CASTIMONIA

Sexual Purity Support & Recovery Group

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Physical and Sexual Abuse

Posted by James Browning on April 29, 2013

Abuse: Touching someone’s body without their permission, hitting, punching, pinching, slapping, tickling, pulling hair, hitting with objects, banging the head, so that marks are left on the person…Punching someone to the point of knocking them off their feet, slamming them into walls or hard objects, strangling or choking someone…Intimidating someone with the threat of violence, punching walls or throwing objects. …you might think that because some other member of your family was receiving the blows you are not a victim of physical abuse, but (you were) if the underlying fear is, “When will it be me?” Physical sexual abuse is bodily sexual activity with a child or touching in a sexual way. It includes: intercourse, oral sex, anal sex, an adult masturbating a child or having a child masturbate an adult, sexual hugging, sexual kissing, and sexual touching. Many people who have been molested or incested feel responsible for what happened, feel that they caused it to happen or wanted it to happen. I have also heard clients express acceptance since it was the only kind of attention that they received. You are not responsible and it is not acceptable behavior. A child will not seek out sexual encounters except what may be age-appropriate sex play with other children. It is the adult’s responsibility to set appropriate boundaries and protect the child. Taken from “Adults Abused as Children” by Licia Ginne, LMFT http://www.latherapists.com/articles.html

“The consequences of your denial will be with you for a lifetime and will be passed down to the next generation. Break your Silence on Abuse!” – Patty Rase Hopson

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A Tribe’s Epidemic of Child Sex Abuse, Minimized for Years

A Tribe’s Epidemic of Child Sex Abuse, Minimized for Years
Originally posted by Socialogical Ruminations
September 20, 2012

A very disturbing article on the front cover of the New York Times discusses the normalization of child sexual abuse on the Spirit Lake Indian Reservation in North Dakota.  Please understand that the subject of this article may not be suitable for everyone and this deals with sexual abuse of children.  Keep in mind that it is normal to feel anger after reading this, but please don’t read this article if you feel you are not ready to read on this subject in your own recovery.  The article says:

While members of the tribe say that sexual violence against children on the reservation is common and barely concealed, the reasons for the abuse here are poorly understood, though poverty and alcohol are thought to be factors. The crimes are rarely prosecuted, few arrests are made, and people say that because of safety fears and law enforcement’s lack of interest, they no longer report even the most sadistic violence against children.

The article says that one offender told the police

that he thought he was entitled to have sex with his niece because she told him that she had previously been sexually abused by her father.

Here is the article:

A Tribe’s Epidemic of Child Sex Abuse, Minimized for Years
By
Published: September 19, 2012

SPIRIT LAKE INDIAN RESERVATION, N.D. — The man who plays Santa Claus here is a registered child sex offender and a convicted rapist. One of the brothers of the tribal chairman raped a child, and a second brother sexually abused a 12-year-old girl. They are among a number of men convicted of sex crimes against children on this remote home of the Spirit Lake Sioux tribe, which has among the highest proportion of sex offenders in the country.

Federal officials are now moving to take over the tribe’s social service programs, according to members of the tribe, government officials and documents. The action comes after years of failure by government and tribal law enforcement officials to conduct proper investigations of dozens of cases of child sexual abuse, including rape.

While members of the tribe say that sexual violence against children on the reservation is common and barely concealed, the reasons for the abuse here are poorly understood, though poverty and alcohol are thought to be factors. The crimes are rarely prosecuted, few arrests are made, and people say that because of safety fears and law enforcement’s lack of interest, they no longer report even the most sadistic violence against children. In May 2011, a 9-year-old girl and her 6-year-old brother were killed on the reservation after being raped and sodomized.

“It bothers me that it is so accepted, that it is considered so normal. It’s lawless,” said Molly McDonald, who was a tribal judge until March, handling juvenile cases.

The reservation has 38 registered sex offenders among its 6,200 residents, a rate of one offender for every 163 residents. By contrast, Grand Forks, N.D., about 85 miles away, has 13 sex offenders out of a population of 53,000 — a rate of about one in 4,000. In one home on the reservation, nine children are under the care of the father, an uncle and a grandfather, each a convicted sex offender, a federal official said. Two of the children, brothers who are 6 and 8, were recently observed engaging in public sex, residents said.

“Those little boys are crying out for help,” said a neighbor, who called the Bureau of Indian Affairs Police but said that officers declined to take a report or notify child welfare officials.

Another member of the tribe said that police officers and social workers failed to act after a 9-year-old girl described giving oral sex to a man.

Neither the tribe nor the federal government provided current figures on abuse, but in 2007 there were 26 confirmed cases of child sexual abuse and nearly 10 times as many allegations of abuse or neglect. Ms. McDonald said she presided over 20 to 30 cases of child sexual abuse each year. In 2011, fewer than a dozen cases of sex crimes against children were prosecuted by either the tribe or the federal government, which has jurisdiction, according to federal and tribal records.

Betty Jo Krenz, a former tribal social worker, said she oversaw 131 children — 100 more than the state’s average caseload. In some instances, members of the tribe say, there are generations of victims from the same family who have been preyed upon by generations of child rapists from other families. Others abuse their own children, including one tribal government employee who publicly complained that his young daughter had bitten his penis, according to a relative of the man and a federal official.

Federal agencies, however, have sought to minimize the extent of the problem, including disciplining employees who have spoken publicly about sexual abuse and questioning the competence of others, according to federal and tribal officials.

Thomas F. Sullivan, a director of the federal Administration for Children and Families, who has emerged as a crucial whistle-blower, is among those who have been prevented from speaking to reporters, he said. Still, his periodic reports to his superiors in Washington have been blistering.

“If we fail in our role as leaders, we will deserve the same condemnation society so correctly applied to those leaders at Penn State and in the Catholic Church who, knowing of the abuse being inflicted on children by their colleagues, did nothing, failing in their basic obligation to protect children,” Mr. Sullivan wrote last month to his supervisors.

And weeks before the scheduled federal takeover on Oct. 1 of the reservation’s social service system, which is responsible for the care of the tribe’s sexually abused children, senior staff members at the Bureau of Indian Affairs continued to play down the issue.

Hankie Ortiz, deputy bureau director of the Office of Indian Services, said the news media and whistle-blowers had exaggerated the problem. “Their social service program has made steady progress,” Ms. Ortiz said, adding that she was unable to discuss specific cases under privacy laws or because she was unaware of them.

Roger Yankton, the tribe’s chairman, did not respond to requests for interviews.

But in a letter published last month in The Devils Lake Journal, a local newspaper, tribal officials cast blame on whistle-blowers and a lack of federal money.

“The tribe’s elected leaders and its people are well aware of the gravity and difficult nature of these problems,” the letter said, “particularly because we live with their consequences every day.”

But members of the tribe say their leadership has often sought to hide abuse.

Ms. McDonald said that the police investigated sex crimes against children only if a victim requested hospitalization, and that tribal leaders frequently sought to sway judges’ opinions improperly. She said she was forced to dismiss many cases because social workers forgot to submit required paperwork.

“The perpetrators know they can get away with it because the authorities don’t do anything,” said Joanne Streifel, a tribal elder.

Among the sex offenders is Quentin Yankton, 61, who stands 6 feet 5 inches and is a brother of the tribe’s chairman. He was first convicted of raping a child in 1976, state records show. In 1992, he was convicted of a similar crime after he forced his 15-year-old niece into sex. The girl became pregnant with twins, and DNA analysis showed that he was the father.

Mr. Yankton told the police, according to court documents, that he thought he was entitled to have sex with his niece because she told him that she had previously been sexually abused by her father.

Mr. Yankton was sentenced to 12 years in prison. The girl’s father was never prosecuted, but Alfred Longie, 67, a half-brother of the men, was convicted in 2008 for undressing and rubbing the genitals of a 12-year-old who had passed out after he had given her alcohol.

Joseph Alberts, 59, who plays Santa Claus for the tribe, was convicted of rape in 1983, and in 1986 was found guilty of committing lewd acts with a child under 14 on four different occasions. He served one year in jail for that crime and 18 months for the rape.

In another case, after a woman tried to burn down her house with her 5-year-old daughter inside, the girl was put in a foster home where a sex offender was living, according to Mr. Sullivan and a member of the tribe. Once the foster parent’s criminal record was discovered, the tribe removed the child and put her back in her mother’s home.

But when the child proved too much for the mother to care for, Mr. Sullivan said, she sold her daughter back to the family of the registered sex offender for $50 and a ride to Grand Forks.

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Japan’s child porn addiction

Japan’s child porn addiction

A nation that openly sexualises youngsters has become the world hub for a dark, booming industry. Now police have decided to tackle the culture of abuse
by David McNeill, October 12, 2012

It was a shocking find: crudely made DVDs with images of grown men having sex with children as young as 12. Until this year, the men who bought those images faced little more than a slap on the wrist. But police in Kyoto, Japan’s ancient capital, decided for the first time during the summer to pursue criminal charges against three male customers in a country widely seen as much too lenient on child pornography.

The police campaign is largely the work of Kyoto’s prefectural Governor, Keiji Yamada. During his fight for office two years ago, Mr Yamada pledged to roll out an ordinance banning the buying and possession of child porn – still legal under Japanese law, unless there is proven intent to sell or distribute. Even if the makers are arrested, the images circulate for years on the internet and in secondary markets.

Child porn-related crimes have grown fivefold in Japan through the last decade, according to the country’s National Police Agency. At least 600 children a year fall victim to paedophile directors and photographers. “The internet is probably the biggest factor,” said Akira Koga, spokesman for the Kyoto Police. “It’s very difficult to monitor and control.” A new police cyber patrol uncovered the trail back to the three men from the DVD producer in Tokyo.

Japan has long been considered a hub for the production and possession of paedophile images. It is the only OECD (Organisation of Economic Co-operation and Development) nation that has not banned possession of child porn, partly to protect its manga and anime industries, which churn out thousands of titles every year that sail close to the legal wind. A government survey in 2002 found that 10 per cent of Japanese men admitted to owning child porn at some stage.

Bookstores and convenience stores across the country stock magazines carrying semi-naked pictures of pubescent and pre-pubescent children. Many underage girls have built careers as so-called “junior idols”, posing in suggestive poses. In the electronics district of Akihabara, Tokyo’s capital of geeky cool, tourists gawk at cartoon images of children in various stages of sexual distress, all perfectly legal. One of the nation’s most popular pop groups, AKB48, features a revolving cast of members, some as young as 13, persuaded to pout in adult lingerie for videos and magazine covers.

The UK-based Internet Watch Foundation traced nearly 16,250 websites depicting child abuse back to Japan in 2006, enough to put it third on a global watch list. In 2009, the Canadian Centre for Child Protection placed Japan fourth among the top five countries hosting websites with child abuse images, according to ECPAT International, an NGO that fights to end the commercial exploitation of children.

Campaigners engaged in a cat-mouse-game with paedophiles across the world say a new approach is long overdue. “The US is very frustrated with Japan,” says Jake Adelstein, a journalist and board member with the Polaris Project Japan, a non-profit organisation that combats human trafficking and sexual exploitation. “The FBI and Homeland Security Investigations give Japan’s police hundreds of tips on child pornography makers and distributors every year and none of them are acted upon.”

Police complain that they do not have the legal resources to fight the problem. Japan only banned the production and distribution of child porn in 1999, mandating punishment of up to five years in prison. Kyoto today is still the only one of Japan’s 47 prefectures that threatens prison for possessing child porn. Since Governor Yamada’s ordinance, possession carries a maximum one-year jail term or a fine of up to 500,000 yen (£4000).

One reason for the reluctance to roll out new national legislation is the fear that police may use it too liberally, threatening freedom of creative expression. Conservative politicians have long demanded a clampdown on pornographic images. Two years ago, Tokyo’s metropolitan assembly banned the sale or rent of comics and anime movies depicting younger characters engaging in “extreme” sexual acts, including rape.

But the ban was resisted by Japan’s biggest publishers, who produce hundreds of risqué manga a year featuring fetishism, incest and “Lolita porn”, along with more mainstream fare. The Tokyo Bar Association also criticised the wording of the legislation, warning that it could be the thin edge of the censorship wedge against sexualised images of any kind. The association and many legislators want the police to continue targeting producers and distributors of child porn, not consumers.

Opinion polls suggest that most Japanese voters want stricter laws. But with parliament essentially gridlocked ahead of a general election, widely expected this autumn, there is little appetite for a messy political fight over what is seen as a relatively minor issue. The ruling Democratic Party (DPJ) has shelved a 2008 draft law that would have banned any involvement in child pornography. Their conservative opponents, the Liberal Democrats, have promised a tougher line.

Until then, say campaigners, paedophiles will continue to have the upper hand. “Child pornography prosecutions almost always involve images contained on computer hard drives or start with an internet protocol (IP) address that is known to have accessed child pornography material,” said a spokesperson for ECPAT International. “The fact that Japanese courts cannot grant search warrants based on IP address information hampers the fight against child pornography.”

The organisation warns that Japanese police cannot coordinate with international sting operations because domestic law is out of sync with most of the developed world.

As if to underline the legal challenges ahead, Kyoto police say prosecutors have declined to press charges against the three men, citing a lack of evidence. The three bought the DVDs from a dealer in Tokyo after seeing them advertised on the internet. Police raided the dealer’s house and found transaction records showing many more customers around the country. Unfortunately for the victims, few of the men can be prosecuted, even when the law works well.

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I Was in Denial About My Childhood Sexual Abuse

This is a very painful subject for me, something I really don’t like to talk about.  However, since the month of April is childhood abuse month, I figured I would tell a small part of my life story.  I was sexually abused from age 3 until age 7.  I continued to act out sexually on a nearly a daily basis until I entered recovery at age 33.  It took me three years of recovery and therapy to finally admit that I was sexually abused as a child.  Because of the circumstances, I was in complete denial about my abuse and my abuser.

Scan59The reason I was in denial is because the girl that abused me was just a little older than me, maybe 6 months or a year.  When my family moved away from our home country to a university setting in the United States, I didn’t know many children that spoke my native tongue.  She did and it was a relief that I could speak to her and she could speak to me and we could understand one another.  I was around 3 years old at this time.  I don’t remember all of the details of our relationship, but a few points do stand out.  I recall the time we hid from our parents (her idea) and we snuck into the university swimming pool that was located about 2 miles from our apartment complex.  Apparently our parents called the police and everyone was looking for us while we enjoyed ourselves at the pool.  I don’t recall what occurred when we came home but knowing my parents, it wasn’t good.

I trusted this girl a lot, so when she decided we should play sexual games together, I went along with her.  I do recall the words to this day she spoke to me in my native tongue stating, “don’t tell your parents.”  I didn’t tell my parents, not until 30+ years later when I entered recovery.  Even then, I minimized the fact she abused me for 4 years, I was still in denial.  Amazing how I always thought my parents suspected something but when I asked them about it, they said they never knew.  She and I were together almost every day and the sexual activities were basically based on what she wanted to do to me, with me, and with other boys at the apartment complex.  I don’t know where she learned all these things, but I suspect her older siblings or parents had something to do with it, perhaps with pornography and or an extremely liberal stance on human sexuality.  I may never know the answers, nor do I wish to pursue them.

I do know that this sexual abuse and what I thought was “love” has affected the rest of my life up until I entered recovery.  I believed this girl loved me, that she and I would be together forever.  Why else would she want to do sexual things with me?  Allowing her violate me sexually was the way I showed her that I too loved her.  As an adult, I repeated this same love = sex behavior thousands of times.  For a majority of my life, I had the belief that being sexual with a woman meant I loved her and she loved me.  A woman who wanted to be sexual with me, who initiated sex with me, who pursued me sexually was a woman that loved me: this is what I believed for 30+ years.  This idea was ingrained in me by my abuser, an idea I still struggle with on occasions.  I’m not attempting to minimize by saying that it could have been worse, I could have been abused by an adult, but in actuality, the fact that it was another child, masked the abuse, keeping me living in denial for so long and in turn pursuing a false sense of love.  The abuse was not traumatic, it was what I used to consider consensual; I believed it was because I enjoyed it.  As an adult, I reenacted various things we did together, with other women, ultimately believing I was fulfilling some great fantasy locked within the depths of my mind.  The saying “follow your fantasy and you’ll find your wound” makes perfect sense to me now.

GiselaI don’t like the fact that I was sexually abused.  When I finally broke through the denial, with the help of my therapist, I was a complete mess.  However, it allowed for God to begin healing this wound that I had held onto for so long.  Being labeled a victim of childhood sexual abuse was not pleasant, it made me feel dirty, it made me feel like I was worse than I really am.  One of my friends in recovery let me know that I am no different today (the day I finally acknowledged it as sexual abuse) than I was yesterday (when I was “just” a recovering sex addict).  This helped me tremendously.  Breaking through the stigma of dirtiness and brokenness was difficult but necessary.  I still struggle with negative intrusive thoughts about the abuse and being unwanted or being broken.  However, I have come to understand that feeling “unwanted” is just a lie and also, God can’t fix me if I’m not broken….

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Adult Manifestations of Childhood Sexual Abuse

Adult Manifestations of Childhood Sexual Abuse
Full PDF article and figures can be found here:
http://publichealth.lacounty.gov/wwwfiles/ph/media/media/TPH-409.pdf

Background

While childhood sexual abuse (CSA) continues to be a major public health problem, an equally severe and silent epidemic are the estimated 39 million adult survivors of childhood sexual abuse in the United States who continue to exhibit aftereffects of CSA that predispose them to adverse psychosocial outcomes throughout their adolescent and adult life.

Early childhood traumas such as sexual abuse can have lifelong effects throughout adulthood, and the cost to society is high. Ninety percent of cases go unreported and untreated, as the symptoms of CSA are often misdiagnosed and unappreciated.

This article attempts to provide clinicians with awareness of the neurodevelopmental effects of CSA, the adult clinical symptoms, and the adverse psychosocial outcomes of CSA. It will also present tools to help identify the aftereffects of CSA in adulthood and provide mandated reporting protocols.

Definition

Sexual abuse is defined as any sexual activity that a child cannot comprehend or consent to. It includes acts such as fondling, oral-genital contact, and genital and anal intercourse, as well as exhibitionism, voyeurism, and exposure to pornography. A central characteristic of any abuse is the dominant position of an adult that allows him or her to force or coerce a child into sexual activity. Researchers have determined that child sexual abuse victims come from all cultural, racial, and economic groups. The lack of a universal definition of CSA contributes to the complexity of data collection and estimates.

Incidence and Prevalence

Currently, CSA prevalence in the U.S. is not known, but estimates vary from 12% to 40%. Incidence studies suggest that while on average 5.5 children per 10,000 enrolled in day care are sexually abused, a greater number of children (8.9 children per 10,000) are sexually abused in their home. Further CSA studies suggest that 53% of the abuse occurs in the home, 57% report the perpetrator was a family member, and 65% report repeated abuse. Overall, studies show that 1 in 3 females, and 1 in 6 males have experienced childhood sexual abuse by the age of 18.

While nearly 90,000 cases of child sexual abuse are reported each year in the U.S., between 88%-90% of CSA cases are estimated to be unreported and interestingly, between 21%-49% of CSA victims appear asymptomatic following victimization. The lack of disclosing a history of sexual abuse contributes to the lifelong effects of the abuse.

Neurodevelopmental Damage of CSA

Controlled studies have shown that adult survivors of child sexual abuse (ASCSA) are more likely to exhibit adverse psychopathologies in adulthood, and neuroimaging studies confirm that exposure to sexual abuse in childhood alters the neurobiology and neurostructures in the brain, leading to scarring, an abnormal neurohormonal response to future stressors, and predisposes the victim to a lifetime of negative consequences.

Neurological damage from sexual abuse alters early brain development, increasing the risk for psychopathology in adolescence and adulthood (Table 1). The hippocampus, responsible for new learning and memory, plays a critical role in recording emotions that are attached to a stressful event such as sexual abuse. The hippocampus is known to be very sensitive to stress. During stress, high levels of glucocorticoids are released, and over time (as observed among CSA victims, including those re-victimized) elevated levels of glucocorticoids damage neurons in the CA3 region of the hippocampus and lead to atrophy. While the hippocampus has been shown to regenerate neurons, stress inhibits neurogenesis.

Abnormalities of the hippocampus have been shown to be associated with pathological fear, mood imbalances, and anxiety reactions in trauma-related disorders (also hallmarks among ASCSA).

Magnetic resonance imaging (MRI) studies have demonstrated a 12% left hippocampal volume size reduction among adults who have been sexually abused in childhood as compared to healthy controls (Figure 1). Similar reductions are exhibited among subjects with trauma-spectrum disorders such as depression, dissociation, PTSD, and borderline personality disorder. In addition, the amygdala, responsible for emotional and fear regulation, is affected by early sexual trauma, resulting in similar psychopathologies.

Studies suggest sexually traumatized children are also less able to utilize both brain hemispheres to process experiences. The corpus callosum, a longitudinal fissure that connects the left and right cerebral hemispheres, is shown to be abnormal in sexually abused children. Generally, the left side of the brain processes positive emotions and logical thinking, and the right processes negative emotions such as fear. When the corpus callosum is not operating properly these processes are unable to function at the same time, thus supporting theories why many abused individuals divide people into “all good” or “all bad” and exhibit mood swings, as observed in borderline patients.

Adult Manifestations of CSA

There is no adopted definition to identify the symptoms exhibited among ASCSA; however, evidence-based research has confirmed long-term effects of CSA in adolescence and into adulthood. Later in their lives, many ASCSA, whether reported or not, exhibit psychopathology, acting-out behaviors (social dysfunction), relationship problems (interpersonally), somatic symptoms, and sexual disorders.

CSA survivor studies suggest that ASCSA use health care services more often than the general population, are shown to exhibit more somatic symptoms that do not respond to medical treatment, and present more severe and complex symptoms.The response to sexual abuse during childhood varies, and is largely dependent on 1) age at onset; 2) severity; 3) duration; 4) relationship to the perpetrator; 5) the child’s resiliency; and 6) stability of and support from the family.

Childhood survivors might initially seem unaffected by the trauma; however, by adolescence and adulthood, the consequences eventually become symptomatic, resulting in eating disorders, dissociation, phobias, obsessions, borderline personality disorder, depression, anxiety, bulimia, obesity, post traumatic stress disorder, hallucinations, conduct disorder, substance abuse disorder, panic disorder, antisocial personality disorder, affective disorder, and impaired sense of self.

Behavioral Effects of CSA 

Acting out

Children are limited in their physical, cognitive, and emotional development and, thus, dependent upon adult and often sibling caregivers to provide love, trust, and support. Once a child is violated however, shame and stigma often follow, as well as fear that disclosing the abuse will result in re-victimization, loneliness and isolation, physical violence, and death. Poor coping skills are common among this cohort, such as substance abuse, tobacco use, overeating, addiction, lying/stealing, poor academic performance, expectation of early death, poor adherence to medical treatment, suicide, anger, prostitution, and increased risk of sex crimes.

Relationship problems

Controlled studies identify an association between childhood sexual abuse and adult relationship problems. Adult manifestations of CSA increase the risk of intimate partner violence victimization and perpetration, rape after 18 years of age, low self-esteem, intimate relationship problems, divorce, interpersonal problems, victim-perpetrator cycle, superficial idealization of sexual relationships, and the inability to trust others.

Somatic symptoms

Evidence illustrates that CSA also results in biophysical changes. ASCSA show a decreased threshold for pain. Other effects include a heightened sensitivity in the pelvic or abdominal region, various bowel symptoms, musculoskeletal disorders, back pain, severe headaches, gastrointestinal problems, sleep disorders, asthma, and pseudocyesis.

Sexual disorders

Adult manifestations of CSA increase adolescent and adult risk of exposure to sexually transmitted diseases, compulsive sexual behaviors, early sexual activity, extreme masturbation, sexual promiscuity, poor sexual adjustment, poor contraceptive practices, and teen pregnancy.

Functional amnesia

Functional amnesia (dissociative amnesia–dissociative disorders) can develop after severe trauma, such as child sexual trauma. This is especially true among children experiencing severe sexual trauma or in those aged 5 years or younger. Functional amnesia among CSA cases varies widely, from 19% to 88%. While theories about amnesia and delayed recall of CSA vary and may be controversial due to false memories, it is important to recognize that later in adolescence or adulthood, the victim may not recall the experience. Additionally, if the abuse occurred in middle childhood, ages 6-12, the victim may 1) develop false memories that the abuse ever occurred; 2) be in denial; or 3) be unaware that the type of experience was determined to be sexual abuse. 

Role of the Clinician

The clinician plays an important role in caring for adult survivors of childhood sexual abuse. Because the presenting symptoms can be somatic in nature, the role of CSA in the patient’s illness or presenting symptoms can be overlooked.

Despite never reporting the abuse, 85% of adult survivors of child sexual abuse favor physician screening. Directly asking patients about the occurrence of abuse has been shown to elicit more positive responses compared to self-reporting, 29% versus 7% respectively. Further, especially among adolescent patients, it is important to remember that early disclosure of sexual abuse by the victim is critical to reducing the effects of CSA and to helping reduce psychological distress later in life. Symptoms of ASCSA can vary greatly and, in fact, the patient can be asymptomatic.

Evidence-based research suggests that many interventions can be useful in this population. For example, coping-skill interventions seem to help diminish or prevent post traumatic stress disorder and related adult aftereffects of CSA. Physicians can use the SAVE universal screening tool (Table-2) for childhood sexual abuse in adulthood, developed by the Florida Council Against Sexual Violence. This useful tool screens patients for sexual violence.

Physicians should also be familiar with their own hospital, clinic, or HMO policies and procedures regarding sexual violence reporting, as well as the use of specific reporting forms. The California Medical Training Center develops instructional materials and conducts training in clinical forensic medicine techniques for physician and other health care professionals, social workers, and related reporters.

 

James M. DeCarli, MPH, MPA, CHES
Injury and Violence Prevention Program
Los Angeles County Department of Public Health