Posted by another reader on May 01, 2002 at 08:34:48:
Getting past the myth of cycles of abuse
Only a small fraction of children who are molested become perpetrators, experts say. They say various factors determine the effects of such abuse.
By Stacey Burling
Inquirer Staff Writer
Every year, Bette Bottoms performs a little exercise with her psychology students at the University of Illinois at Chicago. "Raise your hand if you think most people who've been abused go on to abuse their own children," she says.
Many of her students raise their hands.
The truth, she and other experts on abuse said, is that only a small percentage of children who are sexually abused become abusers themselves. Some estimate the number at no more than 2 percent.
Just how abuse affects victims is a complicated, emotionally explosive subject in which increased risk can easily be misconstrued as destiny. Disproportionate numbers of sex offenders report that they were abused as children, experts said, but that doesn't mean victims will be abusers.
Victims are at higher risk for many psychological or physical problems, but whether they flounder through dysfunctional lives or flourish depends on many factors: the type of abuse, who molested them, how their families and communities reacted, other family problems, and their coping skills and personality.
Social scientists are far from figuring out how all the factors work together, but they are beginning to investigate sex abuse in a more sophisticated way.
Child sex abuse includes everything from touching clothed children inappropriately once or twice to repeated rape. Twenty to 25 percent of adult women and 10 to 12 percent of men say they experienced such abuse before age 18, said Anthony Mannarino, a clinical psychologist who chairs the psychiatry department at Pittsburgh's Allegheny General Hospital. Fondling is the most common abuse.
Studies have shown that victims of child sexual abuse are more likely than non-victims to suffer from depression, post-traumatic stress disorder, and substance-abuse problems.
Kathleen Kendall-Tackett, a psychologist at the University of New Hampshire's Family Research Laboratory, said they were also more prone to chronic pain syndromes and irritable bowel syndrome. Subtle psychological effects include cynicism, mistrust and emotional hypervigilance, traits that can impair relationships.
Gail Wyatt, a psychologist who researches sexual behavior at UCLA, said half of the HIV-positive women she studied were child sex-abuse victims, compared with one-third of similar women without the virus. She believes their abuse history led them to feel less in control of their sexuality and to make poor sexual choices.
In 1998, three Philadelphia and Baltimore researchers were pilloried by conservative commentators for saying that the long-term effects of child sexual abuse are not as serious as many believe and that scientists should classify sexual encounters between adults and children according to the age and "willingness" of the child.
While the report remains controversial in academic circles as well, researchers said one of its premises - that all types of abuse should not be lumped together - made sense.
"It's an enormously variable process and, as a result, the outcomes are going to be variable," said William Friedrich, a psychologist and expert on child sexual abuse at the Mayo Medical School in Rochester, Minn.
For example, Lucy Berliner, director of the Harborview Center for Sexual Assault and Traumatic Stress in Seattle, is putting together a newsletter for the American Professional Society on the Abuse of Children on "compliant" victims of sex abuse, such as teenagers who seek sexual contacts on the Internet. Therapists and law enforcement officials need to work with such children differently from those who were coerced, she said.
Evidence that abuse is damaging doesn't mean victims are emotionally doomed. "Even though these problems are elevated... it does not mean that, if you've been abused, you will have these problems," said Bottoms, who is president of the American Psychological Association's section on child maltreatment. "Although the effects of sexual abuse can be devastating, many abused children are very resilient and suffer few long-term problems. Of course, sexual abuse is never right - it is never a positive experience for a child."
Children are more likely to suffer serious psychological consequences if the abuse was sustained and violent or painful. Abuse by a trusted parent or authority figure can be more damaging than abuse by a stranger. "Not too many people get over being raped by a parent," Berliner said.
Sometimes young children recover better than older victims, who are more likely to feel responsible for allowing the abuse to continue.
The more that other problems are present in a child's life, such as physical abuse or parental mental illness, the greater the likelihood of long-term problems. Sadly, sexual abuse often travels with other serious social and economic problems.
Therapy helps, and family support is crucial.
"The physical brutality of the assault is less important than the support the victim has prior to the abuse and after the abuse," said Erin Sorenson, executive director of the Chicago Children's Advocacy Center.
Several experts said that victims now coming forward to talk about sexual encounters with priests may have had a particularly difficult time because the abuse often occurred decades ago, when people didn't feel free to talk and often weren't believed when they did. "They lived with this big, dark secret for a long, long time," Mannarino said.
While all the risk factors are useful, they don't predict what will happen to a particular person. Some people appear to recover well from horrific abuse. Others may be terribly wounded by a onetime encounter.
Experts said they did not want to imply that abuse is not bad by saying that it does not always leave victims emotionally crippled.
Jeffrey Haugaard, professor of human development at Cornell University in Ithaca, N.Y., likened it to losing a leg in childhood and learning to walk with a prosthesis.
"You can be very successful in your life, have a nice family, but the effect of losing that leg is always there," he said.
People who work with child-abuse victims contend the public has an exaggerated idea of the consequences. "I think the common wisdom is that people are ruined for life, which is a sad result of us being too effective in helping the community become aware that sexual abuse in childhood can be harmful," Berliner said.
Some experts think victims need a more hopeful message. "Get treatment," Mannarino said, "and you'll get better."