Family Research Laboratory, University of New Hampshire
Oh, children, children, how fraught with peril are your years!
In many regions of the world, it is dangerous to be a girl. Before birth, girls may succumb to sex-selective abortion. During infancy, they are vulnerable to female infanticide or selective neglect of female infants. Girlhood brings the risk of sexual abuse, child marriage, child prostitution and pornography, and female genital mutilation (“female circumcision”). During adolescence and adulthood, they are vulnerable to dating violence, rape, forced prostitution, dowry murders, and partner abuse (World Health Organization, 1997).
Dating violence, child prostitution, and female “circumcision” are described in other chapters in this volume. In this chapter, I describe the two types of victimization of female children: sexual abuse and female infanticide. Sexual abuse of girls is described as it occurs in the United States, and is compared to physical abuse and neglect. Although physical abuse and neglect are more common types of child maltreatment, in this country they affect boys and girls in approximately equal numbers. Such is not the case in other parts of the world, where girls are more likely to be abused and neglected--sometimes fatally so. Fatal abuse and neglect are described in the final half of this chapter.
The Third National Incidence Study of Child Abuse and Neglect (NIS-3) revealed that in America, girls’ risk of abuse was 33% higher than that of boys. The difference was due to girls’ increased risk of sexual abuse. Girls experienced sexual abuse at more than three times the rate that boys did (Sedlak & Broadhurst, 1996).
With girls being at higher risk, we might ask how often does sexual abuse occur? Incidence of sexual abuse varies depending on definition of abuse and the population that is surveyed. In samples drawn from people seeking clinical mental health services, percentages are generally higher that when drawing from the community at large. Current estimates across studies of contact abuse are that at least 20% of women (1 in 5), and 5-10% of men (1 in 10) have been sexually abused as children (Finkelhor, 1994; Gorey & Leslie, 1997). The peak age of vulnerability to sexual abuse is between 7 to 13 years of age (Finkelhor, 1994), but children older and much younger have been abused.
Why does this sex difference exist? Two possible explanations have been offered, but neither completely explains the sex differences. One explanation is male dominance of women. In this framework, men are described as the abusers of women and girls, especially within the family. Research has in fact demonstrated that perpetrators of sexual abuse are overwhelmingly male (Finkelhor, 1994), and the majority of victims are female. But this does not explain all sexual abuse. There are male victims and female perpetrators too, and male dominance of women does not explain these, indicating that this theory is not a complete explanation of why sexual abuse occurs (Sedlak & Broadhurst).
Access is another possible explanation for the sex difference in sexual abuse rates. Girls are most likely to be abused by family members, especially step-fathers, while boys are more likely to be abused outside the family (Finkelhor, 1994; Kendall-Tackett & Simon, 1992). Girls may be more vulnerable to sexual abuse because the people most likely to abuse them are right in their homes. Analyzing data across several studies, Finkelhor (1994) found that for girls, 33-50% of perpetrators are family members, while for boys only 10 to 20% are. But girls abused outside the home and boys abused by family members do not fit within this framework. For example, in one clinical study, 10% of girls were abused by “friends of the family,” and 33% of boys were also abused within the home (Kendall-Tackett & Simon, 1992). When looking at the entire data set from this study (males and females together), approximately 10% of abusers were brothers and another 10% were uncles. Grandfathers were the abusers approximately 3% of the time, and strangers were approximately 1% (Kendall-Tackett & Simon, 1987). There were no significant sex differences.
The effects of sexual abuse are probably its most highly studied aspect—and its most political. Some claim sexual abuse is always harmful. Yet there are many children who show no symptoms at all (Kendall-Tackett, Williams & Finkelhor, 1993). Others maintain that some children actually benefit from these sexual experiences, and that research is biased towards negative effects (Sandfort, 1984). The research reveals, however, the complexity of responses to sexual abuse. Some victims will show very few, if any, effects. Others will have mild symptoms. Still others will be severely affected. Briere and Runtz (1987) estimate that 20% of adult survivors of sexual abuse (or 5% of the total population) will experience major long-term effects and show significant symptoms. Studies of the effects of sexual abuse are divided into short-term (the effects on children) and long-term (the effects on adults).
Children experience a wide range of difficulties after they have been sexually abused. Some of the most common symptoms are nightmares, depression, withdrawn behavior, aggression, and regressive behavior. Some children are very symptomatic, while others show very few symptoms. Sometimes symptoms appear as “delayed responses.” For others, symptoms may get better over time.
Symptoms of post-traumatic stress disorder (PTSD) are common but not specific to sexual abuse (meaning that children who have experienced other traumatic events may also show symptoms of PTSD). PTSD, as the name implies, is a constellation of behaviors and reactions that occur in the wake of traumatic events. They were first categorized among combat veterans, but more recently, this diagnosis has been used to describe the aftermath of other traumatic experiences including child sexual abuse. These reactions may be manifested as hypervigilance, sleep disturbances, startle responses, intrusive thoughts or flashbacks.
Perhaps the symptom that is most characteristic of children who have been sexually abused is sexualized behavior. Even this symptom does not occur in all sexually abused children, so its absence does not mean that sexual abuse has not occurred (Kendall-Tackett, et al. 1993). Sexualized behavior is also one of the more disturbing symptoms, especially when noted in children who are six years old or younger. It includes public masturbation, sexual play with dolls, and asking other children and adults to participate in sexual activity. As children mature, these activities may be identified as promiscuity, or there may be involvement in prostitution or pornography.
The symptoms that children manifest also vary by age of the child. For example, preschool-age children are more likely to experience anxiety or sexual acting out, whereas adolescents are more likely to manifest substance abuse or illegal behaviors. Table 1 gives an overview of symptoms that are most likely to occur within a given age group. Symptoms may also change over time. For example, a preschooler who is sexually acting out may become a teen who is highly promiscuous.
While not everyone who experiences sexual abuse shows symptoms, the effects of childhood abuse can also continue well into adulthood. These are known as long-term effects. Sometimes children show very functional coping behaviors in childhood (such as seeking the assistance of a supportive adult), and do not become symptomatic as adults. Other times, their coping abilities are less positive but still serve an important function during childhood. Symptoms adult survivors manifest are often “logical extensions” of dysfunctional coping mechanisms developed during childhood (Briere & Elliot, 1994). While these dysfunctional behaviors may have helped the child cope with ongoing abuse, they often have a negative impact on adult functions. Long-term effects can be divided into seven categories (Briere & Elliot, 1994; Kendall-Tackett & Marshall, 1998). These are described below.
PTSD is also a commonly occurring symptom among adult survivors of sexual abuse. According the Briere and Elliot (1994), 80% of abuse survivors have symptoms of PTSD, even if they don’t meet the full diagnostic criteria. Again, these reactions may be
manifested as hypervigilance, sleep disturbances, startle responses, intrusive thoughts or flashbacks.
Sexual abuse survivors may develop a mental framework (or “internal working model”) where they perceive the world as a dangerous place. Further, they may feel helpless and unable to defend themselves. These cognitive distortions make them more vulnerable to both re-victimization and depression because they perceive themselves to be powerless in their lives.
Emotional distress is perhaps the most common symptom that occurs among adult survivors. It includes depression, anxiety, and anger. Adult survivors of childhood sexual abuse have a four-time higher lifetime risk of depression than do their non-abused counterparts (Briere & Elliot, 1994). They may also experience anxiety ranging from mild to severe, and may also be angry, or experience rage, on a regular basis.
Survivors may have difficulty separating their emotional states from the reactions of others. In other words, their moods may often depend on the moods of others. For example, their partners are depressed or angry, so they are too without necessarily considering whether they really feel the same way. They may also have difficulties in self-protection, increasing their risk of re-victimization.
Avoidance includes some of the more serious sequelae of past abuse. Survivors may experience dissociation, which includes alterations in body perception (including feelings of separation from their bodies), emotional numbing, amnesia for painful memories, and multiple personality disorder. Other types of avoidant behavior are substance abuse, suicidal ideation and attempts, and “tension-reducing activities” including indiscriminate sexual behavior, bingeing and purging and self-mutilation.
Adult survivors may have problems with interpersonal relationships. They may adopt an “avoidant” style, characterized by low interdependency, self-disclosure and warmth. Or they may adopt an “intrusive” style, characterized by extremely high needs for closeness, excessive self-disclosure and a demanding and controlling style (Becker-Lausen & Mallon-Kraft, 1997). Both styles result in loneliness.
Women who report a history of abuse may have a variety of health problems. Some of the symptoms that have been noted in adult survivors of childhood abuse include chronic pelvic pain, frequent feelings of fatigue, severe PMS, irritable bowel syndrome, frequent headaches, trouble sleeping, and frequent vaginal infections. Adult survivors also had overall lower satisfaction with their physical health than their non-abused counterparts (Moeller, Bachman, & Moeller, 1993; Walling, Reiter, O’Hara, Milburn, Lilly, & Vincent, 1994).
As described earlier, children and adults vary widely in their reactions to sexual abuse. Some of the variation can be explained in terms of the child’s overall coping abilities or the support available to the child at the time of disclosure (assuming that the abuse actually was disclosed). But characteristics of the abuse itself can also exert an influence. Some people are more seriously affected by abuse because their experiences were more severe. Characteristics that make an experience more or less serious include the identity of the perpetrator; the severity of the sexual acts; duration and frequency of the abuse; and whether force was used. Some ethnic group differences in response to child sexual abuse have also recently been observed.
Studying the characteristics of abuse demonstrates the complexity of their effects. For almost any statement made, exceptions occur. To further complicate matters, many of these factors are related to each other. For example, a perpetrator who is a family member will have more access to a child and for a longer time. So identity of the perpetrator is often related to duration of the abuse. Severity of the sexual acts is often related to duration of the abuse as well, with more severe acts occurring over time. However, many one-time assaults are rapes. In other words, instead of abuse that becomes gradually more severe over time, the first contact includes penetration. Factors affecting overall severity of the abuse experience are described below.
In general, abuse will be more harmful if the abuser is someone the child knows and trusts, and the abuse violates that trust (Finkelhor, 1987). This is reflected in the difference in the percentage of abuse by parent-figures in clinical vs. non-clinical samples. (Presumably, more harmful abuse occurred among people who are seeking treatment.) Abuse by parent-figures ranges from 16% in non-clinical samples to as high 62% in clinical samples (Berliner & Elliot, 1996; Kendall-Tackett & Simon, 1987). However, abuse by family members is not necessarily always more harmful. The child’s emotional attachment to the perpetrator and sense of betrayal can be more important predictors of harm than is strict familial relationship (Finkelhor, 1987).
Another important component related to symptoms is severity of the sexual acts. “Severity” tends to be defined by whether the abuse experiences included penetration (oral, vaginal or anal). The percentage of subjects reporting penetration also varies by sample. In non-clinical samples, the range is 4% to 25% (Conte & Berliner, 1988;
Russell, 1984), while clinical samples range from 43% to 48% (Kendall-Tackett & Simon, 1987; Pierce & Pierce, 1985).
Abuse that occurs often and lasts for years will typically be more harmful than abuse that happens only sporadically and over less time. The exception is the one-time violent assault (Kendall-Tackett et al., 1993). Not surprisingly, use of force has been shown to increase the severity of reaction to sexual abuse (Elwell & Ephross, 1987). Force may be more likely in stranger and/or one-time assaults, but this is not always true (Kendall-Tackett et al., 1993). While all sexual abuse is, by definition, non-consensual, sometimes the abuser will use trickery or mental coercion, rather than force, to gain compliance. In other situations, the abuser will hit, assault, or physically restrain his victim. Victims who experience this type of abuse are more likely to have symptoms.
There are also some ethnic group differences in both characteristics of abuse and in reactions to it. Asian children tend to be older at the onset of victimization than their non-Asian counterparts, while African-American children tend to be younger at onset of victimization than either their Asian or Caucasian counterparts (Berliner & Elliot, 1996). African-American victims have approximately the same rates of victimization as Caucasian children, but are more likely to experience penetration as part of their victimization experience (Wyatt, 1985). Moreover, Wyatt (1985) found a difference between the age of onset for blacks and whites, but the age for both ethnic groups was prepubescent. Abuse of white girls was likely to start between 6 and 8 years of age, while abuse of black girls was likely to start between 9 and 12 years of age.
The overall rates of sexual abuse are lowest for Asian women, but high for Hispanic women, when reported retrospectively (Russell, 1984). Mennen (1995) found no overall effect of ethnicity on the severity of symptoms manifested by Latina, African-American, or white girls. Mennen did find that ethnicity and type of abuse together severity of influence symptoms. Latina girls who experienced penetration during their abuse had more anxiety and depression than did African-American or white girls. The author feels that some of these findings could be due to the emphasis in Latin communities on purity and virginity. When virginity is lost, the trauma of sexual abuse is compounded because the Latina girls feel that they are no longer suitable marriage partners.
In this section, I have focused on child sexual abuse because girls are much more likely than boys to experience this type of maltreatment. However, it is important to realize that although there are no sex differences in other types of maltreatment, many girls are physically abused or neglected (Sedlak & Broadhurst, 1996). For example, in the Third National Incidence Study of Child Abuse and Neglect cited earlier, the rate or maltreatment per 1000 children of sexual abuse is 4.9 for females (1.6 for males). Yet for physical abuse the rate is 5.6 per 1000 and 5.8 for males. For neglect, the rate is 12.9 per 1000 and 13.3 for males. As you can see, when compared to sexual abuse, girls are much more likely to be physically abused or neglected. Girls and boys have approximately the same rates of fatal injuries (.01/1000 and .04/1000 for females and males respectively), and girls are more likely to have had moderate injuries as a result of their abuse than are boys (13.3/1000 and 11.3/1000), but this is not a significant difference. Although there is not a sex difference in these other types of child maltreatment, they do effect large numbers of girls and should also be of concern.
The experience of sexual abuse differs and reactions to it vary from person to person. The experiences of some survivors are relatively mild, while others experience severe abuse. Even when the experience is severe, however, there is hope for healing. In one study, survivors reported that good came from the tragedy of their abuse (McMillen, Zuravin, & Rideout, 1995). They described how their abusive pasts made them more sensitive to the needs of others. Many felt compelled to help others who had suffered similar experiences.
In describing the impact of past sexual abuse, we must also be mindful of the other types of child maltreatment that girls are likely to experience. In our country, boys and girls experience physical abuse and neglect in approximately equal numbers. But this is not true in other countries. In the next section, I describe two cultures where life-and-death decisions are made on the basis of a baby’s sex.