Arthur H. Green

Child Sexual Abuse: Immediate and Long-Term Effects and Intervention

OBJECTIVEnThe primary purpose of this review is to highlight the progress made in the area of child sexual abuse during the recent decade and to identify the gaps in our current knowledge about this syndrome.nnnMETHODnMore than 100 articles on child sexual abuse were reviewed, the majority written from 1980 to the present concerning the demographics of child sexual abuse, the psychological effects of child sexual victimization, the psychopathology encountered in adult survivors of child sexual abuse, hypotheses regarding the nature of the trauma, a critique of the research, and approaches to intervention.nnnRESULTSnAlthough a wide variety of psychological sequelae have been documented in sexually abused children referred for evaluation or treatment, there appears to be considerable variability in the severity of the symptoms, and we remain ignorant of sequelae in abused children who never enter the mental health system. However, some of these children may become symptomatic in adult life. Validation of sexual abuse is hampered by the lack of specific behavioral markers. Methodological difficulties in child sexual abuse research include problems with definition, failure to measure severity of the abuse, sampling problems, failure to use standardized or appropriate instruments, problems with validation, and failure to use control groups.nnnCONCLUSIONSnDespite an increased focus on child sexual abuse in the recent decade, many gaps remain in our knowledge. Prospective longitudinal follow-up studies of sexually abused children and treatment outcome studies are urgently needed.

True and False Allegations of Sexual Abuse in Child Custody Disputes

This paper describes a method of evaluating children referred for suspected sexual molestation based upon our current knowledge of the symptoms and sequelae associated with child sexual abuse. This evaluation is specifically designed to differentiate between “true” and “false” cases of sexual abuse. Important forensic issues are also discussed in order to prepare the clinician for the role of an expert witness in court. Case histories are presented which illustrate the typical problems and pitfalls encountered during these evaluations.

Psychiatric Impairment and Childhood Victimization Experiences in Female Child Molesters

OBJECTIVEnTo assess psychiatric impairment and childhood victimization experiences in female child molesters.nnnMETHODnEleven incarcerated female child molesters were compared to 11 women imprisoned for nonsexual offenses as to their psychiatric diagnoses based on interviews with the Structured Clinical Interview for DSM-III-R, Outpatient Version (SCID-OP), the SCID II for Personality Disorders, and the Harvard-Upjohn Post-Traumatic Stress Disorder (PTSD) Interview. A family and sexual history with a description of childhood victimization experiences was also obtained by using the Wyatt Sexual History Questionnaire.nnnRESULTSnThe majority of the subjects in each group exhibited major depression, alcohol/substance abuse, and PTSD, but the sexual offenders demonstrated more psychiatric impairment on the Global Assessment of Functioning Scale on the SCID-OP. The sexual offenders demonstrated a higher incidence of childhood physical and sexual abuse within the family than the comparison group, and these victimization experiences were more severe and more frequently associated with PTSD. The sexual offenders and the comparison women described negative relationships with parents and caretakers, and with spouses or boyfriends. However, the sexual offenders perceived their parents as more abusive, while the comparison women regarded their parents as more neglecting.nnnCONCLUSIONSnIncarcerated female child molesters exhibited greater psychiatric impairment and more intrafamilial physical and sexual abuse than a comparison group of women imprisoned for nonsexual offenses.

Incarcerated female sexual offenders: A comparison of sexual histories with eleven female nonsexual offenders

Although there is a body of literature on male sexual offenders, there is a paucity of data on female sexual offenders. In this study, 11 incarcerated female sexual offenders against children were matched with a comparison group of 11 female offenders incarcerated for nonsexual crimes regarding their own prior sexual and physical victimization experiences and sexual histories. Results indicated that the sexual offenders demonstrated a higher incidence of childhood sexual abuse and were victimized exclusively within the family. The sexual offender group also demonstrated a higher incidence of physical abuse. Additional descriptions of psychiatric status are presented. In comparing sex histories between groups, the sexual offenders reported that most sexual activity was initiated at later ages than the nonsexual offenders. Although the sample is small, there also were differences within the groups. The sexually abused sexual offenders had a later age of first masturbation, first orgasm, and satisfaction with adult partners. Prior victimization, regardless of group, played a common role in preventing sexual satisfaction in adulthood. Regarding the sexual offenses, there was a great deal of denial and minimization as well as denial of atypical sexual fantasy. Both groups were given a self-report sexual interest card sort. Four offenders from each group endorsed various atypical sexual scenes. A case study is presented to illustrate the complex nature of a female sexual offender in this study. Recommendations for future research in the assessment of female sexual offenders are discussed.

Incest revisited: Delayed post-traumatic stress disorder in mothers following the sexual abuse of their children

The case histories of four women who developed symptoms of post-traumatic stress disorder following the disclosure of the sexual abuse of their daughters are presented. These individuals also exhibited comorbid symptoms of depression and personality disorders. Awareness of the sexual abuse of their daughters catalyzed a reliving of their own childhood victimization. The psychodynamics operating in these cases, as well as treatment strategies are also presented. A brief follow-up of three of the four cases is included.

Maternal psychopathology and perception of child behavior in psychiatrically referred and child maltreatment families.

Thirty-five mothers of abused and neglected children and 35 demographically matched mothers of children referred to a general child psychiatry clinic were compared on the basis of maternal psychopathology and index child behaviors. Standardized assessment instruments (the BSI and Achenbach CBC) were employed. While comparable levels of child maladjustment were reported, maternal psychopathology was greater for the maltreatment group who, in addition, demonstrated IQs in the Dull Normal Range. Nonabused siblings were seen as relatively well-adjusted. Perceived child behavior was strongly associated with self-reported maternal psychopathology.

Child abuse by siblings

The case histories of five children who inflicted serious injuries on their younger siblings are described in detail. The children shared several experiences in common: They had been physically abused themselves; their families were undergoing crises, which accentuated their maternal deprivation and rejection; they were burdened with excessive caretaking for the target sibling, who was perceived as the favorite; they had also experienced the recent loss of their father or paternal caretaker. The psychodynamics associated with sibling abuse represented an intensification of normal sibling rivalry due to the abusers own maltreatment and deprivation. Pent-up rage towards the mother was displaced onto the sibling rival. The abusers made use of identification with the aggressor as a prominent mechanism of defense. The sibling attacks were adaptive for the abusers in the following ways: (a) They afforded them a measure of revenge against the more highly regarded sibling rival; (b) they served as an outlet for rage directed towards the mother; (c) they were used as an attention getting device; (d) they provided a sense of mastery over the trauma of their own abuse; and (e) were used to educate the abusing parent.