Child sexual abuse in religiously affiliated and secular institutions: a retrospective descriptive analysis of data provided by victims in a government-sponsored reappraisal program in Germany

Detecting orphanage trafficking and exploitation

BACKGROUND

There is growing awareness that a proportion of children in orphanages have been recruited or transferred into the facility for a purpose of exploitation and/or profit. These children are often falsely presented as orphans to evoke sympathy and solicit funding. This process is known as orphanage trafficking. Although orphanage trafficking can be prosecuted under legal frameworks in some jurisdictions, including Cambodia, there have been limited prosecutions to date. One factor that likely contributes to a lack of prosecution is poor detection, yet the indicators of orphanage trafficking have not been considered by extant research.

OBJECTIVE

The current study was conducted as a first step towards providing evidence-based indicators of orphanage trafficking.

PARTICIPANTS AND SETTING

Professionals who had identified or responded to cases of orphanage-based exploitation in Cambodia were interviewed. Participants included criminal justice professionals, investigators from civil society organisations, and child protection social workers.

METHODS

Professionals' perspectives on how to identify orphanage trafficking were explored via in-depth interviews, and the data were analysed via thematic analysis.

RESULTS

The analysis revealed a distinct set of indicators that may be used to detect orphanage trafficking, including the operation of an unauthorised facility, orphanage tourism and volunteering, and an overt focus on fundraising.

CONCLUSION

The indicators revealed in this study point to the need for an effective and thorough monitoring system for orphanages, as well as adequate education and training of relevant personnel to aid in the detection of orphanage trafficking.

Modesty, religion, and community: Therapists' perspectives regarding the treatment of child sexual abuse in the ultra-orthodox community

BACKGROUND

Religion is a significant cultural component that impacts child sexual abuse (CSA) in various ways, including its definition, perception, and treatment. This study focuses on the Jewish ultra-Orthodox community in Israel, a strictly religious, segregated, and close-knit community with unique cultural practices and beliefs that impact children's safety and vulnerability to CSA.

OBJECTIVE

This qualitative study aimed to explore therapists' perceptions and ascribed meanings of CSA treatment within the ultra-Orthodox community.

PARTICIPANTS AND SETTING

Thirty in-depth interviews were conducted with therapists working with the ultra-Orthodox community in Israel.

METHODS

The interviews were analyzed using thematic qualitative analysis.

RESULTS

Three central axes pertinent to the treatment of CSA in the ultra-Orthodox community were discovered: 1) religious interventions, 2) modest approach, relating to the community's taboo attitude towards sexuality; and 3) the collectivistic nature of the community. The results include specific effect sizes and their statistical significance.

CONCLUSIONS

The discussion explores the findings in light of the literature on CSA among religious minority communities and connects them to the unique underlying perception of sexuality in the ultra-Orthodox community. Specific ramifications and recommendations for practice are then considered, alongside the limitations and directions for future study.

Child Sexual Abuse in the Roman Catholic Church in France: Prevalence and Comparison With Other Social Spheres

This study aims to estimate and compare Roman Catholic Church-related child sexual abuse (CSA) prevalence and characteristics to CSA in other social spheres in France since 1950. Using a cross-sectional representative web-based survey of 28,026 adults in 2021, the weighted prevalence of CSA was estimated according to six social spheres of perpetration: family, Church, school, sports club, artistic activities, and summer camps. Altogether, 14.60%, 95% confidence interval [CI: 13.41; 15.80] of female respondents and 6.38% [5.73; 7.03] of male respondents had experienced CSA. Family was the most common social sphere of perpetration (3.55% [3.18; 3.92]), followed by the Church (0.81% [0.62; 0.99] of respondents exposed) and public schools (0.32% [0.23; 0.40] of respondents exposed). Altogether, we estimate 213,000, 95% CI [147,000; 278,000] people were victims of Church CSA since 1950 in France. Church CSA was more common among men than women (1.28% [0.93; 1.64] vs. 0.34% [0.20; 0.48]) while the opposite was true for other social spheres. CSA was overwhelmingly perpetrated by men ranging from 93.37% in the Church to 97.65% in schools. Many victims spoke with someone about these abuses: 41.81% of the Catholic Church compared to 41.25% of school CSA victims and 51.68% of family CSA victims. Results suggest structural factors including gender norms, but also the spiritual authority of the priest and the culture of secrecy contribute to clerical CSA.

"It was Really Hard for Me to Tell": The Gap between the Child's Difficulty in Disclosing Sexual Abuse, and their Perception of the Disclosure Recipient's Response

Disclosure of child sexual abuse (CSA) is essential to its mitigation and the protection of children. Previous studies have greatly contributed to the understanding of disclosure rates both in childhood and adulthood, in addition to delayed disclosure and disclosure barriers. In acknowledging the relevancy of the ecological framework, researchers have illustrated how the various systems in the children's lives have a role in their decision to disclose the abuse. The current study was designed to delve into the disclosure stories shared by children during their forensic interviews. Fifty children, 30 girls and 20 boys, from diverse communities in the Jewish society in Israel (15 secular, 15 Orthodox and 20 ultra-Orthodox) were forensically interviewed for the first time following CSA. Thematic analysis was carried out on their narratives, focusing on two main themes. The first was the children's descriptions of their difficulties to disclose, which were embedded in their own perceptions and experiences, their fear of the disclosure recipient's response, and their dynamic with the perpetrator. The second theme provided a glance into the children's descriptions of the disclosure recipients' responses, which highlighted the children's central experience of loneliness in the context of the abuse. Theoretical and practical ramifications pertaining to these crucial gaps will be discussed. In addition, specific religious-cultural elements raised in relation to the disclosure will be highlighted. Limitations of the study as well as further recommendations and implications will be introduced.

Childhood adversity and later life prosocial behavior: A qualitative comparative study of Irish older adult survivors

Objective

Although childhood adversity can have lasting effects into later life, positive adaptations have also been observed, including an increased tendency toward prosocial behavior. However, little is known about the link between childhood adversity and later life prosocial behavior, with a particular scarcity of research on intrafamilial childhood adversity. Therefore, this study aimed to examine older adult's experiences of childhood adversity and identify mechanisms linked to prosocial behavior. Two adversity contexts (intrafamilial and extrafamilial) were compared to explore individual, as well as broader cultural and contextual mechanisms linking childhood adversity and later life prosocial behavior.

Method

Semi-structured interviews (60–120 min) were conducted with N = 29 Irish (older) adult survivors of childhood adversity: n = 12 intrafamilial survivors (mean age: 58 years, range: 51–72), n = 17 institutional survivors (mean age: 61 years, range: 50–77). Interviews were analyzed using the framework analysis method, with reference to the conceptual model of altruism born of suffering.

Results

Five themes were identified on prosocial mechanisms, with three themes in both survivor groups (enhanced empathy, self-identity, amelioration), and two group-specific themes (compassion fatigue in intrafamilial survivors; denouncing detrimental social values in institutional survivors).

Conclusion

Results identified motivational processes and volitional factors linked to later life prosocial behavior. Connections to caring roles, (lack of) support, and social norms in childhood, as well as the need for a sense of purpose and meaning from the adversities in adulthood, highlight potential targets for psychotherapeutic intervention to promote prosocial responding and positive adaptation for childhood adversity survivors.

Childhood Sexual Abuse, Spirituality/Religion, Anxiety and Depression in a Jewish Community Sample: the Mediating Role of Religious Coping

Childhood sexual abuse (CSA) is a pervasive problem impacting a broad range of mental health outcomes. Previous research has shown that spiritual and religious (S/R) factors both positively and negatively relate to mental health issues among survivors of CSA, but mediating mechanisms of effect are unclear. The present study examined CSA, anxiety, depression, and positive/negative religious coping among 372 Jewish community members with and without CSA histories. Individuals who experienced CSA endorsed significantly higher anxiety and depression as well as negative religious coping than those without CSA. Negative religious coping mediated the relationship between CSA and anxiety and depression. We discuss clinical and social implications of these findings, including the need to address S/R factors in treatment of CSA, especially within religious communities. Further research examining abuser identity, survivors' disclosure experience, and other S/R mediators of effect is warranted.

An Exploratory Study on Mental Health, Social Problems and Spiritual Damage in Victims of Child Sexual Abuse by Catholic Clergy and Other Perpetrators

The Catholic Church has faced a large number of complaints against its representatives for sexual crimes that involved children and adolescents as victims. The objective of this study was to characterize the dynamics of this type of event, its characteristics, and its effects in terms of mental health and social consequences, as well as the spiritual damage generated. The sample comprised 182 victims from Spain and Chile, divided into three mutually exclusive groups (n = 40 committed by a representative of the Catholic Church; n = 85 by a family member; n = 57 by a perpetrator outside the family and the Church). The results show that victims of child sexual abuse (CSA) by a representative of the Catholic Church and other perpetrators are similar in many respects (e.g., religiosity, characteristics of the abuse, and mental health and social problems), but that the effects on religiosity are more serious for victims of the clergy, affecting their belief in God. Finally, the extreme decline in belief in God, due to CSA, is an important predictor for most mental health and social problems. Our results show the need to include the Catholic identity, faith and spirituality in the therapeutic context.

Sexual Abuse in the Orthodox Jewish Community: A Literature Review

Sexual abuse is a cross-cultural phenomenon related to multiple cultural contexts including religious affiliation. The Haredi, or Orthodox Jewish community (OJC), constitutes a significant minority group of the worldwide Jewish population, characterized by cultural conservatism, steadfast loyalty to the community, and strict religious behavioral codes. To date, only few empirical studies (as opposed to multiple media reports) have dealt with the issue of sexual abuse within the OJC. Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we conducted a systematic review of the literature on sexual abuse within the OJC and its subgroups that addresses experiences and reports of victims, perpetrators, the Jewish and general community, and professionals in the North America, Israel, and Australia. Articles were collected from peer-reviewed databases and bibliographies; 13 quantitative and qualitative articles were included in the final sample. Three themes emerged: disclosure of sexual abuse, perceptions and attitudes toward the abuse, and its implications. Results indicated that alongside several findings that were specifically grounded in the context of closed collective or religious societies and the OJC in particular, most essentially reflected universal aspects of sexual abuse. The results suggest promoting context-informed interventions based on community knowledge and resilience, together with appropriate training in order to better understand the needs of the OJC and of closed communities in general.

Häufigkeiten von Übergriffen auf Kinder und Jugendliche durch Angehörige der Heil- und Pflegeberufe

Zusammenfassung. Theoretischer Hintergrund: Kindesmisshandlung, -missbrauch und Vernachlässigung stellen ein gesamtgesellschaftliches Entwicklungsrisiko für Kinder in Deutschland dar. Zweithäufigster Kontext des Geschehens nach dem familiären Umfeld sind Institutionen. Fragestellung: Der vorliegende Artikel gibt eine Übersicht zu Häufigkeiten von Übergriffen durch Angehörige der Heil- und Pflegeberufe mit Schwerpunkt auf dem kinder- und jugendpsychiatrischen/-psychotherapeutischen Bereich. Methode: Mittels Literaturrecherche wird der Forschungsstand zum Thema dargestellt. Ergebnisse: Neben Auswertungen zu Zwangsmaßnahmen, welche von Betroffenen häufig als viktimisierend erlebt werden, existieren für Deutschland zwei repräsentative retrospektive Befragungen zum medizinischen Bereich. Hier ergaben sich Prävalenzen zwischen einem Fünftel und einem Drittel der Befragten, die mindestens eine Form von Gewalt oder Vernachlässigung bejahten. Diskussion und Schlussfolgerung: Neben alarmierenden Zahlen zeigt sich der große Bedarf an weiterer Forschung zum Thema.

Sexual Violence and the Coach-Athlete Relationship-a Scoping Review From Sport Sociological and Sport Psychological Perspectives

Sexual violence against athletes in elite and leisure sport has become of growing interest in recent years. In line with social media initiatives such as #SportToo and #CoachDontTouchMe and a rise in general media coverage, research in this field indicates an urgent need for action. These recent developments occasionally have led to no-touch policies, which may result in moral panic, uncertainty, and fear of unjustified suspicion among coaches. However, the role of closeness and distance in the development of sexual violence within the coach–athlete relationship has not yet been researched systematically. In this scoping review, the authors focus on the coach–athlete relationship, particularly its predispositions to sexual violence and how to prevent abusive relationships. Some characteristics typical of elite sport may predispose coaches to commit abuse, such as gender and power relations, the need for physical touch, hierarchical structures in sport, and trust and closeness between coaches and athletes. This scoping review follows an interdisciplinary approach combining sociological and psychological perspectives. It comprises 25 publications in English and German published from 2000 to 2019. The literature review highlights that closeness, power, blurred boundaries, and ambiguous roles are areas that seem to be crucial to the analysis of the coach–athlete relationship from both sociological and psychological perspectives.

Victims/Survivors' Perceptions of Helpful Institutional Responses to Incidents of Institutional Child Sexual Abuse

Like in many countries, the Australian Government has conducted an inquiry into child sexual abuse that occurred in institutional settings (The Royal Commission into Institutional Responses to Child Sexual Abuse). Drawing on the findings from a qualitative study commissioned by the Royal Commission, this paper explores the perceptions of victim/survivors^{1 1} The term 'victim' is used within the criminal justice system and the term 'survivor' can be used as to denote recovery and empowerment, so we use them interchangeably throughout. of the ways in which institutions (or individuals within them) responded supportively when sexual abuse was reported. While researchers and inquiries have reported on inadequacy of institutional responses, this paper addresses a research gap by investigating responses that victims/survivors perceived as helpful, while mindful of the overwhelmingly negative nature of their experiences. The paper contributes to the literature on institutional responses to child sexual abuse methodologically - by reporting on the challenges of a study of this type - and theoretically, by proposing a framework indicating how different helpful elements of an institutional response to child sexual abuse relate to each other in the victim/survivors' experiences. The findings are relevant for research on best practice in institutional responses to child sexual abuse.

Violence against children and adolescents by nursing staff: prevalence rates and implications for practice

BACKGROUND

International studies show that child maltreatment is a widespread but often underestimated problem that causes high individual, social and economic costs. Child maltreatment is an important topic for the medical sector as well. On the one hand, affected persons often seek support and help from healthcare professionals, but on the other hand, assaults can also occur in medical institutions by healthcare professionals. Surprisingly, there is hardly any data on the frequency of child maltreatment by healthcare professionals in general and particularly by nursing staff.

METHODS

Therefore, in a large representative survey of the German population of 2,516 subjects aged between 14 and 91, the experience of child maltreatment in medical institutions by nursing staff was assessed retrospectively.

RESULTS

Of the 46 subjects who had an inpatient stay in a child and adolescent psychiatry before the age of 18, 33.3% reported to have experienced maltreatment by nursing staff, while 17.3% of the 474 persons who had an inpatient stay in general or pediatric hospitals experienced maltreatment by nursing staff. All forms of maltreatment were significantly more frequent in psychiatric compared to general and pediatric hospitals.

CONCLUSIONS

The results of our representative retrospective survey demonstrate that maltreatment by nursing staff are not rare individual cases, but that medical facilities bear systemic risks for assault. Therefore, it is necessary that all medical institutions, in particular psychiatric hospitals, address this issue. In order to reduce the risk for assaults, it is important not only to implement structural measures but also to develop an attitude that emphasizes zero tolerance for violence against children and adolescents.

A Systematic Review of the Outcome of Child Abuse in Long-Term Care

The aim of the systematic review described in this article was to determine the outcome of child maltreatment in long-term childcare and the scope of the evidence base in this area. Searches of 10 databases were conducted. Forty-nine documents describing 21 primary studies and 25 secondary studies were selected for review. Searches, study selection, data extraction, and study quality assessments were independently conducted by two researchers, with a high degree of interrater reliability. Participants in the 21 primary studies included 3,856 abuse survivors and 1,577 nonabused controls. In six primary studies, survivors were under 18 years, and participants in the remaining primary studies were adults with a mean age of 54 years. Reviewed studies were conducted in the United Kingdom, the United States, Finland, Romania, Tanzania, Canada, Ireland, Australia, the Netherlands, Germany, Austria, and Switzerland. Participants were abused in religious and nonreligious residential care centers and foster care. There were significant associations between the experience of child abuse in long-term care and adjustment across the life span in the domains of mental health, physical health, and psychosocial adjustment. Evidence-based trauma-focused treatment should be offered to child abuse survivors. Future research in this area should prioritize longitudinal studies.

Female-Perpetrated Child Sexual Abuse: Prevalence Rates in Germany

Research on female-perpetrated child sexual abuse, especially maternal sexual abuse, is scarce. Prevalences are assumed to be lower compared to male-perpetrated abuse; however, representative studies including female perpetrators are rare. Experiences of male- and female-perpetrated child sexual abuse were examined in a representative German sample. Questions included experiences of hands-on and penetrative sexual abuse. The perpetrator-victim relationship was assessed to calculate prevalences of maternal sexual abuse. A total of 2516 participants (54.53% female, 14-91 years) were questioned and prevalences, as well as group differences between victims of male perpetrators compared to female perpetrators, were calculated. Overall, 10.5% of all participants reported experiences of child sexual abuse. Female perpetrators were involved in 9.9% of the cases, i.e. 1.0% of all participants. Victims of female perpetrators were significantly more often male. A quarter of the adult female perpetrators were the mother figure of the child. The findings suggest that the share of female perpetrators in cases of child sexual abuse is rather small; concurrently, female perpetration is insufficiently recognized. Especially male victims seem to be at risk for sexual abuse by female perpetrators. Contacts for children especially within the professional support system need to be aware of the existence of female perpetrators.

The Prevalence of Sexual Abuse in Institutions: Results From a Representative Population-Based Sample in Germany

The lifetime prevalence of sexual abuse in institutional settings in Germany was examined in a sample representative of the general adult population (N = 2,437). Participants completed a survey on whether they had ever experienced such abuse, its nature (contact, noncontact, forced sexual, intercourse), the type of institution (e.g. school, club), and the relationship of perpetrator to victim (peer, caregiver, staff member). Overall, 3.1% of adult respondents (women: 4.8%, men: 0.8%) reported having experienced some type of sexual abuse in institutions. Adult women reported higher rates of all types than did men, with rates of 3.9% versus 0.8% for contact sexual abuse, 1.2% versus 0.3% for noncontact sexual abuse, and 1.7% versus 0.2% for forced sexual intercourse. We conclude that a remarkable proportion of the general population experiences sexual abuse in institutions, underscoring the need for development of protective strategies. Especially, schools seem to represent good starting points for primary prevention strategies.

Developments in Psychotraumatology: A Conceptual, Biological, and Cultural Update

This report discusses recent developments of psychotraumatology mainly related to the recently published ICD-11, but also from a societal point of view.

The selected aspects of the development of this field will be presented as a scoping review.

In the first section, the new concept of disorders specifically associated with stress and its relevant diagnostic groups (posttraumatic stress disorder [PTSD], complex PTSD, prolonged grief disorder, and adjustment disorder) are presented, with an emphasis on PTSD. The second section embeds these diagnostic concepts within a broader context. In particular, the concept of psychotraumatology is applied to the impact of adverse childhood experiences. More specifically, recent scientific developments are discussed with respect to biological stress research. In a third section, a global perspective is applied that reflects psychotraumatology as embedded in culturally-specific concepts. Lastly, societal developments are taken into consideration. This section focusses on recent processes of victim acknowledgement and compensation taking place in Europe and beyond. Examples are provided for how traumatic stress is perceived and processed in society. Concepts such as continuous stress and historical trauma are also discussed.

Demands and opportunities of basic research and psychological interventions with a global focus are outlined.

Psychotraumatology is an expanding field including both basic research and intervention-related research.

Starting points of this new research area are not only potential traumatic events but also adverse childhood experiences.

In a globalized world, cultural and societal factors play an increasingly important role in psychotraumatology.

Coming to terms with oneself: a mixed methods approach to perceived self-esteem of adult survivors of childhood maltreatment in foster care settings

BACKGROUND

A broad range of psychopathological sequelae was found in adult survivors of institutional childhood maltreatment (IM). Childhood maltreatment is also associated with lower self-esteem (SE). In previous qualitative research, adult survivors of IM reported feelings of worthlessness and self-doubts, but research on IM and its associations with SE is still scarce.

METHOD

To investigate the emotional facet of SE in 46 adult survivors of IM in foster care settings provided by the City of Vienna we used the Emotional SE subscale of the Multidimensional Self-Esteem Scale ('Multidimensionale Selbstwertskala', MSWS) and applied a semi-structured interview with open-ended questions. Qualitative data were analyzed with thematic analysis. Finally, qualitative and quantitative data were merged in a mixed method approach to detect similarities and differences between both assessment modalities.

RESULTS

Findings showed a significantly lower emotional SE level (MSWS) in adult survivors compared to a norm sample. Qualitative findings revealed five main themes reporting positive and negative emotions and attitudes towards oneself. Merged data showed a tendency of more positive attitudes and emotions within participants with higher emotional SE levels and more negative attitudes within participants with lower levels. No gender differences were found in both data sets.

CONCLUSIONS

IM seems to predict lower emotional SE. Observed qualitative aspects of emotional SE seem to concur with symptoms of disturbances in self-organization (DSO) that are typically present in persons suffering from Complex PTSD. Considering emotional SE in future research could facilitate the understanding of the sequelae of complex trauma.

Childhood sexual abuse, mental health, and religion across the Jewish community

Current estimates of childhood sexual abuse among Jews in the United States are only available for females and do not include a spectrum of religiosity. We examined sexual abuse, mental health, and religion, in a religiously diverse sample of male and female Jewish adults from North America, using a novel methodology to minimize sampling/response biases. A total of 372 diversely religious Jews participated. Prevalence of any form of childhood sexual abuse was statistically equivalent to national rates, except that females reported less involuntary penetration (OR = 0.53). All Jewish religious groups reported equivalent levels of sexual abuse, except that history of involuntary penetration was greater among formerly (but not presently) Orthodox Jews (OR = 3.00). Across our sample, sexual abuse was associated with increased likelihood of psychiatric diagnosis (OR = 1.34), greater mental distress (F ranging from 2.99 to 9.08, p < .05 for all analyses), lower religious observance (F = 4.53, p = .03), and lower intrinsic religiosity (F = 4.85, p = .03). Further, across our sample we observed a moderate buffering effect of spiritual/religious factors against mental distress (ΔR² values ranging from 0.028 to 0.045, p <.01 for all analyses). Thus, we found childhood sexual abuse to occur across the spectrum of Jewish religious affiliation and greater prevalence among formerly Orthodox individuals. Furthermore, history of childhood sexual abuse was associated with greater risk for psychiatric distress and less religious involvement, however spiritual/religious engagement and belief appeared to facilitate resilience in the context of abuse.

Sexual Violence by Juveniles in Institutions: A Descriptive Study on Prevalence and Circumstances

Adolescents in institutionalized care are at a particularly high risk of exhibiting sexually aggressive behavior including sexual harassment. So far, however, studies about the prevalence of sexually aggressive behavior in institutions are lacking. In this survey, 322 adolescents (43% female, average age 16.7 years) from 32 residential care facilities and boarding schools across Germany were asked about sexually aggressive behavior via a standardized questionnaire. Overall, 23.5% of the participants engaged in some form of sexually aggressive behavior in their lives, and 4.6% reported having committed a sexual assault with (actual or attempted) penetration. A closer look at the circumstances of those offenses shows that the victims were in most cases acquainted with and of the same age as the offenders, that threats and violence were used in some cases, and especially in the case of actual or attempted penetration, and that only a minority of offenders suffered any consequences for their acts. The implementation of protective measures for institutions and the treatment of adolescents in institutions will be discussed.

The impacts of institutional child sexual abuse: A rapid review of the evidence

While awareness of institutional child sexual abuse has grown in recent years, there remains limited understanding of its occurrence and outcomes as a distinct form of abuse. Drawing on research commissioned by the Australian Royal Commission into Institutional Responses to Child Sexual Abuse, this article presents a rapid review of available evidence on the impacts of institutional abuse on victim/survivors. Literature searches identified 75 sources spanning international peer reviewed work and reports to Government that document or quantify the impacts of mostly historical child sexual abuse occurring in religious, educational, sporting and residential or out-of-home care settings. Consistent with child sexual abuse in other contexts, institutional child sexual abuse is found to be associated with numerous, pervasive and connected impacts upon the psychological, physical, social, educative and economic wellbeing of victims/survivors. Further, institutional child sexual abuse is associated with vicarious trauma at the individual, family and community level, and with impacts to the spiritual wellbeing of victims/survivors of abuse that occurs in religious settings. The identified literature suggests the trauma of institutional child sexual abuse may be exacerbated by the interplay of abuse dynamics in institutional settings, which may reduce or impede circumstances supporting disclosure, belief, support and protection from future harm. Acknowledging the limitations of the present study and the available evidence, this narrative synthesis provides insights into the complex impacts of institutional child sexual abuse.

[Child abuse from a pediatric perspective]

CLINICAL ISSUE

Child abuse is the physical, sexual or emotional maltreatment, or neglect of a child or children. Child maltreatment is defined as any act or series of acts of commission or omission by a parent or other caregiver that results in harm, potential for harm, or threat of harm to a child. Child abuse can occur in a child's home, or in the organizations, schools or communities the child interacts with. There are four major categories of child abuse: neglect, physical abuse, psychological or emotional abuse, and sexual abuse.

DIAGNOSTIC WORK-UP

In child abuse, establishing an early diagnosis is essential. Apart from taking a detailed history and performing a meticulous physical examination, including forensic evaluation as indicated, further diagnostic steps (imaging studies, ophthalmic examination/funduscopy, laboratory studies, etc.) may be warranted.

PRACTICAL RECOMMENDATIONS

In addition to providing acute medical help, longer-term, multidisciplinary interventions have to be put in place in cases of child abuse. This article summarizes the most important facts pertinent to this subject.

Sexual abuse of minors within the Catholic Church and other institutions : A literature review

Sexual violence against children remains a global public health problem. The health sector has an opportunity and responsibility to be part of the multisector collaboration to prevent and respond to sexual abuse of minors. The following article presents a critical analysis of hitherto published empirical studies that examine the extent and variety of sexual abuse of minors within the Catholic Church and other institutions. The analysis consists of 40 studies concerning the Catholic Church and 13 studies concerning other institutions not belonging to the Catholic Church. We report the characteristics of the offenders and the offenses. Furthermore, the devastating consequences for children abused by members of powerful institutions are discussed. Knowledge on the role of institutions in sexual abuse of minors and psychological distress following these experiences is necessary to point the way to improvements in prevention and intervention strategies. This literature review is part of a larger research project on the sexual abuse of minors in the context of the Catholic Church in Germany (MHG Study) that is conducted by an interdisciplinary team of psychologists, psychiatrists, criminologists, and sociologists and is funded by the German Bishops' Conference.

[Disclosure of Adolescents in Residential Care Institutions and Boarding Schools after Exposure to Sexual Violence]

Disclosure of Adolescents in Residential Care Institutions and Boarding Schools after Exposure to Sexual Violence In international research, many papers exist about the issue of disclosure after having experienced sexual violence. However, specific research regarding disclosure processes of children and adolescents in institutional care are missing, even though those are particularly often affected by sexual violence. In the Germany-wide study "Sprich mit!", adolescents from the age of 15 up (n = 322; average age 16,69 (SD = 1,3); 57,1 % males) who live in residential care or boarding schools were asked for experiences of sexual violence and their consequences by means of a self-report questionnaire. Results showed that the majority of the adolescents (82 %) entrusted themselves to someone, mostly towards peers (56 %) and less frequent towards adults (24 %). Boys and girls opened up equally often, regardless of the severity of the experienced violence. Adolescents who entrusted themselves towards their peers indicated retrospectively more satisfaction than those entrusting themselves towards adults, even if there were no consequences following the disclosure. Considering that the disclosure towards peers did not initiate a process of help, adolescents in institutional care should be better informed about relevant possibilities to entrust themselves and receive support.

Risk Factors for Sexual Offending in Men Working With Children: A Community-Based Survey

Identifying risk factors for sexual abuse in men who work with children and who have already abused a child could lead to more appropriate screening and prevention strategies and is thus of major scientific and societal relevance. A total of 8649 German men from the community were assessed in an extensive anonymous and confidential online survey. Of those, 37 (0.4 %) could be classified as child sexual abusers working with children, 90 (1.0 %) as child sexual abusers not working with children, and 816 (9.4 %) as men who work with children and who have not abused a child. We assessed the impact of working with children as an individual risk factor for self-reported child sexual abuse and compared personal factors, pedophilic sexual fantasies, deviant sexual behaviors, antisocial behaviors, and hypersexuality among the three groups. Most interestingly, working with children was significantly associated with a self-reported sexual offense against children; however, it explained only three percent of its variance. Child sexual abusers working with children admitted more antisocial and more sexually deviant behaviors than child sexual abusers not working with children and than men working with children who have not abused a child. Our findings support some of the suggestions made by other researchers concerning factors that could be considered in applicants for child- or youth-serving institutions. However, it has to be pointed out that the scientific basis still seems premature.

Child sexual abuse in the context of the Roman Catholic Church: a review of literature from 1981-2013

Child sexual abuse in the Catholic Church has been increasingly recognized as a problem not limited to individual institutions. Recent inquiry commission reports provide substantial information on offense dynamics, but their conclusions have not been synthesized with empirical research to date. The aim of this systematic literature review was to bring together key findings and identify gaps in the evidence base. The three main focus points were (a) types of publications and methodology used, (b) frequency information on child sexual abuse in the Catholic Church, (c) individual factors in offending, and (d) institutional factors in offending. It was found that reports, legal assessments, and research on child sexual abuse within the Catholic Church provide extensive descriptive and qualitative information for five different countries. This includes individual psychological factors (static risk predictors, multiple trajectories) and institutional factors (opportunity, social dynamics) as well as prevalence rates illustrating a high "dark figure" of child sexual abuse.