PSYCHOLOGY: The Science of Child Sexual Abuse

Alleged false accusations of abuse: characteristics, consequences, and coping

ABSTRACTWe have very little knowledge about the characteristics and consequences of false abuse accusations. Sixty-one members of a German support organisation for allegedly falsely accused individuals provided information about themselves, the accuser, the accusation, the consequences of the allegation, and their coping strategies. The majority of respondents were male (90%), accused of sexual abuse (89%), and a parent of the accuser (71%). The initial allegations were frequently (72%) associated with the accuser undergoing psychotherapy. The consequences for the accused were psychological, physiological, familial, job-related, personal, and legal in nature. These included a loss of contact (98%), altered family dynamics (92%), depressive symptoms (48%), and problems focussing at work (44%). Eleven accused (18%) faced legal prosecution, but none of them were charged. Frequent strategies to cope with the allegation included contacting the victim support organisation (100%), seeking therapy (51%), contacting counselling centres (43%) and other victim support organisations (23%). Most of the accused felt supported by their environment (84%). Supporting and elaborating upon previous studies, this study exposes the potential consequences of alleged false accusations.

The Role of Second Step Child Protection Unit Online Teacher Training in Explaining Teacher and Student Outcomes: Multilevel SEM Analysis

Child sexual abuse (CSA) is a concern given its prevalence and harmful consequences such as depression, anxiety, substance misuse, and low academic performance, which pose great threats to children's sustainable development. In response, teachers must be empowered to play crucial roles in preventing CSA and intervening to avert CSA-related harm. We therefore explored the potential for online teacher training to improve teachers' preventive outcomes of CSA (awareness, commitment, and confidence in reporting) and student outcomes (CSA knowledge and ability to recognize, refuse, and report CSA). To assess the immediate effect of online teaching training, we analyzed pre-and post-test data from the implementation of the Second Step Child Protection Unit (CPU) on 131 teachers and 2,172 students using a multilevel structural equation modeling approach. We found a significant direct effect of online teacher training on improving teachers' preventive outcomes. Furthermore, we detected a significant indirect effect of online teacher training on children's preventive outcomes of CSA knowledge and ability to recognize, refuse, and report CSA via teachers' preventive outcomes of CSA awareness.

Sustaining Treatment for Youth with Problematic Sexual Behavior: Administrator and Stakeholder Perspectives Following Implementation

This study examines administrator and stakeholder perspectives on factors influencing the sustainability of Problematic Sexual Behavior Cognitive Behavioral Therapy (PSB-CBT). After initial implementation of PSB-CBT, qualitative interviews (N = 42) on the sustainability of services were conducted with treatment program administrators (n = 10) and community stakeholders (n = 32) from six sites across the USA. Interviewees discussed key facilitators and barriers for sustainability and identified the following factors as impacting the sustainability of PSB-CBT: public relations, policy, inter-agency collaboration, funding, and workforce issues. Results were overall consistent with the EPIS (Exploration, Preparation, Implementation, Sustainment) model for implementation in public service sectors, but proposed modifications are also noted. Findings underscore the value of qualitative research in identifying best practices for sustaining valuable therapeutic interventions. The authors argue that future efforts to sustain evidence-based interventions, especially those dealing with sensitive topics around which misinformation and stigma are associated, should prioritize public relations (i.e., outreach, education) in addition to the intervention.

Economic value of community-based services for problematic sexual behaviors in youth: A mixed-method cost-effectiveness analysis

BACKGROUND

Problematic sexual behavior in youth represents a significant public health problem in need of evidence-based treatments. Unfortunately, such treatments are not available in most communities.

OBJECTIVE

This study used a mixed quantitative-qualitative approach to investigate the economics of the implementation of Problematic Sexual Behavior - Cognitive-Behavioral Therapy (PSB-CBT), an evidence-based treatment for problem sexual behaviors in youth.

PARTICIPANTS AND SETTING

Youth (N = 413) participated in PSB-CBT at six program sites in youth service agencies across the United States.

METHOD

We used cost-effectiveness ratios (CERs) to compare the direct and indirect costs of PSB-CBT to self- and caregiver-reported youth clinical outcomes (i.e., problem sexual behavior as well as secondary behavioral health problems). CERs represented the cost of achieving one standard unit of change on a measure (i.e., d = 1.0). The design and interpretation of those quantitative analyses were informed by qualitative themes about program costs and benefits that were derived from interviews with 59 therapists, administrators, and stakeholders.

RESULTS

CERs (i.e., $ per SD) were $1,772 per youth for problem sexual behavior and ranged from $2,867 to $4,899 per youth for secondary outcomes. These quantitative results, considered alongside the qualitative perspectives of interviewees, suggested that the implementation of PSB-CBT was cost-effective. The results were robust to uncertainty in key parameters under most, but not all, conditions.

CONCLUSIONS

The results have important implications for decisions made by administrators, policymakers, and therapists regarding use of community-based approaches to address problematic sexual behavior of youth.

Demystifying ritual abuse - insights by self-identified victims and health care professionals

Empirical evidence on organized and ritual child sexual abuse (ORA), that is, organized child sexual abuse with an ideological framework, is rare and definitions of the term "ritual" are often vague or inhomogeneous. The aim of the current study is to analyze contents, purposes and acts of violence in ORA.In a project of the Independent Inquiry into Child Sexual Abuse in Germany, 165 adults who identified themselves as ORA victims as well as 174 health care professionals who supported ORA victims were recruited via various sources and completed anonymous online surveys.Both samples report experiences with ideological frameworks in organized child sexual abuse contexts at the same ratio (88%). Ideologies are mostly perceived as a means to facilitate violent acts (e.g. commercial sexual exploitation). Positive correlations between the manifestation of ideologies and all violent acts suggest that organized and ritual perpetrator groups use the same violent strategies, but ritual or ideological groups, in which perpetrators are more often family members, use them to a greater extent.A modified narrative of "ritual abuse" as a (pseudo-)ideological, domestic and more violent subtype of organized child sexual abuse could enhance the credibility and visibility of ORA in science as well as in society.

Adverse Childhood Experiences are Associated with High-Intensity Binge Drinking Behavior in Adulthood and Mediated by Psychiatric Disorders

AIM

High-intensity binge drinking (HIBD), defined as two or more times the gender-specific binge threshold, is rapidly increasing in the USA; however, the underlying contributing factors are poorly understood. This study investigated the relationship of adverse childhood experiences (ACEs) and HIBD.

METHODS

Two independent, cross-sectional samples were analysed: (a) past 12-month drinkers in the National Epidemiological Survey on Alcohol and Related Conditions-III (NESARC-III; n = 25,552) and (b) the National Institute on Alcohol Abuse and Alcoholism (NIAAA) clinical sample (n = 1303). Multinomial logistic regressions were utilized to estimate adjusted odds ratios (AORs) of ACEs on HIBD. Mediation analysis was performed to examine the relationship between the past 12-month psychiatric disorders, ACEs, and HIBD.

RESULTS

In the NESARC-III sample, prevalence of ACEs increased across all binge levels with the highest prevalence in extreme HIBD; ACEs were associated with higher odds for HIBD (level II, odds ratio (OR) = 1.2-1.4; P = 0.03-0.001; level III, OR = 1.3-1.9; P < 0.001). Prevalence of DSM-5 diagnoses also increased across all binge levels. Substance use disorders (SUD), mood, personality and post-traumatic stress disorders (PTSD) conferred the highest odds with extreme HIBD (SUD: OR = 21.32; mood: 1.73; personality: 2.84; PTSD: 1.97; all Ps < 0.001). Mediation analyses showed that the association between ACEs and HIBD was fully mediated through SUD (proportion mediated: 70-90%) and partially through other psychiatric disorders (20-80%). In the NIAAA sample, ACEs were 2-5 times more prevalent in extreme HIBD with higher odds (ORs = 3-8, P < 0.001) compared with non-bingers.

CONCLUSION

ACEs were associated with significantly increased odds of HIBD and the relationship may be mediated by psychiatric disorders.

Maltreatment history, trauma symptoms and research reactivity among adolescents in child protection services

OBJECTIVE

There is a well-documented link between child maltreatment and poor health across the lifespan. This provides a strong case for ongoing research with youth involved in the child welfare system to reduce negative outcomes and support resilience while being inclusive of youth voices. However, detailed inquiries about maltreatment history and health consequences may cause re-experiencing of events and psychological distress for study participants. Data that accounts for different contexts, such as severity of maltreatment history and current trauma symptomatology, have been limited in considering the question of potential harms to youth who participate in research-especially longitudinal studies.

METHODS

This study compared self-reported impact of research participation against maltreatment history and current post-traumatic stress symptomatology among a randomly selected group of adolescents (< 18 years old) in the child protection service (CPS) system.

RESULTS

Adolescents who report more serious child maltreatment and current trauma symptom severity reported higher scores on distress questions from pre- to post-assessment participation. Critically, participants who were more negatively impacted by study involvement also reported greater benefit from study involvement.

CONCLUSION

The increase in both negative and positive impact does not shift the risk/reward ratio for participation, as risks alone do not increase for this vulnerable group of CPS involved youth. These results are consistent with previous findings from studies involving non-CPS populations and underlies the importance of empirical data to address the question of change in the risk/reward ratio and what factors might play a role in any change. This information can inform inclusion/exclusion criteria for future research with these vulnerable populations, thereby reducing the risk of distress among study participants.

The Frequency of False Allegations of Child Sexual Abuse: A Critical Review

The rate of false allegations has been a topic of research spanning back to as early as the 1970s. Studies have often relied on data gathered by Child Protective Services workers and court administrators. Some researchers have also used hypothetical scenarios to estimate rates. However, given the plethora of sampling methods, there is a large variation in estimated rates of false allegations of sexual abuse depending on the data source and context of the allegation. Additionally, methodological problems such as unclear or invalid criteria used to judge truth or falsity of an allegation, unrepresentative samples, and ignoring important contextual variables such as the stage at which an allegation is made, currently all render the determination of actual rates of false child sexual abuse allegations to be unknown. This examination of literature is intended to gain a firmer understanding of the frequency at which allegations are false and during which stage of prosecution they occur, thus assisting with the legal practice of distinguishing between a false versus positive allegation. Research reviewed supports two general conclusions: (a) the vast majority of allegations are true but (b) false allegations do occur at some non-negligible rate. Suggestions for future research, as well as cautions about claims about specific rates of false allegations in the courtroom, are provided.

Relation between premorbid adjustment, duration of untreated psychosis and close interpersonal trauma in first-episode psychosis

AIM

Interpersonal traumas are highly prevalent in patients with psychotic disorders. Trauma caused by those close to the patient might have a more profound impact than other types of trauma and may influence early life social functioning. The aim is to investigate the associations between different types of trauma, in particular close interpersonal traumas experienced before the age of 18, premorbid factors and baseline clinical characteristics in a sample of first-episode psychosis patients.

METHODS

A total of 191 patients from the 'TIPS' cohort completed assessment with the Brief Betrayal Trauma Survey at their 5 years follow-up interview.

RESULTS

Half of the patients reported that they had experienced interpersonal trauma and one-third reported having experienced close interpersonal trauma before the age of 18. Women reported more sexual abuse, physical attacks and emotional and physical maltreatment than men. There were significant associations between early interpersonal trauma and premorbid adjustment and duration of untreated psychosis, but no significant associations with length of education, comorbid substance use or baseline clinical symptomatology.

CONCLUSIONS

Close interpersonal trauma before the age of 18 is associated with poorer premorbid adjustment and a longer duration of untreated psychosis. This may indicate that traumatic experiences delay help-seeking behaviour.

Dissociation mediates the relationship between sexual abuse and child psychological difficulties

The aim of the present study was to evaluate, using structural equation modeling, a theoretical model in which dissociation is a core process mediating the relationship between childhood sexual abuse (CSA) and internalizing, externalizing, and sexualized behaviour difficulties in children. A total of 290 children aged 2-12 participated in this study in Québec, Canada from 1998 to 2004, including 138 children with histories of CSA and 152 non-abused children. To assess child dissociative symptoms, internalizing and externalizing difficulties, as well as sexualized behaviour difficulties, the Child Dissociative Checklist, the Child Behaviour Checklist and the Child Sexualized Behaviour Inventory were completed by parents. Dissociation mediated the relationship between CSA and internalizing, externalizing, and sexualized behaviour difficulties, with the model explaining respectively 42.5%, 49.9% and 33.9% of the variance of these difficulties. Findings are consistent with a model where dissociation is a common pathway linking CSA and child psycho-sexual difficulties.

Evidence-Based Treatments for Youths Who Engage in Illegal Sexual Behaviors

Effective treatments for youths who have engaged in illegal sexual behaviors are needed to reduce the societal impact of sexual crimes. This article reviews the state of the evidence base for treatments that target this clinical population. We conducted a comprehensive literature review to identify studies that evaluated outcomes of treatments for youths who have engaged in illegal sexual behaviors. Based on the results of our review, we characterized each treatment using established criteria for five evidence-based treatment classifications. We identified 10 treatment studies that met inclusion criteria. We classified one treatment-multisystemic therapy for problem sexual behaviors-as Probably Efficacious (Level 2), and two treatments-cognitive-behavioral therapy and behavior management through adventure-as Experimental (Level 4). Cognitive-behavioral therapy has limited research support with youths who have engaged in illegal sexual behaviors, but it is widely used in the United States and Canada. In contrast, multisystemic therapy for problem sexual behaviors had the highest level of research support but is used much less extensively with this population. We discuss implications of the present findings for treatment providers, policymakers, and researchers who seek to improve clinical services in this area.

Dissociative Tendencies and Memory Performance on Directed-Forgetting Tasks

The current article presents two studies that aimed to replicate DePrince and Freyd's (2001, 2004) studies demonstrating that high and low dissociators differentially recall neutral and trauma words under conditions of varying cognitive load. We did not find this effect. This lack of replication was apparent for both free recall and word recognition memory and in both studies. In effect, we found little evidence to support betrayal trauma theory, yet observed increased memory fallibility, as demonstrated by lower general recall and (in one study) commission errors, in high dissociators.

Impact of early life adversity on EMG stress reactivity of the trapezius muscle

Human and animal research indicates that exposure to early life adversity increases stress sensitivity later in life. While behavioral markers of adversity-induced stress sensitivity have been suggested, physiological markers remain to be elucidated. It is known that trapezius muscle activity increases during stressful situations. The present study examined to what degree early life adverse events experienced during early childhood (0-11 years) and adolescence (12-17 years) moderate experimentally induced electromyographic (EMG) stress activity of the trapezius muscles, in an experimental setting. In a general population sample (n = 115), an anticipatory stress effect was generated by presenting a single unpredictable and uncontrollable electrical painful stimulus at t = 3 minutes. Subjects were unaware of the precise moment of stimulus delivery and its intensity level. Linear and nonlinear time courses in EMG activity were modeled using multilevel analysis. The study protocol included 2 experimental sessions (t = 0 and t = 6 months) allowing for examination of reliability.Results show that EMG stress reactivity during the stress paradigm was consistently stronger in people with higher levels of early life adverse events; early childhood adversity had a stronger moderating effect than adolescent adversity. The impact of early life adversity on EMG stress reactivity may represent a reliable facet that can be used in both clinical and nonclinical studies.

What Influences Believing Child Sexual Abuse Disclosures? The Roles of Depicted Memory Persistence, Participant Gender, Trauma History, and Sexism

This vignette study investigated factors that influence believing child sexual abuse disclosures. College student participants ( N = 318) in a university human subject pool completed measures about their own trauma history and responded to questions about sexist attitudes. Participants then read vignettes in which an adult disclosed a history of child sexual abuse, rated disclosures for accuracy and believability, and judged the level of abusiveness. Continuous memories were believed more than recovered memories. Men believed abuse reports less than did women, and people who had not experienced trauma were less likely to believe trauma reports. Gender and personal history interacted such that trauma history did not impact women's judgments but did impact men's judgments. Men with a trauma history responded similarly to women with or without a trauma history. High sexism predicted lower judgments of an event being abusive. Hostile sexism was negatively correlated with believing abuse disclosures. Results are considered in light of myths about child sexual abuse.

Child sexual abuse: Raising awareness and empathy is essential to promote new public health responses

Child sexual abuse is a major global public health concern, affecting one in eight children and causing massive costs including depression, unwanted pregnancy, and HIV. The gravity of this global issue is reflected by the United Nations' new effort to respond to sexual abuse in the 2015 Sustainable Development Goals. The fundamental policy aims are to improve prevention, identification, and optimal responses to sexual abuse. As shown in our literature review, policymakers face difficult challenges because child sexual abuse is hidden, psychologically complex, and socially sensitive. This article offers new ideas for international progress. Insights about needed strategies are informed by an innovative multidisciplinary analysis of research from public health, medicine, social science, psychology, and neurology. Using an ecological model comprising individual, institutional, and societal dimensions, we propose that two preconditions for progress are the enhancement of awareness of child sexual abuse, and of empathic responses towards its victims.Journal of Public Health Policy advance online publication, 12 May 2016; doi:10.1057/jphp.2016.21.

Testing the "Sexually Abused-Abuser Hypothesis" in Adolescents: A Population-Based Study

A long-standing belief in the literature on sex offenders is that sexually victimized youths are at increased risk of becoming sex offenders themselves. The present study tested the link between past sexual abuse, either with or without contact, and sexually offending behavior in a representative sample of male and female adolescents while controlling for other types of abuse, mental health problems, substance use, and non-sexual violent behaviors. Self-reported data were collected from a nationally representative sample of 6,628 students attending 9th grade public school in Switzerland (3,434 males, 3,194 females, mean age = 15.50 years, SD = 0.66 years). Exposure to contact and non-contact types of sexual abuse was assessed using the Child Sexual Abuse Questionnaire and sexually offending behavior by the presence of any of three behaviors indicating sexual coercion. Two-hundred-forty-five males (7.1 %) and 40 females (1.2 %) reported having sexually coerced another person. After controlling for non-sexual abuse, low parent education, urban versus rural living, mental health problems, substance use, and non-sexual violent behavior, male adolescents who were victims of contact sexual abuse and non-contact sexual abuse were significantly more likely to report coercive sexual behaviors. Females who experienced contact or non-contact sexual abuse were also found at increased risk of committing sexual coercion after controlling for covariates. The present findings demonstrate a strong relationship between past sexual abuse, with and without physical contact, and sexual-offending behavior in male and female adolescents. Reducing exposure to non-contact sexual abuse (like Internet-based sexual exploitation) should become a new area of sexual violence prevention in youths.

Impaired Maternal Behavior in Usp46 Mutant Mice: A Model for Trans-Generational Transmission of Maternal Care

Usp46 mutant mice (congenic strain on a B6 genetic background; MT mice) have a low weaning rate and display poor maternal behavior compared to C57BL/6J mice (B6 mice). Based on these observations, we examined how maternal behavior is shaped by cross-fostering and in-fostering MT and B6 mice. The experiments consisted of six groups: B6 mice fostered by their biological mother (B6-CO); MT mice fostered by their biological mother (MT-CO); B6 mice fostered by a different B6 mother (B6-IF); MT mice fostered by a different MT mother (MT-IF); B6 mice fostered by an MT mother (B6-CF); and MT mice fostered by a B6 mother (MT-CF). Maternal behavior was assessed using the pup-retrieval test in adult female offspring, and four parameters, time nursing pups in the nest, time sniffing or licking pups, rearing behavior, and latency to retrieve pups, were measured. Cross-fostering significantly reduced time spent nursing and sniffing/licking pup, and increased the number of instances of rearing in the B6-CF group, and improved three parameters of maternal behaviors (nursing, rearing and latency) in the MT-CF group. These results indicate that the level of maternal care is transmitted to their pups and proper maternal behaviors can be shaped if adequate postpartum maternal care is given, even in genetically vulnerable mice. However, the offspring’s genotype may also influence the development of maternal behaviors in adulthood. Thus, MT mice may prove useful as a model for trans-generational transmission of maternal care, and these findings may provide insight into the mechanisms of maltreating behaviors in human child abuse.

Sexually coercive behavior following childhood maltreatment

Child maltreatment is associated with adult sexually coercive behavior. The association may be causal or confounders that increase the risk of both childhood victimization and sexually coercive behavior might explain the observed links. We examined if childhood maltreatment was related to sexual coercion independently of familial (genetic or common family environment) risk factors, thereby addressing potential causality. Participants were 6,255 18 to 33-year-old twins from the Finnish population-based study "Genetics of Sex and Aggression" who responded to self-report questionnaires of child maltreatment and sexually coercive behavior. We used generalized estimating equations to elucidate risk of sexual coercion in maltreated compared to unrelated, non-maltreated individuals. To adjust for unmeasured familial factors, we used the co-twin control method and compared sexual coercion risk within maltreatment-discordant twin pairs. Further, we examined possible differential effects of maltreatment subtypes and compared mean differences in maltreatment summary scores between sexually coercive individuals and controls. Sexual coercion was moderately more common among individuals maltreated as children versus unrelated controls (38.3 vs. 22.8 %; age- and gender-adjusted odds ratio, aOR = 2.31, 95 % CI 1.75-3.05) and the risk increase remained similar within maltreatment-discordant twins (OR = 2.82, 95 % CI 1.42-5.61). Moreover, different maltreatment subtypes predicted sexual coercion equally well and effect sizes remained similar within discordant twin pairs. We conclude that associations between child maltreatment and sexual coercion are largely independent of shared familial confounds, consistent with a causal inference. Importantly, detection and targeted interventions for maltreated children should remain a priority to reduce societal sexually coercive behavior.

Preservice teachers' sources of information on mandatory reporting of child sexual abuse

Teachers in many countries are mandated by law, professional codes, or education authorities to report child abuse and neglect, including child sexual abuse. However, teachers may not receive adequate preparation for such sensitive interventions, as preservice teacher education degrees provide very few or no compulsory courses on child protection and crucially related, lifelong health and well-being issues. So, where do preservice teachers source their information regarding the mandatory reporting of such abuse? This research examines preservice teachers' professional university education for their sources of information about mandatory reporting and child sexual abuse. A sample cohort of 56 final 4th-year university bachelor of education (primary school) student teachers in Australia identified the sources they used regarding 10 important aspects of child protection. The results suggest that most did not learn about mandatory reporting or child sexual abuse, and others cited sparse and sporadic public media as their primary information source. These findings, building on previous evidence about inadequate or nonexistent preservice mandatory intervention courses in primary teacher education, may guide the design of appropriate training responses enhancing educational professionals' knowledge, competencies, skills, and efficacies as mandatory reporters of child sexual abuse.

Child sexual abuse and mandatory reporting intervention preservice content preferred by student teachers

The importance of preservice university teacher training about child sexual abuse and its mandatory reporting intervention is addressed in educational literature, although very little is known about student teachers' learning interests and preferences in this area. In this article, student teachers refer to students in university who are training to become teachers whose training includes teaching experiences in schools. This study examines the content about child sexual abuse and its intervention that student teachers believe they should learn. Results based on quantitative analyses show the relative importance of gender in determining responses to questions about university training and, to a lesser extent, the importance of a previous acquaintance with victims of sexual abuse, previous employment, and the length of the university course. Results based on qualitative data show that content knowledge preferred by elementary/primary and secondary school student teachers includes the teacher's role in mandatory reporting of child sexual abuse and signs, experiences, and responses to student disclosure. Student teachers prefer content examples of school professionals' responses and procedures after disclosure and prefer direct learning content from intervening school professionals. These outcomes could usefully guide teachers and educators who design intervention curricula on child sexual abuse for preservice teachers.

Preventing sexual abusers of children from reoffending: systematic review of medical and psychological interventions

OBJECTIVE

To evaluate the effectiveness of current medical and psychological interventions for individuals at risk of sexually abusing children, both in known abusers and those at risk of abusing.

DESIGN

Systematic review of interventions designed to prevent reoffending among known abusers and prevention for individuals at risk of sexually abusing children. Randomised controlled trials and prospective observational studies were eligible. Primary outcomes were arrests, convictions, breaches of conditions, and self reported sexual abuse of children after one year or more.

RESULTS

After review of 1447 abstracts, we retrieved 167 full text studies, and finally included eight studies with low to moderate risk of bias. We found weak evidence for interventions aimed at reducing reoffending in identified sexual abusers of children. For adults, evidence from five trials was insufficient regarding both benefits and risks with psychological treatment and pharmacotherapy. For adolescents, limited evidence from one trial suggested that multisystemic therapy prevented reoffence (relative risk 0.18, 95% confidence interval 0.04 to 0.73); lack of adequate research prevented conclusions about effects of other treatments. Evidence was also inadequate regarding effectiveness of treatment for children with sexual behavioural problems in the one trial identified. Finally, we found no eligible research on preventive methods for adults and adolescents who had not sexually abused children but were at higher risk of doing so (such as those with paedophilic sexual preference).

CONCLUSION

There are major weaknesses in the scientific evidence, particularly regarding adult men, the main category of sexual abusers of children. Better coordinated and funded high quality studies including several countries are urgently needed. Until conclusive evidence is available, realistic clinical strategies might involve reduction of specific risk factors for sex crimes, such as sexual preoccupation, in abusers at risk of reoffending.

Rape: Legal issues in mental health perspective

Rape of women by men has occurred throughout recorded history and across cultures and religions. It is a crime against basic human right and a most common crime against women in India. In this article, rape is discussed from legal and mental health perspective. In India 'rape laws' began with enactment of Indian Penal Code in 1860. There have been subsequent amendments and the main issue of focus remained the definition of 'rape and inclusion of 'marital rape' in the ambit of rape. Law Commission Reports related to rape and the psychological impacts of rape have been discussed.

Complex posttraumatic stress disorder: voices of healing

In this article, we report on a phenomenological study of experiences of recovery of 7 women with histories of childhood maltreatment. We propose a model that recalls the Anglo-Franc etymological origins of rekeverer: to regain consciousness, health, or strength. Dimensions include development of a selfhood; tasks of connection and separation; regulation of overwhelming emotions; management of choices; and internalization of therapeutic relational dynamics. Based on the findings, we suggest that theory and research need to extend concepts of healing, add methodologies privileging victim/survivor voices, and revisit concepts such as neutrality and resistance as they apply to dissociative disorders. Practitioners should have specific training in trauma models, although they need to hold these theories lightly because therapeutic goals and pathways of change might well differ for each client. Integrated whole-of-government initiatives need to identify those at risk of abuse as early as possible, and provide response funding beyond assessment services.

Veracity for children in pediatric forensics

Child sexual abuse is a heinous crime, and school-age children are the age group most commonly victimized. When occurring within the family, it is particularly difficult and confusing for the child to disclose. The role of the sexual assault nurse examiner, and the challenges in applying the ethical concept of veracity when caring for these young victims is examined, using vignettes based on actual situations. It is essential for the forensic nurse to be able to understand and apply theories of childhood development to these cases in order to facilitate communication with the child, while providing assurance that they are believed.

Child maltreatment and adult violent offending: population-based twin study addressing the 'cycle of violence' hypothesis

BACKGROUND

Associations between child maltreatment and adult violence, often termed the 'cycle of violence', are well documented. However, the nature of such links after appropriate control for confounding remains uncertain. We aimed to determine whether child maltreatment causes adult violent offending or whether suggested links are due to genetic or family environment confounding.

METHOD

A total of 18 083 20- to 47-year-old twins from the Swedish population-based Study of Twin Adults: Genes and Environment (STAGE) participated. We linked information on self-reported child maltreatment with national register data on convictions for adult crime. We used a case-control design to elucidate associations among unrelated individuals and also conducted within-discordant twin pair analyses to estimate the influence of familial confounding on this association.

RESULTS

The odds ratio (OR), adjusted for age, sex and education, for violent offending in maltreated children grown up versus unrelated controls was 1.98 [95% confidence interval (CI) 1.52-2.57]. However, the association decreased to 1.18 (95% CI 0.62-2.25) when maltreated children were compared to their non-maltreated twins, suggesting substantial confounding by genetic or family environmental factors (within-twin OR<1.98) and a weak, non-significant causal effect (within-twin OR>1.00). Familial confounding was also pronounced for the association between child maltreatment and any offending.

CONCLUSIONS

Childhood maltreatment was found to be a weak causal risk factor for adult violent offending; hence, reducing maltreatment might decrease violent crime less than previously expected. Instead, considerable familial confounding of the link between child maltreatment and adult violent offending suggests that prevention strategies need to address overlapping genetic and/or family environmental liability for abusive and violent behavior.

Childhood betrayal trauma and self-blame appraisals among survivors of intimate partner abuse

Child abuse perpetrated by a close other, such as a parent, is linked to a wide range of detrimental effects, including an increased risk of self-blame. The current study evaluated whether experiences of childhood betrayal trauma were linked to self-blame following victimization in adulthood. A diverse sample of women (n = 230) from an urban city were recruited based on having experienced an incident of intimate partner abuse (IPA) reported to the local police. Women reported on their trauma histories and levels of self-blame for the target IPA incident. Results showed that a history of childhood betrayal trauma exposure predicted the degree of self-blame for the IPA incident. Women who experienced severe IPA during the target incident also indicated higher levels of self-blame. Findings from this study suggest that it may be important to target self-blame appraisals in interventions with adults exposed to abuse in childhood.

Child sexual abuse myths: attitudes, beliefs, and individual differences

Child sexual abuse myths comprise incorrect beliefs regarding sexual abuse, victims, and perpetrators. Relations among myth acceptance, responses to disclosure, legal decisions, and victims' subsequent psychological and health outcomes underscore the importance of understanding child sexual abuse myths. Despite accurate knowledge regarding child sexual abuse among many professional and other individuals, child sexual abuse myths persist. A Google search produced 119 child sexual abuse myths, some with overlapping themes. Coders grouped myths into four categories: (a) minimizations or exaggerations of the extent of harm child sexual abuse poses, (b) denials of the extent of child sexual abuse, (c) diffusions of perpetrator blame, and (d) perpetrator stereotypes. This review provides available data regarding the prevalence for these myths, empirical research that refutes or confirms myth categories, and considerations of cultural contexts and implications.

Sexual coercion experience and sexually coercive behavior: a population study of Swedish and Norwegian male youth

The authors tested the hypothesis that experiencing sexual coercion and engaging in sexually coercive behavior are positively associated in a representative sample totaling almost 4,000 Swedish or Norwegian male high school students (estimated response rate 80%). In both surveys, youths who had experienced sexual coercion were approximately three times more likely to engage in sexually coercive behavior than those without such experience (10%-12% vs. 4%). The association between sexual coercion experience and sexually coercive behavior was attenuated but remained significant and moderately strong in both surveys when controlling for nonsexual antisocial behavior, substance use, and noncoercive sexual behavior in multivariate logistic regression models. The population attributable fraction (proportion of sexually coercive behavior that can be explained by sexual coercion experience) was 18%-25%. The findings support a robust link between having been sexually coerced and engaging in coercive sexual behavior in the general population.

Onanism and child sexual abuse: a comparative study of two hypotheses

For some decades now in the West, there has been a growing social anxiety with regard to a phenomenon which has become known as child sexual abuse (CSA). This anxiety is fed by scientific theories whose cornerstone is the assessment of these experiences as necessarily harmful, due to their presumed serious consequences for the present and future lives of the minors involved in them. This principle, widely held by experts and laypersons alike, was also part and parcel of the danger presumably posed by Onanism, a phenomenon which occupied a similar position in society and medical science in the West during the eighteenth through twentieth centuries. The present work is a comparative review of these two hypotheses and the central objective was to compare the evolution and fundamental elements of the two hypotheses in light of what history tells us about Onanism theory. This comparative analysis will allow a critical look at the assumptions of the CSA hypothesis in order to make evident the similarities to the conceptual model that enabled the Onanism hypothesis in the past.

Child sexual abuse in southern Brazil and associated factors: a population-based study

Background

The prevalence of child sexual abuse (CSA) in the population has been poorly described in developing countries. Population data on child sexual abuse in Brazil is very limited. This paper aims to estimate lifetime prevalence of child sexual abuse and associated factors in a representative sample of the population aged 14 and over in a city of southern Brazil.

Methods

A two-stage sampling strategy was used and individuals were invited to respond to a confidential questionnaire in their households. CSA was defined as non-consensual oral-genital, genital-genital, genital-rectal, hand-genital, hand-rectal, or hand-breast contact/intercourse between ages 0 and 18. Associations between socio-demographic variables and CSA, before and after age 12, were estimated through multinomial regression.

Results

Complete data were available for 1936 respondents from 1040 households. Prevalence of CSA among girls (5.6% 95%CI [4.8;7.5]) was higher than among boys (1.6% 95%CI [0.9;2.6]). Boys experienced CSA at younger ages than girls and 60% of all reported CSA happened before age 12. Physical abuse was frequently associated with CSA at younger (OR 5.6 95%CI [2.5;12.3]) and older (OR 9.4 95%CI [4.5;18.7]) ages. CSA after age 12 was associated with an increased number of sexual partners in the last 2 months.

Conclusion

Results suggest that CSA takes place at young ages and is associated with physical violence, making it more likely to have serious health and developmental consequences. Except for gender, no other socio-demographic characteristic identified high-risk sub-populations.

Child abuse: betrayal and disclosure

OBJECTIVE

The current study tested several hypotheses about disclosure of childhood sexual, physical, and emotional abuse derived from Betrayal Trauma Theory [Freyd, J. J. (1996). Betrayal trauma: The logic of forgetting childhood abuse. Cambridge, MA: Harvard University Press]. We predicted that the duration of time from abuse to its disclosure would vary as a function of victim-perpetrator closeness.

METHODS

Data collected from 202 undergraduate participants using a survey methodology were submitted to logistic regression analyses. The relative variance explained by other variables was also examined.

RESULTS

Compared to survivors of emotional abuse (EA) who were in not very close (NVC) victim-perpetrator relationships, EA survivors in very close (VC) victim-perpetrator relationships were significantly more likely to wait 1 or more years to disclose, or never to disclose, than to wait a period of time less than 1 year (OR=2.65). Further, survivors of physical abuse (PA) in VC victim-perpetrator relationships were significantly more likely to wait 1 or more years to disclose their abuse, if it was disclosed at all, than PA survivors of NVC victim-perpetrator relationships (OR=3.99). Results for sexual abuse were not significant.

CONCLUSIONS

For EA and PA, VC victim-perpetrator relationships predicted longer durations of time from abuse to its disclosure than NVC victim-perpetrator relationships.

PRACTICE IMPLICATIONS

Although delayed disclosure may support necessary (albeit abusive) attachments with caregivers, it may also prolong the abuse and prevent receipt of support. Increased awareness that VC victim-perpetrator relationships may predict longer durations of time from abuse to its disclosure, and that these delays may serve a functional purpose, can help guide supportive and empathic responses to traumatic disclosures.

Developmental risk factor research and sexual offending against children: a review of some methodological issues

Research on developmental risk factors for sexual offending against children is inherently difficult. Although there are numerous studies in the area, methodological problems are often not given sufficient attention in the design and interpretation of research. Despite the large number of variables retrospectively associated with sexual offending, the status of these as developmental risk factors remains unclear. If sexual offending research is to make progress, five methodological challenges must be met. These include: (1) establishing the temporal relationship between a putative risk factor and sexual perpetration; (2) ruling out third variable effects; (3) avoiding retrospective reporting bias; (4) generating informative tests of risk mechanisms; and (5) modeling complex developmental phenomena. In this review, we outline these methodological problems and suggest that the study of sexualized behavior in childhood and adolescence may provide some leverage on each of these difficulties.

CONFOUNDING VARIABLES WITHIN “REFERRAL CONTROLS” FOR CHILDREN WITH HISTORIES OF SEXUAL STIMULATION BY ADULTS: IMPLICATIONS FOR ERRONEOUS ATTRIBUTIONS FROM “CHILDHOOD SEXUAL ABUSE”

Verbal and performance scores from a standardized intelligence battery for age-matched children from four groups (n = 67) were compared to discern if the depressed scores for verbal intelligence displayed by children with histories of verified sexual stimulation by adults were epiphenomenal. The children had been referred to a psychiatric facility because of early sexual stimulation by adults, from a children's mental health service because of family problems, or from a school board for conduct disorders. The fourth group was hospital controls for the first group. The children with nonculturally approved sexual activity with adults and those from the mental health service displayed verbal intelligence scores that were about one SD below the scores for children referred by the school board and for the control group. These results suggest that psychological variables may not reflect a causal relationship and hence group differences should not be attributed exclusively to the diagnosis of sexual abuse.

Pedophilia is linked to reduced activation in hypothalamus and lateral prefrontal cortex during visual erotic stimulation

BACKGROUND

Although pedophilia is of high public concern, little is known about underlying neural mechanisms. Although pedophilic patients are sexually attracted to prepubescent children, they show no sexual interest toward adults. This study aimed to investigate the neural correlates of deficits of sexual and emotional arousal in pedophiles.

METHODS

Thirteen pedophilic patients and 14 healthy control subjects were tested for differential neural activity during visual stimulation with emotional and erotic pictures with functional magnetic resonance imaging.

RESULTS

Regions showing differential activations during the erotic condition comprised the hypothalamus, the periaqueductal gray, and dorsolateral prefrontal cortex, the latter correlating with a clinical measure. Alterations of emotional processing concerned the amygdala-hippocampus and dorsomedial prefrontal cortex.

CONCLUSIONS

Hypothesized regions relevant for processing of erotic stimuli in healthy individuals showed reduced activations during visual erotic stimulation in pedophilic patients. This suggests an impaired recruitment of key structures that might contribute to an altered sexual interest of these patients toward adults.

People believe it is plausible to have forgotten memories of childhood sexual abuse

Pezdek, Blandon-Gitlin, and Gabbay (2006) found that perceptions of the plausibility of events increase the likelihood that imagination may induce false memories of those events. Using a survey conducted by Gallup, we asked a large sample of the general population how plausible it would be for a person with longstanding emotional problems and a need for psychotherapy to be a victim of childhood sexual abuse, even though the person could not remember the abuse. Only 18% indicated that it was implausible or very implausible, whereas 67% indicated that such an occurrence was either plausible or very plausible. Combined with Pezdek et al.s' findings, and counter to their conclusions, our findings imply that there is a substantial danger of inducing false memories of childhood sexual abuse through imagination in psychotherapy.

Betrayal trauma theory: A critical appraisal

Freyd's (1996) betrayal trauma theory holds that children sexually abused by their caretakers are prone to develop amnesia for their abuse because awareness of abuse would imperil the survival of victims by disrupting their attachment to caretakers on whom they depend for food, shelter, and clothing. The purpose of this article is to provide an empirical and conceptual critique of betrayal trauma theory. Data from studies adduced as supporting the theory have usually been open to alternative interpretations, whereas other studies have failed to provide any support for the theory. Moreover, there is no convincing evidence that children are incapable of remembering their abuse--develop genuine amnesia for it--shortly after their molestation. Also, even if children abused by caretakers fear disruption of their attachment to the offender, there is no reason to assume that they must develop amnesia for their abuse; they can maintain the relationship merely by failing to disclose their abuse. Finally, a more parsimonious explanation for why some adults may fail to think about their abuse until many years later is provided.

False claims about false memory research

Pezdek and Lam [Pezdek, K. & Lam, S. (2007). What research paradigms have cognitive psychologists used to study "False memory," and what are the implications of these choices? Consciousness and Cognition] claim that the majority of research into false memories has been misguided. Specifically, they charge that false memory scientists have been (1) misusing the term "false memory," (2) relying on the wrong methodologies to study false memories, and (3) misapplying false memory research to real world situations. We review each of these claims and highlight the problems with them. We conclude that several types of false memory research have advanced our knowledge of autobiographical and recovered memories, and that future research will continue to make significant contributions to how we understand memory and memory errors.

Neurodevelopmental sequelae of postnatal maternal care in rodents: clinical and research implications of molecular insights

Parental care plays an important role in the emotional and cognitive development of the offspring. Children who have been exposed to abuse or neglect are more likely to develop numerous psychopathologies, while good parent-infant bonding is associated with improved resiliency to stress. Similar observations have also been reported in non-human primates and rodents, suggesting that at least some neurodevelopmental aspects of parent-offspring interactions are conserved among mammals and could therefore be studied in animals. We present data to suggest that frequency of licking and grooming provided by the dam during a critical period in development plays an important role in modifying neurodevelopment. These findings are examined in the broader context in which exposure to other sensory modalities such as vision or hearing during a specific period in development shapes brain development with functional consequences that persist into adulthood. We also discuss recent rodent work showing that increased frequency of licking and grooming provided by the dam during the first week of life is associated with changes in DNA methylation of promoter elements that control expression of these genes and behavior. The stability of DNA methylation in postmitotic cells provides a possible molecular scaffold by which changes in gene expression and behavioral traits induced by postnatal maternal care are maintained throughout life. Finally, the relevance of findings reported in rodents to those noted in non-human primates and humans are assessed and the research and clinical implications of these observations for future work are explored.