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Childhood Sexual Abuse: Lifting the Veil of Denial

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Child and Adolescent Psychiatry

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Abstract

The reality and enormity of child and adolescent sexual abuse, especially in the Asian subcontinent had been until recently shrouded by collective denial and a conspiracy of silence. Child sexual abuse (CSA) in its various forms is alarmingly common. In a 2007 large-scale study undertaken by the Government of India, as many as 53 % of children reported being subjected to one or more forms of sexual abuse, several fold higher than that reflected in legal statistics. In a large number of these cases, the perpetrator is someone in the family or someone responsible for the child’s care like a school teacher. Risk factors involved in occurrence of CSA include lower socio-economic status, single parenthood, parental substance use amongst others. The response of the family and community is often that of disbelief, blaming the child and holding her/him responsible, and fear of and actual stigma and ostracism. Such a response coupled with insensitivity towards, anticipated harassment and inadequate protection of victims by concerned agencies and authorities increases the woes of the child. This also often results in under-reporting and ‘out of court settlements’. Unfortunately, the psychological impact of sexual abuse on children though unequivocally clear and well documented in the literature, is completely neglected in the aftermath. This is partly due to efforts of the family in protecting itself from social ostracism at the cost of protection and psychological health of the child—hushing rather than discussing. Partly, it is due to lack of defined governmental policies and guidelines or its implementation and of trained mental health professionals working in this area. Thus, occurrence of CSA and its consequences are enmeshed in a complex web of many aspects of the child’s life and circumstances, societal attitudes, attitude of the government and its agencies, and attitude and commitment of professionals. In this chapter, epidemiological, clinical and policy-related matters shall be discussed to understand this complex web, particularly in Asian context.

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References

  • Agathonos-Georgopoulou, H. (1992). Cross-cultural perspectives in child abuse and neglect. Child Abuse Review, 1(2), 80–88.

    Article  Google Scholar 

  • Bal, S., Van Oost, P., De Bourdeaudhuij, I., & Crombez, G. (2003). Avoidant coping as a mediator between self-reported sexual abuse and stress-related symptoms in adolescents. Child Abuse and Neglect, 27(8), 883–897.

    Article  PubMed  Google Scholar 

  • Beaudoin, G., Hébert, M., & Bernier, A. (2013). Contribution of attachment security to the prediction of internalizing and externalizing behavior problems in preschoolers victims of sexual abuse. Revue Europeenne de Psychologie Appliquee, 63(3), 147–157.

    Article  Google Scholar 

  • Behere, P., Rao, T. S. S., & Mulmule, A. N. (2013). Sexual abuse in women with special reference to children: Barriers, boundaries and beyond. Indian Journal of Psychiatry, 55(4), 316–319.

    Article  PubMed  PubMed Central  Google Scholar 

  • Bhilwar, M., Upadhyay, R. P., Rajavel, S., Singh, S. K., Vasudevan, K., & Chinnakali, P. (2015). Childhood experiences of physical, emotional and sexual abuse among college students in South India. Journal of Tropical Pediatrics, 61(5), 329–338.

    Article  PubMed  Google Scholar 

  • Bhugra, D., & Cordle, C. (1988). A case control study of sexual dysfunction in Asian and non-Asian couples 1981–1985. Sexual and Marital Therapy, 3, 71–76.

    Article  Google Scholar 

  • Browne, A., & Finkelhor, D. (1996). Impact of child sexual abuse: A review of the research. Psychological Bulletin, 99, 66–77.

    Article  Google Scholar 

  • Burgess, A. W., & Hartman, C. R. (1993). Children’s drawings. Child Abuse and Neglect, 17(1), 161–168.

    Article  PubMed  Google Scholar 

  • Chan, K. L. (2009). Sexual violence against women and children in Chinese societies. Trauma, Violence, and Abuse, 10, 69–85.

    Article  Google Scholar 

  • Chan, S., & Leong, C. W. (1994). Chinese families in transition: Cultural conflicts and adjustment problems. Journal of Social Distress and the Homeless, 3, 263–281.

    Article  Google Scholar 

  • Chantler, L., Pelco, L., & Mertin, P. (1993). The psychological evaluation of child sexual abuse using the Louisville behavior checklist and human figure drawing. Child Abuse and Neglect, 17(2), 271–279.

    Article  PubMed  Google Scholar 

  • Chin, J. L. (1998). Mental health services and treatment. In L. C. Lee & N. W. S. Zane (Eds.), Handbook of Asian American psychology (pp. 485–504). Thousand Oaks, CA: Sage.

    Google Scholar 

  • Cheng, B. K. (1997). Cultural clash between providers of majority culture and patients of Chinese culture. Journal of Long-Term Home Health Care, 16, 39–43.

    PubMed  Google Scholar 

  • Cohen, J. A., & Mannarino, A. P. (1998). Interventions for sexually abused children: Initial treatment outcome findings. Child Maltreatment, 3(1), 17–26.

    Article  Google Scholar 

  • Collin-Vézina, D., Daigneault, I., & Hébert, M. (2013). Lessons learned from child sexual abuse research: Prevalence, outcomes, and preventive strategies. Child and Adolescent Psychiatry and Mental Health, 7(1), 22.

    Article  PubMed  PubMed Central  Google Scholar 

  • Daigneault, I., Hébert, M., & Tourigny, M. (2007). Personal and interpersonal characteristics related to resilient developmental pathways of sexually abused adolescents. Child and Adolescent Psychiatric Clinics of North America, 16(2), 415–434.

    Article  PubMed  Google Scholar 

  • Damon, L. L., Card, J. A., & Todd, J. (1992). Incest in young children. Assessment of family violence: A clinical and legal sourcebook (pp. 148–172). New York: Wiley.

    Google Scholar 

  • Daral, S., Khokhar, A., & Pradhan, S. (2016). Prevalence and determinants of child maltreatment among school-going adolescent girls in a semi-urban area of Delhi, India. Journal of Tropical Pediatrics, doi:10.1093/tropej/fmv106

    Google Scholar 

  • Davis, M. K., & Gidycz, C. A. (2000). Child sexual abuse prevention programs: A meta-analysis. Journal of Clinical Child Psychology, 29(2), 257–265.

    Article  PubMed  Google Scholar 

  • Deb, S., & Modak, S. (2010). Prevalence of violence against children in families in Tripura and Its relationship with socio-economic factors. Journal of Injury and Violence Research, 2(1), 5–18.

    Article  PubMed  PubMed Central  Google Scholar 

  • Delhi Juvenile Justice (Care and Protection of Children) Rules. (2009). Govt of NCT of Delhi, India.

    Google Scholar 

  • Feiring, C., Miller-Johnson, S., & Cleland, C. M. (2007). Potential pathways from stigmatization and internalizing symptoms to delinquency in sexually abused youth. Child Maltreatment, 12(3), 220–232.

    Article  PubMed  Google Scholar 

  • Finkelhor, D. (2009). The prevention of childhood sexual abuse. The Future of Children/Center for the Future of Children, the David and Lucile Packard Foundation, 19(2), 169–194.

    Article  Google Scholar 

  • Finkelhor, D., & Browne, A. (1985). The traumatic impact of child sexual abuse: A conceptualization. The American Journal of Orthopsychiatry, 55(4), 530–541.

    Article  PubMed  Google Scholar 

  • Fontes, L. A., & Plummer, A. (2010). Cultural issues in disclosures of child sexual abuse. Journal of Child Sexual Abuse, 19, 491–518.

    Article  PubMed  Google Scholar 

  • Friedrich, W. N., Grambsch, P., Broughton, D., Kuiper, J., & Beilke, R. L. (1991). Normative sexual behavior in children. Pediatrics, 88(3), 456–464.

    PubMed  Google Scholar 

  • Garnefski, N., & Arends, E. (1998). Sexual abuse and adolescent maladjustment: differences between male and female victims. Journal of Adolescence, 21, 99–107.

    Google Scholar 

  • Gilbert, R., Kemp, A., Thoburn, J., Sidebotham, P., Radford, L., Glaser, D., et al. (2009a). Recognising and responding to child maltreatment. Lancet (London, England), 373(9658), 167–180.

    Google Scholar 

  • Gilbert, R., Widom, C. S., Browne, K., Fergusson, D., Webb, E., & Janson, S. (2009b). Burden and consequences of child maltreatment in high-income countries. Lancet (London, England), 373(9657), 68–81.

    Google Scholar 

  • Gilligan, P. A., & Akhtar, S. (2006). Cultural barriers to the disclosure of child sexual abuse in Asian communities: Listening to what women say. British Journal of Social Work, 36, 1361–1377.

    Article  Google Scholar 

  • Goodyear-Brown, P., Fath, A., & Myers, L. (2012). Child sexual abuse: The scope of the problem. Handbook of child sexual abuse (pp. 1–5). New York: Wiley.

    Google Scholar 

  • Gosset, D., & Hédouin, V. (2002). Sexual assaults. La Revue Du Praticien, 52(7), 734–738.

    PubMed  Google Scholar 

  • Graupner, H. (2000). Sexual consent: The criminal law in Europe and overseas. Archives of Sexual Behavior, 29(5), 415–461.

    Article  PubMed  Google Scholar 

  • Guidelines for Prevention of Child Abuse. (2014). Delhi commission for protection of child rights. India: Govt of NCT of Delhi.

    Google Scholar 

  • Haj-Yahi, M. M., & Tamish, S. (2001). The rates of child sexual abuse and its psychological consequences as revealed by a study among Palestinian university students. Child Abuse and Neglect, 25(10), 1303–1327.

    Article  PubMed  Google Scholar 

  • Hall, G. C., Windover, A. K., & Maramba, G. G. (1998). Sexual aggression among Asian Americans: Risk and protective factors. Cultural Diversity and Mental Health, 4(4), 305–318.

    Article  PubMed  Google Scholar 

  • Hébert, M., Collin-Vézina, D., Daigneault, I., Parent, N., & Tremblay, C. (2006). Factors linked to outcomes in sexually abused girls: A regression tree analysis. Comprehensive Psychiatry, 47(6), 443–455.

    Article  PubMed  Google Scholar 

  • Ho, C. K. (1990). An analysis of domestic violence in Asian American communities: A multicultural approach to counseling. Women & Therapy, 9(1–2), 129–150.

    Article  Google Scholar 

  • Human Rights Watch. (2013). Breaking the silence: Child sexual abuse in India.

    Google Scholar 

  • Johnson, C. F. (1999). The use of charts and models to facilitate a physician’s testimony in court. Child Maltreatment, 4, 228–241.

    Article  Google Scholar 

  • Johnson, C. F. (2004). Child sexual abuse. Lancet (London, England), 364(9432), 462–470.

    Google Scholar 

  • Kalof, L. (2000). Ethnic differences in female sexual victimization. Sexuality and Culture, 4, 75–97.

    Article  Google Scholar 

  • Kassis, W., Artz, S., Scambor, C., Scambor, E., & Moldenhauer, S. (2013). Finding the way out: A non-dichotomous understanding of violence and depression resilience of adolescents who are exposed to family violence. Child Abuse and Neglect, 37(2–3), 181–199.

    Article  PubMed  Google Scholar 

  • Kaufman, K., Johnson, C. F., & Weller, A. M. (1995). The victims of female and male perpetrators of sexual abuse: A comparative study. Journal of Interpersonal Violence, 3, 322–333.

    Article  Google Scholar 

  • Kelly, R. J., Wood, J. J., Gonzalez, L. S., MacDonald, V., & Waterman, J. (2002). Effects of mother-son incest and positive perceptions of sexual abuse experiences on the psychosocial adjustment of clinic-referred men. Child Abuse and Neglect, 26(4), 425–441.

    Article  PubMed  Google Scholar 

  • Kendall-Tackett, K. A., Williams, L. M., & Finkelhor, D. (1993). Impact of sexual abuse on children: A review and synthesis of recent empirical studies. Psychological Bulletin, 113(1), 164–180.

    Article  PubMed  Google Scholar 

  • Kessler, R. C., McLaughlin, K. A., Green, J. G., Gruber, M. J., Sampson, N. A., Zaslavsky, A. M., et al. (2010). Childhood adversities and adult psychopathology in the WHO World Mental Health Surveys. The British Journal of Psychiatry: The Journal of Mental Science, 197(5), 378–385.

    Article  Google Scholar 

  • King, M., Coxell, A., & Mezey, G. (2002). Sexual molestation of males: Associations with psychological disturbance. The British Journal of Psychiatry: The Journal of Mental Science, 181, 153–157.

    Google Scholar 

  • Kohli, A. (2004). Child sexual abuse. Bulletin PGI, 38, 152–159.

    Google Scholar 

  • Krishnakumar, P., Satheesan, K., Geeta, M. G., & Sureshkumar, K. (2014). Prevalence and spectrum of sexual abuse among adolescents in Kerala, South India. Indian Journal of Pediatrics, 81(8), 770–774.

    Article  PubMed  Google Scholar 

  • Lataster, T., van Os, J., Drukker, M., Henquet, C., Feron, F., Gunther, N., et al. (2006). Childhood victimisation and developmental expression of non-clinical delusional ideation and hallucinatory experiences: Victimisation and non-clinical psychotic experiences. Social Psychiatry and Psychiatric Epidemiology, 41(6), 423–428.

    Article  PubMed  Google Scholar 

  • Lee, E. (1996). Asian American families: An overview. In Ethnicity and family therapy (2nd Ed., pp. 227–248). New York: The Guilford Press.

    Google Scholar 

  • Leifer, M., Shapiro, J. P., Martone, M. W., & Kassem, L. (1991). Rorschach assessment of psychological functioning in sexually abused girls. Journal of Personality Assessment, 56(1), 14–28.

    Article  PubMed  Google Scholar 

  • Lum, J. L. (1998). Family violence. Handbook of Asian American psychology (pp. 505–525). Thousand Oaks, CA: Sage.

    Google Scholar 

  • Luo, Y., Parish, W. L., & Laumann, E. O. (2008). A population-based study of childhood sexual contact in China: Prevalence and long-term consequences. Child Abuse and Neglect, 32(7), 721–731.

    Article  PubMed  PubMed Central  Google Scholar 

  • MacMillan, H. L., Tanaka, M., Duku, E., Vaillancourt, T., & Boyle, M. H. (2013). Child physical and sexual abuse in a community sample of young adults: Results from the Ontario child health study. Child Abuse and Neglect, 37(1), 14–21.

    Article  PubMed  Google Scholar 

  • Martin, E. K., & Silverstone, P. H. (2013). How much child sexual abuse is “below the surface”, and can we help adults identify it early? Frontiers in Psychiatry, 4, 58.

    PubMed  PubMed Central  Google Scholar 

  • McLeer, S. V., Deblinger, E., Henry, D., & Orvaschel, H. (1992). Sexually abused children at high risk for post-traumatic stress disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 31(5), 875–879.

    Article  PubMed  Google Scholar 

  • Ministry of Women and Child development. (2007). Study on child abuse: India. Government of India.

    Google Scholar 

  • Ministry of Women and Child Development. (2013). National Policy for Children. Ministry of Women and Child Development, Government of India.

    Google Scholar 

  • Ministry of Women and Child Development. (2016, March 3). Conviction under POCSO Act.

    Google Scholar 

  • Ministry of Women and Child Development, Government of India. http://pib.nic.in/newsite/PrintRelease.aspx?relid=137261

  • Molnar, B. E., Buka, S. L., & Kessler, R. C. (2001). Child sexual abuse and subsequent psychopathology: Results from the National Comorbidity Survey. American Journal of Public Health, 91(5), 753–760.

    Article  PubMed  PubMed Central  Google Scholar 

  • O’Briain, M. (2008). Sexual exploitation of children and adolescents in tourism. A contribution of ECPAT International to the World Congress III against Sexual Exploitation of Children and Adolescents, Bangkok.

    Google Scholar 

  • Okamura, A., Heras, P., & Wong-Kerberg, L. (1995). Asian, Pacific island, and Filipino Americans and sexual child abuse. Sexual abuse in nine North American cultures: Treatment and prevention (pp. 67–96). Thousand Oaks, CA: Sage.

    Chapter  Google Scholar 

  • O’Keefe, M. (2004). A case of suspected child sexual abuse. Journal of Clinical Forensic Medicine, 11(6), 316–320.

    Article  PubMed  Google Scholar 

  • Patel, R. R., Methiwalla, S., Rane, A., & Gore, S. (1997). Child sexual abuse: Psychosocial aspects. Indian Journal of Psychiatry, 39(Suppl), 56.

    Google Scholar 

  • Protection of Children from Sexual Offences (POCSO) Act. (2012). Government of India.

    Google Scholar 

  • Rao, K., DiClemente, R. J., & Ponton, L. E. (1992). Child sexual abuse of Asians compared with other populations. Journal of the American Academy of Child and Adolescent Psychiatry, 31(5), 880–886.

    Article  PubMed  Google Scholar 

  • Ray, A. (2014, September 12). 42 % of Indian girls are sexually abused before 19: UNICEF. The Times of India.

    Google Scholar 

  • Root, M. P. (1985). Guidelines for facilitating therapy with Asian American clients. Psychotherapy, 22, 349–356.

    Article  Google Scholar 

  • Sagar, R. (2014). Child sexual abuse: Need for a preventive framework in Indian context, 19, 53–55.

    Google Scholar 

  • Saywitz, K. J., Mannarino, A. P., Berliner, L., & Cohen, J. A. (2000). Treatment for sexually abused children and adolescents. The American Psychologist, 55(9), 1040–1049.

    Article  PubMed  Google Scholar 

  • Singh, M. M., Parsekar, S. S., & Nair, S. N. (2014). An epidemiological overview of child sexual abuse. Journal of Family Medicine and Primary Care, 3(4), 430–435.

    Article  PubMed  PubMed Central  Google Scholar 

  • Singleton, K. W. (2004). Strategies of survival: Coping, characteristics of resiliency, and perceived impact of abuse in resilient black female survivors of sexual trauma. Dissertation abstracts international section B. The Sciences & Engineering, 64, 12–B.

    Google Scholar 

  • Song, Y., Ji, C.-Y., & Agardh, A. (2014). Sexual coercion and health-risk behaviors among urban Chinese high school students. Global Health Action, 7, 24418.

    Article  Google Scholar 

  • Subedi, G. (2002). Trafficking and sexual abuse among street children in Kathmandu. International Programme on the Elimination of Child Labour. International Labour Organization, Kathmandu, Nepal.

    Google Scholar 

  • Sue, D. (1997). The interplay of sociocultural factors on the psychological development of Asian in America. In Counseling American minorities: A cross-cultural perspective (5th Ed., pp. 205–213). Boston: McGraw-Hill.

    Google Scholar 

  • Sue, D. W., & Sue, D. (1999). Counseling the culturally different: Theory and practice (3rd ed.). New York: Wiley.

    Google Scholar 

  • Summit, R. C. (1983). The child sexual abuse accommodation syndrome. Child Abuse and Neglect, 7(2), 177–193.

    Article  PubMed  Google Scholar 

  • Tang, C. S. (2002). Childhood experience of sexual abuse among Hong Kong Chinese college students. Child Abuse and Neglect, 26(1), 23–37.

    Article  PubMed  Google Scholar 

  • The Criminal Law (Amendment) Act. (2013). Government of India.

    Google Scholar 

  • Thomas, J. (1992). An interview with Amy Okamura. The Advisor: American Professional Society on the Abuse of Children, 8, 16–18.

    Google Scholar 

  • Topping, K. J., & Barron, I. G. (2009). School-based child sexual abuse prevention programs: A review of effectiveness. PubMed Health.

    Google Scholar 

  • Uba, L. (1994). Asian Americans: Personality patterns, identity, and mental health. New York: Guilford.

    Google Scholar 

  • UNICEF. (2001, December). Commercial sexual exploitation and sexual abuse of children in South Asia. Kathmandu, Nepal. UNICEF.

    Google Scholar 

  • UNICEF. (2012). Child maltreatment: Prevalence, incidence and consequences in the East Asia and Pacific Region: A systematic review of research strengthening child protection systems series: No 1. UNICEF.

    Google Scholar 

  • Wihbey, J. (2009). Global prevalence of child sexual abuse. Journalist Resource.

    Google Scholar 

  • Williams, J., & Nelson-Gardell, D. (2012). Predicting resilience in sexually abused adolescents. Child Abuse and Neglect, 36(1), 53–63.

    Article  PubMed  Google Scholar 

  • Wong, D., & Wittet, S. (1987). Be aware, be safe. Renton, WA: King County Rape Relief.

    Google Scholar 

  • World Health Organization. (2003). Guidelines for medico-legal care for victims of sexual violence, gender and women’s Health, family and community health injuries and violence prevention, non-communicable diseases and mental health. Geneva, World Health Organization.

    Google Scholar 

  • World Health Organization, Updated. (2003). Guidelines for medicolegal care for victims of sexual violence. Child sexual abuse. Geneva. World Health Organization, Updated.

    Google Scholar 

  • World Health Organisation. (2006). Sexual violence. Geneva. World Health Organization http://www.who.int/violence_injury_prevention/violence/global_campaign/en/chap6.pdf

  • WHO report. (2013). Global and regional estimates of violence against women. Prevalence and health effects of intimate partner violence and non-partner sexual violence. Available from:http://apps.who.int/iris/bitstream/10665/85239/1/9789241564625_eng.pdf?ua=1. Accessed 4 Oct 2016.

  • Wyatt, G., & Powell, G. (1988). Identifying the lasting effects of child sexual abuse. In The lasting effects of child sexual abuse (pp. 15–17), CA: Sage.

    Google Scholar 

  • Yuille, J. C., Hunter, J., Joffe, R., & Zaparnuik, J. (1997). Interviewing children in sexual abuse cases. In Child Victims (Ed.), Child witnesses: Understanding and improving testimony. New York: Illford.

    Google Scholar 

  • Zimbroff, J. (2007). Cultural differences in perceptions of and responses to sexual harassment. Duke Journal of Gender Law & Policy, 14, 1311–1341.

    Google Scholar 

  • Zollner, H., Fuchs, K. A., & Fegert, J. M. (2014). Prevention of sexual abuse: Improved information is crucial. Child and Adolescent Psychiatry and Mental Health, 8(1), 5.

    Article  PubMed  Google Scholar 

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  1. Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India

    Ruchita Shah & Aakanksha Singh

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  1. Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, Chandigarh, India

    Savita Malhotra

  2. Child and Adolescent Mental Health Serv., Centre for Interventional Paediatric(CIPPRD) Child and Adolescent Mental Health Serv., London, United Kingdom

    Paramala Santosh

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Shah, R., Singh, A. (2016). Childhood Sexual Abuse: Lifting the Veil of Denial. In: Malhotra, S., Santosh, P. (eds) Child and Adolescent Psychiatry. Springer, New Delhi. https://doi.org/10.1007/978-81-322-3619-1_11

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