Sexual abuse

This is a topical and controversial subject. Sexual abuse of children appears to be a common problem, but poses diagnostic difficulties because it is so often concealed. Both over- and under-diagnosis may have serious consequences for both (alleged) victim and (alleged) perpetrator. Possibly about 10 per cent of children undergo sexual abuse, ranging from touching to penetrative intercourse.

Most victims are girls, abused by their fathers, brothers, or other male relatives. Sexual abuse of boys is more often carried out by men outside the family, either an authority figure such as teacher, clergyman, or scoutmaster, or a stranger who offers bribes. Occasionally the perpetrator is female.

Some cases come to light because the child, or mother, seeks help directly from a treatment agency. More often the presentation is indirect, such as genital bruising or infection, early teenage pregnancy, a crisis such as an overdose or running away from home, vague neurotic symptoms, or inhibited development. Many cases remain concealed.

Victims of child sex abuse appear to be at increased risk of certain psychiatric disorders in adult life. These include psychosexual difficulties, neuroses, personality disorders, eating disorders, somatization, and deliberate self-harm. The proportion of victims who suffer serious long-term effects of this kind is not known; however, most authorities agree that sexual experience with adults is almost always harmful to the child. Even if it takes place in the context of a superficially affectionate relationship, the surrounding secrecy and coercion are likely to induce fear or guilt in the child.

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