Arnon Bentovim

Development of sexually abusive behaviour in sexually victimised males: a longitudinal study

BACKGROUND Sexual maltreatment is one of the most common forms of child abuse. To identify risk factors for sexually abusive behaviour by adults, we prospectively assessed childhood experiences and personal characteristics of male child victims who became abusers in later life. METHODS In a longitudinal study (7-19 years duration), we included 224 former male victims of sexual abuse. Risk factors contemporaneous with the abuse, and putative protective influences, were identified from social service and clinical records. Evidence of later criminal acts was obtained from a nationwide search of official records. FINDINGS Of the 224 former victims, 26 had subsequently committed sexual offences (victim-abusers), in almost all cases with children, mainly outside their families. Risk factors during childhood for later offending included material neglect (odds ratio 3.4, 95% CI 1.2-9.7), lack of supervision (3.0, 1.1-8.3), and sexual abuse by a female person (3.0, 1.1-8.7). Victim-abusers had more frequently witnessed serious intrafamilial violence (3.1, 1.0-10.0). Six (29%) of 21 victim-abusers on whom we had relevant data had been cruel to animals (7.9, 2.0-31.4). No single putative protective factor, nor a composite protective index, significantly reduced the risk of paedophilic behaviour. INTERPRETATION Most male victims of child sexual abuse do not become paedophiles, but particular experiences and patterns of childhood behaviour are associated with an increased risk of victims becoming abusers in later life. Our findings have implications for the design of selective interventions with a vulnerable subgroup of male victims, aimed at reducing the risk of paedophilic behaviour in later life.

Sexual abuse of children in the United Kingdom

Questionnaires were circulated to 1,599 family doctors, police surgeons, paediatricians, and child psychiatrists to determine the frequency and nature of child sexual abuse in the United Kingdom. At least three per 1,000 children are currently being recognized as sexually abused sometime during their childhood. The majority of cases reported involved actual or attempted intercourse, and 74% of the perpetrators were known to the child. Family disturbance was noted in 56% of the cases. The most common outcome (43%) was criminal prosecution of the perpetrator. Area Review Committees had no clear policy for the management of sexual abuse. Before it is possible to protect children and to develop therapeutic services for the family, it will be necessary to acknowledge that sexual abuse is part of the child abuse spectrum.

Using spoken attributions to classify abusive families

Despite claims that beliefs held by abusive parents are important indicators of family functioning, few studies have explored the relationship between patterns of beliefs and severity of abuse. This study applies findings from marital research that demonstrate that maladaptive attributional patterns predict the level of distress experienced in adult relationships. It examines spoken attributions produced by 18 families during diagnostic therapy sessions following serious abuse of a child. Attributions were identified from transcripts and coded using a standard system. Patterns of attributions, defined on the basis of previous work, successfully predicted classification of families by therapists as Good, Uncertain, and Poor, in terms of prognosis for rehabilitation. Using this classification to test hypotheses based on attributional style, group differences were found. In families rated Good, parents were more likely to attribute more control to self than child for negative outcomes. They were also more likely to nominate themselves as causing negative events. Case accounts of families from each category are presented to illustrate how attributional analysis can contribute to an understanding of the individual nature of child abuse.

Incest and the Dysfunctional Family System

Publisher Summary This chapter discusses incest and the dysfunctional family system. Understanding the family as a system includes, but goes beyond, an individual model of diagnosis and treatment to focus also on the other family members and their context as well as on the feedback loops that connect them. In the systems model, the locus of pathology is the individual in context. A systems understanding includes not only the behavior of the family members but also their perceptions and memories that change over time as interactions occur. A healthy system is never static but rather is always changing and evolving. An incestuous family is one where the surface action of the family does not meet the needs of family members for nurturance, care, and warmth in an appropriate way relative to the maturity of those individuals.

Recognition of Child Sexual Abuse in the United Kingdom

Publisher Summary This chapter discusses the recognition of child sexual abuse in the United Kingdom. It presents the survey data as an example of the process of recognition of child sexual abuse. In the United States in 1978, sexual abuse of children was a growing national concern. The number of reported cases was increasing considerably, and many communities were developing treatment programs for victims and their families. In the United Kingdom, however, this was not happening. There was not as yet any widespread recognition of child sexual abuse as a major social problem. Even though there is no mandatory reporting of child abuse in Britain, identification and intervention are heavily influenced by government guidelines. Until 1980, circulars from the Department of Health and Social Security had not included sexual abuse within the definition of child abuse. The only figures available in the United Kingdom on the incidence of child sexual abuse were criminal statistics, particularly those on incest. There were no boys identified in this age group, but older boys were more vulnerable. It is possible that as boys and girls become more sexually developed as they approach adolescence, their chances of being sexually abused increase. Another possibility is that it is easier for professionals to identify sexual abuse in this age group because these children talk about their experiences.

Withholding consent to lifesaving treatment: three cases

The refusal of children or their parents to consent to treatment that professionals regard as essential always results in a dilemma. Responding to such refusals demands careful and sensitive clinical and thicolegal intervention and close cooperation among professionals, in particular doctors and social workers. Since the introduction of the Children Act 1989 the number of cases in which children have withheld consent to lifesaving treatment has risen, and it is now increasingly recognised that children have a right to have their views legally represented if a local authority or health authority seeks a courts leave to carry out treatment. Professionals have to consider which legal route, under either the Children Act or the Mental Health Act, is likely to be best for the individual child.

A Full Circle: Psycho-dynamic Understanding and Systems Theory

Two papers published in 1979 are reviewed, one which looked at theories of family interaction and techniques of intervention, and the other at developments of the focal approach to family therapy which has its base in a dynamic understanding of the nature of relationships, but uses a variety of systemic interventions to create change. The development of the approach is described, along with its application to work in the abuse field. A recent case where two daughters were sexually abused by the grandfather who had abused their mother is used as an illustration.

A psychiatric family day centre meeting the needs of abused or at risk pre-school children and their parents

1. The development of a psychiatric day centre for therapeutic work with families when children under the age of five years are the presenting problem. The centre is part of the psychiatric facilities at the Hospital for Sick Children, Great Ormond Street and has been in operation since 1970 (Bentovim & Boston (l), Bentovim & Lansdown (2)). This has now developed into a setting where families are offered one days intensive therapeutic experience weekly, and in this way we have been able to give a service to a large number of families with a wide variety of problems. At any one time we are dealing with a wide variety of presenting problems, speech and language disorders, feeding disorders, developmental problems, behavioural and emotional difficulties in the children and a wide range of parent-child marital and family dysfunction giving rise to problems or by their response compounding difficulties. Over the last 2-3 years these have included increasing numbers of families where abuse or neglect has occurred or there is felt to be a serious risk. Approximately eight to ten families attend daily so that forty families can be helped each week. At present approximately 25 percent of children attending are abused or at risk. The therapeutic model followed is as follows:

Michael R Pokorny

Michael R Pokorny initially trained in psychiatry in Sheffield. He was a senior registrar in the adult department of the Tavistock Clinic and became a member of the Institute of Psychoanalysis. …