By Kathy A. Goodrich, CSW-R

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

Introduction

This is an era when a six-year-old child, whose small world is just now expanding from her home, church, extended family and school, sees the graffiti on a local playground wall and declares to her Mommy, "That means sexy, and sexy is how boys like you." Pre-teens and teenagers, skilled with computer use and finding their way to chat rooms, are meeting virtual (and not-so-virtuous) strangers at the local mall or park, being showered with ego-stroking words of admiration, and ultimately engaged in far more than the parent-circumventing correspondence suggested. How can one know anymore what behaviors indicate a strong possibility of sexual abuse as currently defined by law versus cognitions, language and behaviors that reflect secular culture?

An early pioneer in the identification and treatment of child sexual abuse, Suzanne M. Sgroi, M.D., stated years ago that "Recognition of sexual molestation in a child is entirely dependent on the individual's inherent willingness to entertain the possibility that the condition may exist." All of you [reading this article] are to be commended for your willingness to contemplate the dynamics and consequences of intra- and extra-familial child sexual abuse.

I would like to attempt to define sexual abuse for you, so that we understand the broad scope of the problem. (I say "attempt" because human beings motivated by distorted thinking and selfish desires continually discover additional methods such as the newer technologies to achieve self-gratification through sexualized relationships.) Sexual abuse may be overt, that is obvious and with no effort to hide the fact that it is sexual in nature. Or abuse may be covert, in which the offender behaves as if he or she is doing something non-sexual while all along he or she is being sexual. Many survivors of covert sexual abuse have learned to mistrust their own emotions and perceptions of reality.

Lucy Berliner, well-known author, trainer and therapists with the Sexual Assault Center of Seattle, WA, defines sexual abuse as: "the sexual exploitation of a child who is not developmentally capable of understanding or resisting the contact, or who may be psychologically and socially dependent upon the offender." Mic Hunter, author of Abused Boys: The Neglected Victims of Sexual Abuse (1990), includes the following behavior as types of sexual abuse: the adult sexually touching the child or using penetrating objects; having the child touch the adult sexually; photographing the child for sexual purposes; sexualized talk; showing the child pornographic materials or making them available to the child for 'sex education' and to sexually groom the child; making fun of or ridiculing the child's sexual development, preferences, or organs; the adult exposing his or her genitals to the child for sexual gratification; masturbating or otherwise being sexual in front of the child; voyeurism, with repeated observations about how the child is or is not physically maturing; boring peepholes in bedroom or bathroom walls; walking in on people bathing or dressing without their permission; removal of doors to prevent privacy; forcing overly rigid rules on dress or overly revealing dress (establishing by sexually compulsive adults who believe that sexual urges are nearly impossible to control); stripping to hit or spank, or getting sexual excitement out of hitting while calling the child sexual names or accusing him of sexual crimes; verbal and emotional abuse of a sexual nature; having the child be sexual with animals; engaging the child in prostitution; witnessing others being sexually abused, often leading to hypervigilance, second-guessing, obsessive thinking, false sense of responsibility.

Family Patterns Indicative of Child Sexual Abuse

Three interactional patterns of parents in incest families are often seen by professionals:

The Dependent-Domineering Relationship - a dependent, inadequate man and a stronger, domineering woman. The woman often may refer to her husband as "one of the kids." He has little real power in the family, although he may be provoked to violent outbursts of anger. Eventually the mother-wife grows tired of her husband's dependency and his inability to meet her needs, and withdraws from him emotionally and sexually. He may then turn to a less threatening, more accepting and sympathetic female--his daughter.

The Possessive-Passive Relationship - occurs in patriarchal and certain conservative Christian families that emphasize male headship. The father controls everyone and everything in the home and perceives family members as his possessions. Although the wife may complain, for example about her limited grocery allowance, ultimately she tends to collude with her husband to maintain secrecy and keep the family system as it is.

Incestrogenic or Dependent-Dependent Relationships - frequently one or both of the parents have been sexually abused by their parents or other family members during childhood. These emotionally dependent and resentful adults cannot meet each other's needs or those of their children, and instead, they look to their children for love and parenting.

The Fowler family represents many of the dynamics of a system in which child sexual abuse can and does occur. They were referred for intensive family counseling by County Department of Social Services (DSS) in 1980. During that time, before managed care and permanency planning required short-term services, we were able to meet in both office- and home-based sessions for three years.

Sam, the father, was a functional alcoholic employed by a local corporation as a blue collar worker. While growing up in Brooklyn , Sam often heard that his father had never wanted children. Drafted into the Army, Sam saw the terrors of war in Vietnam and tried to cope with the pain through alcohol and drugs. His self-image was already distorted by turned to self-loathing when, as a bid to be accepted by other African American brothers, he engaged in a group rape. Despite the powerful role of the church in the African American community, Sam did not know how to appropriate forgiveness.

Ethel, the mother, struggled to raise their three sons and a daughter without the active involvement of Sam. Initially, she kept the two older sons home from school to confide in, creating a diffuse boundary between the parental subsystem and the children. She reportedly shot Sam once when he had threatened her with his gun. She considered leaving him during his convalescence but stayed due to religious convictions and financial dependence. During Sam's weekend binges, he engaged in various sexual liaisons and then came home early Sunday morning, pounding on the door until let in to sleep off his intoxication. Ethel often retreated to the attic to read her Bible and pray. The second son, Ivan, knifed his older brother, Sam Jr., in a TV dispute and exhibited explosive behaviors at school. The third son, Michael, had been infantilized and used pointing instead of verbal language to get his needs met. Jennifer, the pre-schooler, was obese.

During the three years of counseling, Ethel developed supportive relationships with relatives and friends, and sent her children to school. The pediatrician was unusually helpful, even calling the utilities company to get heat and electricity restored. Donations of good, used clothing and furniture were provided. Sam's health deteriorated, and one day, he requested help in getting into a VA hospital. Upon discharge, he relapsed, moved to his mother's home in Georgia to avoid a bench warrant, used an alias, and totaled a car. Ethel sued for divorce in order to not be legally responsible for Sam's behavior.

Eleven months after the required case closing, Ethel called to sadly report that her oldest son had molested her daughter and was on probation. Poor role models, blurred intra-familial boundaries, emotional abuse and neglect all had contributed to the sexualized expression of rage and power.

Differentiating Age-Appropriate Sexual Interest/Play from Problematic Sexual Behaviors

Children are born, with rare exceptions, with the capacity to develop sexual curiosity and eventually, sexual behaviors. Normal sexual development usually progresses along a continuum shared with physical, emotional, cognitive, psychological, and moral development. Many variables affect the child's ability to follow along this developmental path, and these variables need to be considered when one is assessing whether childhood sexual behavior is age-appropriate.

Family dynamics are a critical factor in child sexual development. Over-sexualized parents who speak with sexual innuendo or frequently comment on their children's pubertal body changes or interest in the opposite gender may create a sexually charged atmosphere in which undue emphasis is placed on this aspect of the whole person. Under-sexualized parents who are unwilling to provide sex education or to answer their children's basic questions may convey that bodies are shameful and sex is altogether dirty or taboo. Either extreme may harm the child's sexual development.

Nudity, to some degree, is normal and healthy in daily family living. Runs to and from the bathroom, watching a younger sibling's diaper changer, or trying on clothes in front of each other are not harmful experiences. When parents expose themselves because they want adult sexual gratification, children experience eroticized nudity that can heighten interest and lead to aggressive sexual play with same age peers or vulnerability to abuse by adults.

Relaxed standards for television-watching and music-listening also influence children's interest in sexuality. Eliana Gil, Ph.D., states that children, when allowed to watch X-rated movies with explicit sexual information, obtain knowledge that may influence their fantasies and arousal mechanisms. Their developmental process is accelerated as they look for additional gratification (Gil, 27).

Children who are traumatized by incidents of incest or extra-familial abuse are not allowed to learn about sexuality at their own pace but instead are coerced into activities with an older personal 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 which I co-facilitated. 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.

Effects of Sexual Abuse on Victims Post-Traumatic Stress Disorder. Post Traumatic Stress Disorder (PTSD) is a term commonly used to described the characteristic psychosocial reactions that often follow disaster or extreme psychological stress. PTSD has been observed in war veterans, survivors of major earthquakes and hostage situations, and survivors of other severe types of trauma including sexual abuse. The symptoms may be manifested for less than three months (acute), for more than three months (chronic), or with delayed onset, that is, at least 6 months and sometimes years after the traumatic event.

Specifically, survivors of sexual abuse often: fear a reoccurrence of abuse and believe the offender's power is still in effect; fear the loss of control; fear vulnerability; feel rage at those exempt from trauma; have survivor guilt; have deep grief; feel isolated; experience paranoia and hypervigilance; have various addictions and compulsions. Jean Goodwin, M.D. concludes that most incest experiences are potentially traumatogenic, and add that the trauma is more accurately understood as one explores the daily childhood realities of the incest survivor.

Borderline Personality Disorder. Borderline Personality Disorder (BPD) is another constellation of behaviors commonly seen among some survivors of childhood sexual abuse. It represents a pervasive pattern of instability in interpersonal relationships, self-image and affect.

Frequently one sees frantic efforts to avoid real or imagined abandonment. The person has a pattern of unstable and intense interpersonal relationships alternating between extremes of idealization and devaluation. The person has an unstable sense of self and confusion about boundaries, like the old Wind Song commercial "Where do I end and you begin?"

Often, individuals with borderline personality disorder are impulsive in potentially self-damaging areas such as spending, sex, substance abuse, or binge eating. They have recurring suicidal behavior, gestures or threats, or self-mutilating behavior. They experience episodes of mood reactivity and irritability lasting from a few hours to a few days. During such times, they may, for example, threaten to cut their children out of their will or turn their grandchildren's hearts against the latter's parents. They may also have inappropriate, intense anger and/or physical fights.

Another symptom of borderline personality disorder is chronic feelings of emptiness. Dr. Jon Briere of UCLA Medical Center likens this to a profoundly deep well which persons with BPD continually seek to fill up. Lastly, sufferers may have temporary periods of stress-related paranoid ideation or severe dissociative symptoms.

Dissociative Identity Disorder. There is not another psychiatric condition that generates such skepticism and disbelief as Dissociatve Identity Disorder (DID), previously known as Multiple Personality Disorder. Yet dissociation occurs with a comparable regularity. In the general population, 5-10% suffer from a dissociatve disorder and 1% struggle with DID. The rates of prevalence are higher in clinical populations: 21% of adult psychiatric inpatients have been diagnosed with a dissociative disorder, and 5% with DID.

What is DID? The individual with DID has 2 or more distinct identities or personality states, each with its own pattern of perceiving, relating to, and thinking about the environment and self. At least 2 of these identities or personality states recurrently take control of the person's behavior. The individual is unable to recall important personal information that is too extensive to be explained by ordinary forgetfulness (e.g. only fleeting memories until age ten). The disturbance is not due to the direct physiological effects of a substance (e.g. blackouts in alcohol intoxication), or a general medical condition (e.g. complex partial seizures). In children, the symptoms cannot be attributed to imaginary playmates. According to John P. Wilson, "Dissociation is a safety-oriented cognitive mechanism in which the individual is attempting to avoid situations of conflict or threat that disrupt the psychic equilibrium." It is strongly linked to severe sexual and physical abuse beginning in early childhood. In such instances, the child flees inward to create alternate self-states. Once this adaptation is established, these fragmented components become personified. The person may or may not have names for these parts, and may or may not be aware of their separate functions and age range. Co-consciousness of different parts tends to develop over time in therapy.

It is important to note that an individual can be dissociative but not have DID. A person might say to you, "You must have just said something important; I didn't hear it." A combination of factors such as your authoritative role, words, tone of voice and other circumstances may have triggered memories which led the person to automatically dissociate. This is NOT a parent-teenager phenomenon of tuning out because one is individuating. Rather, dissociation in the context of sexual abuse is trauma-based and is a creative survival mechanism used when more traditional defenses are inadequate and one must escape the intolerable.

Behavior clues of possible dissociation include the following: staring; repetitive motion such as rocking; rigidity of the body; unresponsiveness; disorientation to time, place or person; visual, auditory or tactile hallucinations; seizure-like behavior; and, signs of regression (e.g. childlike voice, posture or habits). Affective clues include: reports of feeling numb, terrified, spacy, floating, dizzy, cold, away, icy, lightheaded, lost, confused, distant, disconnected, weird.

Sensory clues include: limb paralysis; numbness; tingling or buzzing; trouble hearing; choking or sensation of suffocating; tightness in chest; tunnel vision; pain in body parts (e.g. pelvis, rectum, vagina, jaw, wrists, ankles, neck or abdomen); headaches; nausea; sensation of falling; coldness; palpitations; stigmata (e.g. bruising, bleeding,blistering).

Finally, verbal clues of possible dissociation include these types of statements: "I left my body and went to the ceiling;" " I don't know if that happened to me or my brother;" "I saw abuse happen to another little boy;" "I knew it was happening, but I thought about something else;" "He came over to the bed and turned out the light, and I went out to play."

Eating Disorders. Some survivors of sexual abuse develop eating disorders as a means to control one area of their lives. In the case of bulimia, the compulsive taking in and expulsion of food parallels the sexual abuse experience and to the survivor, it may seem like a means to purge or cleanse the body and mind of what she perceives as culpability.

Eating disorders and dissociative disorders have several common criteria: vulnerability to temporary episodes of depersonalization; secretiveness; pseudo-relationships marked by a quality of falseness; rigidity of cognitions and distortion of thinking; perfectionism to gain approval and acceptance; chemical dependency and self-mutilation; fear of intimacy, attachment and abandonment.

Additional Problems Experienced by Victims of Sexual Abuse: chemical dependency; self-mutilation; panic attacks; acute or chronic depression; outbursts of unreasonable, violent rage; running away from home; punitive attitude toward self and others; intense dislike or distrust of authority figures; terror of pelvic or rectal exams or dental work; significant drop in school grades; excessive fear of being touched and then flinching; sleep disturbances; domestic violence; sexual acting out in childhood and adolescence; enuresis (wetting) or encopresis (soiling); feelings of hopelessness; extreme hatred or fear of men or women; suicide attempts.

Sibling Sexual Abuse

Sibling sexual abuse involves the following: (typically) an age difference of five years or more; misrepresentation of facts, threats, physical aggression; physical trauma (sometimes); the victim/survivor feels fear or anxiety as a result. Sibling sexual abuse is not: playing "doctor;" brief episodes of child exhibitionism ("You show me yours and I'll show you mine"); pre-school siblings bathing together or early pre-pubescent brothers comparing the size of their genitals.

The juvenile offender can be characterized as the following: does not consider the other's feelings; typically pre-plans and watches for opportunities to abuse; engages in a repetitious pattern of behavior; maintains secrecy through bribery, threats, coercion; may be motivated by revenge; uses another child as a sexual outlet. In this last case, the offender is a sexually reactive youth who previously was sexually abused or was exposed to adult sexual activity.

There are numerous family patterns in which sibling abuse occurs:

(1) Older brother, who somehow perceives himself as socially rejected and powerless, abuses his younger sister. She is disbelieved or blamed by their parents, who form an alliance with the son to maintain secrecy and prevent outside interference and possible residential placement.

(2) Family in which the father is a repeat sex offender. The family presents a sub-clinical picture of abuse, that is, a sexually charged or extremely repressive atmosphere, and the children engage in sibling abuse.

(3) Duo-status family in which one or both parents sexually abuse the children, and then the children sexually abuse one another. In some cases, a father grooms an older son in sexual offending behaviors, then engaging him in dating games with his younger sisters.

(4) Older, special-needs adoptive children are brought into a family without adequate records from the original adoption agency, state, or country. After the adoptions are finalized, the loving parents are shocked to learn that their adopted child or sibling group engage in compulsive sexual activities. Children who have spent their formative years in crack houses, houses of prostitution, and similar settings often have learned to prevent violence between adults and to stay alive themselves by offering themselves sexually to parent figures or other adult visitors. Moreover, some adopted children abused by their siblings and coerced to keep the secret in order to stay in the family and not be cast into oblivion.

Characteristics of family systems at high risk for sibling abuse include the following: a home environment that fails to protect; poor boundaries, with little regard for physical and emotional space or individual needs for privacy; physical or emotional absence of one or both parents; frequent unresolved issues; poor conflict resolution; poor communication avenues for the children; isolation from the community; parent(s)' chemical dependency and/or depression, which impairs the adult(s)' ability to protect and creates role reversal whereby the children seek to protect and nurture their parents. While the general public minimizes the impact of sibling sexual abuse, the emotional effects on survivors are significant. Such effects include the following: deep guilt for involvement with the sibling; clinical depression; self-destructive behaviors, such as self-mutilation; a sense of being different from peers; little or no validation for their search for treatment; boundary issues, ranging from "touchy-feely" behaviors and little observance of others' personal space and privacy, to overt offers to provide sexual services; split loyalty to the sibling with whom one had sexual bonding and to parents and other authority figures; emotional trauma which needs to be reduced via therapy. There are numerous components of treatment for sibling sexual abuse. First, there is a need for individual assessment and therapy for both the offender and victim/survivor. If available, group therapy is helpful. Second, parents can enter therapy with a psycho-educational approach, teaching them to identify warning signs of sibling incest, boundaries, safety rules, assertiveness and communication skills, and offender and victims issues. Third, concurrent parent and child session, joining the sub-systems for the last quarter-hour, is a method unsuccessfully used to reduce multiple trips to the counseling center and to ensure a more functional family system. These families may be just catching up with pediatric and dental appointment, school registration and teacher consultations, legal services and various court hearings.

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.