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EDITORIAL |
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| Ahead of print
publication |
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| Childhood sexual abuse history, should it be a part of routine psychiatry case notes? |
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Vijaya Chandra Reddy Avula
Additional Professor, Department of Psychiatry, AIIMS, Mangalagiri, Andhra Pradesh, India
Click here for correspondence address and email
| Date of Web Publication | 29-Dec-2022 |
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Child sexual abuse (CSA), often known as child molestation, is in which an adult or older adolescent sexually exploits a child. CSA includes taking part in sexual acts with a child (whether by request, coercion, or other methods), indecency (of the genitals, female nipples, etc.), child grooming, and child sexual exploitation, such as employing a child to create child pornography.[1]
The estimated global occurrence of CSA is 19.7% for girls and 7.9% for boys.[2] Most sexual abuse perpetrators are known to their victims; approximately 30% are relatives of the child, most frequently brothers, fathers, uncles, or cousins.[3] Approximately 60% are other acquaintances, such as “friends” of the family, babysitters, or neighbors; and approximately 10% are strangers. Studies on female child molesters indicate women are responsible for 14%–40% of recorded offenses against males and 6% of reported offenses against girls.[4]
The Ministry of Women and Child Development conducted a large-scale national study in 2007 to assess the extent and nature of child abuse in India. Among the 12,447 children interviewed, more than half (53%) reported experience of sexual abuse, defined as “sexual assault, making the child fondle private parts, making the child exhibit private body parts, and being photographed in the nude,” and over 20% reported experience of physical abuse. Even though these figures must be regarded with caution because it is derived from a convenience sample and not a nationally representative one, the numbers speak to the gravity of the situation and identify certain high-risk populations. Smaller studies from India have revealed an extremely high rate of CSA.[5]
CSA causes short-term and long-term psychopathology.[6]
Depression, anxiety, eating disorders, low self-esteem, somatization, sleep problems, dissociative and anxiety disorders, and posttraumatic stress disorder are symptoms. Sexual behavior and incorrect sexual knowledge and desire are the best markers of CSA. Victims may drop out and develop learning and behavioral disorders, including cruelty to animals, ADHD, conduct disorder, and oppositional defiant disorder. Teen pregnancy is common. CSA victims self-harm four times more. A National Institute of Drug Abuse research found that “Over 1400 adult females with childhood sexual abuse had mental, alcohol, and drug problems. Drug addiction was 2.83 times more common in women who were nongenital sexually molested as youngsters.” Childhood and adult victimization have lasting effects. Crime, suicide, alcoholism, and drug dependence result from childhood sexual abuse. The risk of ending up in prison is high for sexually abused boys. Middle-aged women who were molested as children had higher healthcare costs. CSA victims have more behavioral, social, and emotional disorders than their peers.[7]
There are various ideas concerning the causation of these connections, and no distinct symptom pattern. About 51%–79% of sexually abused children develop psychological issues. If the abuser is a relative, the abuse involves intercourse or attempted intercourse, or threats or force are utilized, the risk of injury increases. Penetration, length, frequency, and application of force can also affect injury.[8]
Social stigma, strong patriarchal society and gender inequality, ignorance about the impact of such trauma on children, overestimating children's capacity for auto-healing or ignoring their needs to heal trauma, a lack of an appropriate clinical setup for proper assessment and treatment, poverty/access to health care, and a lack of resources are all factors that contribute to parents of survivors delaying or forgoing treatment. Most Asian nations have yet to realize the “one-window” solution that would prevent unnecessary trauma, problems, and suffering associated with the pitfalls of medico-legal proceedings.[9]
This editorial recommends history taken about sexual abuse should be a routine part of case taking in psychiatry; the information provided will help in better psychiatric management. School curricula on awareness of sexual abuse and sex education are quintessential. Counselors as primary contact for victims of sexual abuse should be an integral part of the school. Awareness of Protection of Children from Sexual Offences Act, 2012, in schools and colleges. We should take up rigorous research on sexual abuse in all genders in the Indian population across various subcommunities. We should ensure the confidentiality and protection of the sexually abused victim. Indian Psychiatric Society and all its state branches should strive toward awareness of psychological problems because of sexual abuse in children, promote the disclosure by parents and provide one-window services to victims of sexual abuse.
| References | |  |
| 1. | Guidelines for psychological evaluations in child protection matters. Committee on professional practice and standards, APA board of professional affairs. Am Psychol 1999;54:586-93.  |
| 2. | Pereda N, Guilera G, Forns M, Gómez-Benito J. The prevalence of child sexual abuse in community and student samples: A meta-analysis. Clin Psychol Rev 2009;29:328-38. |
| 3. | |
| 4. | Finkelhor D. Current information on the scope and nature of child sexual abuse. Future Child 1994;4:31-53. |
| 5. | Study on Child Abuse 2007, Ministry of Women and Child Development, Government of India. Contemp Educ Dialogue. 2007;5:117-20. |
| 6. | Dinwiddie S, Heath AC, Dunne MP, Bucholz KK, Madden PA, Slutske WS, et al. Early sexual abuse and lifetime psychopathology: A co-twin-control study. Psychol Med 2000;30:41-52. |
| 7. | Roberts R, O'Connor T, Dunn J, Golding J, ALSPAC Study Team. The effects of child sexual abuse in later family life; Mental health, parenting and adjustment of offspring. Child Abuse Negl 2004;28:525-45. |
| 8. | Stoltenborgh M, van Ijzendoorn MH, Euser EM, Bakermans-Kranenburg MJ. A global perspective on child sexual abuse: Meta-analysis of prevalence around the world. Child Maltreat 2011;16:79-101. |
| 9. | Choudhary V, Satapathy S, Sagar R. Multidimensional scale for child sexual abuse (MSCSA): Development and psychometric properties. Asian J Psychiatr 2021;60:102643. |
Correspondence Address:
Vijaya Chandra Reddy Avula,
Department of Psychiatry, AIIMS, Mangalagiri - 522 503, Andhra Pradesh
India
 Source of Support: None, Conflict of Interest: None DOI: 10.4103/amh.amh_164_22
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