NCJ Number
47127
Journal
American Journal of Orthopsychiatry Volume: 47 Issue: 1 Dated: (JANUARY 1977) Pages: 80-90
Date Published
1977
Length
11 pages
Annotation
FAMILY PATHOLOGY, MODES OF CLINICAL PRESENTATION, LEGAL ASPECTS, AND ACUTE CASE MANAGEMENT OF SEXUAL MISUSE OR ABUSE OF CHILDREN ARE DISCUSSED. ILLUSTRATIVE CASE REPORTS ARE ALSO INCLUDED AS AIDS TO IDENTIFICATION.
Abstract
WORK IN THE EMERGENCY ROOM OF A PEDIATRIC HOSPITAL HAS SUGGESTD THAT A GREAT MANY CASES OF SEXUAL ABUSE OR MISUSE GO UNDETECTED BECAUSE OF THE VARIED CLINICAL PRESENTATIONS AND THE SPECTRUM OF BEHAVIORS ENCOMPASSED. RESEARCH HAS SHOWN THAT SEXUAL MISUSE OF CHILDREN IS IN MOST CASES A REFLECTION OF FAMILY DYSFUNCTION: A LARGE MAJORITY OF OFFENSES ARE PERPETRATED BY SOMEONE KNOWN TO THE CHILD (USUALLY A PARENT OR PARENT SUBSTITUTE) EITHER BY DIRECT OR INDIRECT PERPETRATION OF MISUSE OR BY ACT OF OMMISSION. IT IS CONSEQUENTLY IMPORTANT THAT A FAMILY-ORIENTED APPROACH TO CASE RECOGNITION BE USED, IN ADDITION TO A WILLINGNESS TO ENTERTAIN THE POSSIBILITY THAT A SITUATION OF SEXUAL MISUSE MAY EXIST. WHILE IN SOME CASES A PARENTAL COMPLAINT OF SEXUAL MISUSE MAY BE A PROJECTION OF THE PARENT'S OWN PAST EXPERIENCES, FANTASIES, OR ANXIETIES, IN MANY CASES GENITAL IRRITATION, INFECTION, VENERAL DISEASE, PREGNANCY, OVERDEPENDENCE AND CLINGING BEHAVIORS, SEXUAL PROMISCUITY IN THE CHILD, OR SEDUCTIVENESS, MAY ALL BE INDICATIONS OF SEXUAL ABUSE/MISUSE AND/OR FAMILY SEXUAL DYSFUNCTION. THE DYNAMICS OF FAMILY INTERACTIONS AND SYMPTOMS OF SEXUAL MISUSE ARE ILLUSTRATED AND DISCUSSED IN 11 CASE REPORTS. FACTORS WHICH MAY BE ASSOCIATED WITH INCIDENTS OF SEXUAL MISUSE INCLUDE LARGE UNSUPERVISED FAMILIES, LONELY AND SOCIALY ISOLATED PARENTS, PREVIOUS EXPOSURE OF THE PARENT OR THE CHILD TO SEXUAL ABUSE OR MISUSE, AND ANGER TOWARD ONE OR BOTH PARENTS. SEXUAL MISUSE/ABUSE CAN RANGE FROM VIOLENT SEXUAL ASSAULT AND INCEST TO CASES OF FANTASY OR THE BORDERLINE BETWEEN APPROPRIATE EXPRESSION OF PARENT/CHILD AFFECTION AND MISUSE. LEGAL DEFINITIONS OF SEXUAL CHILD ABUSE VARY FROM STATE TO STATE AND INVOLVE A DEGREE OF SUBJECTIVE JUDGEMENT AS TO THE SERIOUSNESS OF PHYSICAL OR PSYCHOLOGICAL INJURY SUSTAINED BY THE CHILD IN DECISIONS OF WHETHER TO REPORT A SUSPECTED CASE TO GOVERNMENT AGENCIES. IT MAY ALSO BE NECESSARY TO REFER THE CHILD TO THE COURT OR PROTECTIVE AGENCIES IN CASES WHERE THE PARENT APPEARS UNABLE TO PROTECT THE CHILD FROM FURTHER HARM. IN SOME CASES, THE ABUSE MAY COME UNDER THE JURISDICTION OF THE CRIMINAL COURTS. THE CRIMINAL PROCESS IS OFTEN TRAUMATIC FOR CHILD AND FAMILY, AND SUPPORT THROUGHOUT THE TRIAL CONSTITUTES AN IMPORTANT PART OF THE TREATMENT PROGRAM. ACUTE MANAGEMENT OF SEXUAL MISUSE OR ABUSE CASES WILL REQUIRE A MULTIDISCIPLINARY SUPPORT SYSTEM FOR THESE CHILDREN AND THEIR FAMILIES, AND LIAISON WITH THE COURTS AND GOVERNMENT AGENCIES IS HELPFUL FOR CASES WHERE THE CHILD IS IN SERIOUS JEOPARDY. THERAPY SHOULD HAVE A FAMILY FOCUS TO GAUGE FAMILY FACTORS INVOLVED AS WELL AS THE FAMILY'S REACTION TO THE EVENT. THE FAMILY'S CAPACITY TO PROVIDE SAFETY AND PROTECTION TO ITS MEMBERS MUST BE CAREFULLY ASSESSED. FINALLY CARE MUST BE TAKEN TO INSURE THAT INTERVENTION STRATEGIES ARE IN THE BEST INTEREST OF THE CHILD AND HIS FAMILY. REFERENCES ARE PROVIDED. (JAP)