The possible consequences of sexual abuse committed against children and adolescents
“And you shall know the truth, and the truth shall make you free.”
Jesus Christ
The central aim of this article is to discuss the impacts of sexual violence against children and adolescents. Taking into consideration that the professionals who deal with this demand must be attentive to the different and potential implications due to that circumstance, this article aims at realizing a systematization of the main theoretical contributions relevant to this issue and contribute to divulging the knowledge which has already been elaborated about the possible consequences of sexual abuse against a child or adolescent. The systematization of previous studies shows that the effects of sexual abuse are severe, extensive and diverse.
Introduction
Violence against children and adolescents is a universal problem that affects thousands of victims silently and covertly. It is, therefore, a problem that affects both sexes and does not usually obey any rules such as social, economic, religious or cultural level (BALLONE; ORTOLANI; MOURA, 2008; CUNHA; SILVA; GIOVANETTI, 2008; DEL PRIORE, 2007; FREITAS, 1997; PRADO, 2004; ROMARO; CAPITÃO, 2007).
Domestic violence, according to Adorno (1988), is a form of social relationship that is directly related to how men produce and reproduce their social conditions of existence. At the same time, it is the denial of universal values, such as freedom, equality and life itself. In this process, children and adolescents are the biggest victims of abusive acts and mistreatment caused by their greater vulnerability and dependence.
Sexual violence, on the other hand, is characterized by acts carried out for sexual purposes which, as they are harmful to the body and mind of the subject violated (children and adolescents), disrespect individual rights and guarantees such as freedom, respect and dignity provided for in Law no. 8.069/90 – Child and Adolescent Statute (BRASIL, 1990, Articles 7, 15, 16, 17 and 19).
Sexual violence is characterized by:
[...] for a sexual act or game in a heterosexual or homosexual relationship, between one or more adults and a child or adolescent, to sexually stimulate this child or adolescent or use it to obtain sexual stimulation on your person or someone else's (AZEVEDO; GUERRA, 1998, p.33).
It is noteworthy that sexual violence can be understood based on two specificities/peculiarities: sexual exploitation and sexual abuse – the latter being the object of interest of this article.
Sexual exploitation is characterized by commercial relations, mediated by the body/sex trade, by coercive or non-coercive means. It is expressed in four forms: pornography, trafficking, sexual tourism and prostitution.
Sexual abuse is characterized by any action of sexual interest by one or more adults in relation to a child or adolescent. It can occur within the family – relationships between people who have emotional ties, and extra-family – relationships between people who are not related.
The first category of sexual abuse, defined previously, can also be understood as incest, which commonly lasts a long period and can be practiced with the knowledge and coverage of other family members. In our culture, incest is one of the most frequent forms of sexual abuse, which generally causes consequences – on a psychological level – that are extremely harmful to the victims.
In this sense, it is essential to search for elements in the literature that can illuminate and point to some consequences arising from child sexual abuse to understand its impact on the child's development.
What can be observed in the existing literature is the agreement among experts in recognizing that children who are victims of abuse and sexual violence are at risk of severe psychopathology, which disrupts their psychological, affective and sexual development (ROMARO; CAPITÃO, 2007, p 144 ).
Methodology
This work was constructed based on bibliographical research, which, according to Gil (1991, p. 48):
It is developed from already prepared material, mainly books and scientific articles. Although almost all studies require some work of this nature, research is developed exclusively from bibliographic sources.
This article was based on qualitative-descriptive studies, whose main objective “is to outline or analyze the characteristics of a phenomenon” (CAMPOS, 2000, p. 54). To prepare the work, works of history, psychology, sociology, social work and law were used, characterizing documentary research.
Documentary research, for example, uses documents, written or not, as a primary data source. It is a characteristic research of the Human Sciences. It covers all information already made public about the topic, and its purpose is to put the researcher in direct contact with everything that has been said, written or filmed on a given subject (CAMPOS, 2000, p. 53).
The methodology followed the steps of reading, recording and interpreting references.
Sexual abuse and its potential consequences on child and adolescent development
According to Kaplan and Sadock (1990), childhood maltreatment represents a medical-social disease that is assuming epidemic proportions in the world population. Sexual abuse of children and adolescents is one of the most frequent types of mistreatment, presenting medical, legal and psychosocial implications that must be carefully studied and understood by professionals who deal with this issue.
Several studies demonstrate that the consequences of child and adolescent sexual abuse are present in all aspects of the human condition, leaving marks – physical, psychological, social, sexual, among others – that could seriously compromise the life of the victim (child or adolescent) who experienced specific violence (ABRAPIA, 1997; CUNHA; SILVA; GIOVANETTI, 2008; FURNISS, 1993; GABEL, 1997; KAPLAN; SADOCK, 1990; PRADO, 2004; ROMARO; CAPITÃO, 2007; SILVA, 2000).
It can be stated that sexual abuse and its consequences on the victim's health "are primarily a violation of human rights, not choosing colour, race, creed, ethnicity, sex and age to happen" (CUNHA; SILVA; GIOVANETTI, 2008, p. 245).
Symptoms affect all spheres of activity and can be symbolically the realization of what the child or adolescent has suffered at the level of the body and behaviour. When going through an experience of violation of their own body, they react somatically regardless of age since new sensations are awakened and cannot be integrated (PRADO, 2004, p. 64).
Understanding and evaluating the extent of the consequences of child sexual abuse is not an easy task, as there is a considerable lack of longitudinal studies that propose to follow victims over the long term. This is due to the absence of appropriate control groups[1]. Therefore, the little knowledge (existing in the literature) about the consequences of this type of violence was built from the reports of some isolated people who sought help and the professionals and scholars who intervened with them.
However,
Most researchers agree that child sexual abuse facilitates the emergence of severe psychopathologies, harming the victim's psychological, affective and social development. The effects of abuse in childhood can manifest themselves in several ways at any age in life (ROMARO; CAPITÃO, 2007, p. 151).
When debating the consequences of child sexual abuse, it is necessary to consider some particularities that involve the violence committed, such as degree of penetration, accompanying insults or psychological violence, use of force or physical violence, among other brutalities that, obviously, are variations that compromise conclusions about the consequences of sexual abuse.
Furniss (1993) states that the consequences or degree of severity of the effects of sexual abuse vary according to some conditions or predeterminations of each individual, among them: the age of the child[2] when the violence began, the duration and number of times the abuse occurred;[3] the degree of violence used at the time of the situation; the age difference between the person who committed and the person who suffered the abuse; if there is any type of bond4 between the abuser and the victim; monitoring threats (psychological violence) if the abuse is revealed.
Day et al. (2003) cite some possible psychological manifestations resulting from domestic violence[5] that occur in the short and long term. In their study, the potential short-term indications are fear of the aggressor and people of the aggressor's sex; symptomatic complaints; psychotic symptoms; social isolation and feelings of stigmatization; phobic-anxiety, obsessive-compulsive, depression; sleep, learning and eating disorders; feelings of rejection, confusion, humiliation, shame and fear; excessive secularization, such as compulsive masturbatory activities. Late damage can manifest itself through the occurrence and incidence of psychiatric disorders such as affective dissociation, invasive thoughts, suicidal ideation and more acute phobias; more intense levels of fear, anxiety, depression, anger, guilt, isolation and hostility; chronic feelings of danger and confusion, distorted cognition, distorted images of the world and difficulty perceiving reality; illogical thinking; reduced understanding of more complex roles and difficulty resolving interpersonal problems; abuse of alcohol and other drugs; sexual dysfunctions; menstrual dysfunctions and homosexuality/lesbianism.
When discussing the consequences of sexual abuse committed against children and adolescents, it is essential to think about how monstrous the distortion of the physical, biological or organic condition is,[6] as sexual abuse involves a violation of the victim's body, which often results in injuries to the skin itself.[7] In this way, it is possible to point out the following as organic consequences: general physical injuries; genital injuries; anal injuries; pregnancy, sexually transmitted diseases; sexual dysfunctions; bruises; bruises and fractures. Usually, the victim suffers from injuries resulting from attempted hanging; genital injuries that do not occur only through penetration but through the introduction of fingers and objects into the victim's vagina; injuries that reveal the aggressor's sadism, such as cigarette burns, for example; painful lacerations and genital bleeding; irritation of the vaginal mucosa; various anal injuries, such as laceration of the anal mucosa, bleeding and loss of sphincter control in situations where there is increased abdominal pressure.
Gabel (1997 p. 67) describes several somatic complaints that are common after the occurrence of sexual abuse in children and adolescents, which manifest themselves in the form of diffuse discomfort; printing of physical changes; persistence of the sensations that were imposed on him; enuresis and encopresis; sharp abdominal pain; bouts of shortness of breath and fainting; problems related to eating such as nausea, vomiting, anorexia or bulimia; interruption of menstruation even when there was no vaginal penetration.
In the field of neurology, there is research and studies supporting hypotheses that situations of violence and sexual abuse can result in temporary or permanent damage to the structure of the brain, as shown in the following quote:
Seeking to observe the effect on the limbic system of people who had suffered abuse in childhood, he used the electroencephalogram coherence technique, a sophisticated method of quantitative analysis that provides evidence about the microstructure of the brain. It compared 15 healthy volunteers with 15 psychiatric patients, children and adolescents, who had a confirmed history of intense physical or sexual abuse. Coherence measures showed that the left cortices of the young people in the control group were more developed than the right ones. The patients who had suffered abuse had a clearly more developed right cortex, although they were all right-handed and, therefore, had a dominant left cortex. The resulting hypothesis was that maltreated children would have stored their disturbing memories in the right hemisphere, and the activation of such memories could activate it preferentially (TEICHER, 2002 apud ROMARO; CAPITÃO, 2007 p. 143).
Despite the discussion presented based on psychiatric, biological and neurological aspects, it is considered that “the issue of psychic trauma is at the heart of the situation of sexual abuse” (GABEL, 1997, p. 206).
In this sense, the discussion is returned to the subjective field, debating an issue that practically all victims of sexual abuse immediately go through after the abusive situation – post-traumatic stress or Post-Traumatic Stress Disorder, as some authors usually name it. Post-traumatic stress disorder – PTSD8 – is linked to unusual experiences of human existence that cause a severe emotional impact on the individual, leaving consequences that affect physical and mental health.
Silva (2000) reviewed the literature on the effects of post-traumatic stress disorder and pointed out six elements common to people who have experienced PTSD: re-experiencing intrusive and persistent memories linked to the trauma; compulsive exposure to situations that resemble the trauma; a constant impediment to the exposure of specific conditions, usually related to the emotion of the trauma experienced and numbness to emotional reactions, in general; decreased ability to use spoken language, replacing it with gestures as a guide to action; disorders linked to inattention, such as deconcentration, stimulus discrimination, changes in the psychological defence mechanism and personal identity; and, finally, changes in personal identity.
According to Flores and Caminha (1994), the main manifestations of PTSD are divided into three groups: re-experiencing phenomena – intrusive memories, traumatic dreams, reconstitution behaviour, anguish in traumatic memories; psychological avoidance – escape from feelings, thoughts, places and situations, reduced interest in usual activities, feeling of being alone, restricted emotional scope, memory disorder, loss of already acquired skills, change in orientation towards the future; and state of increased arousal – sleep disorder, irritability, anger, difficulty concentrating, hypervigilance, exaggerated startle response, and autonomic response to traumatic memories.
Symptoms created during a traumatic experience affect not only the individual's thoughts but also their memory, state of consciousness and the entire field of action, initiative and objectivity in life. Many victims create a protective zone around themselves that prevents them from continuing their everyday lives. A victim of physical violence, be it rape or beatings, avoids leaving home, is afraid of walking alone, rejects sex or any physical contact (SILVA, 2000, p. 32).
Silva (2000) states that how a person reacts to a traumatic situation depends on their ability to regulate the effects of the problem. If the individual can handle the impact, they can continue with some control over their lives, even after the trauma. For the author, some people believe that human beings can control trauma (to a certain extent). However, this thought of total control over life is optimistic but unrealistic.
Another situation that compromises the lives of children and adolescents who are victims of sexual abuse is secrecy. The secret carries a prohibition on verbalizing the facts that are explicit in some instances but can be linked to the non-verbal mode of communication, predominantly when the abuser and abuser are in the family environment. This victim seeks to keep the situations they are experiencing secret, either for fear of suffering sanctions and punishments from both parents or because they feel the responsibility of maintaining the balance and integrity of the family on their shoulders.
About the victim, it can be said that silence in the face of a situation that violates, oppresses, embarrasses and, often, dehumanizes them constitutes a natural reaction to the problem experienced, given that they are a “citizen in special conditions of development,” subjected to an asymmetric relationship of power (physical and psychological) that often extends beyond the control and dominance of the victim itself (CUNHA; SILVA; GIOVANETTI, 2008, p. 283).
Prado (2004) confirms the statement that the secret remains, causing several psychological impairments fueled by double anguish: not telling for fear of the aggressor and not telling for fear of not being believed by the mother or the rest of the family. In her silence, it is possible to see that, at the same time that the victim does not report the aggressor, she also becomes paralyzed, not protecting herself by other means as if there were a lack of mediating resources to do so. Depending on the victim's age, the mediating help often involves the symbolic order and maybe what they can show or say with their words or behaviours.
It is observed that the pact of silence established in cases of sexual abuse against children is an obstacle to preventing it and punishing the aggressors. The lack of punishment and the recurrence of violent sexual acts can often lead to the child's death or leave severe physical and psychological consequences (ROMARO; CAPITÃO, 2007, p. 171).
Gabel (1997) states that when a child can reveal this secret, receiving credit and help from professionals, for example, the most notable manifestations disappear. This makes the child or adolescent rediscover an interest in themselves, in others and play, even though the anguish can unfold into other forms of neurosis, including various phobias: fear of the dark, loneliness, agoraphobia, separation from family, friends, people of the same sex.
The reflection established so far seems to denounce the seriousness of the phenomenon since its consequences for the victim can be traumatic. Sexual abuse, whether incestuous or not, leaves the child feeling completely helpless. The adult, who should be synonymous with protection, becomes a source of disturbance and threat. She has no one to count on, cannot comment on the fact and is still driven by the complexity of the relationship to feel guilty. Silence, therefore, may be associated with feelings of guilt, threats made, and the bond established in the connection, especially on the part of the child (ROMARO; CAPITÃO, 2007, p. 180).
It is possible to say that children or adolescents will easily find reasons to feel guilty in a situation of sexual abuse. Therefore, it is essential to listen to the child and allow him to express himself at the level of his guilt because what he can say and feel on a conscious and unconscious level may be very different from our projections and our logic as adults.
Feelings of guilt are common among sexually abused children and adolescents, with guilt being one of the most severe emotional effects that result from an abusive interaction, especially if it was incestuous and lasted for a long time. As for the feeling of guilt, there is the secondary damage of stigmatization due to accusations by parents and family (FURNISS, 1993).
Sexual violence against children and adolescents, according to Vaz (2001), often occurs within the family or in nearby places, such as the neighbourhood or a relative's house. Violence, in most cases, is not reported, and relatives or acquaintances are not aware of the crime committed. Such violence leaves "affective wounds" in the child that are not healed since the act is carried out by someone the child trusts (ROMARO; CAPITÃO, 2007, p. 157).
As previously stated, the consequences of sexual abuse vary according to the link that unites the child and the person who abused them. In most cases, incest has more severe and lasting consequences. It confuses parental images because the father stops playing a protective role. He represents the law associated with the mother's weakness and omission in the act (GABEL, 1997).
In cases of intra-family sexual abuse, the family, which should represent a safe place for its members, becomes a space of insecurity, fear, mistrust, conflicts and uncertainty between what is right and wrong. There is a role reversal, in which the child or adolescent is placed in the place of a pseudo-equal partner in the sexual relationship. Family roles begin to be experienced confusingly, mischaracterizing the family as a place of growth, trust and support – which will cause enormous damage to the development of the child or adolescent (FURNISS, 1993; GABEL, 1997; ROMARO; CAPITÃO, 2007).
As for the social behaviour of victims, it is known that sexual abuse affects children and adolescents in a significant way, destroying the way they relate to and trust other people. Flores and Caminha (1994) present a study in which the results show that abused children and adolescents have less pro-social behaviour: they share less, are helpless and associate less with other children when compared to non-abused children, withdrawal and superficial relationships.
The various forms of violence or abuse affect the mental health of children or adolescents, as they are in the process of psychological and physical development, producing harmful effects on their academic performance, social adaptation and organic growth. Several studies link domestic violence with the development of personality disorders, anxiety disorders, mood disorders, aggressive behaviours, difficulties in the sexual sphere, psychosomatic illnesses, and panic disorders, among other damages, in addition to undermining self-esteem, for through identification with the aggressor, aggressive behaviour (ROMARO; CAPITÃO, 2007, p. 121).
Inappropriate sexual behaviour can be considered another very characteristic symptom of sexually abused children. Inappropriate sexual behaviour is characterized by sexual toys or games with dolls; inserting objects or fingers into the anus or vagina; excessive masturbation; seductive behaviour; age-inappropriate sexual knowledge and request for sexual stimulation to adults or other children. An example of this type of situation is exemplified in the following report:
Five-year-old Paul was quickly placed in a state-supported foster family after his stepfather sodomized him. The adoptive mother no longer wanted to take him in after having surprised him with her three-year-old son, reproducing with an object what he had suffered. We sometimes discover chain reactions: Cécile, aged six, was reported by a neighbour, aged ten, who was asked to undress. At that moment, it became known that she had been forced to have a relationship with a fourteen-year-old teenager, who was himself the victim of a teacher. Nurses and teachers of maternity courses describe the discomfort they experience when faced with children who seek erotic contact and ask them for genital caresses. These provocations, which are very common after sexual abuse, will make people think that the child is perverse and that he is lying when he reports what happened to him (GABEL, 1997, p. 69).
Among adolescents, it is possible to detect sexual aggression against other children, especially in the case of boys who suffered sexual attacks during pre-puberty. Among girls, it is expected to observe a tendency to repeat what they suffered through behaviours that manifest themselves in attitudes of seduction. In the most extreme cases, it is possible to verify the occurrence of situations considered perverse, in which, in a certain way, some victims of sexual abuse may lean towards nymphomania and even prostitution (GABEL, 1997).
Romaro and Capitão (2007) refer to other types of disorders that can be caused by abuse suffered in childhood or adolescence. These are sexual dysfunctions such as lack or loss of sexual desire which includes frigidity, sexual aversion and lack of sexual pleasure, failure of genital response including sexual impotence, orgasmic dysfunction (which is inhibited orgasm), premature ejaculation (inability to control ejaculation enough for both partners to enjoy sexual interaction), non-organic vaginismus (spasm of the muscle surrounding the vagina, causing occlusion of the vaginal opening), non-organic dyspaurenia (pain during sexual intercourse) and nymphomania (excessive sexual drive).
However, the results of an international survey revealed that the consequences of sexual abuse can manifest themselves in the short term (childhood) and long term (adolescence and adulthood), with the main symptoms or signs being noticeable through manifestations of high sexual activity. ; confusion and anxiety about sexual identity for those who have experienced homosexual abuse, especially male victims; difficulties in adult sexual adjustment (marital difficulties, impotence, sexual anxiety, less sexual satisfaction, avoidance of sex or compulsive desire for sex); and confusion regarding sexual values (ROMARO; CAPITÃO, 2007).
Dalgalarrondo (2000) indicates that some studies present results that confirm the existence of a strong relationship between having suffered abuse in childhood and conduct disorders in adolescence and adulthood. Some disorders are classified as gender identity disorders. There are also sexual preference disorders, which include paraphilias such as fetishism (dependence on some inanimate objects as a stimulus for sexual excitement and satisfaction), voyeurism (sexual excitement from looking at people engaged in sexual or intimate behaviour), sadomasochism (preference for sexual activity that involves bondage or the influence of pain or humiliation); pedophilia (sexual preference for pubescent children); and others, as described in the Classification of Mental and Behavioral Disorders – ICD – 10 (WORLD HEALTH ORGANIZATION, 1993).
Final considerations
As pointed out through the systematization of studies by various authors, the consequences of sexual abuse are extensive and diverse for victims. Different authors approach the topic from the most unique points of view. Doctors, psychiatrists, psychologists, sociologists and other professional categories have already tried, and continue to try, to outline the consequences resulting from a situation of child and adolescent sexual abuse so that proposals for more specific interventions can be created to minimize the damage of this violence.
Given the brutality in which sexual abuse occurs, often associated with other types of violence, such as physical violence and psychological violence, juxtaposed with the fact that the child is not prepared – from an emotional and physical point of view – for the sexual act, as it constitutes a subject in a peculiar condition of development, it is almost certain that she will develop different types or manifestations of the consequences mentioned above.
In short, it is not possible to generalize or perfectly delimit the effects of sexual abuse since the severity and extent of the consequences depend on the particularities of each victim's experience. Within this perspective, it is essential to think about the subject from the perspective of the uniqueness of each individual – child or adolescent – so as not to fall into reductionism or generalism of the issue. Each child or adolescent who suffers sexual abuse is a potential victim of one or more of the consequences described above. Therefore, it is essential that the psychologist who comes across such cases – in a public policy or private practice – has the necessary sensitivity and is qualified to face this highly complex and challenging situation.
“And you shall know the truth, and the truth shall make you free.” Jesus Christ
References
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1. We believe that this occurs because those who have suffered sexual abuse want to forget the event, they do not want to relive it or be monitored as part of a “control group” that aims to assess whether people are having delayed reactions to a traumatic experience like that of sexual abuse.
2. Although it is known that the child's age is a factor that affects the type of impairment that the child may develop, it is not known at which age there is greater or less impairment.
4. If there is a bond between the abuser and the victim, another factor that compromises the consequences is the quality of this existing relationship.
5. As there are not many specific studies on the consequences of sexual abuse, we searched for references in the literature on domestic violence, understanding that sexual abuse is a specificity of such violence, therefore, when referring to domestic violence, the authors are also referring to sexual abuse.
6. Although the biological consequences of sexual abuse may seem distant from the psychology debate, they need to be mentioned, since the presence of injuries to the body is a component that certainly interferes with the way of experiencing the experience and worsens subjective impairments.
7. Skin in the sense of body, object, living and organic matter and not just skin in the sense of body tissue.
8. Prado (2004, p. 148) characterizes Post Traumatic Stress Disorder as a nosological entity developed after a traumatic event, being an anxiety disorder that appears as an immediate or delayed response to a stressful event of an exceptionally threatening nature, like sexual abuse, for example.