Long-term effects of child sexual abuse (4)

Dangers of post-traumatic stress model

The belief that child sexual abuse is not only a potent cause of adult psychopathology but can be understood and treated within a post-traumatic stress disorder framework has spawned a minor industry in sexual abuse counselling. Though many working in this area have shifted, on the basis of their clinical experience, to broader conceptualisations, there remains a considerable vested interest in a specific post-abuse syndrome.

There are also political agendas linked to seeing child sexual abuse as a product of misdirected and ill controlled male sexuality (which it is), and as independent of social circumstances and family background (which it isn’t). Herman’s (1992) description of child sexual abuse as one of the combat neurosis women suffer from as a result of the sex war neatly conflates the post-traumatic stress model with the political agenda of some feminists.

The understandable wish to avoid repeating the deplorable error made in domestic violence of blaming the victim (Snell et al. 1964) can lead to an insistence on looking no further than the perpetrator (and often just his maleness) for an understanding of why abuse occurs. This potentially impoverishes research aimed at identifying the social and family correlates of child sexual abuse that constitute risk factors for such abuse. The knowledge of such risk factors is essential to the development of programs aimed at primary prevention.

Family risk factors

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).

Similarly, there are increased risks of abuse with a stepparent in the family, and when family breakdown results in institutional or foster care. Poor parent­child attachment is associated with increased risk of child sexual abuse, though it is not always easy to separate the impact of abuse on intimate family relationships from the influence of poor attachments on vulnerability to abuse (Fergusson et al. 1996; Fleming et al. 1997).

Disrupted family function could, in theory, be related to child sexual abuse because of the disruptive influence of a perpetrator in the family. However, given the majority of abusers are not immediate family members, it is more likely that the linkage reflects a lack of adequate care, supervision and protection that leaves the child exposed to the approaches of molesters, and vulnerable to offers of apparent interest and affection (Fergusson and Mullen in press).

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