Abstract and Introduction
Sexual abuse is a problem of epidemic proportions in the United States. Given the sheer numbers of sexually abused children, it is vital for pediatric nurse practitioners to understand both short-term and long-term consequences of sexual abuse. Understanding consequences of sexual abuse can assist the pediatric nurse practitioner in anticipating the physical and mental health needs of patients and also may assist in the identification of sexual abuse victims. Sexual abuse typically does not occur in isolation. Implications for practice will be discussed.
Sexual abuse is a problem of epidemic proportions in the United States. The U.S. Department of Health and Human Services (2008) states that nearly 80,000 American children were victims of sexual abuse in 2006. Based on retrospective studies of adults, it is estimated that only 1 in 20 cases of sexual abuse is identified by or reported to authorities (Kellogg, 2005). Given the sheer numbers of sexually abused children, both detected and undetected, it is vital for pediatric nurse practitioners (PNPs) to understand both short-term and long-term consequences of sexual abuse. Understanding the consequences of sexual abuse can assist the PNP in anticipating the physical and mental health needs of children and also may assist in the identification of undetected sexual abuse victims.
It is important for PNPs to be aware that sexual abuse typically does not occur in isolation. The child who experiences sexual abuse is at high risk for other negative childhood experiences. Dong, Anda, Dube, Giles, and Felitti (2003) found sexual abuse to be strongly associated with multiple other forms of negative childhood experiences. Dong and colleagues analyzed data from the Adverse Childhood Experiences Study, which examined the association of many inter-related adverse childhood experiences to a wide variety of health behaviors and health conditions. The study sample included more than 27,000 adults who were members of the Kaiser Health Plan. Questionnaires mailed to members included detailed questions regarding childhood abuse (sexual, emotional, or physical), neglect, and family dysfunction (domestic violence, parental separation or divorce, mental illness, substance abuse, or crime). Information related to health behaviors also was obtained. Child sexual abuse was reported by nearly one fourth (21%) of participants. Dong and colleagues found a strong relationship between sexual abuse and emotional abuse, physical abuse, battered mother, household substance abuse, household mental illness, parental separation/divorce, criminal household member, emotional neglect, and physical neglect. Especially strong relationships were noted between sexual abuse and emotional abuse, physical abuse, physical neglect, and having a battered mother. Previous studies also have reported a relationship between sexual abuse, neglect, or family dysfunction (Finkelhor and Dziuba-Leatherman, 1994, Madu and Peltzer, 2000). Clearly, when discussing the consequences of sexual abuse, an understanding of the multiple stressors that many sexual abuse victims are or have been exposed to is important when developing a plan of care for the child and for the prevention of further abuse.
Sexual abuse is a complex life experience, not a disorder or diagnosis (Putnam, 2003). Sexual abuse is defined as any sexual conduct or contact of an adult or significantly older child with or upon a child for the purposes of the sexual gratification of the perpetrator. Sexual abuse involves both touching and non-touching behaviors. The behaviors include fondling of breasts, genitalia, or buttocks under or on top of clothing, exposure to pornography or adults engaging in sexual activity, or even oral, anal, or vaginal penetration. The diversity of behaviors included in sexual abuse, along with differences in the age and gender of the child victim, the nature of the relationship between the child and the perpetrator, and the frequency and duration of the sexual abuse, all help to ensure differences in consequences for the child sexual abuse victim. Not every child reacts to sexual abuse in the same manner.
Social support also influences the development of sequelae to child sexual abuse. Experiencing sexual abuse within the context of a positive family or social environment may be associated with a lower risk for adverse mental health outcomes (Kinnally et al., 2009). Familial support, especially parental belief in the sexual abuse allegation and support, can act as a strong buffer against the development of negative consequences for sexual abuse victims (Tremblay, Hebert, & Piche, 1999).
The majority of children who are sexually abused will be moderately to severely symptomatic at some point in their life. Experiencing sexual abuse creates a feeling of powerlessness in the child and leaves the child with the perception of having little control over what happens (Dube et al., 2005). This lack of a sense of control acts as a stressor that has effects on the neurodevelopment of both male and female victims. Boys and girls cope differently with the stressor of sexual abuse. Girls are more likely to exhibit internalizing behaviors, such as depression and disordered eating (anorexia, bulimia, or obesity). Externalizing behaviors such as delinquency and heavy drinking are more likely exhibited by boys. Understanding the underlying feelings of powerlessness and loss of control experienced by children who are sexually abused helps in understanding the behaviors and consequences that some sexual abuse victims exhibit.
J Pediatr Health Care. 2010;24(6):358-364. © 2010 Mosby, Inc.
Cite this: Child Sexual Abuse: Consequences and Implications - Medscape - Nov 01, 2010.