It has been historically conceived that males are the specific gender that are often associated with particular types of abuse. However, recent research studies have indicated that both males and females are subject to different types of abuse. In the case of sexual abuse, it is not only females that are found victims of these heinous crimes but also males. There is accumulating evidence from epidemiological and clinical investigations that the predictors, symptoms and progression of sexual abuse are specific to each gender.
This observation has thus triggered efforts in analyzing gender-specific features and characteristic effects of sexual abuse among males and females. The identification of gender-specific differences among victims is of utmost importance because this information facilitates the treatment and support that will be provided to the victims of sexual abuse. The quality and amount of intervention may be based on these gender-specific characteristics among the victims of sexual abuse.
More importantly, psychosocial and cognitive approaches to the understanding and treatment of the victims may be based on these sex-specific observations. This research paper aims to discuss gender-specific effects of sexual abuse. For several years there has been significant research and investigation on the topic of sexual abuse of children, as well as the necessary and appropriate intervention and treatment.
Psychosocial and clinical researchers have identified that sexual abuse is a serious matter for an increasing number of children. It has been estimated that one in four girls is abused in a sexual manner before she reaches the age of 14 years old (Hopper, 1997a). On the other hand, it has been determined that one in six boys is sexually abused before he reaches the age of 16.
It is of interest to note that while approximately 25% to 30% of the reported cases of sexual abuse are associated with victims who are essentially boys, most of the literature and investigations that have been conducted have focused mostly on the side of the females (Bolton et al. , 1989; Finkelhor, 1990; Hack et al. , 1994). There has been an increase in the number of cases reported on sexual abuse for both sexes hence it is imperative that psychiatric counselors to understand the impact of such experience and identify effective intervention programs for these children, based on their gender.
Psychosocial analyses describes that sexual abuse is comprised on several kinds of sexual experiences that may or may not be associated with a form of contact between the perpetrator and the child victim. It should be primarily understood that the sex offender is generally considered to be in control of the situation and the child is innocently lured in the act (Cain, 1996; Parker, 1997).
The sexual incidents may vary, ranging from the exposure of the sexual offenders genitals to the child victim as well as fondling of private body parts of the child victim. The incidents may also reach the extreme end of the wide range of acts including penetration through the oral, anal or even vaginal routes (Cain, 1996). The sexual abuse may also be involved with voyeurism and exhibition of private parts to the child victim and even child pornography and prostitution (Parker, 1997).
Children who have been sexually abused display a wide variety of early and long-term symptoms. The nature and severity of symptoms a child experiences is often influenced by a wide range of variables including the characteristics of the abuse, family, child, and the amount/type of support provided to the child after the abuse (Beitchman, Zucker, Hood, DaCosta, & Akma, 1991; Cohen & Mannarinno, 1996a; Damon, Todd, MacFarlane, 1987; Kempe & Kempe, 1984; Kendall-Tackett, Williams, & Finkelhor, 1993) .
Several studies examining treatment outcomes for preadolescent children of sexual abuse recommend a course of treatment that involves a multi-modal approach including: abuse-specific, structured group therapy; and family involvement (Berman, 1990; Cohen & Mannarino, 1996b; Finkelhor & Berliner, 1995; Rencken, 1994).
Sexual abuse is associated with a wide variety of symptoms and symptom patterns. According to an extensive review of the literature by Finkelhor (1990) and Kendall-Tackett et al. 1993), there does not appear to be any one symptom or pattern of symptoms that is characteristic of the majority of sexually abused children. The most frequently observed symptoms include depression, aggression/hostility, sexually inappropriate behavior, fear, and school/academic problems (Bolton et al. , 1989; Cain, 1996; Damon et al. , 1987; Kendall-Tackett et al. , 1993; Kempe & Kempe, 1984; Kitchur & Bell, 1989).
According to Cain (1997), sexually abused children may also experience problems with hyperactivity, changes in sleeping and/or habits, regression in behavior, bad dreams, bed wetting, moodiness, and hurting animals. Kendall-Tackett et al. (1993) also found social withdrawal, PTSD, poor self-esteem, and somatic complaints to be common problems for sexually abused children.
Several authors found that the symptoms of sexually abused boys and girls often differ along the dimension of internalizing and externalizing behaviors (Bolton et al. 1989; Damon et al. , 1987; Finkelhor, 1990). These authors found that boys tend to display more externalizing behaviors (such as acting out aggressively, limit testing, and antisocial behavior); while girls tend to display more internalizing behaviors (such as fear, social withdrawal, depression, and inhibition). According to Bolton et al. (1989), boys also display a greater degree of inappropriate sexualized behavior.
Boys may also experience a greater sense of shame about the abuse than girls due to cultural stereotypes about masculinity, machismo, and victim status (Bolton et al. 1989; Hack et al. , 1994; McGain & McKinzey, 1995). In our culture, where boys are expected to be strong, tough, and independent, a boy who is sexually abused may believe that he should have been able to stop the abuse. Boys’ experience of sexual abuse is also more likely to be associated the stigma of homosexuality (Hack et al. , 1994). If the perpetrator is a male, boys may fear that others will incorrectly label them; or that perhaps the abuse will actually make them homosexual. These cultural stereotypes may prevent accurate reporting of the sexual abuse of boys.
As children who have experienced sexual abuse mature into adulthood, they often experience problems with depression; dissociation; impaired relationships and difficulty trusting others; sexual dysfunction; and substance abuse (Hopper, 1997b; Kempe & Kempe, 1984). According to Finkelhor (1990), men who were sexually abused are more likely to express a sexual interest in children and a desire to hurt others. They also experience more confusion about gender and their sexual identity/orientation (Hopper, 1997).
Men are more likely to have multiple sexual partners, victimize others, and engage in dangerous or violent behavior as an attempt to prove their masculinity (Hopper, 1997). While men ,who experienced sexual abuse as a child, are more likely to victimize others; women, who experienced sexual abuse as a child, are more likely to fall into a pattern of re-victimization (Finkelhor, 1990). This tendency for male victims of sexual abuse to become perpetrators of abuse against others emphasizes the importance of directing more attention and research toward the treatment of sexually abused boys.
There are many factors, in addition to gender, which mediate the effect of sexual abuse on children. The nature of the act itself, the frequency, duration, relationship of the perpetrator to the child, and parental reaction and support all influence the severity and presentation of symptoms. The use of force, penetration, father figure as the perpetrator, multiple perpetrators, and maternal depression are associated with a greater number and severity of symptoms displayed by the child (Beitchman et al. , 1991; Damon et al. 1987; Kempe & Kempe, 1984; Kendall-Tackett et al. , 1993).
Parental reaction and support after the disclosure is a highly influential mediating factor of both the presentation of symptoms and treatment outcome. According to Beitchman et al (1991), “children who were not supported by their parents following disclosure of the abuse (65 % of her sample) had more severe symptoms and were more likely to be hospitalized compared to children whose families were supportive” (p. 551). Age and developmental level of the child also influence the severity and presentation of symptoms.
According to Kitchur & Bell (1989) “sexually abused children in the 7-13 age group display the greatest degree of psychopathology, with 40% falling within the severely disturbed range” (p. 287). TREATMENT OF SEXUAL ABUSE Positive treatment outcomes for sexually abused children are associated with early intervention and treatment; parental involvement in therapy; a combination of individual and group therapy; and abuse-specific therapy with a cognitive behavioral component (Finklehor & Berliner, 1995; Kempe & Kempe, 1984).
Parental involvement in the treatment greatly determines the child’s prognosis for improvement and recovery. According to Cohen & Mannarino (1996a), “sexually abused children whose parents were included in active treatment showed greater improvement in behavioral symptoms than those whose parents were not provided with treatment” (p. 1408). Damon et al (1987) recommend using a parallel, abuse-specific group therapy format for the sexually abused child and his/her non-offending parent(s).
In this format, the child and his/her parent(s) attend separate groups that address the same information, topics, and issues at the same time. Group Therapy Group therapy is a vital component of the treatment of sexually abused children. The group environment provides children with a sense of universality, a feeling that “others are like me” or “have experienced what I have experienced”, which may reduce a child’s sense of shame and isolation (Celano, 1996).
According to Rencken (1989), groups are very useful for addressing issues of “responsibility, anger, fear, and guilt” due to the support and feedback children receive from their peers, which can be extremely validating and more effective than that provided by an adult counselor (p. 48). Several authors recommend a time limited (8-16 sessions), structured, abuse-specific group therapy format that addresses a specific topic each week (Damon et al. , 1987; Nelki & Watters, 1989; Sturkie, 1983; Zamanian & Adams, 1997).
These authors recommend small groups (4-8 children) that are homogeneous in regard to gender of the members and lead by a male/female co-facilitating team. According to Hack et al (1994), this type of group, when used with boys, effectively reduced anxiety and depression; improved externalizing and internalizing behaviors; and reduced their sense of stigma and isolation. Similar results were also found for girls. McGain & McKinzey (1995) found this type of group reduced anxiety, levels of conduct disordered behavior, and social aggression in girls. Abuse-specific Therapy
Structured abuse-specific group therapy is particularly useful for working with preadolescent children. It ensures that the group will address many important issues in a reasonable amount of time; without this structure, time in treatment is lengthened due to the tendency of preadolescent children to avoid discussing the important but difficult issues associated with sexual abuse (Damon et al, 1987). According to Celano (1996), this abuse-specific structure is necessary to “facilitate discussion because abused children do not spontaneously disclose or discuss their abuse even among peers who have had similar experiences” (p. 20).
Several authors provide detailed models for abuse-specific group therapy with girls (Kitchur & Bell, 1989; Nelki & Watters, 1989; Reichert 1994; Sturkie, 1983). These authors emphasize several important goals for group therapy: 1) provide a safe environment and appropriate adult role models; 2) decrease social isolation, shame, and stigmatization; 3) increase assertiveness and prevent re-victimization; 4) identify, express, and resolve feelings toward perpetrator, non-offending parent(s), and self; 5) provide basic sex education 6) enhance self-esteem; and 7) prevent long-term psychological problems.
Reichert (1994) and Sturkie (1983) also emphasize the importance of addressing abuse related feelings of powerlessness, guilt, fault, fear, and ambivalence. In addition to these issues and goals, Hack et al (1994) emphasize that abuse-specific group therapy with boys must also address externalizing behaviors, especially sexual acting out and aggression. According to Hack et al (1994), “Boys who have been sexually abused often engage in verbally and physically aggressive behavior in group programs” (p. 26). These authors recommend developing a concrete list of rules and a primary reinforcement schedule to use with boys in group therapy, in order to reduce these externalizing behaviors. According to these authors, it is these behaviors that often prevent community agencies from providing group therapy for sexually abused boys. According to Zamanian & Adams (1997), “themes of loss of power, sadomasochism, sexual identity confusion, and anger” also require attention in group therapy with boys.
In general, sexually abused children display a wide variety of early and long-term symptoms. The nature and severity these symptoms is often influenced by a wide range of variables including the characteristics of: the abuse, family, child, and the amount of support provided to the child after the abuse has occurred (Beitchman, Zucker, Hood, DaCosta, & Akma, 1991; Cohen & Mannarinno, 1996a; Damon, Todd, MacFarlane, 1987; Kempe & Kempe, 1984; Kendall-Tackett, Williams, & Finkelhor, 1993) . Gender of the child may also influence the effect the abuse has on the child.
Sexually abused boys tend to display more externalizing behaviors; a greater degree of sexualized behavior; a greater sense of shame; and more confusion regarding sexual identity (Bolton et al. , 1989). Several studies examining treatment outcomes for preadolescent children of sexual abuse recommend a course of treatment that involves a multi-modal approach including: abuse-specific, structured group therapy; and family involvement (Berman, 1990; Cohen & Mannarino, 1996b; Finkelhor & Berliner, 1995; Rencken, 1994).
Active parental involvement in therapy (Cohen & Mannarino,1996a; Damon et al. , 1987; Kendall-Tackett, 1993) and structured, abuse-specific group therapy (Finklehor & Berliner, 1995; Kempe & Kempe, 1984) are vital components of the intervention for childhood sexual abuse. It is evident that more research addressing the symptoms and treatment of sexually abused boys is necessary.
This is particularly important given that the research available has found that males who have been sexually abused are more likely, are adults, to 1) be sexually attracted to children (Finkelhor, 1990) and 2) victimize others (Hack et al. , 1994). In comparison to that for females, there is little research or literature specifically addressing treatment issues or outcome measures for sexually abused boys. The small collection of literature available acknowledges that certain differences exist between boys and girls regarding symptoms and treatment issues.