Suspicion becoming FACT

Although mainstream media promote most NEWS releases, with ‘surprise-denial-regret’, any acknowledgement of Child Sexual Abuse is taken with expectations by CSA Survivours & those who work in the field. Even the Catholic Church’s Hierarchy are now admitting there is a problem, which needs to be solved.

More & more CSA Survivours are being brought to awareness that those close to them may not change their POV, yet with the gradual International flow, parallel with MeToo Movements Equality may be coming more into balance(?). Alike earlier ‘pendulum’ posts, preparation for counter-swings to Racism-Sexism-Instabilities will always occur. Staying connected, with those who truly know, understand & share with you is most important.

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Safe and happy childhood … ?!

If “all children deserve a safe and happy childhood”, as the Letters Patent began Australia’s recent CARC (Child Abuse Royal Commission) – how far along this journey are Survivors, Family-Friends, Institutions & Perpetrators? While some fairytales have more possibility of ‘safe & happy’ endings, reality is that multiple Victims are losing their chance to experience any Compensation &/or Redress from the Institutions & Perpetrators responsible. Perhaps this extension of time is part of the calculated risk of Predators targeting the Vulnerable … ‘don’t worry, they’ll be dead/unable/incapacitated before we need to worry about things’ may frequently be thought.

Back to the returning of our youth’s lost safety and happiness of childhood – this is a far greater accomplishment of “trust, intimacy, agency & sexuality” that many Victims have not fully experienced. I hope for more Messages-Posts-Questions-Discussions around these 4 broad points!

Light at the end of the tunnel

Of great interest is the growth in visits of this ‘RoyalCommBBC.blog’! As more acceptance, coping & awareness of these HIDDEN patterns becomes available – there is ‘light at the end of the tunnel’. Many Survivours are delayed in speaking about their past, which Counsellors-Psychologists are available to help you out. From the ChildAbuseRoyalCommission & NationalRedressScheme sites, the following details are provided. If you feel like you’d like to talk with someone: BlueKnot (ASCA) have provided us extreme help on 1300 657 380. Finding someone you find comfortable, may take some time, yet these are a great place to start.

Long-term Effects of Child Sexual Abuse (9)

Prevention 

The ideal response to child sexual abuse would be primary prevention strategies aimed at eliminating, or at least reducing, the sexual abuse of children (Tomison, 1995). This review has, however, focused on issues related to the deleterious outcomes linked to child sexual abuse rather than on the characteristics of abusers and the contexts in which abuse is more likely to occur, which are relevant to primary prevention. From the information presented here, the implications are for secondary and tertiary preventive strategies aimed at ameliorating the damage inflicted by abuse, and reducing the subsequent reverberations of that damage. 

Child sexual abuse may be a necessary, but rarely (if ever) a sufficient, cause of adult problems. Child sexual abuse acts in concert with other developmental experiences to leave the growing child with areas of vulnerability. This is a dynamic process at every level, and one in which there are few irremediable absolutes. Abuse is not destiny. It is damaging, and that damage, if not always reparable, is open to amelioration and limitation.

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). Even aspects of the parental figures’ relationship to each other seem to have an influence. Expressions of physical affection between parents was associated with better outcomes, and marked domestic disharmony, particularly if associated with violence, added to the damage (Romans et al. 1995; Spaccarelli and Kim 1995). Finally, those who can establish stable and satisfactory intimate relationships as adults have significantly better outcomes. 

There is no reason why a well-organised and funded school system should not provide all children with a positive experience academically, socially or in sport. There is no need to identify and target abuse victims, but simply to make every effort to ensure adolescents have the opportunity to share in the enhanced social opportunities, the increased mastery, and the pleasure of achievement that school should provide at some level to all. 

The encouragement of sport may seem trivial, but it has a protective influence on psychiatric disorders in all adolescents, not just those with histories of child abuse (Romans et al. 1996; Thorlindsson et al. 1990; Simonsick 1991). Similarly in adult life, success in tertiary education and in the workforce is associated with reduced vulnerability to psychiatric problems for the abused and the non-abused alike, but particularly for the abused (Romans et al. 1996).

The secondary preventive strategies of relevance in reducing the impact of child sexual abuse are equally relevant to reducing a wide range of adolescent and adult problems unrelated to abuse. These include improved parental relationships, reduced domestic violence and disharmony, improved school opportunities, work opportunities, better social networks, and better intimate relationships as adults. The list is so familiar as to be platitudinous, but is nonetheless of central importance. 

The model advanced in this paper is of child sexual abuse contributing to developmental disruptions that lay the basis for interpersonal and social problems in adult life. These, in turn, increase the risks of adult psychiatric problems and disorders. If this is correct, then focusing on improving the social and interpersonal difficulties of those with histories of child sexual abuse may be the most effective manner of reducing subsequent psychiatric disorder. 

This argues for tertiary prevention strategies aimed at improving self-esteem, encouraging more effective action in work and recreational pursuits, attempting to overcome sexual difficulties, and working specifically on improving the victim’s social networks and capacities to trust in, and accept, intimacy. This does not imply that established affective disorders or eating disorders should not be treated in their own right, but suggests that focusing on current vulnerabilities and deficits may be more productive than extended archeologies of past abuse in the search of an elusive retrospective mastery. 

Conclusion 

The hypothesis advanced in this paper is that, in most cases, the fundamental damage inflicted by child sexual abuse is to the child’s developing capacities for trust, intimacy, agency and sexuality, and that many of the mental health problems of adult life associated with histories of child sexual abuse are second-order effects. This hypothesis runs counter to the post-traumatic stress disorder model, and suggests different therapeutic strategies and strategies of secondary prevention. 

In practice, both models may be of value. The post-traumatic stress disorder like mechanisms may predominate in the short term, and in those who have been exposed to the grossest form of child sexual abuse. The developmental and social model may carry the weight of causality in the far commoner, but less utterly overwhelming, forms of child sexual abuse. 

References (see Library)

Long-term Effects of Child Sexual Abuse 
by Paul E. Mullen and Jillian Fleming

wwww.aaets.org/article176.htm

GLOBAL Articles …

After reading through the recent WP Articles of Supply and Demand – What about the Truth?, Abuse – Turning a Blind Eye no MoreOfficial: Priest accused of going AWOL & How to Let Go of the Need to Control Others it is noted that the patterns of Child Sexual Abuse is by no means cases of ‘isolated incidents’, ‘sole Predators’ or ‘one-off errors’. In what some have long suspected as an endemic problem, this will also require a common solution. Beyond the Religious basis of Catholicism (where many of these ordeals were hidden; 7% of all Catholic priests in Australia; age at the time of the abuse was 11.5 for boys and 10.5 for girls) , a multi-facetted approach will be needed. Australia’s 5 yr Royal Commission 2013-2017 uncovered many of these ingrained occasions, yet so much more is needed for effective change. It is known that many families of CSA Victims continue to follow their Church beliefs, ahead of acknowledging the wrongful impacts on their targeted child.
Perhaps the ingrained element of Control over our vulnerable stems from Caesar’s control over Rome, Anakin’s/Darth Vader’s control over Resistance (Star Wars), or simply the control dynamics found in many a child’s playground. The 4th Article gives us an outlook of personal stresses with micromanaging our children & spouse. Control of ourselves is a major stage in Dr Perry’s Article, involving personal strengthening stages. There may always be others trying to control us, yet through effective parenting-family-networks light will always be possible.

Fresh sexual abuse claims at The Armidale School

The prestigious NSW private school, where a boarding house mistress admitted to sleeping with several male students, has been embroiled in new claims of sexual abuse by a staff member.
— Read on www.smh.com.au/national/nsw/fresh-sexual-abuse-claims-at-the-armidale-school-20181228-p50ong.html

Long-term Effects of Child Sexual Abuse (8)

Alcohol abuse

Research into the relationship between child sexual abuse and alcohol abuse began with reports that clients with substance abuse problems reported high levels of exposure to child sexual abuse. A review of 12 studies conducted prior to 1995 indicated that the rates of child sexual abuse among those in treatment for alcohol abuse varied from as high as 84 per cent to as low as 20 per cent (Fleming et al. in press (b)).

Other evidence suggesting a relationship between child sexual abuse and alcohol abuse came from studies of women with histories of child sexual abuse who were attending treatment for mental health problems. These studies generally found higher rates of alcohol abuse in women with a history of child sexual abuse (Pribor and Dinwiddie 1992; Swett and Halpert 1994).

Recent research into the relationship between child sexual abuse and alcohol abuse has been methodologically more sophisticated than in the past, and has used community samples with larger sample sizes, random samples and more adequate definitions for both alcohol abuse and child sexual abuse (Peters 1988; Bushnell et al. 1992; Fergusson et al. 1996). However, conflicting results on the possible linkage between child sexual abuse and alcohol abuse have been reported. This has given rise to doubt about the strength of an association, the extent to which this relationship reflects a causal connection, and how any connection is mediated and influenced by other aspects of background and development.

The link between child sexual abuse and alcohol abuse may not be a simple causal chain. Fleming et al. (in press, (b)) in a case-control study examining the relationship between a reported history of child sexual abuse and the development of alcohol abuse in a sample of 710 Australian women, proposed that a history of child sexual abuse was not, by itself, sufficient to cause alcohol dependency in women. The relationship between child sexual abuse and alcohol abuse more likely reflects a complex interplay between child sexual abuse and a range of other factors in a woman’s life. Their results showed that in combination with the perception of a mother who was uncaring and overly controlling, being sexually abused did increase the risk of alcohol abuse in women. These results also suggest evidence for protective effects such that the perception of having a kind, caring and loving mother may help overcome some of the potentially adverse effects of child sexual abuse on subsequent vulnerability to alcohol abuse.

The proposition that the long-term effects of child sexual abuse may be modified by an individual’s experience subsequent to the abuse has also been suggested. Romans et al. (1995 and 1997) demonstrated that long-term problems following child sexual abuse were significantly lower in those who had supportive and confiding relationships with their mothers. In addition, in adults with a history of child sexual abuse, a three-way interaction was found between child sexual abuse, having an alcoholic partner, and having high expectancies of alcohol as a sexual disinhibitor.

The research on child sexual abuse and alcohol abuse illustrates the complexity of the interactions between abuse and the emergence of adult problems. As a minimum, there are interactions between the severity of the abuse, the family relationships prior and subsequent to the abuse, the adult victims’ preconceptions about alcohol reducing sexual anxieties and, finally, the drinking habits of their eventual partner. Even this list fails to convey the complexity of the dynamic interactions between development, abuse and family and social experiences. This is not complexity for the sake of complexity. Understanding the impact of child sexual abuse in a developmental and interactive perspective is central to effective therapy for adults and child victims, and for secondary prevention strategies.

Unravelling the associations between abuse and long-term problems

There is a wide range of potential adverse adult outcomes associated with child sexual abuse. However, there is no unique pattern to these long-term effects and no discernible specific post-abuse syndrome. This suggests that child sexual abuse is best viewed as a risk factor for a wide range of subsequent problems.

In studies on the long-term impact of child sexual abuse that employ adult subjects, it is all too easy to forget the abuse occurred in childhood, and to resort to applying inappropriately adult-centred conceptualisations. In deriving models of the link between child sexual abuse and adult difficulties, the heavy reliance on the concept of post-traumatic stress disorder may be an example of such an error.

The sexual abuse of children occurs during a period in life where complex and, hopefully, ordered changes are occurring in the child’s physical, psychological and social being. The state of flux leaves the child vulnerable to sustaining damage that will retard, pervert or prevent the normal developmental processes. The impact of abuse is likely to be modified by the developmental stage at which it occurs. It will also vary according to how resilient the child is in terms of their psychological and social development up to that point. A child who has already had to cope with, for example, a problematic family background or prior emotional abuse, will be more vulnerable to the additional blow of child sexual abuse. A child from a more secure and privileged background may well be equally distressed at the time by the abuse, but is likely to sustain less long-term developmental damage.

These suppositions are born out by studies that have demonstrated powerful interactions between the child’s prior exposure to potentially damaging situations, and the degree of adult disturbance apparently associated with a history of child sexual abuse (Mullen et al. 1993 and 1994; Fergusson et al. 1996 and 1997).

The long-term effects of child sexual abuse will also be modified by the individual’s experience subsequent to the abuse. Romans et al. (1995 and 1997) demonstrated that long-term problems following child sexual abuse were significantly lower in those who had supportive and confiding relationships with their mothers and in those who, as adolescents, experienced some success at school or with peers. The nature of this success (academic, social or sporting), is probably less important than the accompanying strengthening of self-esteem and enhancement of opportunities for effective social interactions with peers.

The relationship between the potential damage inflicted on elements in the child’s development and subsequent mitigating factors is, of necessity, complex. For example, the observation that those victims of child sexual abuse who manage to establish and maintain stable marital relationships are protected against some of the potentially adverse outcomes of child sexual abuse (Cole et al. 1992) may reflect, in part, the mitigating and healing influence of effective intimacy. However, equally, the association may be a product of the ability of those, who have for other reasons avoided the worst effects of child sexual abuse, to enter and sustain intimate relationships.

Peters (1988) suggested that child sexual abuse interacts with family background to produce disruption of the child’s developing self-esteem and sense of mastery of the world (agency). It is these deficits, in turn, that increase the likelihood of psychological problems in later life. This model of developmental deficits leading to social and personal vulnerabilities in adult life, which in their turn create an increased risk of mental health problems, can usefully be expanded.

Those with histories of child sexual abuse, particularly of the more physically intrusive types, have an increased risk of social, interpersonal and sexual problems in adult life. This association may play a role in mediating at least some of the far better known associations between child sexual abuse and mental health problems.

Greater vulnerability to depression is found in women who lack an intimate and confiding relationship (Henderson and Brown 1988; Harris 1988; Romans et al. 1992). Depression is also associated with lowered self-esteem and a sense of hopelessness about one’s ability to influence one’s life (Browne et al. 1986, Ingram et al. 1986). Thus the social, interpersonal and sexual problems associated with a history of child sexual abuse may themselves provide fertile ground for the development of mental health problems, particularly in the area of depressive disorders.

A plausible hypothesis can be advanced that the developmental disruption engendered by child sexual abuse in the victims’ sense of self-esteem, sense of agency, sense of the world as a safe enough environment, in their capacity for entering trusting intimate relationships and, finally, in their developing sexuality, leads in adult life to an increased risk of low self-esteem, social and economic failure, social insecurity and isolation, difficulties with intimacy and sexual problems.

This constellation of difficulty is a pattern of disadvantage likely to leave the subject prone to depressive and anxiety disorders. The vulnerability may be expressed if, and when, the subject encounters psychosocial or physical stressors, particularly if those stressors target specific areas of developmental vulnerability. (See Figure 1)

Long-term Effects of Child Sexual Abuse 
by Paul E. Mullen and Jillian Fleming
http://www.aifs.gov

Long-term Effects of Child Sexual Abuse (7)

Relationships and intimacy

The sexual problems linked to child sexual abuse could be an entirely specific effect related to traumatic sexualisation, or could be contributed to by a wider constellation of disruption of interpersonal and intimate relatedness. Child sexual abuse involves a breach of trust or an exploitation of vulnerability, and frequently both. 

Sexually abused children not only face an assault on their developing sense of their sexual identity, but a blow to their construction of the world as a safe enough environment and their developing sense of others as trustworthy. In those abused by someone with whom they had a close relationship, the impact is likely to be all the more profound. A history of child sexual abuse is reported to be associated in adult life with insecure and disorganised attachments (Alexander 1993; Briere and Runtz 1988; Jehu 1989). Increased rates of relationship breakdown have also been reported in those exposed to child sexual abuse (Beitchman et al. 1991; Bagley and Ramsey 1986; Mullen et al. 1988). 

Mullen et al. (1994) found that their subjects reporting child sexual abuse were more likely to evince a general instability in their close relationships. Though those with histories of child sexual abuse were just as likely as controls to be currently in a close relationship, they were more likely in the past to have experienced divorce or separation. When asked about the level of satisfaction with their current relationship, those with abuse histories expressed significantly lower levels of satisfaction. The level of current satisfaction was lowest for intercourse victims. 

Relationship problems were also reflected in the evaluations of the quality of their communication with their partners. Less than half of the victims felt able to confide personal problems to their partner, and nearly a quarter reported no meaningful communication with their partners on a more intimate level, whereas only 6 per cent of controls took an equally negative view of their partners receptivity to their concerns. This perceived gap in communication at a deeper level rose to 36 per cent in those reporting child sexual abuse involving penetration. 

In this study, those reporting child sexual abuse were more likely to rate their partners as low on care and concern, and high on intrusive control. Interestingly, the deficiencies perceived in their partners as sources of emotional support by those with histories of child sexual abuse was not generalised to peer relationships where they were just as likely to report they had friends in whom to confide and with whom to share their troubles.

A community study of Australian women found similar results with a history of child sexual abuse adversely affecting the quality of women’s relationships in adult life, and increasing the likelihood of divorce and separation (Fleming, 1997, Fleming et al, in press). Women who reported a history of child sexual abuse were more likely to report their current partner to be uncaring and highly controlling, and to be dissatisfied with the relationship. Child sexual abuse appears to affect a woman’s ability to maintain intimate relationships by interfering with her capacity to develop her sexuality and trust in others. The results of this study also found that women with histories of child sexual abuse who found difficulty in forming satisfying intimate relationships did not, however, report an inability to form close friendships or to receive emotional support from friends. 

It is tempting to suggest that the experience of child sexual abuse at a vulnerable moment in the child’s development of trust in others predisposes to a specific deficit in forming and maintaining intimate relationships. The attribution of a lack of concern and a tendency to be intrusive and overcontrolling to their partners could be a product of these partners’ actual attitudes and behaviour, or could reflect primarily the expectations, interpretations and projections directed at the partner by these women with histories of child sexual abuse. Conversely, those who have been abused may be more prone to enter relationships with emotionally detached and domineering partners because their lowered self-esteem and reduced initiative limits their choices, or from some neurotic compulsion to repeat.

Self-esteem

Self-esteem encompasses the extent to which individuals feel comfortable with the sense they have of themselves (the self for self) and, to a lesser extent, their accomplishments, and how they believe they are viewed by others (the self for others). Robson (1988) wrote that self-esteem is ‘the sense of contentment and self acceptance that stems from a person’s appraisal of his (or her) own worth, significance, attractiveness, competence and ability to satisfy aspirations’. 

A number of studies have implicated child sexual abuse in lowering self esteem in adults (for review, see Beitchman et al. 1992), but the most sophisticated examination of the issue to date is that of Romans et al. (1996). This study showed a clear relationship between poor self-esteem in adulthood and a history of child sexual abuse in those who reported the more intrusive forms of abuse involving penetration. It was, however, those aspects of self-esteem involved with an increased expectation of unpleasant events (pessimism) and a sense of inability to influence external events (fatalism) that were affected, not those involved with a sense of being attractive, having determination, or being able to relate to others.

Long-term impact on mental health

There have been numerous studies examining the association between a history of child sexual abuse and mental health problems in adult life that have employed clinical samples, convenience samples (usually of students), and random community samples. There is now an established body of knowledge clearly linking a history of child sexual abuse with higher rates in adult life of depressive symptoms, anxiety symptoms, substance abuse disorders, eating disorders and post-traumatic stress disorders (Briere and Runtz 1988; Winfield et al. 1990; Bushnell et al. 1992; Mullen et al. 1993; Romans et al. 1995 and 1997; Fergusson et al. 1996; Silverman et al. 1996; Fleming et al. in press). A more controversial literature links multiple personality disorder with child sexual abuse (Bucky and Dallenberg 1992; Spanos 1996). 

Space does not allow a full review of the complex relationships between adult psychopathology and child sexual abuse but to illustrate the trajectory followed by such research in recent years, the literature relating a history of child sexual abuse to alcohol abuse in adult life will be briefly considered.