Sexual abuse accounts for 12% of the 1 million substantiated cases of child abuse and neglect annually. Approximately 20% of adult women and 5% to 10% of men were sexually abused as children. The peak age of vulnerability to sexual abuse is between 7 and 13 years of age. Girls are approximately three times more likely to be sexually abused than boys.
Incest is a subtype of child sexual abuse, referring to sexual abuse that occurs within the family. Research estimates that for girls, 33% to 50% of perpetrators are family members, whereas for boys, only 10% to 20% are. The most common perpetrators of interfamilial abuse of girls are fathers, stepfathers, uncles, cousins, brothers, and grandfathers. The vast majority of perpetrators are male, but mothers and other female relatives can also abuse. Fathers’ involvement in early caretaking may make them less likely to sexually abuse their daughters.
Unique legal issues occur when a child is abused within the family. The nonabusing parent may have to choose between the child and the abuser. A separation or divorce may ensue, including a custody dispute. False allegations of abuse in custody cases appear to be fairly rare. In one study of 9,000 divorces, only 2% (N = 180) had allegations of sexual abuse. Of those 180 cases, less than 1% of the total number were determined to be false reports. Further, professionals who regularly evaluate children report that preschoolers make the smallest percentage of false allegations.
Many factors contribute to severity of the abuse experience. Abuse by a nonblood relative is not automatically less severe than abuse by a blood relative, especially if the victim is emotionally close to the perpetrator. For example, a girl might be seriously affected by a stepfather’s abuse, even though he is not related to her by blood. Other factors that make the experience severe include sexual penetration (oral, vaginal, or anal), use of force, long duration and frequent , and lack of support from a nonabusive parent. Many of these factors relate to each other, and are related to whether the abuse occurs within or outside of the family. For example, abuse that occurs within the family may start earlier, go on for a longer time, and include increasingly more serious sexual acts.
There is a range of symptoms that occur among sexually abused children and adults. Severity of the experience is often, but not always, related to the severity of the symptoms. Symptoms of abuse that occur among preschoolers include anxiety, nightmares, and inappropriate sexual behavior. Among school-age children, symptoms include fear, mental illness, aggression, nightmares, school problems, hyperactivity, and regressive behavior. For adolescents, symptoms include depression; withdrawn, suicidal, or self-injurious behaviors; physical complaints; illegal acts; running away; and substance abuse.
The effects of child sexual abuse can continue well into adulthood. Symptoms adult survivors manifest are often “logical extensions” of dysfunctional coping mechanisms developed during childhood. While these dysfunctional behaviors may have helped the child cope with ongoing abuse, they have a negative impact on adult functioning. Incest and child sexual abuse can affect men and women physiologically, and can influence their behavior, beliefs about themselves and others, social relationships, and emotional health. These effects are described below.
Traumatic events, including incest, can alter the way the body handles stress. After experiencing a severe or overwhelming stressor, the victim’s body becomes “threat sensitized,” which causes it to be over-responsive to current stressors. This can manifest as higher resting heart rate, chronic activation of the sympathetic nervous system, and the presence of chronic pain.
Incest can also shape how survivors see themselves and the world. They may come to view the world as a dangerous place, and respond to others with mistrust and hostility. They may also blame themselves for what happened to them, increasing their risk of revictimization as adults. They are also at higher risk for substance abuse, high-risk sexual practices, smoking, and eating disorders.
Among adult survivors, depression is the most commonly reported symptom. Incest survivors have a four-time greater lifetime risk for depression than others. Incest survivors are also at risk for developing posttraumatic stress disorder. Even if they do not meet full criteria for posttraumatic stress disorder, they may have symptoms that are troubling and may cause difficulties in other areas of their lives (e.g., sleep difficulties).
Also common among incest survivors are problems in relationships such as parent–child relations, relations with partners (including increased risk for revictimization), and relations with others that affect the availability of effective social support for these survivors.
Men and women vary in their reactions to incest and sexual abuse, and not everyone who has been sexually abused will have the problems listed above. There are effective treatments for incest survivors. Indeed, those who have experienced incest or child sexual abuse may use their experiences as an impetus to become better parents, and even to help others who have had similar experiences.
- Arata, C. M. (2000). From child victim to adult victim: A model for predicting sexual revictimization. Child Maltreatment, 5, 28–38.
- Kendall-Tackett, K. A. (2003). Treating the lifetime health effects of childhood victimization. Kingston, NJ: Civic Research Institute.
- Kendall-Tackett, K. A. (2004). Breastfeeding and the sexual abuse survivor. Lactation Consultant Series 2, Unit 9. Schaumburg, IL: La Leche League International.
- Kendall-Tackett, K. A., & Marshall, R. (1998). Sexual victimization of children: Incest and child sexual abuse. In R. K. Bergen (Ed.), Issues in intimate violence (pp. 47–63). Thousand Oaks, CA: Sage.
- Kendall-Tackett, K. A., Williams, L. M., & Finkelhor, D. (1993). The effects of sexual abuse on children: A review and synthesis of recent empirical studies. Psychological Bulletin, 113, 164–180.
- McMillen, C., Zuravin, S., & Rideout, G. (1995). Perceived benefit from child sexual abuse. Journal of Consulting and Clinical Psychology, 63, 1037–1043.
- Reece, R. M. (2000). Treatment of child abuse: Common ground for mental health, medical, and legal practitioners. Baltimore, MD: Johns Hopkins University Press.
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