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Male Child Sexual Abuse and Future Offending: A Discussion of Assessment, Treatment, and Recommendations for Further Study

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Md Cabrera Mcsa

  1. 1. Male Child Sexual Abuse 1RUNNING HEAD: Male Child Sexual Abuse Male Child Sexual Abuse and Future Offending: A Discussion of Assessment, Treatment, and Recommendations for Further Study Melanie Cabrera, M.A.
  2. 2. Male Child Sexual Abuse 2 Author’s Note:The author is a recent graduate of Forensic Psychology at Argosy University. Correspondenceconcerning this article should be addressed to Melanie D. Cabrera, M.A., PO Box 637,Woodstock, CT 06281. E-Mail: Cabreram4321@gmail.comDraft version, 1/26/2011. This paper has not been peer reviewed. Please do not copy or citewithout authors permission.
  3. 3. Male Child Sexual Abuse 3 AbstractAccording to one study, 377 sex offenders admitted they had competed 48,297 acts ofextrafamilial child sexual abuse with 27,416 victims (Salter, 1995). One in seven child victimsin which the acts were reported to law enforcement agencies were under the age of six at the timeof the act (Lovett, 2007). Male child sexual abuse (MCSA) is a serious issue that has to potentialto result in psychological disorders, revictimization, and criminal offending for the victim. Acommunity approach is beneficial in the prevention, intervention, and treatment of child sexualabuse. Unfortunately, research pertaining to early intervention and prevention of MCSA issparse. There is considerable disagreement as to the prevalence of MCSA. However, it is clearadult survivors of male child sexual abuse are overrepresented in correctional facilities andinstitutions on charges involving sexual offenses. Therefore, to understand the offender and stopthe cycle, we must also understand the victim and the impact child sexual abuse may havethrough the victim’s lifespan.
  4. 4. Male Child Sexual Abuse 4 Male Child Sexual Abuse and Future Offending: A Discussion of Assessment, Treatment, and Recommendations for Further Study According to one study, 377 sex offenders admitted they had competed 48,297 acts ofextrafamilial child sexual abuse with 27,416 victims (Salter, 1995). One in seven child victimsin which the acts were reported to law enforcement agencies were under the age of six at the timeof the act (Lovett, 2007). To improve prevention and treatment methods, it is imperative thepsychological effects of the acts on male victims are understood. Moreover, adult survivors ofmale child sexual abuse (MCSA) are overrepresented in correctional facilities and institutions oncharges involving sexual offenses. Therefore, to understand the offender and stop the cycle, wemust also understand the victim and the impact child sexual abuse may have through the victim’slifespan. The available research in the area of MCSA is significantly limited, as most attention hasbeen directed towards the abuse of girls. Of what research is available, there is contradiction asto the prevalence and incidence of MCSA. Two studies indicate prevalence rates of MCSA at7.9% in the general population (Putnam, 2003; Gorey & Leslie, 1997). If we look at specificpopulations, such as institutionalized persons, the rate jumps to a significant 39% for juvenile sexoffenders (Ryan, Miyoshi, Metzner, Krugman & Fryer, 1996) and 76% of serial rapists(McCormack, Rokous, Hazelwood, & Burgess, 1992). One should be cautioned, however, theprevalence rate for the general population might be much higher. There are varying definitionsof sexual abuse that may distort statistics. Moreover, men are less likely than women to reportincidences of MCSA (Alaggia & Millington, 2008). Assessment and impact According to Alaggia and Millington (2008), distinct themes commonly emerge during
  5. 5. Male Child Sexual Abuse 5childhood and adolescence as a result of the male child victims’ experiences. Many use forms ofdenial to block out the sexual abuse, resulting in repressed memories that may emerge later inlife. They suffer from confusion surrounding their role and responsibility in the abuse,particularly if their body reacted during the acts. Many describe feelings of specialness, a senseof being wanted. As the child ages, however, anger and rage replace the feelings of specialnessand belonging. In fact, increased aggressiveness in young children in a school setting is oftenindicative of abuse (Lovett, 2007). Perhaps the most traumatizing aspect is the male child’s fear of disclosure, whichexacerbates as the child ages. “Some boys and men have difficulty disclosing sexual abuse orseeking treatment for it when it does occur because they perceive that socially-defined genderroles cast males as strong, tough and not in need of protection” (Alaggia & Millington, 2008, p.265). Members of society may subscribe to the myth of the all-powerful male, meaning the boymust have consented or must be gay if he became aroused or ejaculated. Equally disturbing,society (and even some therapists) minimizes the effects of abuse on a male child, falling into thestereotype that male rape is not on the same level as female rape. According to Salter (1995), the “harsh self-punitive thinking patterns of adult survivors[of child sexual abuse] can be traced to an internalization of the thinking errors of sex offenders”(p.2). Self-punitive thinking patterns, stemming from the disruption and distortion of normalsexual development transcends into intimacy and behavior problems throughout the lifespan. Asadults, victims may find they have great difficulty maintaining an intimate relationship. Failingto acknowledge and correctly treat victims of MCSA can result in a host of potentiallydestructive disorders including depression, suicide, addictions, post-traumatic stress disorder(PTSD), stress disorder, anxiety disorders, antisocial personality disorder, dissociation, sexual
  6. 6. Male Child Sexual Abuse 6identity disorder, or sexual offending behavior (Alaggio & Millington, 2008; Boeschen, Sales, &Koss, 1998; Brown, Brack, & Mullis, 2008; Lovett, 2007). Adolescents and young adults may be become self-destructive given the confusionsurrounding their sexual identity. Given the societal myth that their body reaction must meanthey enjoyed the act, thus they are gay, victims may exude extra effort to prove theirheterosexuality. “Some men may behave in a really macho way, for example, have sex with anumber of women, try to get a woman pregnant, or harass gay men” (Munro, 2000). Fear, angerand the feeling of helplessness may cause the adolescent victim to look for ways to regain asense of control. One victim, who had turned to sexually abusing others to mitigate the feelingof helplessness that pervaded his life. “The joy of seeing other people hurt, maybe not hurt…It’s hard to describe. Feeling that I was in control of dominating somebody. I had control over them, and they were below me” (Lisak, 1994, 534) Many adolescents and young adults turn to substance abuse to cope with the shame, self-blame, confusion, and anger they feel. Once study reported that sexually abused boys are morelikely than non-abused boys to report alcohol use by the age of 10, marijuana by the age of 12,and multidrug use through adulthood (Holmes & Slap, 1998). The maladaptive coping styles putthe victim of MCSA at risk of legal and health implications. Prevention Most literature to date has focused on early intervention, assessment, and treatment ofchild sexual abuse. Literature pertaining to the prevention of MCSA in the first instance isseverely lacking. “Although sex offenders may seem an unlikely source of information onprevention of child sexual abuse, they can make valuable suggestions” (Sattler, 1998, p. 842).
  7. 7. Male Child Sexual Abuse 7Elliot, Browne, and Kilcoyne (as cited in Sattler, 1998) interviewed known chronic sex offendersto determine how they gain the opportunities to abuse children. From the interviews, theygleaned numerous suggestions for children, parents, and teachers aimed to prevent sexual abuse.The offenders suggest that children be involved in programs to teach them about sexual abuse.Further, children should not be allowed to play alone in quiet areas. Instead, children should goout to play or walk to school with other children in groups. Children need be taught not to be tootrusting if someone is unusually nice or offering special favors. Particularly disturbing,offenders suggest that children should have someone accompany them to public restrooms: “A great place to hang out is in a toilet in a kiddies’ hamburger type restaurant. Little boys, especially go into the toilets alone and they aren’t expecting someone to try to touch them. Most of the time they are too embarrassed even to shout” (as cited it Sattler, 1998, p. 843). Parents should be educated about MCSA and not hold to the belief that only strangers canharm their children. “Parents are so naïve; they’re worried about strangers and should beworried about their brother-in-law” (as cited in Sattler, 1998, p. 843). Moreover, parents need tobe more involved with their children, encourage them to talk about their day and facilitate a moreopen relationship. Secrecy within the family can produce tragic results when the child feels theirparents cannot be approached. Finally, schools should have sex education and encourage frank discussions about childsexual abuse starting at an early age. Prevention programs for the very young children shouldinclude role-play on what to do if someone tries to touch them in an inappropriate manner. Mostimportant, the programs cannot focus solely on stranger danger and other stereotypes as the childmay not be able to link the education to what is happening at home.
  8. 8. Male Child Sexual Abuse 8 Treatment Early intervention and treatment “using multiple modalities has the potential to makesignificant changes in a young, sexually abused child’s life (Lovett, 2007, p.586). Lovett (2007)suggests play therapy become an integrate part of therapy for young victims as it allows the childto express thoughts and feelings regarding the offender and the act the child may not be able toexpress through the spoken word. Through play, an active therapist may help the child reshapehis mental representations of self and others. Perhaps most important is the confusion regardingcomplicity. The child requires reassurance that an automatic physical response to the act did notmean he was responsible. Individualized therapy is crucial and must correlate with the child’s symptomology andstage of development. A child who has learned to dissociate as a way to escape from anxietymust learn coping skills prior to reconnecting with the traumatic event. A child suffering fromPTSD may adamantly deny the act occurred during the avoidance phase of the disorder. In suchcases where PTSD is present, implosive therapy, or flooding, should be used with great care as itmay drastically intensify the symptoms (Putman, 2009). For children reenacting the traumathrough sexualized play, the potential for the child to become an adolescent or adult sex offendermust be addressed. It is imperative the child learn ways to cope with future feelings ofpowerlessness and helplessness, while mitigating the distorted cognitions of specialness,complicity, and sex as a means of achieving power. Adolescents may require a combination of therapeutic techniques, including cognitivebehavioral therapy, anger management, coping skills training and group therapy. Integrating thefamily or caregivers is crucial, particularly for the adolescent whose abuse began during earlychildhood. The adolescent may view the non-offending parent with contempt. How could she
  9. 9. Male Child Sexual Abuse 9not love him enough to protect him? It is quite possible she did not know the abuse was takingplace. Acknowledging she did not know, if this is the case, may provide the victim with a muchneeded sense of being loved. Moreover, “an unknowing parent also will find it easier to sidewith the survivor rather than the perpetrator” (Salter, 1995, p.123). Lovett (2007) also suggests the non-offending parent be included in the treatment toprovide stability when not in therapy. “Given that many sexually abused children present withsymptoms of attachment concerns, involving the primary, non-offending caregivers in thetreatment will be of most importance” (Lovett, 2007, p. 587). Including family in the therapyalso lessens the chance of revictimization. “Numerous studies have shown how [familial] denial,rage, guilt, and blame responses to [child sexual abuse] disclosure serve only to reinforce thesense of stigma, betrayal, and vulnerability typically experienced…” (Graham, Rogers &Davies, 2007, p. 235). Further, as insecure attachment between caregiver and child is a precursorto abuse, strengthening the bond may serve as a protective factor in preventing revictimization(Reid & Sullivan, 2009). In adults who have learned to block the memories of the abuse, treatment may resemblethe modalities used in the treatment of PTSD. The victim should be taught deep relaxationtechniques, which allows the victim to use mental imagery to “turn off” the intrusive images orthoughts when they become overwhelming (James, 2008). While in therapy, the victim is alsoencouraged to explore the deeper meanings of the images or thoughts as the only way to beginthe healing process is to confront and conquer the fears behind the images and come to termswith the reality of the traumatic event. Cognitive behavioral therapy is also beneficial inrestructuring an internal sense of self (Putman, 2009). For the adult survivor of MCSA engaged in sexual offenses, cognitive behavioral therapy
  10. 10. Male Child Sexual Abuse 10is a viable option. In 1989, W.L. Marshall published his ideas regarding the underlying intimacyproblems and loneliness prevalent amongst sex offenders. He explained that some sexualdeviants failed to secure bonds with parents or guardians during childhood because of abuse andwere thus unable to learn the skills and trust essential in forming meaningful intimaterelationships (Mann, 2004). Such a theory provides an explanation as to why most sex offendershave “little experience of adult intimate relationships or they have engaged in relationships thatare superficial or volatile” and explains why sex offenders view sexual activity as an “overlyimportant aspect of intimacy” (Mann, 2004, p.142). It is logical to conclude that MCSA victimswho sexually offend may exhibit such cognitive/behavioral distortions regarding the importanceof sexual relations – even against another person’s will – due, in part, to their own victimization.Distortions in cognitive information processing combined with behavioral flaws due to the lackof parental bonding allow the offender to justify his actions. CBT is essential in such cases as itwill aid the offender in recognizing the distortions concerning the substitution of sexual activityfor affection and provide coping strategies to effectively deal with loneliness and frustration(Mann, 2004). One problem with cognitive behavioral therapy, like most psychologicalinterventions, is that substantial progress takes time to develop. Conclusion MCSA is a serious issue that has to potential to result in psychological disorders,revictimization, and criminal offending for the victim. A community approach is beneficial inthe prevention, intervention, and treatment of child sexual abuse. Unfortunately, researchpertaining to early intervention and prevention of MCSA is sparse. As Lovett (2007) points out,“given the importance of the environment to young children, it may be necessary for a preschoolteacher or other child care providers to be connected in some way to the treatment [of a child
  11. 11. Male Child Sexual Abuse 11victim]” (p.587). For purposes of prevention and intervention, preschool teachers, elementaryschool teachers, and day care providers may be the best line of defense for MCSA, if providedwith the education and resources necessary to detect the early signs of abuse. As play therapymay assist the child in expressing his thoughts or feelings, play behaviors may also act aswarning signs of abuse. For example, the child may reenact the trauma repeatedly through play,become aggressive, dissociate during play, or become overly nurturing to dolls (Brown et al,2008). The abused child may have an inability to concentrate in a school setting, achieve lowgrades, miss or refuse to do homework, routinely lie, place blame on others, and consistentlybecome angry with the teacher or other authority figures (Brown et al, 2008). The similarities between indicators of MCSA and childhood disorders such asOppositional Defiant Disorder or Attention Deficit-Hyperactivity Disorder (ADHD) areastounding. According to the DSM-IV-TR, Oppositional Defiant Disorder is marked by a“recurrent pattern of negativistic, defiant, disobedient, and hostile behavior toward authorityfigures that persists for at least six months” (American Psychiatric Association, 2000, p. 100).The child loses his temper quickly, is argumentative with adults, blames others for his behaviorsor mistakes, and is angry, resentful, and vindictive. For MCSA victims, such acting out may alsooccur, particularly in cases where the abuse has been ongoing for a long period of time. ADHDof the primary inattentive type, which is marked by at least six months of 1) failure to payattention to details that results in careless mistakes, 2) difficulty sustaining attention, 3) notappearing to listen when spoken to directly, 4) failing to finish homework or chores, 5) difficultyorganizing tasks, and 6) forgetful in daily activities may correlate to the confusion and disruptiona MCSA victim experiences (American Psychiatric Association, 2000). To date however,literature exploring these similarities appears to be non-existent. Further research is needed in
  12. 12. Male Child Sexual Abuse 12this area to determine whether male children are routinely misdiagnosed, thus their victimizationremain a horrible secret.
  13. 13. Male Child Sexual Abuse 13 ReferencesAlaggia, R. & Millington, G. (2008). Male child sexual abuse: A phenomenology of betrayal. Clinical Social Work Journal. 36(3), 265-275. Retrieved September 14, 2009 from PsycNet database.American Psychiatric Association. (2000). DSM-IV-TR. APA: Washington, DCBoeschen, L, Sales, B., Koss, M. (1998). Rape trauma experts in the courtroom. Psychology, Public Policy and Law, 4(1-2), 414-432. Retrieved September 20,, 2009 from PsycArticles database.Brown, S., Brack, G., & Mullis, F. (Aug. 2008). Traumatic symptoms in sexually abused children: Implications for school counselors. Professional School Counseling. 11(6), 368-379. Retrieved September 13, 2009 from ProQuest Psychology Journals.Gorey, K. & Leslie, D. (1997). The prevalence of child sexual abuse: Integrative review adjustment for potential response and measurement bias. Child Abuse and Neglect. 21, 391-398. Retrieved September 19, 2009 from PsycNet.Graham, L., Rogers, P., & Davies, M. (2007). Attributions in a hypothetical child sexual abuse case: Roles of abuse type, family response, and respondent gender. Journal of Family Violence. 22, 733-745. Retrieved September 15, 2009 from PsycNet database.Holmes, W & Slap, G. (1998). Sexual abuse of boys: Definition, prevalence, correlates, sequelae and management. Journal of the American Medical Association. 280(21), 1855-1862. Retrieved September 26, 2009 from, Richard. (2008). Crisis Intervention Strategies. (6th ed). Belmont, CA: Thomson Brooks/Cole.
  14. 14. Male Child Sexual Abuse 14Lisak, David. (1994). The psychological impact of sexual abuse: Content analysis of interviews with male survivors. Journal of Traumatic Stress. 7(4), 525-546. Retrieved September 26, 2009 from (1994)_Male_Survivor_Interviews.pdfLovett, Beverly. (2007). Sexual abuse in the preschool years: Blending ideas from Object Relations Theory, Ego Psychology, and Biology. Child Adolescence Social Work Journal. 24, 579-589. Retrieved September 13, 2009 from ProQuest Psychology Journals.Mann, Ruth. (2004). Innovations in sex offender treatment. Journal of Sexual Aggression, 6(2), 141-152. Retrieved September 20, 2009 from ProQuest Criminal Justice DatabaseMcCormack, A., Rokous, I., Hazelwood, R., & Burgess, A. (1992). An exploration of incest in the childhood development of serial rapists. Journal of Family Violence. 7(3), 219-228, Retrieved September 19, 2009 from PsycNet.Munro, K. (2000). Male-to-Male Child Sexual Abuse in the Context of Homophobia. Retrieved September 26, 2009 from, Stacie. (2009). The monsters in my head: Post-Traumatic Stress Disorder and the child survivor of sexual abuse. Journal of Counseling and Development. 87(1), 80 – 89. Retrieved September 14, 2009 from PsycNet database.Putnam, F.W. (2003). Ten-year research update review: Child sexual abuse. Journal of the American Academy of Child and Adolescent Psychiatry. 42(3), 269-278. Retrieved September 20, 2009 from PsycNet.
  15. 15. Male Child Sexual Abuse 15Reid, J. & Sullivan, C. (2009). A model of vulnerability for adult sexual victimization: The impact of attachment, child maltreatment, and scarred sexuality. Violence and Victims. 24(4), 485-501. Retrieved September 15, 2009 from PsycNet database.Ryan, G., Miyoshi, T.J., Metzner, J.L., Krugman, R.D., & Fryer, G.E. (1996). Trends in a national sample of sexually abusive youths. Journal of the American Academy of Child and Adolescent Psychiatry. 35, 17-25. Retrieved September 20, 2009 from PsycNet.Salter, Anna. (1995). Transforming Trauma: A Guide to Understanding and Treating Adult Survivors of Child Sexual Abuse. Thousand Oaks, CA: Sage PublishingSattler, Jerome. (1998). Clinical and Forensic Interviewing of Children and Families: Guidelines for the Mental Health, Education, Pediatric, and Child Maltreatment Fields. San Diego, CA: Jerome M. Sattler, Publisher Inc.