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Child sexual abuse is an Umbrella Term describing criminal and civil offenses in which an Adult engages in sexual activity with a Minor or exploits a minor for the purpose of sexual gratification. ''The Sexual Exploitation of Children,'' University of Pennsylvania Center for Youth Policy Studies, U.S. National Institute of Justice, August 2001. This term includes a variety of sexual offenses, including:
The legal term ''child sexual offender'' refers to a person who has been convicted for one or more child sexual abuse offenses.''Comparison of Connecticut and Florida Child Sexual Offender Laws,'' Susan Price, State of Connecticut Office of Legislative Research, 2005. The term therefore describes a person who has committed child sexual abuse, without regard to the perpetrator’s motivation.''Summary of State Sex Offender Registry Dissemination Procedures,'' Bureau of Justice Statistics, U.S. Dept. of Justice, 1999. The term "pedophile" is used colloquially to refer to child sexual offenders. However, , ''Parade Magazine,'' August 20, 1989. LEGAL RESPONSES TO CHILD SEXUAL ABUSE In the United States Child sexual abuse has been recognized specifically as a type of Child Maltreatment in U.S. federal law since the initial Congressional hearings on child abuse in 1973. ''Child Abuse Prevention and Treatment Act of 1974,'' (most recently reauthorized by Pub. L. No.108-36, (2003)). Child sexual abuse is illegal in every state, ''State Statutes - Child Abuse and Neglect,'' Children's Bureau, U.S. Department of Health and Human Services. as well as under federal law. ''Index of Child Welfare Laws,'' Children's Bureau, U.S. Department of Health and Human Services. Among the states, the specifics of child sexual abuse laws vary, but certain features of these laws are common to all states.''Definitions of Child Abuse and Neglect, Summary of State Laws,'' National Clearinghouse on Child Abuse and Neglect Information, U.S. Department of Health and Human Services. Minors' inability to consent Between adults, most sexual activity does not constitute a criminal offense, unless one of the adults does not Consent to the activity. In contrast, minors are unable to give consent under the law. Indeed, the term "minor" refers to a person who has not yet reached '' Majority ,'' the age at which one may give consent in any legal matter (for example, a minor cannot make a valid contract).''The Age of Majority,'' T.E. James, ''American Journal of Legal History,'' vol. 4 (1960). Consequently, an adult who engages in sexual activity with a minor commits child sexual abuse. Many statesSee, for example, ''Dixon v. State,'' 278 Ga. 4, (2004), stating that 38 states have a such a law. include in their Penal Codes a "Romeo and Juliet" exception for cases where sexual activity occurs between a young adult and a minor whose ages are within a few years of each other.''A Step in the Right Direction,'' Sabrina A. Perelman, ''Georgetown Journal of Gender & Law,'' vol.7 (2006). This exception typically bars charging the young adult with a sex offense, if the young adult did not use Force or Coercion on the minor and the minor is a Teenager . ''Consensual Sex and Age of Sexual Consent,'' Colette S. Peters, Colorado Legislative Council Brief, 2002. Penalties for child sexual abuse Penalties for child sexual abuse vary with the specific offenses for which the perpetrator has been convicted. Criminal penalties may include imprisonment, fines, registration as a sex offender, and restrictions on probation and parole. Civil penalties may include liability for damages, injunctions, involuntary commitment, and, for perpetrators related to their victims, loss of custody or parental rights. During the last three decades many state legislatures''Child Sexual Abuse and the State,'' Ruby Andrew, ''UC Davis Law Review,'' vol. 39, 2006. have increased prison terms and other penalties for child sex offenders. This trend toward more stringent sentences generally targets those perpetrators who are repeat offenders,See, for example,''People v. Murphy,'' 19 P.3d 1129 (2001). who victimize multiple children,See, for example, ''People v. Hammer,'' 69 P.3d 436 (2003) or who stood in a position of trust with respect to their victims, such as a guardian, parent, pastor, or teacher.See, for example, ''Washington v. Grewe,'' 813 P.2d 1238 (1991). Intrafamilial child sexual abuse ''Intrafamilial child sexual abuse'' refers to child sexual abuse offenses where the perpetrator is related to the minor, either by blood or marriage.''Decision-making of the District Attorney: Diverting or Prosecuting Intrafamilial Child Sexual Abuse Offenders,'' Lorie Fridell, ''Criminal Justice Policy Review,'' vol.4, 1990. Such crimes are most commonly addressed in family courts, as opposed to criminal courts, although no laws prohibit simultaneous proceedings in both forums.See, for example, ''In re S.A.,'' 37 P.3d 1172 (Utah Ct.App., 2001) '' Incest '' refers to sexual activity between related persons, without regard to their ages. Incest is a criminal offense in most states. ''List of Child Sexual Abuse Loopholes in State Law.'' In the majority of states with incest laws, a perpetrator of intrafamilial child sexual abuse may be prosecuted for incest instead of child sexual abuse offenses.''The Incest Loophole,'' sexual activity between those too closely related by blood.''Kinship, Incest, and the Dictates of Law,'' Henry A. Kelly, 14 American Journal of Jurisprudence, 1969. International law One hundred forty Nations are signatories to the United Nations Convention On The Rights Of The Child . This international Treaty defines a set of protections which signatories agree to provide for the children of their respective countries. ''Signatories to the United Nations on the Convention of the Rights of the Child.'' Articles 34 and 35 require that signatories protect their nations’ children from all forms of sexual exploitation and sexual abuse. This includes outlawing the coercion of a child to perform sexual activity, the prostitution of children, and the exploitation of children in creating pornography. Signatories also agree to prevent abduction, sale, or trafficking of children. ''United Nations Convention on the Rights of the Child.'' In South Africa In 1995, South Africa ratified the United Nations Convention on the Rights of the Child and committed to a range of obligations aimed at establishing and protecting the rights of children. The Child Care Act, (74 of 1983) and the Child Care Amendment Act, (86 of 1991; 13 of 1999) make sexual abuse of children a criminal offense. In the United Kingdom The United Kingdom rewrote its criminal code in the Sexual Offences Act Of 2003 . This act includes definitions and penalties for child sexual abuse offenses, and applies to England , Northern Ireland , Scotland , and Wales . MEDICAL RESPONSES TO CHILD SEXUAL ABUSE The American Psychological Association defines child sexual abuse as contact between a child and an adult or other person significantly older or in a position of power or control over the child, where the child is being used for sexual stimulation of the adult or another person.''Guidelines for Psychological Evaluations in Child Protection Matters,'' American Psychological Association, February 1998. Studies of the effects of child sexual abuse often define it as including invitations or requests to do anything sexual, sexual kissing or hugging, touching or fondling of the genitals, indecent exposure, and attempted or completed sexual intercourse.Martin, J., Anderson, J., Romans, S., et al (1993). "Asking about child sexual abuse: methodological implications of a two-stage survey," ''Child Abuse and Neglect'', 17, 383-392. Effects of child sexual abuse Depending on the age and size of the child, and the degree of force used, child sexual abuse may cause infections, Sexually Transmitted Diseases , or internal lacerations. In severe cases, damage to internal organs may occur, which, in some cases, may cause death.James F. Anderson; Nancie J. Mangels; Adam Langsam (2004) "Child Sexual Abuse: A Public Health Issue," Criminal Justice Studies, Volume 17, Issue 1 March 2004. Herman-Giddens et.al. found six certain and six probable cases of death due to child sexual abuse in North Carolina between 1985-1994. The victims ranged in age from 2 months to 10 years old. Causes of death included trauma to the genitalia or rectum and sexual mutilation.Marcia E. Herman-Giddens, et.al., "Underascertainment of Child Abuse Mortality in the United States," Journal of the American Medical Association 1999;282:463-467 (1999) Psychological damage may occur even when physical effects are absent. Long term negative effects on development, leading to re-victimization in adulthood, can also occur.Terri L. Messman-Moore & Patricia J. Long, "Child Sexual Abuse and Revictimization in the Form of Adult Sexual Abuse, Adult Physical Abuse, and Adult Psychological Maltreatment," ''15 Journal of Interpersonal Violence'' 489 (2000). Child sexual abuse has been identified as a predictor of future Psychopathology ,Dinwiddie S, Heath AC, Dunne MP, et al (2000). "Early sexual abuse and lifetime psychopathology: a co-twin-control study." ''Psychological Medicine'', 30:41–52Nelson EC, Heath AC, Madden PA, et al (2002). " Association between self-reported childhood sexual abuse and adverse psychosocial outcomes: results from a twin study. ," ''Archives of General Psychiatry'', 59:139–145 though it has no characteristic pattern of symptoms.Fergusson, D.M. & Mullen, P.E. (1999). "Childhood sexual abuse: An evidence based perspective," Thousand Oaks, California: Sage Publications. Kendall-Tackett et al. (1993) and other studies found that a wide range of psychological, emotional, physical, and social effects are associated with child sexual abuse, including s, Complex Post-traumatic Stress Disorder , Emotional Dysregulation , Neurosis , and other more general dysfunctions such as sexualized behavior, school/learning problems, behavior problems and destructive behavior.Kendall-Tacket, K. A., Williams, L. M., & Finkelhor. D. (1993). Impact of Sexual Abuse on Children: A Review and Synthesis of Recent Empirical Studies. Psychological Bulletin, 1993, Vol. 113, No. 1, 164-180.Dozier, M., Stovall, K.C., & Albus, K. (1999) Attachment and Psychopathology in Adulthood. In J. Cassidy & P. Shaver (Eds.). Handbook of Attachment (pp. 497-519). NY: Guilford PressGauthier, L., Stollak, G., Messe, L., & Arnoff, J. (1996). Recall of childhood neglect and physical abuse as differential predictors of current psychological functioning. Child Abuse and Neglect 20, 549-559. A review of studies by Kendell-Tackett et al. found that two-thirds of the children who were sexually abused showed symptoms, but in comparison with children in treatment who were not sexually abused, the sexually abused children were less symptomatic for all measured symptoms except sexualized behavior. Caffaro-Rouget et al. (1989)Caffaro-Rouget, A., Lang, R. A. & vanSanten, V. (1989). The impact of child sexual abuse. Annals of Sex Research, 2, 29-47. found that 51% of their sample was symptomatic; in Mannarino and Cohen (1986),Mannarino, A. P. & Cohen, J. A. (1986). A clinical-demographic study of sexually abused children. Child Abuse and Neglect, 10, 17-23. 69% of forty-five assessed children were symptomatic; 64% of Tong, Oates, and McDowell's (1987)Tong, L., Oates, K. & McDowell, M. (1987). Personality development following sexual abuse. Child Abuse and Neglect, 11, 371-383. forty-nine child sample were not within the normal range on the child behavior checklist; and in Conte and Schuerman (1987),Conte, J. & Schuerman, J. (1987b). The effects of sexual abuse on children: A multidimensional view. Journal of Interpersonal Violence, 2, 380-390. whose assessment included both very specific and broad items such as 'fearful of abuse stimuli' and 'emotional upset,' 79% of the sample was symptomatic. A minority of abused children have been found to be healthy and asymptomatic, Rind, B., Tromovitch, Ph. & Bauserman, R. (1998). A Meta-analytic Examination of Assumed Properties of Child Sexual Abuse Using College Samples. Psychological Bulletin. 124(1), 22-53. {Link without Title} Beitchman, J. H., Zucker, K. J., Hood, J. E., daCosta, G. A., Akman, D., & Cassavia, E. (1992). "A review of the long-term effects of child sexual abuse," ''Child Abuse & Neglect'', 16, 101-118; and Beitchman, J. H.., Zucker, K. J., Hood, J. E., daCosta, G. A., & Akman, D. (1991). "A review of the short-term effects of child sexual abuse," ''Child Abuse & Neglect'', 15, 537-556.Browne, A., & Finkelhor, D. (1986). "Impact of sexual abuse: A review of the research," ''Psychological Bulletin'', 99, 66-77. and the level of harm associated with the abuse may correlate with other factors. Prescott and Kendler (2001) found that the risk of psychopathology increased if the perpetrator was a relative, if the abuse involved intercourse or attempted intercourse, or if threats or force were used. The age at which an individual was first abused did not appear to be related.Bulick, C. M., Prescott, C. A., & Kendler, K. S. (2001). "Features of childhood sexual abuse and the development of psychiatric and substance use disorders," ''British Journal of Psychiatry'', 179, 444-449. Other studies have found that the risk of adverse outcomes is reduced for abused children who have supportive family environments.Romans, S., Martin, J., Anderson, J., et al (1995). "Factors that mediate between child sexual abuse and adult psychological outcome," ''Psychological Medicine'', 25, 127-142.Spaccarelli, S. & Kim, S. (1995). "Resilience criteria and factors associated with resilience in sexually abused girls," ''Child Abuse and Neglect'', 19, 1171-1182. Because child sexual abuse often occurs alongside other possibly confounding variables, such as poor family environment and physical abuse,Mullen, P. E., Martin, J. L., Anderson, J. C., Romans, S. E. and Herbison, G. P. (1996). "The long-term impact of the physical, emotional and sexual abuse of children: a community study," Child Abuse and Neglect, 20, 7 - 22. some scholars argue it is important to control for those variables in studies which measure the effects of sexual abuseKendler, K. S., Bulik, C. M., Silberg, J., Hettema, J. M., Myers, J., & Prescott, C. A. (2000). "Childhood sexual abuse and adult psychiatric and substance use disorders in women: An epidemiological and cotwin control analysis," ''Archives of General Psychiatry'', 57, 953-959.Pope, H. G., & Hudson, J. I. (1995). "Does childhood sexual abuse cause adult psychiatric disorders? Essentials of methodology," ''The Journal of Psychiatry & Law'', 23, 363-381.Levitt, E. E., & Pinnell, C. M. (1995). "Some additional light on the childhood sexual abuse-psychopathology axis," ''International Journal of Clinical and Experimental Hypnosis'', 43, 145-162. and some have hypothesized "that abuse effects are at least in part the results of dysfunctional family dynamics that support sexual abuse and produce psychological disturbance (Fromuth, 1986) and that concomitant physical or psychological abuse may account for some of the difficulties otherwise attributed to sexual abuse (Briere & Runtz, 1990)."Briere, J. (1992). "Methodological issues in the study of sexual abuse effects," Journal of Consulting and Clinical Psychology, p. 199. Martin and Fleming, however, argue that, "in most cases, the fundamental damage inflicted by child sexual abuse is due 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."Mullen, P. & Fleming, J. (1998). "Long-term effects of child sexual abuse," Issues in child abuse prevention (9). Australia: National Child Protection Clearing House. Rind Et Al.'s 1998 meta-analysis of studies using college student samples concluded that the relationship between poorer adjustment and child sexual abuse is generally found nonsignificant in studies which control for variables such as family environment and other forms of abuse. Other studies have found an independent association of child sexual abuse with adverse psychological outcomes.Kendler, K. S., Bulik, C. M., Silberg, J., Hettema, J. M., Myers, J., & Prescott, C. A. (2000). "Childhood sexual abuse and adult psychiatric and substance use disorders in women: An epidemiological and cotwin control analysis," Archives of General Psychiatry, 57 , 953-959. Kendler et al. (2000) found that most of the relationship between severe forms of child sexual abuse and adult psychopathology in their sample could not be explained by family discord, because the Effect Size of this association decreased only slightly after they controlled for possible confounding variables. Their examination of a small sample of CSA-discordant twins also supported a causal link between child sexual abuse and adult psychopathology; the CSA-exposed subjects had a consistently higher risk for psychopathologic disorders than their CSA non-exposed twins. After controlling for possible confounding variables, Widom (1999) found that child sexual abuse independently predicts the number of symptoms for PTSD a person displays. 37.5% of their sexually abused subjects, 32.7% of their physically abused subjects, and 20.4% of their control group met the criteria for a diagnosis of PTSD. The authors concluded, "Victims of child abuse (sexual and physical) and neglect are at increased risk for developing PTSD, but childhood victimization is not a sufficient condition. Family, individual, and lifestyle variables also place individuals at risk and contribute to the symptoms of PTSD." Mullen and Fleming, argue that, "in most cases, the fundamental damage inflicted by child sexual abuse is due 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."Mullen, P. & Fleming, J. (1998). "Long-term effects of child sexual abuse," Issues in child abuse prevention (9). Australia: National Child Protection Clearing House. It has been suggested that young children who are abused sexually by adult females may incur double traumatization due to the widespread denial of female-perpetrated child sexual abuse by non-abusing parents, professional caregivers and the general public. Crawford, (1997) Forbidden Femininity: Child Sexual Abuse and Female Sexuality Turner and Maryanski in ''Incest: Origins of the Taboo'' (2005), suggest that mother-son incest causes the most serious damage to children in comparison to mother-daughter, father-daughter and father-son child incest. Crawford asserts that our socially repressed view of female and maternal sexuality conceals both the reality of female sexual pathologies and the damage done by female sexual abuse to children.Crawford, Colin, ''Forbidden Feminity: Child Sexual Abuse and Female Sexuality'', Ashgate, 1997. Several studies have indicated that some children regard their sexual abuse positively.Sandfort, T. (1987). Boys on their contacts with men: A study of sexually expressed friendships, New York: Global Academic Publishers, 1987.Rind, B. (2001). Gay and Bisexual Adolescent Boys Sexual Experiences With Men: An Empirical Examination of Psychological Correlates in a Nonclinical Sample. Archives of Sexual Behavior, Vol. 30, No. 4, 2001.Okami, P. (1991). Self-reports of “positive” childhood and adolescent sexual contacts with older persons: An exploratory study. Archives of Sexual Behavior, Volume 20, Number 5 / October, 1991. A meta-analysis of 15 studies using college students by Rind et al. found that boys reacted positively in 37% of the cases, while girls reacted positively in 11% of the cases. The methodology of this study has been criticized by Dallam et al. (2002)Dallam, S.J., Gleaves, D.H., Cepeda-Benito, A., Silberg, J.L., Kraemer, H.C. & Spiegel, D. (2001). "The Effects of Child Sexual Abuse: Comment on Rind, Tromovitch, and Bauserman (1998)," ''Psychological Bulletin,'' 127, 715-733. but has also received supportOellerich, T. D. (2000). Rind, Tromovitch, and Bauserman: Politically Incorrect - Scientifically Correct. Sexuality & Culture, 4(2), 67-81 (2000); see Rind Et Al. (1998) . One study found that most men formerly involved in woman-boy sexual relations evaluate their experience as positive upon reflection.S.R. Condy, Parameters of Heterosexual Molestation of Boys (Dissertation, Frenso: California School of Professional Psychology, 1985); S.R. Condy, D.I. Ternpler, R. Brown, and L. Veaco, "Parameters of Sexual Contact of Boys with Women," in Archives of Sexual Behavior 16/1987, pp. 379-395. There is contrasting evidence that some children who initially report positive feelings will sometimes go on to reassess their abuse in a negative light. 38% of the 53 men studied by Urquiza (1987) said that they viewed their experience as positive at the time, but only 15% retained this attitude.Urquiza, A.J. (1987). The effects of childhood sexual abuse in an adult male population. Unpublished doctoral dissertation, University of Washington, Seattle. Cited in Finkelhor, 1990 According to Coffey et al. (1996), this may be due in part to the stigma attached to child sexual abuse.Coffey, P., Leitenberg, H., Henning, K., Turner, T., & Bennett, R. T. (1996). Mediators of the long-term impact of child sexual abuse: Perceived stigma, betrayal, powerlessness, and self-blame. Child Abuse & Neglect, Pages 447-455 Volume 20, Issue 5, (May 1996). Children may also report positive experiences even if their abuse was accompanied by negative emotions: in Okami (1991), for example, 41% of the 63 'positive' subjects recalled feelings of guilt, 35% said they were frightened at the time, and 29% reported feelings of shame. Russell (1986) speculated that the perception of a sexually abusive event as 'positive' could stem from a mechanism for coping with traumatic experiences.Russell, D. (1986). The secret trauma: Incest in the lives of girls and women. New York: Basic Books. Cited in Stanley (2004). Some researchers, such as John Money , David Finkelhor , and Gabriel Holguin, have opined that the presumption of trauma or damage can itself cause Iatrogenic harm to child victims.Besharov, D. J. (1981). The Third International Congress on Child Abuse and Neglect: Congress highlights. Child Abuse & Neglect, 5, 211-215.Money, J. (1988). "Commentary: Current status of sex research," ''Journal of Psychology and Human Sexuality'', 1(1), 5-15.Browne, A., & Finkelhor, D. (1986). Impact of child sexual abuse: A review of the research. Psychological Bulletin, 99.Holguin, G. & Hansen, D. J. (2002). The "sexually abused child": potential mechanisms of adverse influences of such a label, ''Aggression and Violent Behavior'' Browne and Finkelhor (1986) warn "advocates not exaggerate or overstate the intensity or inevitability of [CSA consequences."Browne, A., & Finkelhor, D. (1986), p. 178. Cited in Rind et al. (1997) Neurological differences in clinical research Research has shown that traumatic stress, including stress caused by sexual abuse, causes notable changes in brain functioning and development. Developing Mind, Daniel Siegel, Guilford Press, 1999Perry, Bruce (2007). ''The Boy Who Was Raised As a Dog.'' ISBN 0465056520 Various studies have suggested that severe child sexual abuse may have a deleterious effect on brain development. Ito et al. (1998) found "reversed hemispheric asymmetry and greater left hemisphere coherence in abused subjects;"Ito Y, Teicher MH, Glod CA, et al: "Preliminary evidence for aberrant cortical development in abused children: a quantitative EEG study," ''The Journal of Neuropsychiatry and Clinical Neurosciences'', 10:298–307 Teicher et al. (1993) found that an increased likelihood of "ictal temporal lobe epilepsy-like symptoms" in abused subjects;Teicher MH, Glod CA, Surrey J, et al: Early childhood abuse and limbic system ratings in adult psychiatric outpatients. J Neuropsychiatry Clin. Neuroscience 1993; 5:301–306 Anderson et al. (2002) recorded abnormal area; various studies have found an association of reduced volume of the left hippocampus with child sexual abuse;Teicher, Martin H. (2002). " Scars That Won't Heal: The Neurobiology of Child Abuse ," Scientific American magazine. and Ito et al. (1993) found increased electrophysiological abnormalities in sexually abused children. Ito Y, Teicher MH, Glod CA, et al (1993). "Increased prevalence of electrophysiological abnormalities in children with psychological, physical, and sexual abuse," ''The Journal of Neuropsychiatry and Clinical Neurosciences'', 5:401–408 Some studies indicate that sexual or physical abuse in children can lead to the overexcitation of an undeveloped Limbic System . Teicher et al. (1993) used the "Limbic System Checklist-33" to measure ictal temporal lobe epilepsy-like symptoms in 253 adults. Reports of child sexual abuse were associated with a 49% increase to LSCL-33 scores, 11% higher than the associated increase of self-reported physical abuse. Reports of both physical and sexual abuse were associated with a 113% increase. Male and female victims were similarly affected.Arehart-Treichel, Joan (2001). "Psychological Abuse May Cause Changes in Brain," Psychiatric News. March 2, 2001 A study by Gilbertson found that individuals with a smaller hippocampal volume are more disposed to the development of PTSD.Gilbertson, M. V., Shenton, M. E., Ciszeskwi, A., Kasai, K., Lasko, N. B., Orr, S. P., and Pitman, R. K. 2002. Smaller hippocampal volume predicts pathologic vulnerability to psychological trauma, Nature Neuroscience, 5, 1242-47. This is supported by studies which show that those who have shown damage also have a history of neurocognitive abnormalities.Gurvits, T. V., Gilbertson, M. W., Lasko, N. B., Tarhan, A. S., Simeon, D., Macklin, M. L., Orr, S. P., and Pitman, . K. 2000. Neurological soft signs in chronic posttraumatic stress disorder. Archives of General Psychiatry, 57, 181-186. McNally gave his view on the recent research into this area in his book ''Remembering Trauma'': Another myth debunked by recent research is the notion that elevated cortisol in PTSD has damaged the hippocampi of survivors. Not only is cortisol seldom elevated in PTSD, but smaller hippocampi in those with the disorder are best tributed to genetic factors, not traumatic stress. A smaller hippocampus may constitute a vulnerability for the disorder among those exposed to trauma.McNally, R. J. (2003). Remembering Trauma. The Belknap press of Harvard University press, p. 157King et al. (2001), studying 5 to 7 year old girls who had been abused within the last two months, found victims of early sexual abuse had significantly lower cortisol levels than control subjects.King J.A., Mandansky D., King S., et al. (2001) "Early sexual abuse and low cortisol." Psychiatry and Clinical Neurosciences 55:71–4 However, other studies have found an increase in cortisol levels among victims of child sexual abuse and trauma and damage to various parts of the brain.Developing Mind, Daniel Siegel, Guilford Press, 1999, p. 11, 248.Perry, Bruce (2007). ''The Boy Who Was Raised As a Dog.'', pg. 64, ISBN 0465056520 "Fear literally arises from the core of the brain, affecting all brain areas and their functions in rapidly expanding waves of neurchemical acticity...also important is a stress hormone called cortisol.", p. 64. A short-term longitudinal study of hippocampal volume in thirty-seven trauma survivors by Bonne et al. found no progressive reduction of the hippocampus between 1 week and 6 months after the traumatic incident. Regarding this, they speculated that structural changes to the hippocampus may only occur if the victim's exposure to traumatization is prolonged; that it may take longer than 6 months for any change in volume to manifest; or that a change in volume may have taken place in the period between the incident and the first assessment. They also found that there was no significant difference between the hippocampal volume of survivors of trauma who developed PTSD and those who did not. Because of these findings, they concluded that "smaller hippocampal volume is not a necessary risk factor for developing PTSD and does not occur within 6 months of expressing the disorder."Quoted from the abstract of Bonne et al. (2001), p.2148 This study did not specifically focus on child sexual abuse victims.O. Bonne, D. Brandes, A. Gilboa, J.M. Gomori, M.E. Shenton, R.K. Pitman et al. (2001). " Longitudinal MRI study of hippocampal volume in trauma survivors with PTSD, " ''Am J Psychiatry''; 158:1248–1251 Navalta et al. (2006) found that the self-reported math ate over decades (such as the corpus callosum and hippocampus) may be disturbed by stress, because stress hormones such as Cortisol suppress the final mitosis of Granule Cells and thereby the production of the Oligodendrocytes and Schwann Cells that form the Myelin Sheath . Epidemiology Based on a literature review of 23 studies, Goldman & Padayachi found that the prevalence of child sexual abuse varied between 7-62% for girls and 4-30% for boys.Juliette D. G. Goldman and Usha, K. Padayachi, "Some Methodological Problems in Estimating Incidence and Prevalence in Child Sexual Abuse Research". ''Journal of Sex Research'', Nov, 2000 {Link without Title} A meta-analytic study by Rind, Tromovitch, and Bauserman found that reported prevalence of abuse for males ranged from 3% to 37%, and for females from 8% to 71% with mean rates of 17% and 28% respectively. Berl Kutchinsky argues that most prevalence rates are overexaggerated and claim that the real prevalence of child sexual abuse may be as low as 1-2%.Kutchinsky, B. (1992). The Child Sexual Abuse Panic. Nordisk Sexologi 10 (1) 30, 1992. A study on incest in Finland between fathers and daughters found prevalence rates of 0.2% for biological fathers and 0.5% for step-fathers.Sariola, H. & Uutela, A. (1996). The prevalence and context of incest abuse in Finland. Child Abuse & Neglect, Volume 20, Issue 9, September 1996, Pages 843-850. Others argue that prevalence rates are much higher, and that many cases of child abuse are never reported. One study found that professionals failed to report approximately 40% of the child sexual abuse cases they encounteredKeuhnle, K., Assessing Allegations of Child Sexual Abuse, Professional Resources Press, Sarastota, FL, 1996 A study by Lawson & Chaffin indicated that many children who were sexually abused were "identified solely by a physical complaint that was later diagnosed as a veneral disease...Only 43% of the children who were diagnosed with verneral disease made a verbal disclosure of sexual abuse during the initial interview."pg7., In. Keuhnle, K., Assessing Allegations of Child Sexual Abuse, Professional Resources Press, Sarastota, FL, 1996 In US schools, according to the US Department of Education.Shakeshaft, C, "Educator Sexual Misconduct: A Synthesis of the Literature", U.S. Department of Education, 2004, "nearly 9.6% of students are targets of educator sexual misconduct sometime during their school career." In studies of student sex abuse by male and female educators, male students were reported as targets in ranges from 23% to 44%. In U.S. school settings same-sex (female and male) sexual misconduct against students by educators "ranges from 18-28% or reported cases, depending on the study" Shakeshaft, C, "Educator Sexual Misconduct: A Synthesis of the Literature", U.S. Department of Education, 2004, p26. Significant underreporting of sexual abuse of boys by both women and men is believed to occur due to sex steoreotyping, social denial, the minimization of male victimization, and the relative lack of research on sexual abuse of boys. Watkins, B. & Bentovim, A. (1992). The sexual abuse of male children and adolescents: a review of current research. Journal of Clinical Psychology & Psychiatry, 33(10), 197-248 {Link without Title} Sexual victimization of boys by their mothers or other female relatives is especially rarely researched or reported. Sexual abuse of girls by their mothers, and other related and/or unrelated adult females is beginning to be researched and reported despite the highly taboo nature of female-female child sex abuse. In studies where students are asked about sex offenses, they report higher levels of female sex offenders than found in adult reports.Shakeshaft, C, "Educator Sexual Misconduct: A Synthesis of the Literature", U.S. Department of Education, 2004, p22. This under-reporting has been attributed to cultural denial of female-perpetrated child sex abuseDenov, Myriam S. (2004) "Perspectives on Female Sex Offending: A Culture of Denial", because "males have been socialized to believe they should be flattered or appreciative of sexual interest from a female" and because female sexual abuse of males is often seen as 'desirable' and/or beneficial by judges, mass media pundits and other authorities.Young, Kathy, "Double Standards: The Bias Against Male Victims of Sexual Abuse", 2002, Reasononline A belief common to South Africa holds that sexual intercourse with a virgin will cure a man of . Child welfare groups believe that the number of unreported incidents could be up to 10 times that number. ''South African Men Rape Babies as "Cure" for AIDS,'' Jane Flanagan, ''Daily Telegraph (UK),'' November 11, 2001. Researcher Suzanne Leclerc-Madlala states that the myth that sex with a virgin is a cure for AIDS is not confined to South Africa: "Fellow AIDS researchers in Zambia , Zimbabwe and Nigeria have told me that the myth also exists in these countries and that it is being blamed for the high rate of sexual abuse against young children."''Child Rape: A Taboo within the AIDS Taboo: More and more girls are being raped by men who believe this will 'cleanse' them of the disease, but people don't want to confront the issue,'' by Prega Govender, ''Sunday Times (South Africa),'' April 4, 1999. Offenders Offenders are more likely to be relatives or acquaintances of their victim than strangers.Fergusson, D. M., Lynskey, M. T., and Horwood L. J. (1996). "Childhood sexual abuse and psychiatric disorder in young adulthood: Prevalence of sexual abuse and factors associated with sexual abuse," Journal of the American Academy of Child and Adolescent Psychiatry, 35(10), 1355-64. The percentage of incidents of sexual abuse by female perpetrators that come to the attention of the legal system is usually reported to be between 1% and 4%.Denov, M, S. (2003) The myth of innocence: sexual scripts and the recognition of child sexual abuse by female perpetrators. The Journal of Sex Research, Vol, 40, No, 3, 2003: pp. 303-314. Studies of sexual misconduct in US schools female sex offenders have showed mixed results with rates between 4% to 43% of female offenders.Shakeshaft, C, "Educator Sexual Misconduct: A Synthesis of the Literature", U.S. Department of Education, 2004, p25. In U.S. schools, educators who offend range in age from "21 to 75 years old, with an average age of 28" with teachers, coaches, substitute teachers, bus drivers and teacher's aids (in that order) totaling 69% of the offenders.Shakeshaft, C, "Educator Sexual Misconduct: A Synthesis of the Literature", U.S. Department of Education, 2004, p24-25. Typology Typologies for child sex offenders have been used since the 1970 s. Male offenders are typically classified by their motivation, which is usually assessed by reviewing their offense's characteristics. Phallometric tests may also be used to determine the abuser's level of Pedophilic interest.Terry, Karen J., and Tallon, Jennifer. " Child Sexual Abuse: A Review of the Literature. " Groth et al. proposed a simple, dichotomous system in 1982 which classed offenders as either "regressed" or "fixated."Groth, A.N., Hobson, W.F. and Gary, T.S. (1982). " The child molester: clinical observations. " In ''Journal of Social Work and Child Sexual Abuse'', 1(1/2), 129-144. Regressed offenders Regressed offenders are primarily attracted to their own age group but are passively aroused by minors.
Other scenarios may include:
Fixated offenders Fixated offenders are most often adult pedophiles who are Maladaptive to accepted social norms. The Etiology of Pedophilia is not well-understood. The sexual acts are typically preconceived and are not alcohol or drug related. Maletzky (1993) found that, of his sample of 4,402 convicted pedophilic offenders, 0.4% were female.Maletzky, B.M. (1993). "Factors associated with success and failure in the behavioral and cognitive treatment of sexual offenders," ''Annals of Sex Research'', 6, 241-258. SEE ALSO
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