By Kathy A. Goodrich, CSW-R

Editor's Note: this is the second in a series of articles on sexual abuse by Kathy Goodrich. These articles have been adapted from Ms. Goodrich's teaching at an October 2000 OneByOne Conference.

Early research on the effects of child sexual abuse generally was limited to female victims. Gradually, clinical and empirical studies increased with regard to boy victims and adult male survivors of child sexual abuse as society acknowledged the phenomenon of male victimization. Following is an overview of the initial and long-term effects of sexual abuse on boys and adult males. Matthew Parynik Mendel states in The Male Survivor (CA: Sage Publications, 1995) that "it is futile to try to determine whether males or females are affected more adversely by sexual abuse. Rather, research demonstrates conclusively that all child sexual abuse has pronounced deleterious effects on its victims, regardless of their gender" (101).

Initial Effects of Childhood Sexual Abuse for Boys

(1) Emotional and Psychological Distress: Fear; Self-Concept/Self-Esteem Problems; Guilt and Shame; Anxiety; Depression; Sleep Disturbance; Suicidality; Withdrawal and Isolation; Anger and aggressiveness; Dependency

Burgess et al. (1981) conducted a study of children in sex rings and identified four patterns of impact: 1) integration of the trauma, so it no longer caused problems; 2) avoidance, so victims function adequately until confronted with the trauma, at which time they become anxious or fearful; 3) recurrent symptoms, indicating a continuation of the trauma; and, 4) identification with the exploiter, which often leads to exploitation of others.

2) Behavioral Problems: Male victims report their abuse less often than do females, so they are more likely to come to the attention of helping professionals through behavioral indicators. Even so, boys often miss out on mental health services and instead, their first intervention is provided by the criminal justice system. In a 1987 survey of therapists who worked extensively with male sexual abuse victims, J. Sebold found the following eight common behavioral indicators:

Homophobic Concerns -- anxious attempts to convince others that one is not gay; lack of toleration for effeminate behaviors in others; insults and attacks on those perceived as gay, stereotypical macho behavior or heterosexual braggadocio.

Aggressive and Controlling Behavior -- to reassure themselves they are not small, helpless, and vulnerable, boys may intimidate and overpower others with the unfortunate consequence of further isolation.

Infantile Behavior and Speech, and play with younger children.

Paranoid/Phobic Behavior -- hypersensitivity to environmental cues; feeling terrified of getting caught for minor infractions; and, fear of extreme punishment. This is connected with the severity of their abuse and internalized feelings of guilt..

Sexual Language and Behaviors -- preoccupation with sexual thoughts, language, and behaviors; excessive or public masturbation; related problems with concentration and sleep disturbance.

Dreams of being chased, punished, or isolated.

Body Image Concerns -- compulsive neatness or use of sloppy appearance to decrease their appeal to possible abusers.

Other Indicators -- fire-setting, running away, prostitution, enuresis and encopresis, and struggles with trust and intimacy.

3) Sexual Problems (Outward Behaviors and Internal Concerns)

Confusion/Anxiety Over Sexual Identity -- Male victims often blame themselves for their victimization, and believe it was due to some sign of femininity or homosexuality on their part. Any physical pleasure or sexual arousal created by the abuse leads to more concern about sexual identity.

Inappropriate Attempts to Reassert Masculinity -- compensatory over-identification with the masculine stereotype, including bullying, fights, destruction of property, and confrontational, defiant, or disobedient behavior.

Recapitulation of the Victimizing Experience/Sexual reactivity -- a boy victim sometimes recreates a scenario similar to his own victimization, with methods to gain "compliance, specific sexual acts and even age differences being patterned after the original incident" (C.M. Rogers and T. Terry, 1984, "Clinical Interventions With Boy Victims of Sexual Abuse" in I. Steward and J. Greer, eds., Victims of Sexual Aggression, NY: Van Nostrand Reinhold.) Again, this is considered to be a male victim's efforts to reassure himself of his masculinity which was removed by his own victimization experience. The victimized child may develop a worldview with only two choices--abuser or victim--and he may choose the former to escape the latter.

Long-Term Effects of Childhood Sexual Abuse for Adult Men

1) Emotional and Psychological Distress: In a study presented at the "Third National Conference on the Male Survivor" in Tucson, AZ, R.J. Kelly and LS. Gonzalez reported on the gender-differentiated response of male survivors to the four dynamics of betrayal, powerlessness, stigmatization, and traumatic sexualization identified by D. Finkelhor and A. Browne (1986). Their sample was taken from men registering for an out-patient treatment group for male survivors of sexual abuse.

Some of their significant findings include the following: § 63% had confusion about sexual identity 75% were sexually preoccupied § 44% had aversion to sexual intimacy § 44% had compulsive sexual behaviors § 69% had feelings of extreme guilt and shame § 94% had a sense of being different than others 88% were clinically depressed § 81 % had impaired ability to trust men, and 50% had difficulty trusting women § 100% had marital problems § 81% had experienced flashbacks § 69% had extreme anxiety

2) Relationship Difficulties: Male survivors have particular difficulties with maintaining intimate relationships and meeting personal needs within a relationship. Often, they are unfaithful to partners, promiscuous, or have multiple concurrent partners (Krug, 1989; Steele & Alexander, 1981). Intense involvement is often followed by abrupt withdrawal and isolation, similar to their use of "turning off" and "checking out" during sexual abuse incidents. Male survivors may discover that they recreate the dynamics of their childhood with unhappy, aggressive women and diffuse boundaries. Others become rescuers and head into medical and social work professions, taking too much responsibility for outcomes. Many feel doomed to perpetuate sexual abuse.

3) Sexuality and Sexual Problems: Adult survivors of sexual abuse may try to prove their self-worth and sexual adequacy strictly through sexual activity, or conversely, they may avoid sex altogether due to their insecurity. Compulsive sexuality which includes preoccupation with sexual thoughts, fascination with pornography, compulsive masturbation, sexual interactions in restrooms, and frequent and multiple sex partners is also common.

In a 1984 sample of young male prostitutes, (Janus et al), 39% had been incestuously abused, and 86% reported a coercive sexual experience prior to becoming prostitutes.

4) Sexual Orientation: Sixty-four percent (64%) of male survivors in the 1988 study by Dimock had masculine identity confusion. They doubted their masculinity, called themselves "wimp" and "gay", and struggled emotionally with their inability to protect themselves from sexual abuse. Several researchers have found higher rates of sexual abuse among homosexual than heterosexual populations, or higher rates of homosexual orientation among those who report childhood sexual abuse than among the general population (Mendel, p. 117).

Johnson and Shrier's 1985 and 1987 studies of adolescents in an outpatient medical clinic indicate that homosexual identification is seven times greater and bisexual identification six times greater for victimized males than for a comparison group of non-abused adolescent boys.

In their second study in 1987, the above researchers compared the 11 adolescents molested by females with the 14 adolescents abused by males and found that the sexual orientation effect was specific to the male-molested group. Approximately one-half of those abused by males identified themselves as homosexual and often linked their homosexuality to sexual victimization (Mendel, 118). An earlier 1982 study (C.G. Simari and D. Baskin, "Incestuous Experiences Within Homosexual Populations: A Preliminary Study", Archives of Sexual Behavior, 11, 329-344) found that incest was reported by 46% of male homosexuals, with about two-thirds (64%) of this involving the extended family and one third (36%) involving the nuclear family. The most frequent perpetrators of incest were male first cousins (60%) and brothers (32%). Simari and Baskin state that 96% of their study participants indicated "they identified themselves as actively homosexual before the occurrence" of the abuse incidents. This leaves us to speculate regarding how, if these self-reports are accurate, some of the perceptions and behaviors of the sexually wounded may contribute to vulnerability that is taken advantage of by sexual predators.

5) Addictive Behaviors: Among those who have been sexually abused over a long-term period, we often find high rates of substance abuse, compulsive overworking, compulsive overeating, compulsive spending, and sexual addictions.

Jose was the youngest of 10 children who lived with their rum- drinking parents in a crowded 3-room farmhouse in rural Puerto Rico . Boundaries were diffuse within the family and rigid between the family and larger community. Jose was not allowed to play freely outdoors, so he generally played house with his older sisters. They assigned him the role of mother-in-law. Jose realized at the age of 8 or 9 that he felt different from other boys and preferred to identify with girls. A brother 10 years his senior who shared his bed called him demeaning names and threatened Jose and their parents with knives. The mother's promise that Jose would inherit part of the farm generated sibling jealousy. Jose stated that various male relatives sexually abused him. Despite the existence of police and social services, the rural sub-cultural norm was for vigilantes to take the law into their own hands and to beat up rumored sex offenders. The potential retribution for his disclosure could result in further violence or death, so Jose kept his many secrets. After 5 years of planning his getaway, Jose moved to the mainland. A nephew told Jose's father that Jose was gay, ensuring that he would neither be able to return to visit nor to receive his expected inheritance. Jose successfully completed "English As A Second Language" classes and an "Urban League Clerical Training" course. He struggled, however, with job interviews. He also moved in with an alcoholic construction worker who expressed ambivalence about loving Jose and who demanded that Jose take the passive role in sadomasochistic activities. When I met him, Jose had cut his arms, walked in front of traffic, overdosed, thought of hanging himself, and ran through downtown at night sobbing, I Ayudarne, Senor!" -- Help me, Lord!

6) Cyclical Victimization or Perpetuation of Sexual Abuse: Numerous studies conducted in the past 30 years have found high rates of sexual abuse in the family histories of sex offenders and incest perpetrators. However, childhood sexual abuse does not invariably lead one to become a sex offender. Positive relationships with adult role models, learning appropriate methods to deal with psychological distress and to vent anger, and therapy all may prevent what -- in Family Systems terms -- we call the Multigenerational Transmission Process.

Michael Lew (Victims No Longer, 1990) asserts that male survivors have three primary ways to deal with their confusion regarding their masculinity and use of power: identify with the perpetrator; continue being a victim; or become a protector of others in similar circumstances and assist in the recovery process. Lew proposes that this accounts for the high numbers of sexual abuse survivors in the helping professions. Robert Freeman-Longo (1986) found two (2) critical risk factors for the repetition of sexual abuse: 1) victimization by more than one perpetrator on separate occasions, and 2) abuse that occurs repeatedly over a long period of time. We must recognize males as abuse victims in order to reduce the incidence of males as sex offenders.

Chilren who are traumatized by incidents of incest or extrafamilial. abuse are not allowed to learn about sexuality at their own pace but instead are coerced into activites with an older person with greater power and authority. Sexually abused children experience sexual arousal paired with feelings of fear, confusion, and pain.

Harry was gang-raped by his brother and brother's friends when he was a pre-teen. He recalls hiding in a kitchen cupboard and holding his breath often when he saw his brother arriving home. An early marriage to an equally damaged young woman left him more unhappy. One evening upon lifting his two-year-old son out of the bathtub to towel him off, Harry found himself both fascinated and horrified when he fondled his son. The young boy disclosed and was believed, leading to Harry's arrest, conviction, and four-year prison term. This slightly-built, depressed young man, who had never received survivor treatment, participated in an offender therapy group I co-facilitated at a family service agency. Several months into his therapy, Harry was invited to enter some art work in a local treatment providers conference and art show. His haunting cartoon was of Snoopy, the Peanuts cartoon dog, wearing a mask.

Conclusion Graham was musically and artistically talented at a young age, according to his adoptive parents. Those base talents were further developed as he participated in the church youth choir and bell choir. The youth choir director took a special interest in Graham, offering him additional mentoring and back rubs which led to months of sexual abuse. As occurs with many abuse victims, he believed for a while that he had been a willing participant and the physical arousal seemed to suggest he was gay. Eventually, however, he disclosed to his parents and the church's senior pastor, who decided not to call Child Protective Services or the City Police. Instead, church elders investigated and had the choir director transferred to a church out West.

While not fitting the classic profile of Posttraumatic Stress Disorder, Graham has struggled over the last twenty years with depression and social isolation, trust issues, and doubts as to his sexual orientation. He has explored various occupations and found that he excels in the creative arts. Counseling and movement therapy have assisted along the way, and more recently he has explored Eastern healing arts. Though not abandoning his mainline denomination, Graham struggles to reconcile the concept of an all-powerful God with the prevalence of child sexual abuse and the betrayal by his once-trusted choir director.

In 1990, David Finkelhor updated the review he and Angela Browne had conducted in 1986 regarding childhood sexual abuse. Finkelhor wrote "perhaps the greatest surprise is the relative similarity of response of boys to that of girls" in terms of 4 traumatogenic dynamics: stigmatization, betrayal, traumatic sexualization, and powerlessness.

Matthew Mendel, who conducted the first national survey of male survivors of sexual abuse, found the above themes as well. His subjects felt they were bad, worthless, and different from those around them. They struggled to understand how adults in caretaking roles, many of whom expressed affection at times, could so betray them through abuse. They struggled daily with trust and intimacy. Some found that the abuse seemed to have wrecked their desire, as adults, for sexual activity. Others found sex to be the only way they know to achieve human contact and to express affection. Some men realized they always take a rescuer or parentified role in relationships, and sacrifice their needs and wishes for those of others.

Mendel found 3 other areas of difficulty that are especially characteristic of men, due to differential male and female socialization. These areas are: 1) the inconsistency between and efforts to integrate the male role expectation and the experience of victimization: 2) shame and gender-shame; and 3) identification with the perpetrator and fear of continuing the cycle of abuse. The experience of helplessness and being acted upon is highly threatening to men's sense of themselves as men. Therapy must first affirm the male victim's masculinity, strength and competence before helping him to accept that despite these qualities he was victimized.

While female victims must deal with the myth of the seductive daughter or "Lolita Syndrome", they tend to soften the psychological blow of self-blame by blaming their mothers for not protecting them from incest by their fathers or siblings. In my observations over the years, this anger toward the mother by a female survivor creates a concurrent longing to be nurtured and a desire not to identify with the same-gender parent, a conflict which may set the stage for a homosexual struggle.

Male survivors' shame appears to have a different quality from that experienced by female survivors. Males experience gender shame, or sense of shame about oneself as a member of the class "men" who have become perceived as evil oppressors. This does not help male survivors in their quest for positive sense of self, and as with one of my male clients, may lead to horrendous self-mutilation of genitals that may or may not be surgically repaired.

As previously stated, concerns about sexual orientation are quite ubiquitous among male survivors of childhood sexual abuse. In Mendel's national study, 34% of male participants characterized themselves as primarily or exclusively homosexual (Mendel, 207). However, as survivors explore the distorted messages received from their families of origin and/or extrafamilial offenders and false conclusions based on those distortions, many find same-gender, non-homosexual relationships in which to meet their developmental need for gender affirmation and non-sexualized nurturance, and to develop eventual same-gender friendships and heterosexual interests.

Kathy Goodrich is a certified social worker with over twenty years experience in counseling survivors and offenders of sexual abuse, including both adults and children. She is also a member of the OneByOne Advisory Board.