Chapter 2 Index

A. Evaluation by system

B. Other categories of illnesses:

1. Metabolic and Endocrine

2. Collagen-Vascular Illnesses

3. Chromosomal Abnormalities

4. Generalized

5. Sexual Abuse

Treatment of Sexually Abused Children

Ashley Fiore MSW, CCSW - Shelter and Advocacy Center

Introduction: Child abuse is a crisis event that often overwhelms the victim and can cause severe emotional, cognitive, and behavioral malfunctioning.  Children, with their immature psychological defenses and limited life experiences, are particularly susceptible to stress.  In addition, the perception of the event will vary with the child’s interpretation of it.  As a result, treatment professionals must consider the specific meaning of the abuse to each child.

I. Variables That Can Affect the Degree of Trauma to the Abused Child:

1. Extent of the Abuse: The more serious and invasive the abuse, the more likely the child will suffer emotional harm -eg full penetration more traumatic than fondling; physical scars traumatic.

2. Single Incident vs Long-Term Ongoing Abuse: Multiple events will deplete emotional reserves.  With long-term abuse, problem is in children viewing themselves erroneously as well as the abuse going undetected.

3. Solitary vs. Shared Experience: If experience is shared, might be less guilt, and less of a stigma.

4. Physical Injury or Pain: Constitutes a threat to body integrity.

5. Presence of Violence - Witnessed or Experienced; Degree of Life Threat - to Family/Self/Others: Increases feelings of helplessness; children more likely to be anxious, depressed, phobic, and have conduct and post-traumatic stress disorders.

6. Relationship of Perpetrator to Child: The closer the relationship to the child, the greater the psychological harm.  Abuse by a relative is the ultimate violation of basic trust.

7. Degree of Parental Support: Recovery is much quicker when one parent believes the child, and acts protectively; child’s perception of support by significant others are also important.

8. Child’s Attributional Style: Children with a positive attributional style (positive events have an internal cause and are global and stable; negative events have external cause and are isolated) have a much better prognosis and are more resilient. “This won’t happen to me again.”

II. Goals of Abuse-Specific Treatment for Sexually Abused Children:

1. Encourage Expression of Abuse-Related Feelings: such as anger, guilt, loss, ambivalence, fear.

2. Clarify Erroneous Beliefs that Could Lead to Negative Attributions to Self or Others:

• Self - blame: for not telling sooner, for not “stopping” the abuse, for taking gifts/bribes
• I’m a bad person: “I must be bad or Daddy wouldn’t have done something bad to me.”
• Learned helplessness: 2 common responses: passivity (even in the face of danger), and become abusers themselves as get older.
• Damaged goods syndrome: “I am different, weird, filthy, no longer a virgin.”
• Relationship/trust issues: “Men want sex only; people who love me hurt me.”
• Distorted sexuality: “Only way to get attention is through sexual behavior; since the way I was touched felt good, I must have asked for the abuse.”

3. Teaching Abuse-Prevention Skills: increase assertiveness, learn offender tricks, etc.

4. Diminish Sense of Stigma and Isolation: by reassurance, group therapy with other victims.

5. Teach Coping Skills for Symptoms of Depression and Post-Traumatic Stress: e.g. nightmares, intrusive thoughts, flashbacks, avoidance, withdrawal, etc (Finelhour and Berliner 1995).

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Department of Pediatrics  |  Medical College of Georgia
Please email comments, suggestions or questions to:
John T.  Benjamin M.D.,  jbenj@mcg.edu

February 27, 2004