Monday, August 18, 2014

Child Sexual Assault - The Evidence for Harm

Sexual abuse of children is highly emotive subject, but here I am going to try to delve into the facts and figures dispassionately. I depend mainly on the excellent Bravehearts organisation, an Australian outfit, particularly their 2012 review of the literature. Some of the points will be simply copied and pasted, but I will try to put the data into a clear pattern. If references are not given here, they will be found in the Braveheart Review.

Data in social and psychological science is often fairly uncertain, as it comes from surveys of different populations, in which different criteria may have been used, so we will have to accept figures presented as broad ranges. Part of the difficulty in being precise is that "Abuse" covers a wide range of behavior, from a brief but inappropriate fondle to rape, torture and murder.

The Prevalence of Abuse

Prevalence is the proportion of a population found to have a condition - as opposed to incidence which is a measure of new cases arising in a population over a given period.

An international meta-analysis of 169 studies found that lifetime prevalence rates of sexual abuse for females is 25% and for males it is 8%. [1]
This compares reasonably well with a study in Australia, which concluded that about one in three girls (33%) and one in six boys (17%) will be sexually abused in some way before the age of 18 years. [2]
There is a useful breakdown of figures for different countries here.

All socio-economic groups are affected.
The commonest age of abuse is from 3 to 12, with the greatest risk at 8-9.
Only 17-38% of victims of abuse made a report.
98% of reports made by children are truthful. Only 2% are made up. [3]
Only 5% of cases are perpetrated by a stranger. In 95% of cases the abuser is known to the child.

The vast majority of abusers are male, but 5% of female abusees and 20% of male abusees report that their abuser was female.

The damaging effects of child sexual abuse.

Paedophiles try to make a case that their predilection is natural and an expression of love.
The facts are otherwise.

The behaviours and symptoms listed below have been associated with child sexual abuse.
(Needless to say, not every abused person is destined to get all or even some of these effects, but statistically, the risk is present).

  • lack of confidence, low self esteem, self-hatred
  • agressive feelings
  •  violent behaviour 
  • criminal convictions (70% of prisoners were abused as children [13])
  • promiscuous behaviour
  • suicide (increased by a factor of 4-12 [12])
  • parasuicide
  • self-harm
  • depression, fear, anxiety, anger and guilt feelings
  • psychosomatic symptoms
  • sleeping disorders
  • nightmares
  • eating disorders
  • sexual difficulties
  • inability to form lasting relationships
  • marital problems 
  • poor parenting skills.
Source: [7][8]

67% of men and women in psychiatric hospital were sexually abused as children.[9] 
Given that the prevalence in the general population of sexual abuse is 17-33%, this means that the chance of having serious psychiatric problems is multiplied by a factor of  2-3 times for victims of sexual abuse. This risk increases even more when we remember that many homeless people and prisoners are not helped by psychiatric services.

71% to 90% of adolescent girls, and 
23% to 42% of adolescent boys in a inpatient substance-abuse treatment program 
reported histories of childhood sexual abuse [10]
Teenagers with alcohol problems are 21 times more likely to have been sexually abused than those without such problems. [11]

These are just a few samples of the wealth of evidence presented in the Braveheart document, but they should be enough to persuade any reasonable person that child sexual abuse has a significant impact on the NHS mental health services and on the courts and prisons. Economists who do not necessarily care about 

humanitarian concerns should be impressed at the implications for future funding of these services. 

The evidence is that money put into treatment of survivors of sexual abuse will be a good investment that will reduce the burden on psychiatric and prison services.

Effective help is available, but Government must give it adequate funding.

In particular, effort applied to bringing VIP child abusers to justice will be a good investment.


1 World Health Organization, Comparative risk assessment: Child sexual abuse. 2001,
WHO Collaborating Centre for Evidence and Health Policy in Mental Health: Sydney,
2 Australian Institute of Criminology (1993). Second Conference on Violence (June
3 Dympna House (1990). Facing the Unthinkable. Haberfield [NSW]: Dympna House.
4 Hindman, J. (1988). Research disputes and assumptions about child molesters. National District Attorney Association Bulletin, 7(4): 1-3.
5 National Institute of Mental Health (1988). (Incomplete reference)
6 National Child Protection Clearinghouse (2005). Child Abuse Prevention Resource Sheet (no.7)
7 Waters B. & Kelk N. (1991) Does Being an Incest Victim Influence the Capacity to Parent? In P. Hetherington (Ed.) Incest and the Community: Australian Perspectives. Perth: Penelope Hetherington.
8 Oates, R. K. & Tong, L. (1987). Sexual abuse of children: An area with room for professional reforms. The Medical Journal of Australia, 147.
9 Jacobson A, & Richardson B. (1987). Assault Experiences of 100 Psychiatric
Inpatients: Evidence of the Need for Routine Inquiry. American Journal of
Psychiatry, 144: 908-913.
10 Rohsenow DJ, Corbett R, & Devine D. (1988). Chemical Dependency Treatment Program, Mid-Maine Medical Center, Waterville, Maine. Molested As Children: A Hidden Contribution to Substance Abuse? Journal of Substance Abuse Treatment. 5: 13-18.
11 Clark HW, McClanahan TM, & Sees KL. (1997). Cultural Aspects of Adolescent
Addiction and Treatment. Valparaaiso University Law Review, 31(2).
12 Felitti, VJ, et al. (1998). Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults: The Adverse Childhood Experiences (ACE) Study. American Journal of Preventative Medicine, 14: 245-258. 13 Queensland Children's Commission (1997). Paedophilia in Queensland Report. Brisbane: Children’s Commission.

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