
By Jim Hopper, Ph.D.
(last revised 3/13/2007)
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I am a researcher and therapist with a doctorate (Ph.D.) in clinical psychology, and an Instructor in Psychology at Massachusetts General Hospital and Harvard Medical School. I have studied rates of child abuse and its potential long-term effects initially psychological and behavioral effects in men, more recently effects on biology and regulation of emotions as well as treatments to help people recover from child abuse. My research colleagues include Dr. Bessel van der Kolk and Dr. Roger Pitman, leaders in the field of psychological trauma. As a licensed clinical psychologist, for over 15 years I have been a therapist to men and women abused in childhood, providing individual and group treatment. (I do not work with children or their caregivers, but see Resources for Parents & Caregivers on this page). If you are interested in my professional services, including therapy, talks, workshops, and consultations, visit that page. The contents of this page reflect my level of experience and expertise, as well as opinions I have formed over the years. Finally, I would like to highlight another page of mine, Mindfulness: An Inner Resource for Healing from Child Abuse. It explains the many benefits of cultivating mindfulness and provides resources for learning to be more mindful. For some, simply reading the page will introduce them to new and healing ways of thinking about and experiencing their own mental and emotional processes.
Table of Contents Child Abuse Statistics
Sources of Statistics
- Official Numbers, Actual Numbers, & Estimates
Statistics Are Human Creations
- Tools to Avoid Being Confused & Misled I've already mentioned (Introduction) that historical and cultural factors have created and shaped the concept of "child abuse" as most of us understand it today. The same is true of our relationship to statistics: it is embedded in historical and cultural patterns, particularly how science and statistics are used to define important social problems, shape debates about them, and decide public policies. Unfortunately, our healthy respect for scientific research, empirical data and quantifiable knowledge is often untempered by critical thinking:
Two good, recently published books can help you cut through the confusion and hype that surround most presentations of statistical and scientific findings in the popular media. In this section, I introduce those books, provide a few short excerpts from each, and link to a radio show in which the authors discuss these issues. Keep in mind that the authors of these books, like everyone else, have their biases. The trick is to take what they can teach you (quite a lot), and use it to detect and critically evaluate those biases, even when they are presented as obvious truths. The 3 parts of this section:
This book is the longer of the two, and more focused on how the
media can generate confusion and mislead people. However, it covers
much of the same territory as Best's book (below), in terms of how to think critically
about the statistics we encounter every day, and has more discussion of
child abuse statistics (excerpts below).
Praise from the book jacket:
"Risk and uncertainty plague our daily lives, especially when they drive
media headlines. But savvy consumers of news have a new ally with the
appearance of this timely and entertaining read that manages to take the
process apart and show us the guts of how news is really made." -
John D. Graham, Harvard Center for Risk Analysis
"Asking in Person and on the Phone
"In 1975 sociologists Murray A. Straus of the University of New Hampshire, [Suzanne Steinmetz of
Indiana University-Purdue University at Indianapolis]
and Richard J. Gelles of the University of Pennsylvania conducted the
National Family Violence Survey to determine the incidence of child abuse
and spousal abuse in the United States. In 1985 they conducted a second
survey (the National Family Violence Re-Survey) to update their findings.
Their most striking discovery was that child abuse (which they defined as
kicking, biting, punching, beating, threatening with a gun or knife, or
using a gun or knife) had declined by 47 percent among two-parent families
with at least one child aged three to seventeen. There were thirty-six
incidents of child abuse per thousand children in 1975, but only nineteen
such incidents of child abuse per thousand children in 1985.
"Stricter Standards for Child Abuse
"The National Incidence Study of Child Abuse and Neglect was released in
September 1996, following up on previous studies conducted in 1980 and
1986. The study found that child abuse and neglect were seriously
worsening. Between 1986 and 1993 the number of cases doubled, going from
1.4 million to 2.8 million; and the number of cases involving serious
injuries nearly quadrupled, rising from 143,000 to almost 570,000.
".... In principle, of course, there is nothing wrong with making standards
stricter, for judging child abuse or anything else; it's certainly possible
that prior standards were too lax (and not that the new, toughened standards
are unreasonably exacting). But... the problem is that we won't properly
understand the trendline unless we realize that our measuring instrument
has been altered so that it catches examples of abuse that would have
gone unrecognized in the past.
See also Explanations for the
Decline in Child Sexual Abuse Cases, an excellent 2004 paper on this issue
written for the US Department of Justice by David Finkelhor and Lisa Jones. Dr. Finkelhor is an
internationally renowned researcher and Director of
the Crimes Against Children Research Center.
This book has extremely clear and concise explanations of how activists,
the media, experts and other key players like politicians and the staff of
government agencies create good and bad statistics. The author gives you
lots of tools for critical thinking about how statistics are created by
people and organizations.
In fact, Best gives you some good critical tools
for seeing his own biases, which come across when he addresses issues
like child abuse and sexual assault. Still, we would cheat
ourselves of much knowledge if we failed to learn from people we don't
agree with - and Best has a lot of valuable things to teach about
the social and political creation and uses of statistics. Just reading
the excerpts will be very informative.
Praise from the book jacket:
"In our era, numbers are as much a staple of political debates as stories.
And just as stories so often turn into fables, so Best shows that we often
believe the most implausible of numbersto the detriment of us all." -
Peter Reuter, coauthor of Drug War Heresies
"[T]he first 'statistics' were meant to influence debates over social
issues. The term acquired its modern meaning numeric evidence in
the 1830s. . . The forerunner of statistics was 'political
arithmetic'; these studies mostly attempts to calculate population
size and life expectancy emerged in seventeenth-century Europe,
particularly in England and France. Analysts tried to count births, deaths,
and marriages because they believed that a growing population was evidence
of a healthy state; those who conducted such numeric studies as
well as other, nonquantitative analyses of social and political prosperity
came to be called statists. Over time, the statists' social
research led to the new term for quantitative evidence: statistics.
"[S]ocial problems are products of what people do.
"Most claims drawing attention to social problems aim to persuade all of
us that is, the members of the general public. We are the audience,
or at least one important audience, for statistics and other claims
about social problems. If the public becomes convinced that prostitution
or homelessness is a serious social problem, then something is likely to
be done: officials will take action, new policies will begin, and so on.
Therefore, campaigns to create social problems use statistics to help
arouse the public's concern.
"One reason we tend to accept statistics uncritically is that we assume
that numbers come from experts who know what they're doing. Often these
experts work for government agencies.... Data that come from the
government crime rates, unemployment rates, poverty rates are official
statistics. There is a natural tendency to treat these figures as
straightforward facts that cannot be questioned.
"The lesson should be clear: statistics even official statistics
such as crime rates, unemployment rates, and census counts are
products of social activity. We sometimes talk about statistics as though
they are facts that simply exist, like rocks, completely independent of
people, and that people gather statistics much as rock collectors pick
up stones. This is wrong. All statistics are created through people's
actions: people have to decide what to count and how to count it, people
have to do the counting and the other calculations, and people have to
interpret the resulting statistics, to decide what the numbers mean. All
statistics are social products, the result of people's efforts.
Official Statistics: United States
By far the best site for official United States statistics on child abuse is the
Child Welfare Information Gateway, a service of the Children's Bureau in the
Administration for Children and Families,
which is part of the US Department of Health and Human Services. (See the Gateway's
About Us page for more information about its mission, resources, etc.)
Before following the links below, read the official
definitions of maltreatment. If possible, look at
the law which codified those definitions, the 1996 Federal
Child Abuse Prevention and Treatment Act (CAPTA) (223 KB PDF).
CWIG collects and reports the statistics from two studies conducted using different methods.
The Gateway site has an excellent searchable
catalog of publications (try searching with terms like "bibliography," "fact sheet," "prevention," and "webliography"). Many publications are available in Spanish.
Official Statistics: Canada
Official Canadian statistics on child abuse are available from the Public Health Agency of Canada.
In Canada, national statistics on child abuse and neglect first became available in 2001, with the publication of the first Canadian
Incidence Study of Reported Child Abuse and Neglect (CIS-2001). Before then they had not been compiled, largely due to the challenge posed
by varying definitions of child abuse across the country's provinces and territories.
NCFV also offers many videos on child abuse and family violence, for the
general public and for professionals working in the field. These may be borrowed from partner public libraries across Canada (listed available on the web page), and some are available for purchase.
Official Statistics: Australia
The best site for official statistics on child abuse is the
National Child Protection
Clearinghouse. The Clearinghouse is a great site with many full-text
articles on child abuse and its effects. It is funded by the
Commonwealth
Department of Family and Community Services, under the auspices of the
National Child Protection Council, as part of the National Strategy for
the Prevention of Child Abuse and Neglect. (See
About the Clearinghouse for
more information about its mission, functions, resources, etc.)
It's not easy to find the
Child Protection Statistics page, but it provides
excellent information - on where the official statistics come from, how to make sense
of them, and links to the two most recent national studies. After reading the
introductory paragraphs on that page, you can access the following:
Official Statistics: England
The best place for official statistics is not a web site dedicated to
these issues, but a few pages with reports of studies conducted in a
collaboration between the Office
for National Statistics and the
Department of
Health. Links to these pages can be found under the "Children" heading of Section C - Personal and Social Services
of the Health and Personal Social Services Statistics page of the Statistical Publications web site.
Every year since 1989, the Department of Health has collected and reported
statistics on child abuse and neglect in the publication, "Children and Young
People on Child Protection Registers." The statistics are "derived from
the statistical returns submitted to the Department of Health by local
authorities and include data for individual local authorities and
England estimates."
Summary information and tables from the last four annual surveys are available
for free on the web. (Only the full publication "contains
detailed commentary and comprehensive explanation of the figures at
both England and local authority level." It is available for a charge
of £8 from the Department of Health, PO Box 777, London, SE1 6XH.
Fax: 01623 724 524.)
Before looking at any findings from these studies, it is
important to understand some limitations of the data. The following
statement is from the Statistics Division of the Department of Health:
Child Protection Registers
Each Social Services
Department holds a central register which lists the names of all
those children in the area whose names have been placed on the Child
Protection Register. The decision to register the child's name takes
place at a child protection conference. This decision is made if
the child is at continuing risk of significant harm and hence in
need of a child protection plan and registration. It should be emphasized
that the primary purpose of having child protection registers is
to assist in the protection of children. Their value for statistical
purposes is, therefore, a secondary benefit. The registers are not
intended to be a list of all children in the area who have suffered
or are likely to suffer significant harm but are those for whom
there is a need for a child protection plan. These figures should
therefore not be interpreted as a record of all child abuse.
Official Statistics: International
On October 11, 2006 the United Nations (UN) released the first UN Secretary-General’s Study on Violence Against
Children, which addresses violence against children within the family, schools, alternative care institutions and
detention facilities, places where children work, and communities. The study took years to complete, and was supported
by the United Nations Children’s Fund (UNICEF), the World Health Organization (WHO), and the Office of the
High Commissioner on Human Rights (OHCHR).
As noted in the report's introduction, the study is a "first" in two important ways:
The report includes the following overview statistics (section II. B., pp. 9-10, with references to specific studies provided for each):
Our Right to be Protected from Violence: Activities for Learning and Taking Action for Children and Young People, is an educational booklet for children and young people over the age of 12, which provides information about violence and ideas for actions they can take to prevent violence and respond to it.
Here are links to the web sites devoted to the study:
There is also a 1994 paper by sociologist David Finkelhor, an
internationally recognized expert on research on the incidence
and prevalence of child sexual abuse, and Director of the
Crimes Against Children
Research Center. The countries covered in the
paper: Australia, Austria, Belgium, Canada, Costa Rica,
Denmark, Dominican Republic, Finland, France, Germany, Greece,
Great Britain, Ireland, Netherlands, New Zealand, Norway, South Africa,
Spain, Sweden, Switzerland, and the United States. Please note: Because
this is a 1994 publication, and this is a growing field of research,
additional studies for some of these countries and other countries
have been published by now. Here's the citation and abstract:
Abstract: "Surveys of child sexual abuse in large nonclinical populations
of adults have been conducted in at least 19 countries in addition to the
United States and Canada, including 10 national probability samples. All
studies have found rates in line with comparable North American research,
ranging from 7% to 36% for women and 3% to 29% for men. Most studies found
females to be abused at 1.5 to 3 times the rate for males. Few comparisons
among countries are possible because of methodological and definitional
differences. However, they clearly confirm sexual abuse to be an
international problem."
Retrospective Survey Research Methods
- Tools for Critical Understanding
This section is focused on sexual abuse and the sexual
abuse of boys largely because I have conducted research in these areas.
Another reason is that research on the abuse of male children was once my
main area of expertise, and the sexual abuse of males remains virtually
unacknowledged throughout the world.
This is a long section (4 printed pages). But please consider reading it before
reading (or reading about) studies of child abuse prevalence. It will take
some time, but reading this will help you to understand this kind of research,
and to think more critically about opinions you encounter in the popular
media.
When it comes to measuring prevalence - that is, how many children
are sexually abused in childhood? - the methods used by
researchers are absolutely crucial.
Five important methodological issues are covered below:
Please note:
1. An important methodological issue has to do with the population
(group of people) from which a sample, or selected group of a
population actually researched, is drawn. Different prevalence rates
have been found in samples of: college students; clinical populations
or people receiving psychological treatment; and community populations
or whoever lives in some area (e.g., a city, state, or country). Other
methods being equivalent, compared to samples of people receiving
mental health treatment, broad community samples will yield lower
prevalence rates and provide more accurate data about the rate of child
sexual abuse in a society.
2. Whatever the population and sample, researchers have to ask
questions. They can ask questions by interviewing research subjects,
over the phone or face-to-face. They can also ask questions by giving
people questionnaires, typically anonymous ones. Some have argued that
anonymous questionnaires are better for research on men, who may be
less willing to acknowledge unwanted sexual experiences in the presence
of another person. Some who conduct interview studies disagree, and
there is not yet sufficient evidence to make this judgement. Whichever
of these methods is employed, there are other methodological issues
related to the nature of the questioning; for example, whether or not a
subject must answer "yes" to an initial "gate question" in order to be
asked more questions, the wording of the questions, and the number of
questions asked. These are important methodological parameters that
have had significant effects on the prevalence rates researchers have
found.
For some studies researchers have used gate questions, in which a
subject is only asked a series of questions about possible abuse
experiences if he or she answers "yes" to an initial question. Not
surprisingly, these studies have tended to find lower rates of sexual
abuse in their samples. For example, someone may answer "no" to this
question: "Before the age of 16, did you ever experience unwanted
sexual contact with someone more than 10 years older than you?" But one
minute later this same person may reply "yes" to this question: "Before
age 16, did anyone more than 10 years older than you use threats or
force to get you to fondle his or her genitals?" If subjects in a
research study are not asked further questions after answering "no" to
a general question about unwanted sexual experiences in childhood, many
of those who were in fact sexually abused will be categorized as never
sexually abused.
3. The wording of research questions is extremely important, and can
dramatically skew prevalence rates. Imagine that an interviewer or even
an anonymous questionnaire begins by asking, "Were you ever sexually
abused before age 16?" This question requires subjects to scan their
memories, and to decide whether or not to label any memories that come
up as "abuse," which would be to accept the identity of "sexual abuse
victim." Obviously most people, especially men, will automatically
resist doing these things, even if they have experienced unwanted and
emotionally harmful sexual experiences in childhood. So any study that
uses the words "sexual abuse" will wrongly categorize some people who
have been sexually abused--but don't label their experience that
way--as not having been sexually abused.
This methodological issue, the wording of questions, touches on the
issue of definition, and all the attendant controversy. Some people
given attention by the popular media have focused on the wording of
questions in ways that misrepresent research on sexual abuse and rape.
Major publications like The New York Times Magazine have given
cover-story treatment to people who have minimal understanding of
social science methodology, and apparently even less interest in the
truth about rates of abuse and assault in our country. These people
have claimed that researchers "make up" abuse that never happened by
labeling subjects' experiences as abusive even though the subjects
might not.
This charge has been made against Mary Koss, an accomplished
researcher who has conducted studies on prevalence rates of rape among
college women (and has found that one in four have experienced rape or
attempted rape since age 14). In constructing her questionnaire items,
Koss made a good faith effort to use language that fit the legal
definition of rape in the state where she lived when she conducted
the research. Yet she has been accused of irresponsibly mislabeling her
subjects' experiences and exaggerating rates of rape. (Decide for
yourself: read Koss, M., Gidicz, C., & Wisniewski, N. [1987]. The
scope of rape: Incidence and prevalence of sexual aggression and
victimization in a national sample of higher education students.
Journal of Consulting and Clinical Psychology, 55, 162-170.)
One way that Koss has answered this critique is by referring to an
analogous situation. I will paraphrase her argument. Imagine yourself
questioning an alcoholic: Do you have more than six alcoholic drinks in
one sitting several times a week? Yes. Do you often wake up with such a
hangover that you can't go to work? Yes. Have friends and family members
repeatedly tried to help you stop drinking? Yes. Do you suffer from
withdrawal symptoms when you stop drinking? Yes. Are you an alcoholic?
No.
The point here is that good prevalence research must use
behavioral descriptions to which definitions like "alcoholic" or
"sexual abuse" may be applied. Researchers should not rely on people
defining themselves as alcoholics or defining their sexual experiences
as abusive. Such definitions can only be uninterpretable and
unreliable. Again, for many people who have been sexually exploited and
hurt by others in childhood--especially men, who aren't supposed to be
victims--it's very painful to acknowledge what has happened.
Researchers must not ignore the effects this can have on subjects'
responses to questions about childhood experiences that may have been
abusive.
For these reasons, researchers seeking to determine prevalence rates
should not use the word "abuse" in their interviews or questionnaire
items. Instead, they should provide clear behavioral
descriptions of experiences to which subjects can answer "yes" or
"no". When an answer is yes, further information should be elicited,
including: the age of the subject and the other person involved; the
nature of the relationship (parent, sibling, friend, priest, etc.); the
level of coercion or violence; the number of times and period of time
over which the experience happened; and the person's emotional
appraisal of the event when it occurred and at the time of the
research.
Here are two examples of questionnaire items employing behavioral
descriptions and follow-up questions. Both are from research on the
sexual abuse of males conducted by David Lisak and his colleagues
(Lisak & Luster, 1994; Lisak, Hopper, & Song, 1996; see
Recommended
Books and Articles section of Sexual Abuse of Males for complete
citations):
If yes...
How much force or persuasion
did the person use?
If yes...
4. With this kind of information researchers are in a better position to
evaluate whether or not an experience fits a reasonable and
understandable definition of sexual abuse.
As noted already, the definition of child sexual abuse employed in a
prevalence study may be the most important methodological parameter. I
will only make a few points here, to suggest some of the definitional
issues in prevalence research. For example, it's easy to imagine the
differences in prevalence rates the very same data will yield when
categorized with each of these definitional criteria:
Of course, there are no clear-cut answers when it comes to definitions
of child sexual abuse employed in research studies--or, for that matter,
definitions used by all of us in conversation and debate. There will
always be disagreements about what constitutes "sexual abuse," even among
experts in this area. Some will ground their definitions in the
exploitive intention of the person having the sexual experience with the
child, no matter how the child or remembering adult feels about the
experience. Others will believe this dilutes the meaning of the words and
trivializes the suffering of people who, for example, have been raped by
align="center" a parent repeatedly for years. These people will advocate for very
conservative definitions.
Though they will never all agree, researchers have become increasingly
sensitive to the need for carefully considered, and clearly articulated,
definitions of child sexual abuse. Unfortunately, this has not been the
case for most commentators and critics given attention by the popular
media.
5. Finally, the number of questions asked of subjects in a research
study can have a large effect on prevalence rate findings. Sadly, there are
many ways to sexually abuse a child. Thus only a number of specifically
worded behavioral descriptions of possible experiences (probably at least
10 to 15), will suffice for researchers trying to determine whether a
person was sexually abused in childhood. Having subjects answer a number
of questions also increases the likelihood that some memory of an abusive
experience will be accessed. For example, a subject may read several
questions before remembering and reporting an experience of sexual abuse,
even though earlier questions described aspects of the same experience.
Thus only by using multiple questions consisting of clear behavioral
descriptions can researchers generate sufficient data to which
definitions of abuse may be applied. Obviously, studies that ask fewer
questions will yield lower prevalence rates for childhood sexual
abuse.
These are some of the most important methodological issues in research
conducted on adults to estimate prevalence rates of child sexual abuse.
Keeping these issues in mind, and the built-in biases of certain methods,
will help you to understand the research below or any other studies you
read about, and to think more critically about what you encounter in the
popular media--especially from people who claim abuse rates are
exaggerated and base their claims on uninformed or misleading critiques
of research conducted by social scientists.
And there is one more very important point to keep in mind:
Prevalence of the Sexual Abuse of Boys Why only the early research, up to 1996? That's when I conducted a comprehensive review for my masters thesis, and since then I've been much less focused on rates of sexual abuse among males than on how all kinds of abuse can affect men and women. This section will still be useful to people who want to understand how different research methods yield different prevalence statistics. For the most recent and authoritative evidence supporting the 1 in 6 prevalence estimate, read the study of 17,000 California residents, Long-term consequences of childhood sexual abuse by gender of victim, published in 2005 by Shanta Dube and colleagues in the American Journal of Preventive Medicine. Please note: This section and the one above are nearly identical to sections of my page, Sexual Abuse of Males: Prevalence, Lasting Effects,and Resources. That page also contains a list of references to all the articles and books cited in this section, as well as others addressing lasting effects and links to Web pages for men who were sexually abused in childhood. The following review is grouped into three sections, according to the sample studied:
There is evidence emerging that as many as one in three incidents of child sexual abuse are not remembered by adults who experienced them, and that the younger the child was at the time of the abuse, and the closer the relationship to the abuser, the more likely one is not to remember. Please see the section on Linda Williams' research on my Web page, Recovered Memories of Sexual Abuse: Scientific Research & Scholarly Resources. 1. Studies of male college students have found prevalence rates from 4.8% to 28%. At the lower extreme of 4.8% is a study by Fritz, Stoll and Wagner (1981) in which 412 students responded to a self-report questionnaire that required them to label their experiences as "abusive"--a method guaranteed to cause under-reporting (see discussion in section above). Risin and Koss (1987) obtained a rate of 7.3% in a national sample of 2,972 male college students. They used eight self-report behavioral descriptions about sexual behaviors before age 14. As pure behavioral descriptions, none of the items included the word "abuse." Finkelhor (1979) used a similar list of behavioral self-report items in a study of 266 college students and found an 8.3% prevalence rate; he included non-contact experiences and used specific age criteria (if under 14 there had to be a 5 year age difference with the perpetrator, if 14-15, a 10 year difference). Higher prevalence rates of 20% and 24% came from Fromuth and Burkhart's (1987) study of students in two separate schools. They compared the effect of different definitions of sexual abuse on prevalence rates. However, their questionnaire utilized a gate question. The highest rates of 20% and 24% came from the most inclusive definition: the same as Finkelhor's 1979 study (including non-contact and age differential criteria), but with the addition that sexual contact between peers involving force or threat was categorized as abuse. Research on college students also has been conducted by David Lisak and his colleagues, including myself (Lisak & Luster, 1994; Lisak, Hopper, & Song, 1996). The college samples in these studies were not typical, but consisted of men who commuted to an urban university, were an average of 25 years old, and from socioeconomic background more typical of the surrounding community than many college student populations used in this research. This work yielded prevalence rates of:
Non-contact experiences (e.g., a relative exposing her or his genitals to a child) were investigated because such acts are sexually exploitive and can have negative long-term psychological and interpersonal effects. However, this definition also includes experiences, like a single "flashing" episode involving a stranger, that many would argue are not abusive because the subject suffered no significant or lasting harm, if any at all. As clarified below, Lisak and his colleagues (1994, 1996) deliberately chose to weight their definition of sexual abuse in terms of the power differential accompanying significant age differences and the older person's presumed deliberate sexual use and exploitation of the younger subject. So long as significant differences in age and power existed, Lisak and his colleagues defined incidents as abusive, regardless of subjects' emotional appraisal or lasting effects (the latter were not measured). Lisak and his colleagues (1994, 1996) used an anonymous questionnaire which has 17 behavioral descriptions of possible experiences and an 18th item for "other" experiences subjects describe. If subjects endorsed an item, they were then directed to provide further information about the experience, which was used to categorize the experience as abusive or not. If the subject was age 13 or younger when the incident occurred and the other person was at least 5 years older, the incident was classified as sexually abusive. If the subject was age 13 or younger when the incident occurred and the other person was less than 5 years older, two criteria had to be met for the incident to be classified as abusive: the subject reported feeling "negative" about it and reported that some degree of coercion was used by the other person. Similar principles apply to incidents occurring when the subject was age 14-15: the incident was classified as abusive if the other person was at least 10 years older; if the other person was less than 10 years older, the abuse classification was assigned only if the subject reported feeling negative about it and reported some level of coercion by the other person. Though the definitional criteria in Lisak and his colleagues' studies are complex, they address two important issues.
Lisak and his colleagues argue that the criteria they employed to assess sexual abuse are clear and relatively conservative in their treatment of the issues of power and subjects' responses. A prevalence rate similar to the Lisak et al. studies was found in another study of college males. Collings (1995) used an anonymous questionnaire and defined sexual abuse as "unwanted" sexual experiences taking place before the age of 18. The term "unwanted" is likely to bias rates downward, as noted above, but the inclusion of subjects aged 16 and 17 is likely to increase the found prevalence rate. Not surprisingly, Collings found that 29% of the 284 male respondents had been sexually abused, with 20% reporting non-contact abuse and 6% reporting abuse experiences involving physical contact. 2. Studies with community samples have ranged in their prevalence rates from 2.8% to 16%. Again, methodology has been crucial. Kercher and McShane (1984) mailed a single self-report question including the word "abuse" to a random sample of Texas drivers. They found a prevalence rate of 3%. Given the wording of their single question, this rate is not surprising. Two random-sample telephone interview studies by Murphy (1987, 1989, cited in Urquiza & Keating, 1990) also demonstrate the profound effects of single questions including the word "abuse" rather than instruments with multiple behavioral descriptions. In one of the studies (1987) the former method was employed, and it produced a rate of 2.8% with a sample of 357; in the other study (1989) the latter method yielded a prevalence rate of 11% with a sample of 777. Bagley, Wood and Young (1994) conducted a community study of men aged 18 to 27 in the Canadian city of Calgary. They first contacted subjects by phone, then administered anonymous questionnaires in their homes via programs on portable computers. Their questionnaire asked about "unwanted" experiences before the age of 17. This wording is likely to result in under-reporting because people who have been sexually abused, but especially males, are sometimes convinced that they wanted and were responsible for the sexual contact. Bagley and his colleagues found a prevalence rate of 15.5%, and that 6.9% of their subjects had experienced multiple episodes of sexual abuse. Interestingly, this rate for multiple episodes was identical to that found for women in a previous study that employed the same methodology, despite the fact that the prevalence rate for any unwanted sexual experiences in that study was 32%, or double that found for males (Bagley, 1991). The highest community-sample prevalence rate of 16% was found in a random telephone survey of 2,626 men, known as the "L.A. Times survey" (Finkelhor, 1990). However, these findings are very difficult to interpret, since the wording of the questions would be expected to produce contradictory effects: each question used the word "abuse," but ended with the phrase, "or anything like that?" In contrast to studies with women, published studies using face-to-face interviews with men have yielded very low prevalence rates, perhaps due to subjects' adherence to stereotypes about males not being victims (Urquiza & Keating, 1990). Finkelhor's (1984) face-to-face interview with Boston-area fathers yielded a rate of 6%. Siegel and colleagues (1987), using gate-question interviews with 1,480 Los Angeles-area men, found a prevalence rate of 3.8%. Baker and Duncan (1985) used a single question that described various sexual acts and found the highest face-to-face prevalence rate of 8% in their random sample of 970 men in Great Britain. 3. Studies with clinical samples have obtained prevalence rates from 3% to 23%. The lowest rate was reported from a study that used psychological records of 954 male and female patients of a large regional medical center (Belkin, Greene, Rodrique, & Boggs, 1994). In a chart review of emergency room records of a Buffalo, New York hospital, Ellerstein and Canavan (1980) found an 11% prevalence rate. DeJong and colleagues (DeJong, Emmett, & Hervada, 1982) reviewed several clinical studies and found rates from 11% to 17%, and in their own hospital population found a rate of just under 14% (1982). Metcalfe and his associates (1990) found a prevalence of 23% in their survey of 100 male psychiatric inpatients. However, it is important to note here that assessment for sexual abuse histories in hospitals has traditionally been extremely poor, and remains so in many settings. Thus these rates, based on reviews of records, are likely to be vast underestimates. For example, Briere and Zaidi (1989) reviewed intake reports on women presenting to an urban psychiatric emergency room. They randomly reviewed 50 charts before and 50 after the intake staff were instructed to question clients about previous sexual victimization. The first 50 charts had recorded rates of 6%, and the second set, 70%.
Effects of Child Abuse There are many web sites with information about possible effects of child abuse, including findings from solid research. Unfortunately, too often these are "laundry lists" of problems and symptoms, which can lead people to believe that almost every case of child abuse inevitably leads to permanent damage and great long-term suffering. Of course child abuse can lead to problems and suffering, but it's not that simple. My aim here is to provide some basic information that helps people appreciate the complexity of this issue and avoid unnecessarily pessimistic beliefs as they seek for knowledge and understanding. You may be wondering: "Why do I have problems dealing with emotions, relating to friends, getting close to people? Could it be related to abuse I experienced as a child? Will I (my child, husband, friend, etc.) be forever damaged by the abuse?" I have three basic answers, or at least beginnings of answers to these questions:
Child Abuse and the Human ConditionIt is important to consider these issues in relation to what some people refer to as "the human condition." By this I mean:
The Effects of Child Abuse Depend on a Variety of FactorsWe have learned from many people's experiences and a great deal of research that the effects of abuse and neglect depend on a variety of factors. Below I group these effects into those which research has shown to influence negative outcomes, and a variety of other factors that are harder to measure for research purposes and/or may be very important for some people but not others. Factors research has shown to influence the effects of abuse:
A great deal of research has been conducted, and continues to be conducted, on how such factors determine outcomes for those abused in childhood. Factors that increase the likelihood of negative outcomes have been referred to as "risk factors," and ones that decrease the likelihood of negative outcomes as "protective factors." Every person who has experienced abuse is unique. And every person who has experienced abuse has a unique combination of risk and protective factors that have influenced, and continue to influence, the effects in his or her life. In summary, it is important to appreciate that these issues are very complex, and to be familiar with how abuse and neglect can - depending on a variety of other factors - affect various aspects of a person's life. Keep this in mind as you search the web for information and understanding about the effects of child abuse. Finally, you may find it helpful to keep in mind what I have presented above while reading the following articles:
About Therapy & Recovery - Resources to Inform Your Search For many people, recovery from significant effects of child abuse requires consultation or therapy with a trained professional; this can also be true for those who want to effectively support someone else in his or her healing. But it is not always clear how to go about finding good professional help. You can greatly increase the odds of finding and benefiting from qualified help if you learn about the stages of recovery from the effects of abuse, about how people successfully change problem behaviors in general, and about how and where to find qualified help. Providing some of this knowledge is my goal for this section. This section is primarily addressed to adults who experienced abuse as children, though it also has useful information for teenagers, those subjected to violence in adulthood, and people seeking help for loved ones who have been abused or assaulted. (For more information about seeking help for a spouse, partner, friend, boyfriend, etc., see Resources for Spouses, Partners, Friends, etc. For information about finding help for children and adolescents, see the National Child Traumatic Stress Network's How to Find Help) page, and especially their Network Members page, which lists centers and clinics all around the US, each of which will know of excellent resources in their area.) This section can be downloaded and printed as a MS Word file (with working hyperlinks), and has four subsections:
Among experts in the treatment of people who have suffered from extreme child abuse and other traumas, since the early 1990s there has been a consensus on two points: treatment and healing from the effects of abuse takes place in stages, and there are fundamental principles of good treatment which apply at every stage. In this section, I address the stages of treatment and recovery. My discussion borrows heavily from Judith Herman's classic book, Trauma and Recovery, which goes into great depth on these stages and principles. In this section, I mention particular types of treatment. The "Specific resources" section below (#4 within this overall subsection) has additional information about these treatments and how to find therapists experienced with them. The first stage of healing and of any helpful therapy or counseling is about:
Please note that the first stage of recovery and treatment is not about discussing or "processing" memories of abuse, let alone "recovering" them. (For more on how the stages of recovery are related to memories of abuse, particularly recovered memories, see "Words of Caution II: Personal Concerns & Questions" on my page, Recovered Memories of Sexual Abuse.) Of course, everything is not always so perfectly ordered and sequential. For example, during the first stage it may be necessary to discuss the contents of abuse memories that are disrupting one's life. This may be required to help manage the memories, or to understand why it is hard to care for oneself (the abuser suggested unworthiness of care or love, etc.). However, in this case addressing memories is not the focus of therapy, but a means to achieving safety, stability, and greater ability to take care of oneself. Most important, the key to healing from child abuse is achieving these "stage-one" goals of personal and interpersonal safety, genuine self-care, and healthy emotion-regulation capacities. Once these have become standard operating procedures, great progress and many new choices become possible. Depending on the person, the first stage of treatment may also involve:
Throughout all stages of treatment, it is often necessary to address psychological "themes" and "dynamics" related to one's history of abuse. As discussed below, under "Principles of treatment," some of these are core issues in child abuse trauma that should determine the very nature and structure of treatment. These include:
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