The Effects of the Past in the Current Life - Essay Example

Study of the research and other relevant literature relating to the impact of childhood sexual abuse on women I. Introduction The effects of the pastin the current life of an adult are in most cases significant. This fact can be explicated through the continuation that characterizes the human life but also the intense of several instances of life which cannot be forgotten easily due to the heavy (positive or negative) sentiments that caused to the person during a specific period of time (long or very short). For this reason, the negative experiences of the past can cause really severe implications in a person’s future life and this condition is very difficult to change and in most cases the relevant attempts need a lot of time to succeed. In this context, child sexual abuse (CSA) has been considered as one of the worst experiences in a person’s life as its effects are very likely to last for a long time while the responsible adult has little chances to be caught and penalized in accordance with the existing law. This paper tries to present the most characteristic views of the literature as well as of the empirical research regarding the CSA. Although the forms and the results of this action can have many aspects (see Appendix I) in fact there are certain standards regarding the conditions and the effects related with this action so that their presentation can cover most of the cases having similar characteristics. II. Literature Review Childhood sexual abuse can be defined as any exposure to sexual acts imposed on children who inherently lack the emotional, maturational, and cognitive development to understand or to consent to such acts. These acts do not always involve sexual intercourse or physical force; rather, they involve manipulation and trickery. Authority and power enable the perpetrator to coerce the child into compliance (Hendricks-Matthews 1997). Characteristics and motivations of perpetrators of childhood sexual abuse vary: some may act out sexually to exert dominance over another individual; others may initiate the abuse for their own sexual gratification (Britton et al. 1997). Holz (1994) has broadly defined childhood sexual abuse as, “any sexual activity between a child less than age 18 and a person of power, usually two or more years older, and who has authority over the child” (p. 13). CSA has been further differentiated into incest and extra-familial abuse. The abuse is incestual if it is perpetrated by a consanguineous (“blood”) relative, a relative by marriage, or a person who functions in the role of a family member (Courtois, 1993; Flournoy, 1996; Holz, 1994). Extra-familial abuse is usually perpetrated by parental or family friends who are often trusted people holding power over the child (Courtois, 1993; Holz, 1994). Wealin (2005) proceeded to the presentation of a more analytical definition for CSA. According to her views, child sexual abuse includes a wide range of sexual behaviours that take place between a child and an older person. These sexual behaviours are intended to erotically arouse the older person, generally without consideration for the reactions or choices of the child and without consideration for the effects of the behaviour upon the child; Behaviours that are sexually abusive often involve bodily contact, such as in the case of sexual kissing, touching, fondling of genitals, and oral, anal, or vaginal intercourse; However, behaviours may be sexually abusive even if they dont involve contact, such as in the case of genital exposure ("flashing"), verbal pressure for sex, and sexual exploitation for purposes of prostitution or pornography. Generally, definitions of abuse can range from, "any unwanted touching" to considering the experience itself and not by physical acts alone (Bass et al. 1988). Often the literature distinguishes between a victim - a person who is still in abusive relationship, and a survivor - a person who has physically survived and is no longer in the relationship (Prescott 2002). On the other hand (Wealin 2005) legal definitions of what constitutes child sexual abuse usually require that the perpetrator be older than the victim. For example, in USA and particularly in some states perpetrators must be at least five years older than their victims for the behaviour to be considered child sexual abuse. Most often, sexual abusers know the child they abuse but are not relatives. In fact, about 60% of perpetrators are nonrelative acquaintances, such as a friend of the family, babysitter, or neighbour. About 30% of those who sexually abuse children are relatives of the child, such as fathers, uncles, or cousins. Strangers are perpetrators in about 10% of child sexual abuse cases. It should be noticed that the definition of CSA has been alternated in many cases in accordance with the conditions of a specific case, however for vast majority of similar cases, CSA is related with the physical or mental ‘attack’ in a child using moves or words that have a sexual content. In this context, recent surveys (Brigham Young University, 2005) of adults have estimated that 1 out of 3 adult women and 1 out of 7 adult men in the United States have experienced some form of sexual contact in childhood from someone older and/or more powerful. This, by definition, is childhood sexual abuse. More and more of these individuals are disclosing their abuse and seeking professional help for related difficulties, because of the increased attitude of openness and acceptance regarding this issue in society. This change in people’s and mostly in women’s behaviour towards the CSA does not mean that the problem has been solved. In contrary there are still many times that similar facts do not become known even after many years. However, in many cases the CSA comes into light and the person involved try – if not to prosecute the actor – at least to eliminate the effects of these negative memories in his/ her current life. The impact of childhood sexual abuse on a woman’s life as an adult is really impressive covering all aspects of her life (Tilley 2000; Holz 1994). In this context Parratt (1994) found that 65-70% of women who had been abused were "permanently damaged". On the other hand, the extension of the phenomenon is noticeable. Dominquez et al. (2002) studied the problem of childhood sexual abuse specifically in the USA and found that child sexual abuse is a significant public health problem in the United States and across the world. In the United States one out of three females and one out of five males have been victims of sexual abuse before the age of 18 years. Sexual abuse occurs across all ethnic/racial, socioeconomic, and religious groups. The recognition of CSA as a public problem has not been followed however by specific and intense measures for its limitation. In fact, prevalence rates of women with a history of CSA are estimated at between 12-38% (Finkelhor et al. 1990; Holz, 1994; Lechner et al. 1993; Paxton, 1991, Roberts, 1996; Seng et al. 1998). Women consistently show a higher prevalence of CSA rates than their male counterparts, with one in three to four females, versus one in six to eight males having been sexually abused by age 18 (Finkelhor et. al., 1990; Holz, 1994). The differentiation between women and men regarding the level of CSA appeared can be explicated at a first level by their physical construction, however there are may be other factors that lead to such a differentiation. On the other hand, the identification of sexual abuse can be very difficult in practice because it is rare for a child to speak directly about sexual abuse; Evidence of physical trauma to the genitals or mouth, genital or rectal bleeding, sexually transmitted disease, pregnancy, unusual and offensive odors, and complaints of pain or discomfort of the genital area can all be indicators. An aware medical practitioner may notice these symptoms during a physical examination. However, in most cases of sexual abuse, there are no physical indicators of the crime (Dominquez et al. 2002). Moreover, according to the above researchers, it is rare to actually have positive medical findings upon medical examination, although such findings can provide powerful corroboration of a child’s account of sexual abuse because most often, children who are victims of sexual abuse exhibit emotional or behavioural characteristics that may indicate distress. It has also been noticed by Dominquez et al. (2002) that the presence of any one of these indicators does not necessarily mean that the child is or has been sexually abused. Children with several of these symptoms, however, are often referred for mental health evaluations. In little over a decade, child sexual abuse has come to be widely regarded as a cause of mental health problems in adult life. The influences of child sexual abuse on interpersonal, social and sexual functioning in adult life and its possible role in mediating some, if not all, of the deleterious effects on mental health, has attracted less attention and research, but is arguably equally important (Mullen et al. 1998) Those who have been abused who subsequently have positive school experiences where they feel themselves to have succeeded academically, socially or at sport, have significantly lower rates of adult difficulties (Romans et al. 1995). Those whose relationship with their parents subsequent to abuse was positive and supportive fared better, and a good relationship with the father appeared to have a strong protective influence regarding subsequent psychopathology (Romans et al. 1995). Child sexual abuse is not randomly distributed through the population. It occurs more frequently in children from socially deprived and disorganised family backgrounds (Finkelhor and Baron 1986; Beitchman et al. 1991; Russell 1986; Peters 1988; Mullen et al. 1993). Marital dysfunction, as evidenced by parental separation and domestic violence, is associated with higher risks of child sexual abuse, and involves intrafamilial and extrafamilial perpetrators (Mullen et al 1996; Fergusson et al. 1996; Fleming et al. 1997). The possibility has been raised that characteristics such as physical attractiveness, temperament or physical maturity might increase the risks of children being sexually abused (Finkelhor and Baron 1986). Child molesters are reported to selectively target pretty and trusting children (Elliot et al. 1995). There are a significant number of negative short-term effects of sexual abuse that impact a child’s functioning. The most commonly experienced effect of sexual abuse is posttraumatic stress disorder (PTSD). Posttraumatic stress disorder is a clinical syndrome whose symptoms fall into three clusters: reenactment of the traumatic event; avoidance of cues associated with the event or general withdrawal; and physiological hyper-reactivity (Dominquez et al. 2002). According to the above researchers, it is estimated that somewhere between 21-49% of child sexual abuse victims appear asymptomatic post-victimization while the potential explanations for this include: difficulties with the methods used to detect problems in children, delays in symptom development post-sexual abuse, underreporting of symptoms, resiliency, and mitigating factors that may make the impact of the abuse less severe for some children. Several authors link the effects of childhood sexual abuse and symptoms of PTSD (Bala, 1994; Chalfen, 1993; Doob, 1992; Hays & Stanley, 1996). Symptoms presenting as PTSD include: hyper-arousal, flashbacks, insomnia, nightmares, and anger control problems (Bala, 1994). Survivors may describe intricate sleeping rituals with unusual sleep patterns (Bala, 1994). In an effort to gain control and shield themselves from painful feelings, sometimes survivors have been described as over-achievers, and workaholics, paying constant attention to details (Chalfen, 1993). Although limited by sampling methodology and questionnaire reliability, Hays and Stanley (1996) found symptoms associated with PTSD in their study of dental experiences of female survivors. The symptoms identified included fear, anxiety, dissociation, flashbacks, nausea, and shame. Moreover, the literature suggests that profound, long-term effects may result from CSA. Effects from previous sexual abuse may influence current encounters with health care providers without the awareness of one or both parties. Sequelae of CSA include apart from the post-traumatic stress disorder (PTSD) symptoms, psychological problems, interpersonal problems, self-abuse, pain, and other somatic complaints without organic cause (Bala, 1994; Roy, 1998). Awareness of these symptoms as possible sequelae of CSA and the identification of their presence in a patient may evoke the suspicion of CSA, and serve as a “red flag” (Tudiver et al. 2000). Bagley and Ramsey (1986) noted that those with histories of child sexual abuse tended to have lower status economic roles. A random community sample found women reporting child sexual abuse were more likely to have work histories that placed them in the lowest socioeconomic status categories. (Mullen et al. 1994). They were also more likely to have partners whose occupations fell into the lowest socioeconomic groups. This did not simply reflect women with histories of child sexual abuse coming from lower socioeconomic status homes (which they did) but was also a product of a significant decline in socioeconomic status among those reporting child sexual abuse from their family of origin. This relative decline in socioeconomic status was most marked for women reporting the more severely physically intrusive forms of abuse involving penetration. This latter group had an odds ratio of over four for such a decline, even following a logistic regression that took into account the confounding influences of family background, social disadvantage and concurrent physical and emotional abuse (Mullen et al. 1998). In this context, women with a history of CSA frequently present with symptoms that are psychological in nature. Lechner, Vogel, Garcia-Shelton, Leichter and Steibel (1993) found a statistically significant increase in previous mental health treatment in a group of women with a history of CSA versus a control group. Problems may include but are not limited to: depression, anxiety, low self-esteem, suicidal gestures, or attempts, sleep disturbances, personality disorders, dissociative disorders and panic attacks (Bala, 1994; Courtois, 1993; Doob, 1992; Farley et al. 1997; Hendricks-Mathews, 1993; McKegney, 1993; Paxton, 1991). It is important to recognize the origin of many of the symptoms associated with these problems. Often they developed as coping strategies used during the abusive situation that once helped the patient to survive, but may have become maladaptive (Bala, 1994; Courtois, 1993; Paxton, 1991). The relationship between women with CSA history and self-reported medical complaints was also explored by Lechner et al. (1993). They used a consecutive sample study of 523 primary care patients and determined that the 26% of patients with CSA history reported more problems in respiratory, gastro-intestinal, musculoskeletal, neurological and gynecological functions. The women studied were all seeking treatment for selfidentified medical problems limiting the study’s generalizability to the public. In addition, findings were based entirely on self-report. The specific study however is limited to the physical effects of CSA on women’s health and does not proceed to the examination of possible mental problems or any psychological disorders related with CSA. III. Empirical research related with the issue Current estimates of incest and other childhood sexual abuse range from 12% to 40% depending on settings and population. Most studies have found that among women, approximately 20% - or 1 in 5 - have experienced childhood sexual abuse (Tjaden et al. 1998). Consistent with this range, studies have revealed that: Among girls who had sex before they were 13 years old, 22% reported that first sex was nonvoluntary (Moore et al. 1997). Twelve percent of girls in grades 9 through 12 reported they had been sexually abused; 7% of girls in grades 5 through 8 also reported sexual abuse. Of all the girls who experienced sexual abuse, 65% reported the abuse occurred more than once, 57% reported the abuser was a family member, and 53% reported the abuse occurred at home (Schoen et al. 1997). Approximately 40% of the women surveyed in a primary care setting had experienced some form of childhood sexual contact; of those, 1 in 6 had been raped as a child (Walker et al. 1993). A national telephone survey on violence against women conducted by the National Institute of Justice and the Centers for Disease Control and Prevention found that 18% of 8,000 women surveyed had experienced a completed or attempted rape at some time in their lives. Of this number, 22% were younger than 12 years and 32% were between 12 and 17 years old when they were first raped (Tjaden et al. 1998). On the other hand, the research made by Faulkner (1996) focused on the evaluation of sexual victimization among students. The specific research included the ‘development of an instrument entitled Sexual Abuse Recognition and Non-Disclosure Inventory (SARANDI); The SARANDI was developed for classroom surveys of young adolescents in the age range of 12 through 15’. On the other hand, the researcher made sure that ‘the research presentation and survey were written in terms that could be accepted by school administrators for use with young adolescents while participants were assured anonymity with regard to their responses. Students could elect voluntarily to respond to the survey, or return the sealed response cards unanswered’. The main aim of the survey was the ‘assessment of the prevalence of undisclosed child sexual abuse proximate to time of victimization, not years later, so information could be provided to increase community awareness and for the enhanced development of targeted and timely preventive programs and interventions’. In the context of the above research those students ‘who responded they had been sexually abused, 100% responded they had not disclosed the abuse to an adult; Additionally, six percent of the young adolescents in the study responded "I dont know" to the question of whether they had been sexually abused, confirming there are young adolescents who are uncertain about having been sexually abused’. The problem with the above study seems to be its inability to identify the forms and the effects of CSA as it presents the phenomenon as opinion – related and not fact – related which is the issue. CSA cannot be characterized as a product of a person’s imagination but can be considered as existed when certain requirements have been met leaving very limited place for personal interpretations. In this context, this research although provided an effective tool for the evaluation of personal opinion regarding certain social issues it should however be controlled as of its applicability on the specific case. Warner (2005) tried to explore the long term effects of childhood sexual abuse on adults’ lives (referring both to men and women). For this reason she presents a research conducted in California regarding the above issue. In the specific research, the participants (who were more than 17,000 in total) were asked about their history of childhood sexual abuse as well as current health and social problems. In the survey, 25% of females and 16% of males reported experiencing childhood sexual abuse. When asked about the gender of the perpetrators, women reported that men committed the abuse 94% of the time. But men reported that the abusers were nearly equally divided among men and women, with women accounting for 40% of the perpetrators. The survey also asked the participants if the childhood sexual abuse involved intercourse or inappropriate touching only. Researchers found that the risk of lasting negative effects was slightly higher for both men and women if the abuse included attempted or completed intercourse. The study showed that a history of attempted suicide was more than twice as likely among both male and female victims of childhood sexual abuse compared with others. In addition, sexually abused adults of both genders had a 40% greater risk of marrying an alcoholic and they were 40%-50% more likely to report current problems in their marriage (Warner 2005). According to this research, the effects of CSA to a person’s future behaviour and decisions can be really severe. However, this assumption cannot exclude the existence of other factors that can prevent person from a negative reaction in a similar case. A recent Queensland study (STDs News, 12/10/2005) has found a significant link between childhood sexual abuse and symptoms of sexual dysfunction in adult men and women. The study, conducted by scientists from UQ, QUT and QIMR, is published in the current edition of international journal Archives of Sex Research (Oct 2005). It was found that the rate of sexual dysfunction for men who had experienced childhood sexual abuse was double that of those who had not experienced abuse. For women, similar differences were apparent, with women who had experienced penetrative abuse substantially more likely to report three or more symptoms of sexual dysfunction. Study respondents were randomly selected from the Australian electoral roll. They were interviewed about their health status and sexual experiences, including unwanted sexual experiences before the age of 16. The study observed that women, but not men, who had experienced childhood sexual abuse reported more sexual partners over their lifetime, but neither males nor females who had experienced childhood sexual experience reported more partners in the last year. The characteristic of the above research is that it has very limited area of use as it refers to a specific problem which is CSA – related. On the other hand, the problem put under examination with the above research – i.e. the sexual dysfunction – can be considered as a secondary one if compared with the other effects that CSA has in the human life. A very interesting research is that of Mailings et al. (2003) which refers to the effects of childhood abuse on women’s lives as can be observed in a prison. The researchers tried to study the various elements of childhood sexual abuse and their relationship to HIV/AIDS risk behaviors, using a sample of approximately 1,200 newly admitted female prisoners in 1998-1999. The data used for this study were obtained from the Texas Commission on Alcohol and Drug Abuse by Texas A & M University through face-to-face interviews with a sample of women prisoners incarcerated between May 1998 and March 1999. Respondents were interviewed upon admission at the intake process at two separate facilities. The interview and questionnaire averaged 70 minute. Consistent with a myriad of prior studies, the authors found that sexually abused prisoners were more likely to have experienced childhood neglect, come from one-parent families, and had parents with drug and/or alcohol and psychiatric problems. Female prisoners who had been sexually abused reportedly engaged in more high-risk drug and sexual activities than their non-abused counterparts. More specifically, the results of the study showed that women who had been sexually abused younger than the age 18 were significantly younger at admission to prison and more likely to be white than the non-abused comparison group. Furthermore, sexually abused prisoners reported a wide variety of unstable family characteristics. Overall, the sexually abused group experienced all measures of child neglect at greater frequencies than non-abused women. The behaviour towards the women that have suffered CSA as well as their medical treatment have to be evaluated in accordance with the extension and the aspects of their personal experiences. In this context, Austin, Gallop, McCay, Peternelj-Taylor and Bayer (1999) studied 1701 Canadian psychiatric nurses and their self-perceived ability to nurse clients with a history of CSA when cultural differences are present. They found that only 4.6% of these nurses felt they delivered competent care to culturally diverse groups, the First Nations population being the most predominant. The authors suggested that nurses rating themselves in the middle levels of self-perceived competency (40% of the nurses studied) were, in fact, the most competent. They rationalize that nurses rating themselves with lower competency were aware of the impact of culture, but required further knowledge and experience, while the 4.6% of nurses rating themselves as highly competent may have been unaware of the impact of culture in the care of patients with a history of CSA (Austin et. al., 1999). Measurement of self-perceived ability tends to be affected by individual and subjective factors. Some recommendations made by the authors to improve culturally competent care include an examination of oneself within one’s own culture, increased understanding of different cultural beliefs and customs, and the acquisition of good communication skills, warmth and empathy (Austin et. al., 1999). According to the study of Kenneth et al. (2000) young girls who are forced to have sex are three times more likely to develop psychiatric disorders or abuse alcohol and drugs in adulthood, than girls who are not sexually abused. Moreover, sexual abuse was also more strongly linked with substance abuse than with psychiatric disorders. It was also suggested that sexual abuse may lead some girls to become sexually active at an earlier age and seek out older boyfriends who might, in turn, introduce them to drugs. Psychiatric disorders were from 2.6 to 3.3 times more common among women whose CSA included intercourse, and the risk of substance abuse was increased more than fourfold, according to the results. On the other hand, family factors -- parental education, parenting behavior, family financial status, church attendance -- had little impact on the prevalence of psychiatric or substance abuse disorders among these women, the investigators observe. Similarly, parental psychopathology did not predict the association between CSA and later psychopathology. In a similar context, Lang (1997) presents the results of a survey which was conducted in Cornell University from a group of researchers. In order to reach a secure result the above researchers analyzed questionnaires from 313 undergraduate women at Cornell. The researchers looked at measures of childhood sexual abuse, childhood attachment to caregivers, adult attachment to partners, achievement, interpersonal functioning and adjustment. Of the women surveyed, 68 percent had no history of sexual abuse; 22 percent had been fondled or touched against their will; 9 percent experienced attempted intercourse and 10 percent had experienced oral, vaginal or anal intercourse. Twenty-two percent had been subjected to exposure, which the researchers did not include as sexual abuse. According to the findings of the above survey, college women who were sexually abused before age 18 tend to have less secure and trusting relationships with their partners and lower levels of interpersonal functioning and social adjustment than college women who were not abused, according to a new Cornell study. Moreover, college women who were sexually abused as children also show more signs of post-traumatic stress disorder than other college women, particularly if they had less secure and responsive relationships with their mothers or primary caregivers during childhood. A possible negative aspect of this research is that it is more psychological related and omits a series of important physical consequences that CSA has to the person’s health. However, although the level of importance of CSA’s consequence for every person involved has been recognized by all researchers participated in the relevant studies, it seems that in practice the adults responsible for offenses of this type are usually left without any punishment. According to a series of statistics revealed from the Awareness Center (2005), on a given day in 1994 there were approximately 234,000 offenders convicted of rape or sexual assault under the care, custody, or control of corrections agencies; nearly 60% of these sex offenders are under conditional supervision in the community while the median age of the victims of imprisoned sexual assaulters was less than 13 years old; the median age of rape victims was about 22 years. On the other hand, it has been found that an estimated 24% of those serving time for rape and 19% of those serving time for sexual assault had been on probation or parole at the time of the offense for which they were in State prison in 1991. Moreover, offenders who had victimized a child were on average 5 years older than the violent offenders who had committed their crimes against adults. Nearly 25% of child victimizers were age 40 or older, but about 10% of the inmates with adult victims fell in that age range. It should also be noticed that convicted rape and sexual assault offenders serving time in State prisons report that two-thirds of their victims were under the age of 18, and 58% of those--or nearly 4 in 10 imprisoned violent sex offenders--said their victims were aged 12 or younger; In 90% of the rapes of children less than 12 years old, the child knew the offender, according to police-recorded incident data; Among victims 18 to 29 years old, two-thirds had a prior relationship with the rapist. IV. Conclusion While we know that childhood sexual abuse exists throughout the world, issues of ethnicity and culture have not been given much attention in research specifically related to CSA. Exposing childhood sexual abuse threatens communities with divisions and public shame and sometimes precipitates legal actions against individuals or organizations. Immigrant or racially diverse communities, already marginalized in a dominant society, may be particularly cautious to air internal social problems. Anyone researching these concerns must have the trust and respect of a community (Tudiver et al. 2000). On the other hand, the effects of CSA on a person’s life can be really severe and even lead to premature death. This assumption has to be taken under consideration by the relevant authorities when designing and supervising the legal rules that prohibit the potential offenders from their participation in similar actions or impose punishment in cases that CSA has been found to occur. The relevant efforts should focus on the prohibition of CSA and not on the introduction of severe punishments. 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National Center for PTSD Appendix I Common Symptoms in Adult Survivors of Childhood Sexual Abuse – ACOG Educational Bulletin, 2000 Physical Presentations Chronic pelvic pain Gastrointestinal symptoms/distress Musculoskeletal complaints Obesity, eating disorders Insomnia, sleep disorders Pseudocyesis Sexual dysfunction Asthma, respiratory ailments Addiction Chronic headache Chronic back pain Psychologic and Behavioral Presentations Depression and anxiety Posttraumatic stress disorder symptoms Dissociative states Repeated self-injury Suicide attempts Lying, stealing, truancy, running away Poor contraceptive practices Compulsive sexual behaviors Sexual dysfunction Somatizing disorders Eating disorders Poor adherence to medical recommendations Intolerance of or constant search for intimacy Expectation of early death Read More