Ramona Alaggia MSW, PhD. RSW Associate Professor Factor-Inwentash Chair in Children's Mental Health Faculty of Social Work University of Toronto Canada

1. Male Child Sexual Abuse:
Relational Betrayal and Healing
BASPCAN 2015 CSA Disclosure Symposium
Ramona Alaggia MSW, Ph.D. RSW
Associate Professor
Factor-Inwentash Chair in Children's Mental Health
Faculty of Social Work, University of Toronto
April 13, 2015
1

2. Review of Disclosure Literature
40%- 80% of victims do not purposefully disclose CSA before
adulthood (Arata,1998; Lawson & Chaffin, 1992; Paine &
Hansen, 2001; Smith, Letourneau, Saunders, Kilpatrick, Resnick
& Best, 2000)
Latency to disclosure studies report a mean delay from 3 -18
years (Arata, 1998; Lamb & Edgar-Smith, 1994; Oxman-
Martinez, Rowe, Straka & Thobault, 1997)
Age, gender, relationship to the perpetrator, family and cultural
issues may all play a part in disclosure or lack of it (Alaggia,
2010; Arata, 1998; Bradley & Wood, 1996; Fontes, 1993;
Gartner, 1999; Goodman-Brown, Edelstein, Goodman, Jones &
Gordon, 2003; Smith et al., 2000; Ullman, 2003; Wyatt &
Newcomb, 1990)

3. Canadian Prevalence & Disclosure
Rates of CSA
• Hébert and colleagues (2009) study (n=804)
• 22.1% for women
• 9.7% for men
• 57.5% delayed disclosure (more than 5 years)
• 21.2% disclosed promptly
• Over 20% did not disclose before the survey (1 out of
5)
• Delayed disclosure resulted in clinical levels of
psychological distress and PTSD
• Females abused by non-family members most likely
to disclose

4. Breaking the Silence: Study Objectives
Objectives of the study were designed to identify
influences that inhibit or promote childrens’
disclosure of child sexual abuse. Specific objectives
addressed the following:
1) From the perspective of the victims, what are the
psychological tactics used by perpetrators of CSA to
suppress disclosure?
2) In what specific ways do these tactics interact to
have an impact on the victim's ability to disclose?
3) What individual, familial and environmental
influences impact disclosure?

5. Many Ways of Telling
*Alaggia , R. (2004) International Journal
of Child Abuse & Neglect
 Intentional
behavioral, non-
verbal attempts
to disclose
 Non-intentional,
unconsciously
driven
behaviors, often
effects or
symptoms
 Disclosure
following recovery
of memories
 Memories not fully
accessible due to
developmental
factors
Expanded Framework of Disclosure Types *
 Direct verbal
attempts
 Intentional behavioral
attempts
 Indirect verbal
attempts
Lack of Awareness
Of Sexual Abuse
Purposeful
Disclosure
B
 Intentional
withholding
 False denial
 Disclosure
through
accidental
discovery
 Disclosure only
when prompted
or elicited
Behavioral
Manifestations
Disclosure
Intentionally Withheld

6. Disclosure Iceberg
Silence/Intentional
Withholding
Symptoms
80%80%
20%20%
Repressed/for-
gotten/inaccessible
memories
Behaviours
Accidental
Discovery
Accurate Identification
/Investigation/SubstantiationDirect
Verbal
Disclosure

7. Rates of Male CSA
Incidence and prevalence studies cite estimates range from 3% to
37% for male child sexual abuse (Cawson, Wattam, Brooker &
Kelley, 2000; Finkelhor, Hotaling, Lewis & Smith, 1990; Putnam
2003; Rind, Tromovitch & Bauserman, 1998; Trocmé, Fallon,
MacLaurin, et al., 2005).
26% of men in community samples report having
experienced sexual abuse in their childhood, and up to 36 % of men
in clinical samples report child sexual abuse (Cawson et al. 2000;
Fergusson et al. 1996; Finkelhor et al. 1990, 2008; Putnam, 2003).
1 out of 6 males in Canada are sexually abused by the age of 18
(Badgley Commission Report, 1984).

8. Impact of MCSA
Studies of the long-term psychological impact of MCSA have
found that men are at an increased risk for a host of long-term
effects including:
– major depression
– suicide
– addiction
– interpersonal relational issues
– post-traumatic stress disorder
– anxiety disorders
– antisocial personality disorder
– sexual identity issues and sexual dysfunction
(Alaggia & Millington, 2009)

9. Breaking the Silence: Study Design
• Phenomenological design –lived experiences of adult
survivors of CSA -Long Interview Method (McCracken, 1988)
• Ethics approval through the University of Toronto
• Purposive total sample of 40: 14 male participants (28%)
• Six step data analysis strategy identifying meaning units and
developing phenomenological reduction
• Advisory Research Committee; reference group member
checking; agency feedback
• Mean age 41.1; close to 50% were non-white; half were
middle class; one quarter working poor & one quarter on
social assistance; most were divorced one or more times; vast
majority struggled with concurrent issues of addiction and
mental illness; over 1/3 had conflicts with the law

10. Many Ways of Telling
Withholding Disclosure
“My new friends were just guys talking about the facts of life
one day and I’m all ears. So I was being told what was normal
and what was not and I was devastated, very devastated. I ran,
I literally ran from the conversation and couldn’t tell the guys
why I ran.” P1(M)
Behavioural Manifestations
“It was hard, you know, cause there would be days I’d come
home all angry and she [mother] would be ‘what’s wrong?’
Like nothing, I’d say. Nothing is wrong, don’t worry about it.’
Yeah, I think at one point I didn’t feel resentment to her, but it
was like ‘Why aren’t you picking up on you know, maybe I
am dropping small hints, my moods’?” P14(M)

11. Many Ways of Telling
Indirect Verbal Attempts
“ . . . there were times when we tried to tell my mother or I did
like leave her little hints . . . Um, I would say something like,
oh ‘can you come early tonight’ or ‘do you have to go to
work?’ Um, I couldn’t come out and say it.” P2(M)
Lack of Awareness of the CSA
“I had been doing a lot of work on myself spiritually, became a
Buddhist. I was doing a lot of deep meditation, um, and a lot
of work that way. And I just think it was, um, a lot of the
memories got unlocked . . .The images were ‘bang!’ and it was
just sort of ‘What are these images about?’ And then it was,
well, you’re having flashbacks . . . ” P6(M)

12. Gender Specific Barriers to Male Disclosure
1) most were abused by men and feared being viewed as
homosexual –homophobic societal attitudes
2) they felt profoundly stigmatized, different and isolated
because they believed that boys were rarely sexually abused
(victims) sexist attitudes about being feminine
3) many feared they would become perpetrators because of their
sexual abuse history thus disclosing to seek help

13. Sexuality & sexual orientation issues
“But, I guess it’s burning us to keep our mouths shut; it’s too
embarrassing . . . . Well, you’re going to think I’m a fucking
------ . And I’m not!” P30 (M)
“At the height of the flashbacks and stuff I didn’t want to, um,
I almost became homophobic because I was afraid that if I
went outside um people would know something about me, that
I was gay.” P6(M)
“I don’t know how much of a, how big a part that played in me
disclosing like whether people would believe me, I don’t think
that was the real issue, I think it was more the sexuality thing.”
P2(M)

14. Men not wanting to be viewed as victims
“Yeah. So in a way by saying to somebody you were sexually
abused is the fear of just having that feminine thing attached to
you.” P10 (M)
“I was a very, thin child with very curly light brown hair and I
was called a fucking, a girl, um a sissy, um . . . that just
destroyed myself, my sense of self.” P6 (M)

15. Men’s fears of becoming an abuser
“My kids actually the biggest fear, that was my biggest fear,
sexually abusing my girls.” P2(M)
“What scared me is am I capable of doing what my father did
to me? Am I capable of doing what my uncles did?” P36(M)

16. Hyper-Masculinity
“I think its because growing up guys are always bombarded
with the whole jock mentality.” P30 (M)
“I didn’t understand lovey-dovey feelings. I was strictly out
for what I could get. Fulfill my own needs. I guess I was so
sexualized that would make me feel more like a man and less
confusion about homosexuality.” P14 (M)
“I was very aggressive, sadistic, controlling, manipulating
person. That’s how I lived my childhood, adulthood. I was a
gang leader so I know what its like to go threaten somebody
with a baseball bat. I’ve been paid to hurt people for money.”
P1(M)

17. Hyper-Masculinity
“I was acting out all over the place. I was very promiscuous
even back then. I got more promiscuous as I got older but
y’know, that, that trouble I had was, was where I was acting out
in a sexually curious way. And, uh, inappropriately with females
and I mean I got into trouble with the law for that.” P12 (M)
“Well I got very calm, I just got cold, man. I got very quiet and
very de-sensitized. Even back then I was big trouble . . . Later I
was really freaking out. I was going into another state of extreme
hyper-vigilance. I was actually starting to hunt people down. I
was going out of my way to find people.” P31(M)

18. Ecological Model of CSA Disclosure*
*Alaggia, R. (2010) Canadian Academy
Child and Adolescent Psychiatry, (19)1,
32-39.
Ontogenic child
factors
Age, gender,
temperament,
developmental and
other vulnerabilities,
protective
features/resilience
Inter-personal/micro
factors
Family structure: closed
vs. open system; rigid
vs. flexible roles;
patriarchal hierarchy vs.
egalitarian; family
violence;
maternal support
Macro/structural
level factors
Cultural and societal
attitudes; gender
socialization;
patriarchal attitudes;
sexism, homophobic
& racist attitudes
access to resources
Exo factors -
Community;
neighbourhood
characteristics; level
of safety; availability
of social supports and
activities

19. Summary
Disclosing and seeking help for effects of sexual abuse for men is
difficult in the face of:
– socially prescribed gender roles
– pre-dominance of male perpetrators
– related homophobic attitudes and sexual confusion
– fears of being identified as a risk to offend
– lack of male-specific services

20. Conclusion
Paying attention to male sexual abuse survivors’ unique histories,
distinctive gendered aspects of the abuse, and what it means to be
a male victim sexually abused by a male perpetrator are
important considerations in therapeutic work:
– Important to ask male clients about sexual victimization, even when
this is not the presenting problem but when they exhibit sexual abuse
related problems
– an obligation to educate one’s self on responding therapeutically to
disclosure
– a duty to receive training to counsel sexually victimized males
– a responsibility to advocate for the development of men’s services
– taking an active role in shifting attitudes towards men’s vulnerabilities

21. References
Alaggia, R., & Mishna, F. (2014). Self psychology and male child sexual abuse:
Healing relational betrayal. Clinical Social Work Journal. 2(4), 398-415.
Alaggia, R. (2010). An Ecological Analysis of Child Sexual Abuse Disclosure:
Considerations for Child and Adolescent Mental Health, Canadian Academy
of Child and Adolescent Psychiatry, (19)1, 32-39.
Alaggia, R., & Millington, G. (2008). Male Child Sexual Abuse: A Phenomenology of
Betrayal. Clinical Journal of Social Work, 36(3), 265-275.
Alaggia, R., & Kirshenbaum, S. (2005). Speaking the unspeakable: Exploring the
impact of family dynamics on child sexual abuse disclosures. Families in
Society, 86(2), 227-234.
Alaggia, R. (2005). Disclosing the trauma of child sexual abuse: A gender analysis.
Journal of Loss and Trauma , 10 (5), 453-470.
Alaggia, R. (2004). Many ways of telling: Expanding conceptualization of child sexual
abuse disclosure. Child Abuse & Neglect: An International Journal, 28(11),
1213-1227.

22. Thank you
ramona.alaggia@utoronto.ca