Child Sexual Abuse

Abstract: Many lay persons and professionals believe that child sexual abuse (CSA) causes intense harm, regardless of gender, pervasively in the general population. The authors examined this belief by reviewing 59 studies based on college samples. Meta-analyses revealed that students with CSA were, on average, slightly less well adjusted than controls. However, this poorer adjustment could not be attributed to CSA because family environment (FE) was consistently confounded with CSA, FE explained considerably more adjustment variance than CSA, and CSA-adjustment relations generally became non-significant when studies controlled for FE. Self-reported reactions to and effects from CSA indicated that negative effects were neither pervasive nor typically intense, and that men reacted much less negatively than women. The college data were completely consistent with data from national samples. Basic beliefs about CSA in the general population were not supported.

Introduction

Child sexual abuse (CSA) has received considerable attention since the late 1970s from mental health care professionals, legislative, judicial, and law enforcement personnel, the media, and the lay public (Rind & Tromovitch, 1997). Much of this attention has focused on possible effects of CSA on psychological adjustment, as is shown in the professional literature and popular press (Pope & Hudson, 1995) and in the information and entertainment media (Esman, 1994; Kutchinsky, 1992; West & Woodhouse, 1993). The media have frequently presented lurid CSA cases combined with high prevalence estimates, creating the image that CSA produces intensely negative effects for all of its victims (Esman, 1994; Kutchinsky, 1992; West & Woodhouse, 1993). Many publications in the popular press and the professional literature have similarly portrayed CSA as a “special destroyer of adult mental health” (Seligman, 1994, p. 232), and some have attempted to explain much or all of adult psychopathology as a consequence of CSA (Esman, 1994; Nash, Hulsey, Sexton, Harralson, & Lambert, 1993). Examples in the professional literature include McMillen, Zuravin, and Rideout (1995, p. 1037), who commented that “child sexual abuse is a traumatic event for which there may be few peers,” and Rodriguez, Ryan, Rowen, and Foy (1996), who combined estimates of national prevalence rates of CSA with selected examples of empirical research to argue that post-traumatic stress disorder is a common sequel of CSA in the general population. Opinions expressed in the media and by many popular press and professional writers imply that CSA has certain basic properties or qualities irrespective of the population of interest. These implied properties are (a) CSA causes harm, (b) this harm is pervasive in the population of persons with a history of CSA, (c) this harm is likely to be intense, and (d) CSA is an equivalent experience for boys and girls in terms of its widespread and intensely negative effects. The purpose of the current review was to examine these implied basic properties. Our goal was to address the question: In the population of persons with a history of CSA, does this experience cause intense psychological harm on a widespread basis for both genders?

An important first step is to discuss terminology. The term child sexual abuse has been used in the psychological literature to describe virtually all sexual interactions between children or adolescents and significantly older persons, as well as between same-age children or adolescents when coercion is involved. The indiscriminate use of this term and related terms such as victim and perpetrator has been criticized because of concerns about scientific validity (e.g., Kilpatrick, 1987; Nelson, 1989; Okami, 1990; Rind & Bauserman, 1993). Kilpatrick argued that researchers have often failed to distinguish between “abuse” as harm done to a child or adolescent and “abuse” as a violation of social norms, which is problematic because it cannot be assumed that violations of social norms lead to harm. Similarly, Money (1979) observed that our society has tended to equate “wrongfulness” with harmfulness in sexual matters, but harmfulness cannot be inferred from wrongfulness. Nelson argued that the indiscriminate use of terms suggesting force, coercion, and harm reflects and maintains the belief that these interactions are always harmful, thereby threatening an objective appraisal of them. Rind and Bauserman demonstrated experimentally that appraisals of non-negative sexual interactions between adults and adolescents described in scientific reports can be biased by the use of negatively loaded terms such as CSA.

Problems of scientific validity of the term CSA are perhaps most apparent when contrasting cases such as the repeated rape of a 5-year-old girl by her father and the willing sexual involvement of a mature 15-year-old adolescent boy with an unrelated adult. Although the former case represents a clear violation of the person with implications for serious harm, the latter may represent only a violation of social norms with no implication for personal harm (Bauserman & Rind, 1997). By combining events likely to produce harm with those that are not into a unitary category of CSA, valid understanding of the pathogenicity of CSA is threatened (Okami, 1994). The tendency by researchers to label cases such as the latter as abuse reflects the slippage of legal and moral constructs into scientific definitions (Okami, 1990; 1994). Basing scientific classifications of sexual behavior on legal and moral criteria was pervasive a half century ago (Kinsey, Pomeroy, & Martin, 1948); more recently, this practice has been confined to a much smaller set of sexual behaviors, particularly those labeled CSA.

With these caveats in mind regarding the scientific shortcomings of the term CSA, we have nevertheless retained it for use in the current article because of its pervasive use in the scientific literature and because many researchers as well as lay persons view all types of sociolegally defined CSA as harmful. On the basis of the terminology used in studies reviewed in the current article, CSA is generally defined as a sexual interaction involving either physical contact or no contact (e.g., exhibitionism) between either a child or adolescent and someone significantly older, or between two peers who are children or adolescents when coercion is used.

Pervasiveness and Intensity of Negative Effects or Correlates

Self-reported effects from CSA revealed that lasting psychological harm was uncommon among the SA [sexually abused] college students. Perceived temporary harm, although more common, was far from pervasive. In short, the self-reported effects data do not support the assumption of wide-scale psychological harm from CSA. This conclusion is further suggested by students’ self-reported reactions. The finding that two thirds of SA men and more than one fourth of SA women reported neutral or positive reactions is inconsistent with the assumption of pervasive and intense harm. It is not parsimonious to argue that boys or girls who react neutrally or positively to CSA are likely to experience intense psychological impairment. To argue that positive or neutral reactions are consistent with intense harm, it seems logical to first demonstrate that negative reactions are consistent with intense harm. However, the magnitude of the CSA-adjustment relation was small for women, despite the reporting of negative reactions by a majority of SA women. This low intensity finding for generally negative CSA experiences is inconsistent with an expectation of intense harm from non-negative CSA experiences.

Child Sexual Abuse as a Construct Reconsidered

In light of the current findings, it is appropriate to re-examine the scientific validity of the construct of CSA as it has been generally conceptualized. In most studies examined in the current review, CSA was defined based on legal and moral, rather than empirical and phenomenological, criteria. This approach may form a defensible rationale for legal restrictions of these behaviors, but is inadequate and may be invalid in the context of scientific inquiry (Okami, 1994). In science, abuse implies that particular actions or inactions of an intentional nature are likely to cause harm to an individual (cf. Kilpatrick, 1987; Money & Weinrich, 1983). Classifying a behavior as abuse simply because it is generally viewed as immoral or defined as illegal is problematic, because such a classification may obscure the true nature of the behavior and its actual causes and effects.

The history of attitudes toward sexuality provides numerous examples. Masturbation was formerly labeled “self-abuse” after the 18th century Swiss physician Tissot transformed it from a moral to a medical problem (Bullough & Bullough, 1977). From the mid-1700s until the early 1900s the medical profession was dominated by physicians who believed that masturbation caused a host of maladies ranging from acne to death (Hall, 1992; Money, 1985), and medical pronouncements of dangerousness were accompanied by moral tirades (e.g., Kellogg, 1891). This conflation of morality and science hindered a scientifically valid understanding of this behavior and created iatrogenic victims in the process (Bullough & Bullough, 1977; Hall, 1992; Money, 1985). Kinsey et al. (1948) argued that scientific classifications of sexual behavior were nearly identical with theological classifications and the moral pronouncements of English common law in the 15th century, which were in turn based on medieval ecclesiastic law, which was itself built on the tenets of certain ancient Greek and Roman cults and Talmudic law. Kinsey et al. noted that “either the ancient philosophers were remarkably well-trained psychologists, or modern psychologists have contributed little in defining abnormal sexual behavior” (p. 203). Behaviors such as masturbation, homosexuality, fellatio, cunnilingus, and sexual promiscuity were codified as pathological in the first edition of the American Psychiatric Association’s (1952) Diagnostic and Statistical Manual of Mental Disorders. The number and variety of sexual behaviors labeled pathological has decreased, but mental health professionals continue to designate sexual behaviors as disorders when they violate current sexual scripts for what is considered acceptable (Levine & Troiden, 1988). This history of conflating morality and law with science in the area of human sexuality by psychologists and others indicates a strong need for caution in scientific inquiries of sexual behaviors that remain taboo, with child sexual abuse being a prime example (Rind, 1995).

As discussed previously, abuse implies that harm is likely to result from a behavior. The results for SA male college students, using this scientific conceptualization of abuse, highlight the questionable validity of the construct CSA as defined and used in the studies examined in the current review. For these male college students, 37% viewed their CSA experiences as positive at the time they occurred; 42% viewed these experiences as positive when reflecting back on them; and in the two studies that inquired about positive self-perceived effects, 24% to 37% viewed their CSA experiences as having a positive influence on their current sex lives. Importantly, SA men across all levels of consent (i.e., both willing and unwanted experiences) did not differ from controls in current psychological adjustment, although SA men with unwanted experiences only did, implying that willingness was associated with no impairment to psychological adjustment. The positive reports of reactions and effects, along with normal adjustment for willing participants, are scientifically inconsistent with classifying these male students as having been abused. Their experiences were not associated with harm, and there appears to be no scientific reason to expect such an association (i.e., predicting psychologically harmful effects from events that produced positive reactions lacks face validity). On the other hand, a minority of SA men did report retrospectively recalled negative reactions, negative current reflections, and negative self-perceived effects; moreover, unwanted CSA was associated with adjustment problems. Assuming that negative reactions were associated with unwanted CSA, the term abuse may be scientifically valid for the latter students. Combining positive and negative responders into a single category of abuse may incorrectly suggest harm for the former and simultaneously dilute harm for the latter (Bauserman & Rind, 1997).

Some researchers have questioned their original definitions of sexual abuse after assessing their results. For example, Fishman (1991) borrowed from Finkelhor’s (1979) definition to classify sexual abuse of boys mostly on the basis of age discrepancies (i.e., sex between a boy of 12 or less and someone at least 5 years older, or between a boy aged 13 to 16 with someone at least 10 years older), stating that age differences implied sufficient discrepancy in developmental maturity and knowledge to indicate victimization. He found that SA men in his study did not differ from controls on measures of adjustment and reported a wide range of reactions to and effects from their CSA experiences (mostly positive or neutral). In-depth interviews confirmed and elaborated the quantitative findings, leading Fishman to question his original assumptions. He noted that the men’s stories altered his universal beliefs about the impact of inappropriate sexual experiences on children, and stated that “to impose a confining definition onto someone’s experience does nothing to alter the realities of that experience for the person” (pp. 284-285). Fishman concluded by arguing for the use of language of a more neutral nature rather than labels such as abuse, victim, and molestation – in short, for use of empirical and phenomenological criteria in conceptualizing early sexual relations, rather than legal or moral criteria.

The foregoing discussion does not imply that the construct CSA should be abandoned, but only that it should be used less indiscriminately to achieve better scientific validity. Its use is more scientifically valid when early sexual episodes are unwanted and experienced negatively – a combination commonly reported, for example, in father-daughter incest.⁷ In general, findings from the current review suggest that sociolegal definitions of CSA have more scientific validity in the case of female children and adolescents than for male children and adolescents, given the higher rate of unwanted negative experiences for women. Nevertheless, as Long and Jackson (1993) argued, because some women perceive their early experiences as positive, do not label themselves as victims, and do not show evidence of psychological impairment, it is important for researchers to be cautious in defining abuse for both men and women in attempts to validly examine the antecedents and effects of these experiences.

Summary and Conclusion

Beliefs about CSA in American culture center on the viewpoint that CSA by nature is such a powerfully negative force that (a) it is likely to cause harm, (b) most children or adolescents who experience it will be affected, (c) this harm will typically be severe or intense, and (d) CSA will have an equivalently negative impact on both boys and girls. Despite this widespread belief, the empirical evidence from college and national samples suggests a more cautious opinion. Results of the present review do not support these assumed properties; CSA does not cause intense harm on a pervasive basis regardless of gender in the college population. The finding that college samples closely parallel national samples with regard to prevalence of CSA, types of experiences, self-perceived effects, and CSA-symptom relations strengthens the conclusion that CSA is not a propertied phenomenon and supports Constantine’s (1981) conclusion that CSA has no inbuilt or inevitable outcome or set of emotional reactions.

An important reason why the assumed properties of CSA failed to withstand empirical scrutiny in the current review is that the construct of CSA, as commonly conceptualized by researchers, is of questionable scientific validity. Over-inclusive definitions of abuse that encompass both willing sexual experiences accompanied by positive reactions and coerced sexual experiences with negative reactions produce poor predictive validity. To achieve better scientific validity, a more thoughtful approach is needed by researchers when labeling and categorizing events that have heretofore been defined sociolegally as CSA (Fishman, 1991; Kilpatrick, 1987; Okami, 1994; Rind & Bauserman, 1993).

One possible approach to a scientific definition, consistent with findings in the current review and with suggestions offered by Constantine (1981), is to focus on the young person’s perception of his or her willingness to participate and his or her reactions to the experience. A willing encounter with positive reactions would be labeled simply adult-child sex, a value-neutral term. If a young person felt that he or she did not freely participate in the encounter and if he or she experienced negative reactions to it, then child sexual abuse, a term that implies harm to the individual, would be valid. Moreover, the term child should be restricted to non-adolescent children (Ames & Houston, 1990). Adolescents are different from children in that they are more likely to have sexual interests, to know whether they want a particular sexual encounter, and to resist an encounter that they do not want. Furthermore, unlike adult-child sex, adult-adolescent sex has been commonplace cross-culturally and historically, often in socially sanctioned forms, and may fall within the “normal” range of human sexual behaviors (Bullough, 1990; Greenberg, 1988; Okami, 1994). A willing encounter between an adolescent and an adult with positive reactions on the part of the adolescent would then be labeled scientifically as adult-adolescent sex, while an unwanted encounter with negative reactions would be labeled adolescent sexual abuse. By drawing these distinctions, researchers are likely to achieve a more scientifically valid understanding of the nature, causes, and consequences of the heterogeneous collection of behaviors heretofore labeled CSA.

Finally, it is important to consider implications of the current review for moral and legal positions on CSA. If it is true that wrongfulness in sexual matters does not imply harmfulness (Money, 1979), then it is also true that lack of harmfulness does not imply lack of wrongfulness. Moral codes of a society with respect to sexual behavior need not be, and often have not been, based on considerations of psychological harmfulness or health (cf. Finkelhor, 1984). Similarly, legal codes may be, and have often been, unconnected to such considerations (Kinsey et al., 1948). In this sense, the findings of the current review do not imply that moral or legal definitions of or views on behaviors currently classified as CSA should be abandoned or even altered. The current findings are relevant to moral and legal positions only to the extent that these positions are based on the presumption of psychological harm.