Think corporal punishment is abuse
Consequences of Sexual Abuse (2001)
What happens to a child who is sexually abused? What do the consequences look like and how can you spot them? Often there is uncertainty about how to react. Sometimes the child's reactions are also misunderstood. Or typical reactions are not even recognized as warning signals - even by close caregivers. It is therefore important to get an overview of different forms of violence against children and the resulting consequences in order to be able to intervene at an early stage and also to work preventively. The more the population is made aware of the problem of violence, the more multifaceted the picture of acts of abuse and the faster it can be intervened. Due to the different abuse situations and consequences, the different development status and development environment of the child, it becomes impossible to come up with a kind of patent recipe for interventions. Individual help must be offered. Awareness-raising should lead to the early detection of acts of abuse in order to protect the children and to treat the stressful consequences as early as possible.
Knowledge of the possible consequences of sexual abuse, the different forms of violence and differentiated dimensions of violence can help to raise awareness of this. The boundaries between the different forms of violent acts are often fluid. The understanding of the term in the narrower sense usually only includes cases in which children are physically injured. In the case of sexual abuse, it is difficult to identify direct physical harm. Sexual abuse is rather secret and not obvious. Only in a few cases do organic injuries occur as a direct consequence of the abuse. In contrast, the term abuse, defined in a broader sense, also includes actions that do not necessarily lead to physical or psychological impairment of children. These actions include, for example, frequent scolding, hitting or punishing with withdrawal of love. This understanding of the term is particularly important in preventive work, in order to continue to recognize abuse in small children at an early stage and to be able to intervene there.
Forms of violence against children
A distinction is made between structural and personal violence. Structural violence is understood to be violence that results from social circumstances, such as inadequate living conditions. While these can have direct effects, they do not necessarily have to come from a single person. Personal violence includes the actions and omissions of an adult towards a child. Failure to provide assistance is differentiated into failure to provide assistance.
A distinction is made between four forms of personal acts of violence: [cf. Engfer, 1997, p.22]
Neglect occurs when children are not adequately nourished, provided with health care and / or not properly supervised by their caregivers. This form of violence also includes a lack of age-appropriate support for the child. The use of force in the form of neglect cannot always be clearly identified, since parenting activities depend on social norms and cultural differences in the educational goals must also be taken into account. However, neglect is always an act of omission that can have far-reaching consequences for the child. It is also a matter of neglect if no assistance is provided. For example, when a child tries to communicate experiences of violence by the father to the mother and she encounters incomprehension and disbelief.
Mental abuse is seen separately from neglect as it is a form of action that can frighten children and make them feel worthless. Psychological abuse can inhibit a child in his or her psychological and physical development opportunities. The limit to mental abuse is not always clear. It consists of more or less recognized or tacitly tolerated educational practices, such as punishments with house arrest and withdrawal of love. Psychological abuse is a subtle form of violence against children, although the consequences are usually indistinguishable from those of other forms of violence. The psychological abuse can have the character of an omission and an act.
- Physical abuse
Physical abuse is physical injury inflicted on the child by the caregiver or a stranger. These include blows and intentionally inflicted burns. The intensity of the abuse and the respective sensitivity of the child's organism play a major role in the effects. For the emotional consequences that the child has to experience, there is a difference in the severity of the blows and also with regard to the reason. If an act of violence occurs in the affect, then the subsequent reaction between adult and child is perceived differently than one can perceive (persistent) physical abuse.
This type of violence against a child is the subject of this article. Sexual abuse is a violent act that is undesirable by the child and is forced by the acting (adult). Adults (mostly male) use children for their own sexual satisfaction. This is often accompanied by physical and psychological violence and emotional pressure.
According to police crime statistics, 15,279 cases of child sexual abuse were assumed in Germany in 1999. [www.bundeskriminalamt.de/pks/pks1999. As of August 26, 2001] In addition, there is unfortunately also a high number of unreported cases, which is why this number says disproportionately little about the extent of the acts of violence that actually took place. The number of unreported cases is estimated to be more than ten times the number of cases registered by the police. As of August 26, 2001] Abuses that take place within the family are rarely reported.
If a child is sexually abused by a family member, the feelings of the victims are often ambivalent. It seeks protection from the acts and at the same time does not want to destroy the cohesion of the family. There is a great burden on the child, but they do not want to destroy the relationship with the perpetrator or the family. Many victims are between six and ten years old at the beginning of the crime, some of those affected are already between two and five at the beginning of the crime Years old. [see. Information brochure of the Senate Department for Youth and Family, 1992] This shows that the victims at the time of the crime did not yet have sufficient life experience to deal with the consequences. In the case of sexual abuse in the family, many affected children try to dismiss their experiences as "nothing". Nevertheless, they cannot "master" their ambivalent feelings as long as they do not have a person of trust and can feel relieved by a conversation. The child believes the responsibility for the abuse is being placed on them, which puts a heavy weight on them.
Boys are often met with a tacit expectation that they will not be victims. 'Boys are tough.' Such a role expectation is also burdensome. Boys are usually younger than girls at the time of the crime and the crime is more often associated with the use of violence, so that they have more injuries in the anal area. Boys who already have a broader knowledge of sexuality are also increasingly afraid of homosexuality resulting from abuse. They often think that having sex with a man can lead to homosexuality. This results in an additional fear for the male victims about communicating with someone.
Criteria for Judging Sexual Abuse
Sexual abuse is judged by the intent behind the act, who is benefiting from it, and who the act comes from. Furthermore, the age and reluctance of the child must be taken into account. It is important whether the child is already able to say 'no' and whether this is also respected. In addition to these questions, it is important to consider the child's feelings about certain actions and possible consequences. [see. May, 1997] Knowing about this can serve to prevent possible concealment and concealment maneuvers.
Of particular interest with regard to the consequences are the different dimensions of sexual abuse:
- the type of abuse and its severity,
- the frequency or chronicity of the action,
- the developmental age and context of the child,
- the person of the perpetrator (mother, father, acquaintance, stranger). [see. Egle, Hoffmann, Steffens, 1997, p.19]
The age difference between the perpetrator and the victim can also provide an indication of sexual assault, but sexual assault by young people should not be ignored. Sexual abuse does not just involve a physical act. Rather, the breach of trust, the violation of integrity and the emotional dependency between victim and perpetrator usually play a major role. Sexual abuse often takes place in secret, so the child is forced to maintain secrecy and the reason for the act is not clear to the victim. Within the family there is seldom the possibility for a child to confide in someone with their worries, fears and feelings of physical and psychological threat. Often there is a lack of trust or the person addressed does not want to admit it. Much abuse takes place under the guise of the 'whole family'.
Consequences of violence
Mentally, physically or sexually abused children have extremely diverse, unspecific and different symptoms. The effects of acts of violence can arise on the emotional, behavioral and physical levels. The type of violence and its dimensions play a role, the fact whether the victim is a boy or a girl and injuries that are directly related to the abuse. In some cases these three factors cannot be clearly separated because they can be related to each other.
The consequences of acts of sexual abuse are greater and the memories for the victim all the more stressful, the greater the age difference and kinship between the perpetrator and the victim, the longer the sexual violence lasts, the younger the child is when the offense begins , the more violence is threatened and used, the more complete the secrecy and the associated pressure is exerted on the child and the less protective and trustworthy people are available to the child as contact persons. [see. Information brochure of the Senate Department for Youth and Family, 1992, quoted from www.praevention.org/fachinformationen. As of August 26, 2001]
On the emotional level, sexual abuse can lead to strong feelings of shame, guilt and worthlessness. The victim's integrity is destroyed. The victim mostly rejects his own body because his self-image is disturbed. Affected children find it difficult to trust themselves and others; In addition, the victim often feels unable to relate. One consequence of the experience of abuse can be the fear of entering into relationships or the fear of not being able to muster the necessary trust. The victim's own later sexual life can also be disrupted by the consequences of the abuse. Due to the fact that coercion and violence go hand in hand with abuse, the child does not overlook the meaning of their own sexual life and experiences aversion towards their future partner. The intimate closeness to the partner can lead to memories arising that control is not maintained and cannot be decided by oneself. The later sex life cannot be experienced naturally, desired and positively through these traumatic experiences.
The effects of sexual abuse on the behavioral level include self-destructive behavior, bed-wetting, chronic running away, repeated suicide attempts. Boys often become aggressive due to acts of abuse. They want to prove their manhood, but also keep the control that has been so drastically taken from them. This way, boys compensate for their fear of homosexuality.
The consequences on the body level are characterized by the fact that the body reacts to the psyche and this is mostly done unconsciously. Persistent and aetiologically unclear physical complaints are a possible indication of a sexual abuse situation in the context of anamnesis and behavioral problems. [see. Bürgin, Rost, 1997, p.139]
In the following, various symptoms of sexual abuse on the body level will be discussed. It should be noted that neither all of the symptoms mentioned have to be pronounced, nor that the presence of these symptoms necessarily implies sexual abuse, since other traumatic events (e.g. traffic accidents, deaths) can also lead to the disorders described.
- Dissociative disorders [cf. Eckhardt, Hoffmann, 1997]
Characteristic of dissociative disorders are the partial or complete loss of the ability to adequately integrate stressful memories into one's own wealth of experience, the partial loss of identity awareness and the loss of control over one's own body movements. This disorder usually has a psychogenic cause and there is a close temporal connection to traumatic events, insoluble or unbearable conflicts or disturbed relationships. At the same time, however, a dissociative patient has control over which memories and sensations are allowed and which movements are carried out.
Chronic conditions of dissociative disorder can lead to paralysis and sensory disturbances, but usually the dissociative conditions decline rapidly. Psychosocial difficulties and problems are often denied by dissociative patients.
In the case of dissociative disorders of movement as a consequence, there is a loss or a change in movement functions or one or more limbs of the body. Different forms of lack of coordination can occur in the legs, up to and including the inability to walk freely. Exaggerated tremors may also occur. Dissociative disorders can be associated with psychosomatic disorders.
Seizures are another form of dissociative body movement disorder. These "pseudo-seizures" can be very similar to epileptic seizures. Possible injuries in the context of an epileptic seizure are rather rare. The convulsive seizures often resemble a representation of incestuous contacts.
B. Psychosomatic disorders
In order to be able to ascribe illnesses to psychosomatics, actual organically caused illnesses must be excluded.
As a result of acts of sexual violence, psychosomatic symptoms such as twitching of the extremities, gait and vision disorders and disorders of consciousness can occur. These symptoms are physical means of expressing mentally conditioned conflict situations. They are individual means of expression and the cause is usually difficult to identify.
In many cases, sleep disorders are symptoms of a psychological or physical problem. For example, it also results from increased nightmares, or nightmares and sleep disorders can be mutually dependent. In the so-called fear dreams, the dream experience is very vivid and realistic. As topics in the literature, for example, "threats to life, security or self-esteem" [ICD-10, 1993, p.213 (F 51.5)] are mentioned. Such dreams can haunt an abused child well into the day.
Skin and stomach diseases can occur as a result of the above-mentioned psychosocial stress. Sexual disorders such as sexual dysfunction and vaginismus (a spasm of the pelvic floor muscles surrounding the vagina) can also be an indication of the experience of sexual violence.
Mentally caused head and back pain, chronic abdominal pain, pain in the arms and legs and also in the heart are counted as somatic pain states. Abdominal pain represents a pain choice very close to the realm of abuse experience. In such a form, unbearable feelings and conflicts are unconsciously expressed through pain. For toddlers, this is also the unconscious way to gain affection. As long as an abused child is in pain that is obvious, "one is not alone and being cared for".
Patients with somatoform pain disorders or other psychosomatic illnesses are often convinced of the physical causes of their illness. Possible stressful experiences are suppressed as the cause by the patient and often neglected by doctors.
- Eating disorders [the studies by Root, M., Fallo, P., Friedrich, W. (1986) and Oppenheimer, R., Howells, R., Palmer, RL, Chalonner, DA (1985). See also Willenberg, 1997, p. 280]
Eating disorders such as bulimia and anorexia nervosa are common sequelae of experiencing violence. With these symptoms it becomes particularly clear that the abused child rejects his or her own body. Feelings of shame, guilt and a need to punish oneself are manifested through the eating disorder. Anorectics and bulimia patients have the feeling of being unloved and undesirable and at the same time not being able to communicate with a caregiver. You cannot accept your body in any way. This can also result from sexual abuse, among other things.
Bulimia is characterized by the periodic ingestion of large amounts of food and the subsequent self-induced vomiting or removal of the same. Bulimic patients are not necessarily underweight, but their body sensation is impaired. A pathological fear of getting fat is part of this disease even in the case of a normal weight starting situation. After a seizure, they feel disgust, helplessness, panic and feelings of guilt. The subsequent emptying by vomiting or laxatives has a relieving effect. This disease is kept secret by the victims out of shame. Many bulimic patients are at risk of suicide. Bulimia is rarely diagnosed in men. Consequences of the disease can be serious damage to the health of the intestines and esophagus. Further long-term consequences can also occur.
Anorexia refers to a severe loss of appetite (including the victim's deliberate refusal to eat) and nervosa means that the reasons for this are emotional in nature. Anorectics also have an enormous fear of eating and the associated weight gain. A commonly reported phenomenon of anorexia is an impaired body image and is also primarily diagnosed in women. The consequences of this disease are emaciation, menstrual disorders, hair loss, underdevelopment of the organs, liver damage up to death by starvation. The drastic weight loss from anorexia raises the assumption that emerging sexual development should be halted. [see. Willenberg, 1997, p.277]
The child's body image and the consequences for it
Every person has a three-dimensional picture of himself, consisting of optics, movement and feeling. These levels provide the picture of the whole. From a psychoanalytic point of view, the body image is not uniform, but can only be subjectively reconstructed. [see. Joraschky, 1997, p.124] Our own image arises early on based on interaction patterns, through identification with the body of the other and the experiences of forms of physical encounter. A healthy body image cannot arise when interaction patterns are not experienced or are experienced in a different, incorrect way. When a child experiences forms of physical encounters that do not correspond to their age, which they do not understand and which they cannot defend themselves, a disturbed body image arises. A child who experiences sexual violence experiences it against his will. In addition, there are humiliations, feelings of shame and worthlessness. Typical phenomena in the self-experience of abuse victims are disorders of self-esteem, feelings of absolute disrespect, which go hand in hand with constant self-doubt. The child makes poor contact with their own body. In the child's perception of the environment, all the violence is due to the existence of his own body. The resulting disturbances in your own body sensation can be expressed in the most varied of ways. In addition to body image disorders, there are psychosomatic clinical pictures, disorders due to one's own non-recognition. The false assumption that they themselves are to blame for the acts of abuse leads children to use loose clothing to cover up possible sexual stimuli towards adults. Body feelings of ugliness and disfigurement are very stressful. [see. Joraschky, 1997, p.117]
The body feeling of sexually abused children can be destroyed. Additional states of tension and muscle tension are considered unspecific reactions to various stressful situations: "A conflict pathology leads to disorders in the affective experience in the context of unsuccessful conflict resolution, e.g. fears, exhaustion and depression. The ego pathology that exists at the same time causes the emotional part of this experience is undervalued, neglected in perception, so that attention is focused on accompanying physical disorders "[cf. Egle, 1997, p. 202].
It is characteristic of the consequences of sexual assault that all stressful tensions that the child's body has to endure are discharged through the body. This means that an attempt is made to resolve conflicts with a physical illness. In children, this is particularly evident in the area of motor skills. It is not uncommon for regressive physical reaction patterns to occur, such as thumb sucking and bed wetting. The voltage dissipation takes place automatically. It is tied to affects, but strongly linked to the body. Studies have shown evidence of hyperactivity, apathy, and autoerotic or autoaggressive activities. [see. Bürgin, Rost, 1997, p. 151]
In addition, there is no longer a healthy body feeling, since abused children generally feel bad, bad, stupid and unlovable in their self-experience. They have difficulty recognizing feelings and expressing them even worse. They have little pleasure in themselves or their bodies. As a break in the self, a part of the body is often split off from the victims, the body as a whole is devalued and marginalized [cf. Joraschky, 1997, p.120]. The body is no longer a part of the ego, but is split off - dissociated - and watched with fear.
Conclusion and outlook
The symptoms listed here can be indicative of acts of violence against children. However, before suspicion of sexual abuse is raised, the background to these symptoms should be carefully examined, as organic illnesses as well as other traumatic experiences, such as deaths in close proximity, traffic accidents or separation of parents, can lead to this.
Due to the different forms of violence and dimensions, it is and remains difficult to identify child abuse. Every child reacts individually to situations of abuse. It is precisely because there is no "patent recipe" for the protection of the child that it is essential to raise awareness among caregivers. Knowledge of the forms of violence and the multi-faceted, serious consequences can help to uncover and end the acts of violence.
If a child has experienced sexual abuse, it is important to stand by the child and not leave them alone. It is important to get the child out of the threatening environment and to protect them from renewed abuse. Only when the child is safe can they begin to process the stressful experiences. The caregiver should try to restore the child's trust in himself and others by giving the child reliability.
Bürgin, D., Rost, B. (1997): Mental and psychosomatic illnesses in children and adolescents, in: Egle, U.T., Hoffmann, S.O., Joraschky, P. (1997): Sexual abuse, mistreatment, neglect, Stuttgart, New York, pp. 133-155
Dilling, H., Mombour, W., Schmidt, M.H. (Ed.) (1993): International Classification of Mental Disorders (ICD-10 Chapter V (F)), 2nd edition, Verlag Hans Huber
Eckhardt, A., Hoffmann, S.O. (1997): Dissociative disorders, in: Egle, U.T., Hoffmann, S.O., Joraschky, P. (1997): Sexual abuse, mistreatment, neglect, Stuttgart, New York, pp. 225-237
Egle, U.T., Hoffmann, S.O., Joraschky, P. (1997): Sexual abuse, abuse, neglect, Stuttgart, New York
Egle, S.O. (1997): Somatoform pain disorders, in: Egle, U.T., Hoffmann, S.O., Joraschky, P. (1997): Sexual abuse, mistreatment, neglect, Stuttgart, New York, pp. 195-213
Engfer, A. (1997): Violence against children in the family, in: Egle, U.T., Hoffmann, S.O., Joraschky, P. (1997): Sexual abuse, mistreatment, neglect, Stuttgart, New York, pp. 21-35
Herbert, M. (1999): Post-traumatic stress, Bern, Göttingen, Toronto
Hoffmann, SO, Egle, UT, Joraschky, P. (1997): Significance of traumatizations in childhood and adolescence for the development of psychosomatic illnesses - attempt to take stock, in: Egle, UT, Hoffmann, SO, Joraschky, P. (1997 ): Sexual abuse, mistreatment, neglect, Stuttgart, New York, pp. 417-423
Joraschky, P. (1997): Sexual abuse and neglect in families, in: Egle, U.T., Hoffmann, S.O., Joraschky, P. (1997): Sexual abuse, mistreatment, neglect, Stuttgart, New York, pp. 79-93
May, A. (1997): No is not enough: Prevention and prophylaxis, Ruhnmark: Donna Vita
Root, M., Fallo, P., Friedrich, W. (1986): Bulimia: system approach to treatment, New York, Norton
Senate Department for Youth and Family (1992): Sexual abuse of children and adolescents, Berlin
Oppenheimer, R., Howells, R., Palmer, R.L., Chalonner, D.A. (1985): Adverse sexual experience in childhood and clinical eating disorders: a preliminary description, J. Psychiat Res, pp. 357-361
Wetzels, P. (1997): Experiences of Violence in Childhood, Nomos Verlagsgesellschaft, Baden-Baden
Willenberg, H. (1997): Eating disorders, in: Egle, U.T., Hoffmann, S.O., Joraschky, P. (1997): Sexual abuse, mistreatment, neglect, Stuttgart, New York, pp. 271-284
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