By Jim Hopper, Ph.D.
(last revised 3/23/2008)

Table of Contents

Brief feedback survey - Please help me improve this page and create a new, comprehensive site

Preface - Author Information & Messages of this Page

Words of Caution - Unavoidable Controversies & Biases

Prevalence: Methods - Tools for Critically Understanding Research

Prevalence: Studies - Review to July 1996

Possible Lasting Effects - Basic Information & Outline

Recommended Books and Articles - Including Citations List

Female Perpetrators - Focus Section Requested by Readers

Additional Resources - Hotline, Resources for Partners, Friends, etc., Links

Giving and Receiving Guidance and Hope - Men's Stories of Recovery

Feature: Males Sexually Assaulted in the Military - Relevant to war trauma too

Announcements

Related Pages At This Site

Brief feedback survey - Please help me improve this page and create a new, comprehensive site

I am a psychologist and for 15 years I have participated in therapy and research with men and women subjected to unwanted sexual experiences and other forms of abuse in childhood. (For more information about me, see my home page.)

Here are the reasons I have published this page:

1. To help those looking for resources on the sexual abuse of boys and the lasting effects of childhood sexual abuse in the lives of men.

2. To provide resources for men who were sexually abused in childhood and want to know what professional researchers and therapists have learned, without having to read scholarly journals and books.

3. To provide resources for girlfriends, spouses, partners, friends and family members of men who were (or may have been) sexually abused in childhood.

Here are some key messages for men who were sexually abused in childhood:

• You are not alone.

• You can educate yourself.

• Other guys struggle with their masculinity too.

• There are people who understand what you're dealing with and can help.

Words of Caution
Contents

• Statistics on rates of child abuse and neglect are controversial.

• All statistics on the incidence and prevalence of child abuse and neglect are disputed by some experts. (Incidence refers to the number of new cases each year, and prevalence to the percentage of people in some population who have had such experiences.)

• Complex and subtle scientific issues are involved, including various criticisms of the methods used in the studies that generate these statistics.

• The most controversial issues are how to define abuse, especially sexual abuse, and which definitions are applied to research data.

• Strong emotions and moral commitments influence everyone's reasoning and judgement to some extent.

• Any experts who claim to be without bias are fooling themselves or trying to fool you.

• The presentation of statistics and research on this page is influenced by my values, my informed opinions, and my experiences as a therapist and researcher over many years.

Prevalence: Methodology - Tools for Critically Understanding Research
Contents

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:

1. Population from which the research sample is drawn.
2. Whether or not "gate questions" are used.
3. Wording of questions or items, especially whether or not the word "abuse" is used.
4. Definitions of abuse used to categorize research data.
5. Number of questions or items.

Please note:

I do not attempt or claim to address the definitional issue completely or authoritatively. Indeed, this is a most complex and controversial (methodological) issue, not only among researchers but in society as a whole, and not only in terms of sexual abuse but physical and emotional abuse as well. Thus I will only touch on a few important points, though certainly the definitions of "sexual abuse" applied by researchers to study data have decisive effects on estimates of the prevalence of sexual abuse.

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):

1. Someone fondled you (i.e., touched your genitals or other parts of your body) in a sexual way. YES____ NO____

   If yes...
             Who was the person?___________________
             Was the person male or female?__________
             How old were you at the time?____________
             About how old was the other person?______
             How many times did it happen?___________
             For how long did it happen (i.e., days,
             weeks, months, years)?_________________
             How do you now feel about the experience
             (i.e., negative, neutral or positive)_________
             How distressing did you find this at the time:
             Not at all distressing - A . . . . . B . . . . . C . . . . . D . . . . . E - Very distressing

             How much force or persuasion did the person use?
             (Please check off the appropriate categories below.)
             Activity was voluntary____
             They took advantage of your trust____
             They used bribes or enticements____
             They used sexual seduction____
             They used intimidation or adult authority____
             They used threats against you or someone else____
             They used physical force____
             Other (please explain)_______________________

2. A woman had you perform vaginal intercourse on her. YES____ NO____

   If yes...
             Who was the person?___________________
             . . . . [see above]
   

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:

• A child is a person under age 16, and a sexual experience is abusive if verbal threats were used and the person feels negatively about the experience.
• A child is a person under 14 years old, and sexual abuse must involve physical force.

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 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:

Any research study, even one with the most effective methodology, is likely to underestimate the actual prevalence of sexual abuse in the population being investigated.

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.

Prevalence: Studies - Review to July 1996
Contents

Why only 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. (Full citations for all articles referenced in this section can be found in the following section, "Lasting Effects.")

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.

The following review is grouped into three sections, according to the sample studied:

1. Male college students.
2. Men from an identified community.
3. Men receiving mental health services.

As noted above, please keep in mind: All of the rates below are likely to be underestimates of the actual prevalence of the sexual abuse of boys in our society. This is so because:

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:

• Approximately 17% for child sexual abuse of males involving physical contact.
• Over 25% when non-contact forms of abuse were included.

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.

• The reality of the power differential which characterizes relationships between adults and children, and between young children and adolescents, because whether or not a sexual experience is abusive can depend on this dynamic.
• The fact that whether or not a sexual experience is abusive can also depend on one's subjective appraisal and emotional response to the incident.

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%.

Possible Lasting Effects - Basic Information & Outline
Contents

This section provides some basic information on the complexity of this issue, then reviews research on long-term effects of childhood sexual abuse in men's lives. At the end of this section, several articles and books are listed along with the symptoms and other effects. The complete citations for these articles and books, which you can get from libraries and bookstores, are in the next section of this page (Recommended Books and Articles).

Therefore, I will start with four basic points:

1. Being sexually abused is one of many painful and potentially damaging experiences that a human being may suffer in childhood.
2. Whether and to what extent child abuse and neglect (or other painful experiences) have negative effects depends on a variety of factors - related to the abuse itself, but also to relationships, in which the abuse and the child's responses occur.
3. Child abuse, in itself, does not "doom" people to lives of horrible suffering.
4. If a person has been sexually abused and experiences some of the problems or symptoms listed below, the abuse is not necessarily the primary (let alone only) reason for such suffering.

Child Abuse and the Human Condition

It is important to consider these issues in relation to what some people refer to as "the human condition." By this I mean:

• All human beings suffer painful experiences, and some of these occur in childhood.
• All caregivers of children are sometimes unable to protect them from painful experiences.
• We all need love and support to deal with the effects of painful experiences.
• Everyone must find ways to cope with the emotions generated by painful experiences - whether or not we get love and support from others.
• Many coping or self-regulation strategies work in some ways, but also limit people in other ways. For example:
• Ignoring painful feelings may reduce one's conscious experience of them. But it also prevents one from learning how to manage them in smaller doses, let alone larger ones - which makes one vulnerable to alternating between feeling little or no emotions and being overwhelmed and unable to cope with them.
• Avoiding getting close to people and trying to hide all of one's pain and vulnerabilities may creating a sense of safety. But this approach to relationships leads to a great deal of loneliness, prevents experiences and learning about developing true intimacy and trust, and makes one vulnerable to desperately and naively putting trust in the wrong people and being betrayed again.
• At the extreme, getting really drunk can block out painful memories and feelings, including the feeling of being disconnected from others - but cause lots of other problems and disconnections from people.
• Some people suffer more painful experiences than others, and abuse is one of many possible causes of extreme emotional pain (others include life-threatening illness, death of a loved one, physical disfigurement, etc.).
• Some people get more love and support from their families and friends than others, and families in which abuse occurs tend to provide less of the love and support needed to recover from abuse. But families in which abuse does not happen can also experience significant problems, and can make it hard for family members to deal with the inevitable painful experiences in life.

• Finally, because everyone needs caring relationships and love, emotional neglect can be more devastating than abuse, particularly in the earliest years of life.

The Effects of Child Abuse Depend on a Variety of Factors

We 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:

• Age of the child when the abuse happened.  Younger is usually more damaging, but different effects are associated with different developmental periods.
• Who committed the abuse.  Effects are generally worse when it was a parent, step-parent or trusted adult than a stranger.
• Whether the child told anyone, and if so, the person's response.  Doubting, ignoring, blaming and shaming responses can be extremely damaging - in some cases even more than the abuse itself.
• Whether or not violence was involved, and if so, how severe.
• How long the abuse went on.

• Whether the abuse involved deliberately humiliating the child.
• How "normal" such abuse was in the extended family and local culture.
• Whether the child had loving family members, and/or knew that someone loved her or him.
• Whether the child had some good relationships - with siblings, friends, teachers, coaches, etc.
• Whether the child had relationships in which "negative" feelings were acceptable, and could be expressed and managed safely and constructively.

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.

Potential Long-Term Effects of the Sexual Abuse of Males

This section lists potential, but not inevitable, lasting effects of the sexual abuse of male children. It should not be read as a "laundry list" of problems and symptoms that necessarily follow the sexual abuse of males, nor does the presence of any in males with sexual abuse histories necessarily mean the abuse is their primary cause. (See above.)

Findings on the long-term effects of child sexual abuse in males have been more consistent than those on prevalence. Methodologies for detecting problems and symptoms that could be outcomes are relatively straightforward, and many studies have utilized standardized measures that are widely accepted in the field.

First, I want to recommend a paper by David Lisak, Ph.D. This paper contains many powerful quotations from interviews with male survivors of sexual abuse. Lisak groups the quotations into themes, and discusses them with remarkable insight and compassion. The themes are:

• Anger
• Fear
• Homosexuality Issues
• Helplessness
• Isolation and Alienation
• Legitimacy
• Loss
• Masculinity Issues
• Negative Childhood Peer Relations
• Negative Schemas about People
• Negative Schemas about the Self
• Problems with Sexuality
• Self Blame/Guilt
• Shame/Humiliation

Lisak, D. (1994). The psychological impact of sexual abuse: Content analysis of interviews with male survivors [2 megabyte PDF]. Journal of Traumatic Stress, 7, 525-548.

Using standardized measures of symptoms, researchers have found that men who were sexually abused in childhood, whether or not they seek out mental health services, may suffer from:

• Anxiety
• Depression
• Dissociation
• Hostility and anger
• Impaired relationships
• Low self-esteem
• Sexual dysfunction
• Sleep disturbance
• Suicidal ideas and behavior

The following researchers have used standardized measures and found different combinations of the above symptoms:

• Bagley, Wood, & Young, 1994
• Briere, Evans, Runtz, & Wall, 1988
• Collings, 1995
• Fromuth & Burkhart, 1989
• Hunter, 1991
• Olson, 1990
• Peters & Range, 1995

Therapists working with men who were sexually abused in childhood have conducted clinical case studies and consistently reported findings on long-term problems including:

• Guilt and self-blame

  Lew, 1988; Myers, 1989; Hunter, 1990.

• Low self-esteem and negative self-image

  Lew, 1988; Myers, 1989.

• Problems with intimacy

  Bruckner & Johnson, 1987; Dimock, 1988; Lew, 1988; Krug, 1989; Hunter, 1990.

• Sexual problems, compulsions, or dysfunctions

  Bruckner & Johnson, 1987; Johnson & Shrier, 1987; Dimock, 1988; Lew, 1988; Myers, 1989; Hunter, 1990.

• Substance abuse and depression

  Krug, 1989.

• Symptoms of Post-Traumatic Stress Disorder

  Myers, 1989.

Some of the long-term effects of sexual abuse are related to the development of gender identity. A number of clinicians' case studies indicate that male survivors of childhood sexual abuse may experience:

• Attempts to "prove" their masculinity by having multiple female sexual partners, sexually victimizing others, and/or engaging in dangerous or violent behaviors

  Bruckner & Johnson, 1987; Lew 1988.

• Confusion over their gender and sexual identities

  Nasjleti, 1980; Bruckner & Johnson, 1987; Johnson & Shrier, 1987; Dimock, 1988; Lew, 1988; Myers, 1989; Gilgun & Reiser, 1990.

• Sense of being inadequate as men

  Dimock, 1988; Lew, 1988; Myers, 1989; Pierce & Pierce, 1985.

• Sense of lost power, control, and confidence in their manhood

  Myers, 1989.

Finally, some clinicians have noted that sexually abused males often experience confusion and distress about their sexuality:

• Confusion about their own sexual orientation

  Nasjleti, 1980; Dimock, 1988; Lew, 1988; Myers, 1989; Gilgun & Reiser, 1990.

• Fear that the sexual abuse has caused or will cause them to become homosexual

  Nasjleti, 1980; Finkelhor, 1984; Dimock, 1988; Gilgun & Reiser, 1990; Lew, 1988; Myers, 1989.

• Homophobia, an irrational fear or intolerance of homosexuality

  Gilgun & Reiser, 1990; Lew, 1988; Myers, 1989.

Recommended Books and Articles
Contents

Below is a lengthy but not completely comprehensive listing of books and articles on the sexual abuse of males, including books written to help men recover from sexual abuse. All of the articles and books cited on this page are listed below, and many others as well.

You can purchase books listed below from an online bookseller. The titles of those that I personally recommend are links to the books' pages at Amazon.com, which will give me 5-15% of the price on some purchases (all pages will open in a new browser window or one already open in the background). I have entered into this arrangement in association with Amazon.com to cover some costs of running this website.
     If you live somewhere bookstores do not stock these books, or are not comfortable buying them in a store, ordering them over the web may make the most sense.

The two books that I most highly recommend for men who have experienced sexual abuse are Mike Lew's Victims No Longer, the classic book on the topic, and Richard Gartner's recently published Beyond Betrayal, which is sure to become a classic as well. Lew's book has recently come out in a new edition, which has been extensively revised and updated, including an expanded resources section. Another book that many men have found helpful, though some describe it as overly intense for guys who are early in the process of recovery, is Mic Hunter's Abused Boys.

Three other books that I highly recommend:

Growing Beyond Survival: A Self-Help Toolkit for Managing Traumatic Stress, by Elizabeth Vermilyea
      If you want to start learning and practicing the self-regulation skills essential to recovering from the effects of child abuse, or to build on progress you are already making, I strongly recommend that you get this book. To learn more about the book and/or order it directly from the publisher (for a higher price than Amazon), go to the Growing Beyond Survival page of the Sidran Press catalog.
     Consider Mike Lew's endorsement:

"I'm impressed. This is one of the best - a clear , thoughtful workbook for trauma survivors. If some of it is hard going, stick with it - or come back to it. The effort will reward you. Elizabeth Vermilyea is a genuine ally, providing concrete explanations and specific reasons for everything she suggests. Growing Beyond Survival should be on the bookshelf of every professional who works with survivors [of child abuse]."