Background of Child Sexual Abuse
Child sexual abuse (CSA) is a critical societal problem that is now on the rise. Sexual trauma comes in different forms, ranging from one time attacks by strangers to long-term incestuous abuse by relatives (Duffy, Keenan, & Dillenburger, 2006). Rappley and Woolford (as cited in Duffy, et al., 2006, p. 150) expressed that legally CSA is defined as “… any activity, before the age of legal consent, for sexual gratification of an adult or significantly older child”. Child sexual abuse may be in both contact, and non-contact forms, the former being when there is physical contact such as rape or molestation, and the latter being in the form of encouragement to watch or hear sexual acts as well as distributing materials pertaining to child pornography (Townsend, & Rheingold, 2013).
While determining the prevalence of CSA is an arduous task, Stoltenborgh, Ijzendoorn, Euser, and Bakermans-Kranenburg (2011) found that 11.8% was the global prevalence of CSA. 18% of girls and 7.6 % of boys from the general population are likely to be sexually abused (Stolenborgh, et al., 2011). The prevalence of CSA is unknown in the Malaysian context.
Risk Factors
Child sexual abuse is on the rise due to the lack of reporting of incidences, it is also credited to the fact that there is not enough awareness on the topic (Stolenborgh, et al., 2011). Sedlak, Mettenburg, Basena, Petta, McPherson, Greene, and Li (2010) found that the risk of sexual abuse was 3.8 times higher than that of boys, similarly, children from low socio-economic status (SES) families are at a higher risk than those from high SES families. Children living with married parents were at a lower risk of abuse than those whom were not (Sedlak, et al., 2010). Consequences
Physical Effect
Perpertrator will use external forces such as punching or kicking on children. Visible injuries such as bruises, swelling, and sprain can be seen on child's body. Other internal injuries are bone fractures, pain or itching in genital area (Child Welfare, 2013).
Emotional/behavioural effect
Survivor may suffer from eating disorder, drug use, may self-harm or engage in risky sexual behaviour. They may also have sleeping problem and are discomfort with physical touch (Jackson, Newall, & Backett-Milburn, 2013; Joyful Heart Foundation, 2016).
Phsychological effect
Psychological issues such as anxiety, depression and dissociation may be the consequences of child sexual abuse. Other effects include academic problems, flashbacks, nightmares, etc. (Blueknot, 2016; Jackson et al., 2013).
Impact towards family
Survivor may have trust issues towards their closest relatives because they feel betrayed (Finkelhor & Browne, 1985).
Impact towards spouse
Partner who is the survivor of child sexual abuse may find difficulties engaging in romantic relationship. For example, the male partner may find it hard to feel like a normal couple due to overwhelming needs to be given to female partner (survivor) (National Association for Christian Recovery [NACR], 2016). Survivor might encounter sexual problems such as sexual dysfunctions (arousal difficulty, flashbacks). Sexual guilt/anxiety/low self-esteem may be one of the emotional problems related to sex of survivors (Finkelhor & Browne, 1985; Tharinger, 1990).
Impact towards community
According to Blueknot (2016), when child sexual case keep increasing, government has to build more health support centre for these survivors in order to help them to get back to normal daily functioning. However, many think the tax money should be used to provide better education facilities on children rather than bearing the huge costs later (increasing of juvenile, delinquincies issues etc.).
Treatment
Coping
There are two types of coping style, approach and avoidance focused coping. It is relatively easier to work with those who use approach focused coping as they have acknowledged the trauma emotionally and cognitively where they are ready and actively seeking help to overcome their trauma (Blue Knot Foundation, 2016). On the other hand, those using avoidance focused coping are not ready to be helped as they are in a state of constant denial and potentially dissociate themselves from the traumatic experience and its consequences (Roth & Cohen, 1986).
Treatment Options
Cognitive Behavioural Therapy (CBT). Distorted thoughts about their experiences and the reasons behind them might cause the survivor great deal of pain. By using CBT, the distorted thoughts are corrected to prevent prolonged traumatic stress experienced by the child/adult survivor (Federation of Families for Children’s Mental Health, 2003).
Healthy Lifestyle. Avoiding substance abuse, having balanced diet, sufficient sleep and regular rhythmic exercises will help survivors to strengthen their bodies and minds to better combat their traumas (Help Guide, n.d.).
Reconnecting with Others. It do more harm than good when survivors choose to isolate themselves after a traumatic event for various reasons. By reconnecting with the people around them, it will actually help them heal, maintain their relationship with others and also prevent them from ruminating on unhelpful thoughts when they are alone (Help Guide, n.d.).
Mindfulness Training. Mindful breathing and other relaxation techniques will help survivors to keep their minds grounded and cope better with their physical agitations (Help Guide, n.d.; Federation of Families for Children’s Mental Health, 2003).
Prevention
One of the traditional way to prevent child sexual abuse is through risk reduction— arming children with knowledge and skills necessary to repel child predators. In overall, prevention program for children aims to achieve three targets. First, providing knowledge necessary to recognise an abuse by educating children about private parts and inappropriate touching. Next, the children need to be trained to resist child predators through role-playing sessions and rehearsal: empowering children with rights over their own bodies, such is recommended as active participation of children has proven to be more effective, this can be done by modelling or classroom-teaching (Wurtele, 2008; Martyniuk & Dworkin, 2011). The last goal is to ensure that children will report after being touched or abused.
Although prevention programs that aim at preparing children to defend themselves is important, but that alone is not suffice to succeed, as there are many other factors that contribute to the abuse (Martyniuk & Dworkin, 2011). Hence, the awareness that everyone has a responsibility to stop child sexual abuse needs to be raised. Besides educating children, and the public, caregivers also need to be armed with knowledge (Prevent Child Abuse New York, n.d). According to Wurtele (2008), educational programs targeting caregivers have shown positive results in prevention. It is important for caregivers to be alert to the facts about child molesting: it could be anyone; it happens more frequent than usual. In addition, caregivers should also be aware of the method of perpetrating a molester employs in order to detect suspicious behaviour. Lastly, caregivers need to have sufficient knowledge to recognise and respond appropriately to children’s disclosure of abuse (Vermont Department for Children and Family, 2016).