Description of the Issue
Abusers are able to fool those outside the home because they usually only abuse those inside the home. “Intrafamilial sexual abuse means sexual abuse that occurs within the family” (NCTSN). In this form of abuse, a family member involves an individual (or exposes to) sexual behaviors or activities. The “family member” may not even be a blood relative, but could be someone who is considered part of the family, such as a close family friend, godparent, or included in the family by marriage. Intrafamilial sexual abuse is more common than one may believe. The National Child Traumatic Stress Network has found that more than half of all children who are sexually abused are abused by a parent or other relative and “approximately 10% of all women report a childhood sexual experience with a relative” (Herman.) Sexual abuse of a family member by a trusted adult puts a tremendous strain on relationships within the family. Tensions may arise when different family members have different opinions about loyalty, fairness, justice, forgiveness, and responsibility. BG1
Every culture has their own spoken and unspoken rules about sex and sexuality. These rules can make it even more difficult for individuals to ask for help when they’ve been abused. This can often lead to feelings of shame that in turn lead to further secrecy. “The discovery that someone you love and trust has sexually abused someone in your family can be extremely stressful and can bring up intense feelings of shock, rage, confusion, denial, disbelief, and guilt” (NCTSN). Facing the reality of intrafamilial sexual abuse can be painful, but ending the secrecy surrounding sexual abuse, can help families heal and protect.
Absolutely anyone can be a victim. There are victims of sexual abuse within every country, race and ethnicity, age group, gender, socioeconomic status, education level, and religion. EB2 Perpetrators of sexual abuse don’t fit into any stereotype either. Although, most perpetrators of sexual assault are known to their victims. The Bureau of Justice Statistics (BJS) reports that 6 in 10 rape or sexual assault victims said that they were assaulted by an intimate partner, relative, friend or acquaintance (NIJ). Research on sexual violence indicates that women are far more likely to be victims than men are. EB3 Also, children are victimized at a much higher rate than adults when it comes to intrafamilial sexual abuse. Nearly 70% of all reported sexual assaults (including assaults on adults) occur to children ages 17 and under and approximately 30% of children who are sexually abused are abused by family members (Darkness to Light).
Significantly, abusers can be and often are other children; perpetrators are not always teenagers or adults. As many as 40% of children who are sexually abused are abused by older, or more powerful children. “The younger the child victim, the more likely it is that the perpetrator is a juvenile. Juveniles are the offenders in 43% of assaults on children under age six”. EB4 Most sexual abuse of children occurs in a residence, typically that of the victim or perpetrator. 81% of child sexual abuse incidents for all ages occur in one-perpetrator/one-child circumstances, while 6-11-year-old children are the most likely to be abused in multiple-victim circumstances (Darkness to Light). Most adolescent sex offenders are not sexual predators and will not go on to become adult offendersEB5 .
Intrafamilial sexual abuse is a significant focus of attention because there are far too many assaults going unreported. This is a topic that needs to be discussed more often starting at an early age. Children and older individuals need to know that committing sexual assault or being a victim of abuse is a serious situation that needs to be addressed immediately due to the long-term effects of the abuse. Children and other individuals also need to be reassured that it is safe for them to come forward with the truth and that there is help available for both the victim and the perpetrator. Talking about sexual abuse and becoming more aware of the signs and facts is important for everyone to know. EB6
Theory and Literature Review
The incest taboo is found in all known cultures, ancient, primitive or civilised (Giaretto). One percent of the ten percent of women who report childhood sexual abuse with a relative are victims of father-daughter incest. Father-daughter incest is an umbrella term used to describe any sexual relationships or relations between a father and a daughter. This is the most common form of incest. EB7 “Incestuous families are seen to represent a pathological exaggeration of traditional patriarchal norms” (Herman). In a patriarchal social system, males hold primary power and predominate in roles of political leadership, moral authority, social privilege and control of property. This gives the males complete control over women and children. Some common features of families with father-daughter incest include: extreme paternal dominance, maternal disability, and the imposition of a mothering role on the eldest daughter. Incestual relationships most commonly form before puberty and continue in secrecy for many yearsBG8 . More than one daughter may be involved in the abuse (Herman). The effect that incest has on women is very damaging and may be lifelong. “Adult women with a history of incest exhibit a clinical syndrome that includes low self-esteem, difficulty in intimate relationships, and repeated victimization” (Herman). EB9
Sibling incest, specifically, brother-sister incest is also a form of sexual abuse that occurs within the family. A study conducted in 2015 aimed to compare the differences the effects between father-daughter, brother-sister, and step-father-daughter incest had on women. Seventy-two girls between the ages of five and sixteen were assigned to one of three groups that were divided by age. The young girls were asked to complete measures of traumatic stress. Their mothers completed the Child Behavior Checklist-Parent Report Form (Mireille and Wright)., which is a “113-item informant-report questionnaire assessing behavioral competency and behavioral problems in children” (EB10 The Child Behavior Checklist), and also other self-report questionnaires on family characteristics. Lastly, workers in child protective services completed information regarding the nature and severity of the incest abuse (Mireille and Wright). The results showed that penetration was much more frequent in the sibling incest group (70.8%) than in the stepfather incest (27.3%) or father incest (34.8%) groups. Ninety percent of the girls who were victims of fathers and brothers showed signs of clinically-significant distress on a least one measure as opposed to only sixty-four percent of stepfather victims. Brothers who committed incest were also found more likely be raised in families with more children and a higher rate of alcohol abuse than the other perpetrators. The study concluded that “the characteristics of brother-sister incest and its associated psychosocial distress did not differ from the characteristics of father-daughter or step-father-daughter incest” (Mireille and Wright).EB11
The incidence of child sexual abuse by female perpetrators is underestimated. This could be accredited to our society’s unwillingness to believe that women could commit such acts. Until recently, mother-child incest was considered to be virtually non-existent (Banning). Mother-child incest is more likely to be subtle than other forms of incest because it involves behaviors that are oftentimes difficult to distinguish from normal caregiving, such as gentle touching (Kelly and Wood). Victims often find themselves under persuasion and psychological coercion to participate in sexual acts (Graystona). Among all the forms of child abuse, sexual abuse during infancy is the least often discovered. Three separate cases of mother-child incest were reported to the Perinatal Center for Chemical Dependence of Northwestern Memorial Hospital by women who were undergoing therapy sessions for chemical dependence. Two of the women were bisexual, one was lesbian, and none of them had any sexual relationships following the birth of their baby. All mothers reported breastfeeding and living alone in a home with the newborn with no support from family or friends. The women confessed to fondling their newborn son’s’ genitals, masturbating while stimulating their child, and performing fellatio on their child and using him for masturbation by rubbing him against her own genitals. By the time the children were preschool age, the sexual abuse had stopped but it left a lasting impact on the children. They were reported to exhibit sexual aggressiveness such as pulling off other children’s clothes or reaching under other children’s clothes attempting to fondle their genitals. There was also an increased amount of general “acting out” with other preschool peers (Chasnoff).
Sexual violence can also occur in intimate partner relationships. Intimate relationships play a central role in the overall human experience and married or not, your partner is usually considered to be a part of your family. Intimate partner sexual abuse (IPSA) includes sexual assault and battery, rape, sexual contact without consent, coercion, intimidation, ad acquiescenceBG12 . Approximately eight to fourteen percent of women suffer sexual abuse from an intimate partner at some point during their lives (Sachs and Gomberg). For these women, IPSA is inversely correlated with body image and self-esteem and is cause to a higher rate of homicide. EB13 This is an extremely dangerous situation because victims feel like they cannot reach out for help or report a rape, for example, to the police since it is with someone whom they are in a relationship with. “When the victim-offender relationship is intimate, the likelihood that the incident is defined as rape decreases, attribution of blame to the victim increases, and the level of perceived harm decreases” (Sachs and GombergBG14 ). EB15
“Attachment is a deep and enduring emotional bond that connects one person to another across time and space” (McLeod). It is easy to see, then, just how drastically a person’s sense of attachment towards a family member who is sexually abusive would be negatively affected. John Bowlby’s Attachment Theory seeks to explain the emergence of an emotional bond between an infant and primary caregiver and the way in which this bond affects the child’s behavioral and emotional development into adulthood. There are four types of attachment:secure, avoidant, ambivalent and disorganized. Research shows that secure attachment is the best possible foundation for healthy physical, emotional, intellectual, and social development. Secure attachment is classified by children who show some distress when their caregiver leaves but are able to compose themselves knowing that their caregiver will return. Children with secure attachment feel protected by their caregivers, and they know that they can depend on them to return (Safe). In the case of parent-child incest, Bowlby would accredit this to the child and adult not forming a secure attachment. According to Bowlby, in cases of sexual abuse from a distant relative, brother-sister incest, or intimate partner sexual abuse, the cause would be the perpetrator not forming a secure attachment with his or her own caregiver as an infant.EB16
The psychoanalytic theory, founded by a man by the name of Sigmund Freud, presents a different perspective in which we can view sexual abuse. According to Freud, our behavior and feelings are strongly affected by our unconscious motives. “The unconscious mind comprises mental processes that are inaccessible to consciousness but that influence judgements, feelings, or behavior” (McLeod). The unconscious mind is the primary source of human behavior. Similar to an iceberg, the most important part of the mind cannot be seen. Freud proposed that children must go through a series of fixed psychosexual stages: oral, anal, phallic, latency, and genital in order to develop their personality. Each of the psychosexual stages is associated with a particular conflict that must be resolved before the individual can successfully advance to the next stage. “The resolution of each of these conflicts requires the expenditure of sexual energy and the more energy that is expended at a particular stage, the more the important characteristics of that stage remain with the individual as he/she matures psychologically” (McLeod). Some people are unable to leave one step and continue to the next because their needs have not been adequately met, which is called frustration. On the other hand, some people may have their needs met so well that they chose to not leave a particular stage, which is called overindulgence. Both frustration and overindulgence may lead to a fixation at a certain psychosexual stage. This means that an individual’s libido has been permanently ‘invested’ in a particular stage of his development (McLeod). According to Freud, this fixation, is what would cause individuals to become sexual abusers. Sexual abusers have unmet or overindulgent sexual needs that must be fulfilled. EB17
Approaches to Violence Prevention and Intervention
Violence is predictable and therefore preventable. Violence affects a significant proportion of the population and it threatens the lives and physical and mental health of millions of people. Globally, 1 in 5 women and 1 in 10 men are victims of sexual violence in childhood. All forms of violence, particularly child maltreatment, intimate partner violence, and sexual violence have shown to have a range of other health consequences, such as depression, smoking, obesity, high-risk sexual behaviors, unintended pregnancy, misuse of drugs and alcohol, and increased risk of involvement in violence as a victim or perpetrator. Sexual abuse experienced in childhood accounts for serious health problems in the general population, such as post-traumatic stress disorders, panic disorders, and suicide attempts. EB18 The Adverse Childhood Experiences (ACE) studies suggest that “there are substantial and costly lifelong health and behavioural consequences of child maltreatment and argue for the importance of seeking to prevent violence through initiatives aimed at improving parenting and reducing abuse and neglect” (Violence Prevention Alliance). Though there seems to be a great amount of prevention and intervention programs for victims there is unfortunately, not very many programs for perpetrators. EB19
Trauma-focused cognitive behavioral therapy (TF-CBT) is an evidence-based treatment approach shown to help children, adolescents, and their caregivers overcome trauma-related difficulties as victims. This intervention program is designed to reduce the negative emotional and behavioral responses to sexual abuse, domestic violence, traumatic loss and events. The treatment is based on learning and cognitive theories that addresses distorted beliefs and attributions related to the abuse. This program also provides a supportive environment for both the children and their caregivers (who are not abusive) to effectively cope with their own emotional distress and develop skills to overcome obstacles (Child Welfare Information Gateway).
TF-CBT integrates several treatment approaches that combines elements from cognitive therapy, behavioral therapy, and family therapy. Cognitive therapy aims to change behavior by addressing a person’s thoughts or perceptions. Behavioral therapy focuses on modifying habitual responses such as fear or anger to identified situations. Family therapy examines patterns of interactions among family members to identify and alleviate problems. “The TF-CBT protocol has adapted and refined these procedures to target the specific difficulties exhibited by children who are experiencing PTSD symptoms in response to sexual abuse, domestic violence, or other childhood traumas” (page 3, Child Welfare Information Gateway).
In the immediate as well as long-term aftermath of exposure to trauma, children are at risk of developing significant emotional and behavioral difficulties. Victims of sexual abuse often experience a sense of guilt, anger, feelings of powerlessness, a sense that they are “damaged goods”, a fear that people will treat them differently because of the abuse, acting out behaviors such as engaging in age-inappropriate sexual actions, and mental health disorders including major depressionEB20 . Post-traumatic stress disorders are very common to victims of sexual abuse and this includes intrusive or reoccuring thoughts of the traumatic experience, avoidance of reminders of the trauma such as people, places, or things, emotional numbing, irritability, trouble sleeping or concentrating, and physical and emotional hyperarousal. These symptoms can impact a victim’s daily life tremendously and that is why it is important to intervene immediately. “This treatment helps children to process their traumatic memories, overcome problematic thoughts and behaviors, and develop effective coping and interpersonal skills” (page 3, Child Welfare Information Gateway).
This program is a short-term treatment typically provided in 12-18 sessions of 50-90 minutes, depending on treatment needs. The intervention is usually provided in outpatient facilities, but has been used in hospitals, group homes, school, community, and in-home settings. The goals of trauma therapy long-term are to reduce victim’s negative emotional and behavioral responses to the trauma, correct unhelpful beliefs related to the traumatic experience, and provide support and skills for the non-offending caregivers to cope effectively and to respond optimally (Child Welfare Information Gateway).
The effectiveness of the program is supported by outcome studies and recognized by model and promising treatment programs. “The findings consistently demonstrate TF-CBT to be useful in reducing symptoms of PTSD as well as symptoms of depression and behavioral difficulties in children who have experienced sexual abuse and other traumas” (Page 6). TF-CBT resulted in significantly greater gains in fewer clinical studies. Follow-up studies shown that these gains are sustained over time. Victims showing improvement typically experience significantly fewer intrusive thoughts and avoidance behaviors, able to cope with reminders and associated emotions, show reductions in depression, anxiety, behavior problems, sexualized behaviors, and trauma related shame, demonstrate improved interpersonal trust, and develop improved personal safety skills. Research also demonstrates a positive treatment response for caregivers (Child Welfare Information Gateway).
Limitations for trauma-focused cognitive behavioral therapy may not be appropriate or may need to be modified for victims whose primary problems include serious behavioral problems that existed prior to the trauma who may respond better to an approach that focuses on these issues first. This therapy may also need to be modified for individuals who are acutely suicidal or actively abuse substances because of the gradual exposure that may worsen symptoms. Individuals who have a history of running away, self-harm behaviors, or engage in other parasuicidal behavior may need a more stabilizing approach such as dialectical behavior therapy which is designed to help emotional regulation, distress tolerance, and interpersonal effectiveness (Child Welfare Information Gateway).
This intervention program is one of the best forms of practice to assist victims of sexual abuse including intrafamilial, intimate partner violence, domestic abuse, and other traumas. “Increased availability of TF-CBT, along with increased awareness among those making treatment referrals, can offer significant results in helping children to process their trauma and overcome emotional and behavioral problems following sexual abuse and other childhood traumas” (page 9). This program succeeds in all aspects such as the effectiveness and uniqueness of the type of therapy, it’s far reaching impact, and the ability to promote non-violence (Child Welfare Information Gateway).
Suggestions for Future Research
With the changing roles of men and women and the rise of female equality in Western societies it is likely that we may begin to see an increase in female perpetrators of sexual abuse. Further research needs to be conducted on the cause and effects of female sexual abusers. It would also be beneficial to study the characteristics and red flags of potential female perpetrators. This would allow families to take more precautions towards preventing a female in their family from committing sexual abuse. As the number of female perpetrators rise as will the number of male victims. It will also be important to study the effects this has on males and develop specific therapies and programs that can help them heal in their own unique way.
Topics such as sexual violence, domestic violence, and incest are challenging topics to discuss. If society accepted the stigma surrounding this type of violence and learned more about how common and how traumatizing sexual abuse can be, maybe victims and other individuals would feel more comfortable talking about it. Future research about intrafamilial sexual abuse would be tremendously helpful for all victims, perpetrators, family members, and professional helpers, victim advocates, and therapists.
Sexual abuse within the family is an extremely tough obstacle to overcome. 1 in 5 women and 1 in 10 men are victims of sexual violence in childhood and more than half of all children who are sexually abused are abused by a parent or other relative. Intrafamilial abuse is incredibly common. With help of treatments such trauma-focused cognitive and behavioral therapy, victims can conquer intense emotions, depression, anxiety, behavioral problems, and trust issues. Victims and perpetrators need to know that committing sexual assault is a serious situation that needs to be addressed immediately due to the long-term effects of the abuse. Victims and perpetrators need to reassured that it is safe for them to come forward with the truth and that there is help available for both of them.