{cite web |author=Joint Submission by The Office of the Governor C.L. Butch Otter, Governor and The Office of the Attorney General Lawrence Wasden, Attorney General January, 2008 |title=The Prosecution of Child Sexual Abuse in Idaho July 1, 2006 - June 30, 2007 |url=http://www2.state.id.us/ag/sexual_prosecution_reports/2007IdahoProsecutionOfChildSexualAbuseReport.pdf |accessdate= 2008-01-28 | format = pdf }}</ref>
<ref>[http://www.kpvi.com/Global/story.asp?S=7770431 ''Idaho Releases Yearly Report on Sexual Abuse'', KPVI.com, Suzanne Hobbs]</ref>
More offenders are male than female, though the percentage varies between studies. The percentage of incidents of sexual abuse by female perpetrators that come to the attention of the legal system is usually reported to be between 1% and 4%.<ref>[http://goliath.ecnext.com/coms2/gi_0199-3286320/The-myth-of-innocence-sexual.html The myth of innocence: sexual scripts and the recognition of child sexual abuse by female perpetrators . The Journal of Sex Research, Vol, 40, No, 3, 2003: pp. 303-314, Denov, M, S. (2003)]</ref> Studies of sexual misconduct in US schools with female offenders have shown mixed results with rates between 4% to 43% of female offenders.<ref name="Shakeshaft25">[http://www.ed.gov/rschstat/research/pubs/misconductreview/report.pdf Educator Sexual Misconduct: A Synthesis of the Literature", U.S. Department of Education, 2004, p25, Shakeshaft, C.]</ref> Maletzky (1993) found that, of his sample of 4,402 convicted pedophilic offenders, 0.4% were female.<ref>Maletzky, B.M. (1993). "[http://www.springerlink.com/content/m2tn305232r312g3/ Factors associated with success and failure in the behavioral and cognitive treatment of sexual offenders]," ''Annals of Sex Research'', 6, 241-258.</ref> Another study of a non-clinical population found that, among those in the their sample that had been molested, as much as a third were molested by women.<ref>Tomeo, M,Templer, D, Anderson, S,and Kotler, D (2001). "Comparative Data of Childhood and Adolescence Molestation in Heterosexual and Homosexual Persons" ''Archives of Sexual Behavior'', Vol. 30, No. 5 </ref>
In U.S. schools, educators who offend range in age from "21 to 75 years old, with an average age of 28" with teachers, coaches, substitute teachers, bus drivers and teacher's aides (in that order) totaling 69% of the offenders.<ref>Shakeshaft, C, "[http://www.ed.gov/rschstat/research/pubs/misconductreview/report.pdf Educator Sexual Misconduct: A Synthesis of the Literature]", U.S. Department of Education, 2004, p24-25.</ref>
====Psychological Aspects====
Offenses may be facilitated by [[cognitive distortion]]s of the offender, such as minimization of the abuse, [[victim blaming]], and excuses.<ref>Ward, T., Hudson, S. M., & Marshall, W. L. (1995). "Cognitive distortions and affective deficits in sex offenders: A cognitive deconstructionist interpretation," ''Sexual Abuse: A Journal of Research and Treatment'', 7, 67-83.</ref>
Early research in the 1970s and 80s began to classify offenders based on their motivations and traits. Groth and Birnbaum (1978) categorized child sexual offenders into two groups, "fixated" and "regressed."<ref name="Groth">Groth, A. Nicholas & Birnbaum, H. Jean (1978). "[http://www.springerlink.com/content/tr7388256l7437xh/ Adult sexual orientation and attraction to underage persons]," ''Archives of Sexual Behavior'' Vo. 7, No. 3, 175-181</ref> Fixated were described as having an primary attraction to children, whereas regressed had largely maintained relationships with other adults, and were even married. This study also showed that adult sexual orientation was not related to the sex of the victim targeted, e.g. men who molested boys had previously had adult heterosexual relationships.<ref name="Groth"/>
Later work (Holmes and Holmes, 2002) expanded on the types of offenders and their psychological profiles. They are divided thus<ref name="holmes">{{cite book | last = Holmes | first = Ronald M. | coauthors = Holmes, Stephen T. | title =Profiling Violent Crimes: An Investigative Tool | publisher = Sage Publications, Inc | location = Thousand Oaks, CA | date = 2002-03-12 | isbn = 9780761925934}}</ref>:
*Situational - does not prefer children, but offend under certain conditions.
**''Regressed'' - Typically has relationships with adults, but a stressor causes them to seek children as a substitute.
**''Morally Indiscriminate'' - All-around sexual deviant, who may commit other sexual offenses unrelated to children.
**''Naive/Inadequate'' - Often mentally disabled in some way, finds children less threatening.
*Preferential - has true sexual interest in children.
**''Mysoped'' - Sadistic and violent, target strangers more often than acquaintances.
**''Fixated'' - Little or no activity with own age, described as an "overgrown child."
===Child and young adolescent offenders===
{{main|Child-on-child sexual abuse}}
When a [[prepubescent]] child is sexually abused by one or more other children or [[adolescent]] youths, and no adult is directly involved, it is defined as [[child-on-child sexual abuse]]. The definition includes any sexual activity between children that occurs without consent, without equality, or as a result of [[coercion]],<ref name="shaw">Jon A. Shaw et al. (September, 2004). "[http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6V7N-41NTBY3-7&_user=10&_coverDate=12%2F31%2F2000&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=417a4a74eb9c917b4388d88cc9bb4109 Child on child sexual abuse: psychological perspectives]," Child Abuse & Neglect
Volume 24, Issue 12, December 2000, Pages 1591-1600.</ref> whether the offender uses physical force, threats, trickery or emotional manipulation to compel cooperation. When sexual abuse is perpetrated by one sibling upon another, it is known as "intersibling abuse", a form of [[incest]]. <ref name="Caffaroa">{{cite journal|title=Treating sibling abuse families|author=John V. Caffaroa, Allison Conn-Caffaro |journal=Aggression and Violent Behavior |volume= Volume 10, Issue 5, July-August 2005, Pages 604-623|publisher= Elsevier}}</ref>
==International law==
{{main|Laws regarding child sexual abuse}}
Child sexual abuse is outlawed in every [[developed country]], generally with severe criminal penalties, including in some jurisdictions, [[Life sentence|life imprisonment]] or [[capital punishment]].<ref name=Levesque>{{cite book|title=Sexual Abuse of Children: A Human Rights Perspective |last= Levesque |first=Roger J. R. |publisher= Indiana University Press |year= 1999 |pages=pp1,5-6,176-180|quote=The world community recently has recognized every child's fundamental human right to protection from sexual maltreatment. This right has been expressed in recent declarations, conventions, and programs of action. Indeed, the right to protection from sexual maltreatment is now entrenched so strongly in international human rights law that no country can relinquish its obligation.}}</ref><ref name=UNchildren>{{cite web|url=http://www2.ohchr.org/english/law/crc.htm|title=United Nations Convention on the Rights of the Child|publisher=Office of the United Nations High Commissioner for Human Rights|date=1989|quote=Parties shall take all appropriate legislative, administrative, social and educational measures to protect the child from all forms of physical or mental violence, injury or abuse, neglect or negligent treatment, maltreatment or exploitation, including sexual abuse... States Parties undertake to protect the child from all forms of sexual exploitation and sexual abuse. For these purposes, States Parties shall in particular take all appropriate national, bilateral and multilateral measures to prevent: (a) The inducement or coercion of a child to engage in any unlawful sexual activity; (b) The exploitative use of children in prostitution or other unlawful sexual practices; (c) The exploitative use of children in pornographic performances and materials.}}</ref> An adult's sexual intercourse with a child below the legal [[age of consent]] is defined as [[statutory rape]],<ref>''Black's Law Dictionary 8th Edition''. '''child''', "at common law, a person who has not reached the age of 14." ''See also'' definition under '''rape''' "carnal knowledge of a child is frequently declared to be rape by statute."</ref> based on the principle that a child is not capable of consent and that any apparent consent by a child is not considered to be [[Legal consent#Sex|legal consent]].
One hundred forty [[United Nations member states|nations]] are signatories to the [[United Nations Convention on the Rights of the Child]]. This international [[treaty]] defines a set of protections which signatories agree to provide for the children of their respective countries.<ref>[http://www.ohchr.org/english/countries/ratification/11.htm ''Signatories to the United Nations on the Convention of the Rights of the Child.'']</ref>
Articles 34 and 35 require that signatories protect their nations’ children from all forms of sexual exploitation and sexual abuse. This includes outlawing the coercion of a child to perform sexual activity, the prostitution of children, and the exploitation of children in creating pornography. Signatories also agree to prevent abduction, sale, or trafficking of children.<ref>[http://www.unhchr.ch/html/menu3/b/k2crc.htm ''United Nations Convention on the Rights of the Child.'']</ref>
==History==
Child sexual abuse has gained public attention in the past few decades and has become one of the most high-profile crimes. Since the 1970s the sexual abuse of children and child molestation has increasingly been recognized as deeply damaging to children and thus unacceptable for society as a whole. While sexual use of children by adults has been present throughout history, it has only become the object of significant public attention in recent times.
===Early writings===
The first published work dedicated specifically to child sexual abuse appeared in France in 1857: ''Medical-Legal Studies of Sexual Assault'' ''(Etude Médico-Légale sur les Attentats aux Mœurs)'', by [[Auguste Ambroise Tardieu]], the noted French pathologist and pioneer of [[forensic medicine]] (Masson, 1984, pp. 15-25).
===The rise of public concern===
Child sexual abuse became a public issue in the 1970s and 1980s. Prior to this point in time sexual abuse remained rather secretive and socially unspeakable. Studies on child molestation were nonexistent until the 1920s and the first national estimate of the number of child sexual abuse cases was published in 1948. By 1968 forty four states had enacted mandatory laws that required physicians to report cases of suspicious child abuse. Legal action began to become more prevalent in the 1970s with the enactment of the [[Child Abuse and Treatment Act]] in 1974 in conjunction with the creation of the National Center for Child Abuse and Neglect. Since the creation of the Child Abuse and Treatment Act, reported child abuse cases have increased dramatically. Finally, the [[National Abuse Coalition]] was created in 1979 to create pressure in congress to create more sexual abuse laws.
[[Second wave feminism]] brought greater awareness of child sexual abuse and violence against women, and made them public, political issues. [[Judith Lewis Herman]], Harvard professor of psychiatry, wrote the first book ever on father-daughter incest when she discovered during her medical residency that a large number of the women she was seeing had been victims of father-daughter incest. Herman notes that her approach to her clinical experience grew out of her involvement in the civil rights movement. <ref name="UCB">{{cite web |url=http://globetrotter.berkeley.edu/people/Herman/herman-con0.html |title=Conversation with History; Dr. Judith Lewis Herman |work=Conversations with History: Institute of International Studies |publisher=UC Berkeley| accessmonthday=December 22 |accessyear=2007}}</ref> Her second book ''Trauma and Recovery'', considered a classic and ground-breaking work<ref>[http://www.amazon.com/Trauma-Recovery-Judith-Lewis-Herman/dp/0863584306 Amazon.com: Trauma and Recovery: Judith Lewis Herman: Books<!-- Bot generated title -->]</ref><ref name="hopper">{{cite web|url=http://www.jimhopper.com/trauma_and_recovery/ |title=Trauma and Recovery: Praise, Table of Contents, & Excerpts |publisher=Jim Hopper, Ph.D. with the author and publisher's permission|date=2008-03-23}}</ref> coined the term [[complex post-traumatic stress disorder]]<ref>{{cite book|title=Trauma and recovery: The aftermath of violence from domestic abuse to political terror |first=Judith Lewis |last=Herman |year=1997|publisher=Basic Books |page = p. 119}}</ref>." In it she defines this concept not only in terms of prolonged trauma, but in terms of what she calls "subjection to [[totalitarian]] control." Examples of this concept include:
<blockquote>...[[hostages]], [[prisoners of war]], [[Concentration camp|concentration-camp]] survivors, and survivors of some [[Cult|religious cults]]. Examples also include those subjected to [[totalitarian]] systems in sexual and domestic life, including survivors of [[Domestic violence|domestic battering]], childhood physical or [[sexual abuse]], and organized [[sexual exploitation]].<ref>{{cite book|title=Trauma and recovery: The aftermath of violence from domestic abuse to political terror |first=Judith Lewis |last=Herman |year=1997|publisher=Basic Books |pages =p. 121}}</ref> </blockquote>
In 1986, Congress passed the Child Abuse Victims' Rights Act, giving children a civil claim in sexual abuse cases. The number of laws created in the 1980s and 1990s began to create greater prosecution and detection of child sexual abusers. During the 1970s a large transition began in the legislature related to child sexual abuse. [[Megan's Law]] which was enacted in 2004 gives the public access to knowledge of sex offenders nationwide.<ref>[http://www.klaaskids.org/pg-legmeg2.htm Megan's Law]</ref>
Anne Hastings described these changes in attitudes towards child sexual abuse as "the beginning of one history's largest social revolutions."<ref>''From Generation to Generation: Understanding Sexual Attraction to Children'', p.15</ref>
According to John Jay College of Criminal Justice professor B.J. Cling,
<blockquote>"By the early 21st century, the issue of child sexual abuse has become a legitimate focus of professional attention, while increasingly separated from second wave feminism...As child sexual abuse becomes absorbed into the larger field of interpersonal trauma studies, child sexual abuse studies and intervention strategies have become degendered and largely unaware of their political origins in modern feminism and other vibrant political movements of the 1970s. One may hope that unlike in the past, this rediscovery of child sexual abuse that began in the 70s will not again be followed by collective amnesia. The institutionalization of child maltreatment interventions in federally funded centers, national and international societies, and a host of research studies (in which the United States continues to lead the world) offers grounds for cautious optimism. Nevertheless, as Judith Herman argues cogently, 'The systematic study of psychological trauma...depends on the support of a political movement.'" <ref>{{cite book|title=Sexualized Violence Against Women and Children: A Psychology and Law Perspective|author=B.J. Cling|page=177|year=2004|publisher=Guilford Press|id=ISBN 1593850611}}</ref></blockquote>
==See also==
* [[Catholic sex abuse cases]]
* [[Child pornography]]
* [[Child sex tourism]]
* [[Child-on-child sexual abuse]]
* [[Commercial sexual exploitation of children]]
* [[Day care sexual abuse hysteria]]
* [[False allegation of child sexual abuse]]
* [[History of child sexual abuse]]
* [[List of films portraying paedophilia or sexual abuse of minors]]
* [[Prostitution of children]]
* [[Scouting sex abuse cases]]
* [[Sexual harassment in education#Sexual harassment and abuse of students by teachers|Sexual harassment and abuse of students by teachers]]
==Notes==
{{reflist|2}}
==Further reading==
* {{cite book | last = Waterman | first = Jill | coauthors = Kelly, Robert J.; Oliveri, Mary Kay; and McCord, Jane | title = Behind the Playground Walls - Sexual Abuse in Preschools | publisher = The Guilford Press |date=1993 | location = New York, London | isbn = 0-89862-523-8}}
*{{cite book |author=Davis, Laura; Bass, Ellen |title=The courage to heal: a guide for women survivors of child sexual abuse: featuring "Honoring the truth, a response to the backlash" |publisher=HarperPerennial |location=New York |year=1994 |pages= |isbn=0060950668 |oclc= |doi=}}
* {{cite book |author=Lew, Mike |title=Victims No Longer (Second Edition) : The Classic Guide for Men Recovering from Sexual Child Abuse |publisher=Perennial Currents |location= |year= |pages= |isbn=006053026X |oclc= |doi=}}
==External links==
* {{dmoz|/Society/Issues/Children,_Youth_and_Family/Child_Abuse/Sexual_Abuse/}}
* [http://www.jimhopper.com/abstats/ Child abuse statistics]
* [http://www.aacap.org/cs/root/facts_for_families/child_sexual_abuse American Academy of Child and Adolescent Psychiatry: factsheet on Child Sexual abuse]
===Published articles===
* U.S. Dept. of Health and Human Services, [http://www.childwelfare.gov/pubs/statsinfo/nis3.cfm Executive Summary of the Third National Incidence Study of Child Abuse and Neglect,] 1996.
* Vigil, J. et al., [http://web.missouri.edu/~gearyd/Vigiletal%5BDP2005%5D.pdf A Life History Assessment of Early Childhood Sexual Abuse in Women,] ''Developmental Psychology,'' 2005.
{{Sexual ethics}}
[[Category:Child sexual abuse]]
[[Category:Child abuse]]
[[Category:Human sexuality]]
[[Category:Sexual abuse]]
[[Category:Sex crimes]]
[[da:Seksuelt misbrug af børn]]
[[de:Sexueller Missbrauch von Kindern]]
[[es:Abuso sexual infantil]]
[[fr:Abus sexuel sur mineur]]
[[ko:아동 성학대]]
[[ms:Penderaan seksual kanak-kanak]]
[[ja:児童性的虐待]]
[[pt:Abuso sexual de menor]]
[[ru:Сексуальное насилие над детьми]]
[[simple:Child sexual abuse]]
[[fi:Lapsen seksuaalinen hyväksikäyttö]]
[[ta:சிறுவர் பாலியல் பலாத்காரம்]]
[[tr:Çocuk cinsel istismarı]]