In addition to further refining a definition of child sexual abuse, its prevalence, and its effects, researchers have increasingly begun to examine how survivors of child sexual abuse who hold diverse identities experience abuse and healing.15,16,5 Numerous social locations contextualize the experience of child sexual abuse. This section will explore the specific multicultural considerations associated specifically with gender, race/ethnicity, sexual orientation, socioeconomic status, and disability. Other important identities also intersect with child sexual abuse experiences (e.g., immigration status, national origin) that are beyond the scope of this chapter. However, the influence of the intersection of various identities for child sexual abuse survivors will be explored.
Gender. Considerable research reveals gender-related differences among child sexual abuse victims. For example, the literature suggests that sexual abuse is more prevalent amongst girls1,17,18 and that girls are more likely than boys to have their abuse substantiated by Child Protective Services.19 However, boys are believed to be equally at risk for sexual victimization 20 but are more hesitant and less likely to disclose than girls.20-22 The stigma against homosexuality,19,20,14 being labeled helpless,20 loss of self-esteem,14 and fear of violence retaliation19,14 make boys less likely to report the abuse than girls. Additionally, a sexually abused boy may have been warned that he will be responsible for any bad things that happen to his family if he discloses the abuse.20 Sexually abused girls that are pressured into silence may share this concern. Other gender differences include (a) boys who are sexually abused often come from single-parent homes than do girls20and (b) a boy is more likely to be victimized by his mother than is a girl,20 and (c) boys are more likely to experience anal and oral intercourse than girls.23
Research consistently indicates that sexual abuse has numerous and profound effects. Specifically, sexually abused boys and girls tend to display more behavioral problems, emotional problems, academic difficulties, suicidal tendencies, disordered eating behaviors, substance use, and sexual risk taking than their nonabused peers.24,1,17,20 In a study examining the gender differences in outcomes of male and female teenagers who self-reported a history of sexual abuse, Chandy et al.24 found male adolescents with a history of sexual abuse tended to report performing below average and had a high or very high dropout risk when compared to female adolescents, were at higher risk than females in delinquent activities (e.g., beating up another person, group fights, running away from home, stealing), sexual risk taking (e.g., frequency of intercourse, use of contraception), and marijuana use. On the other hand, female adolescents showed higher risk for suicidal involvement (e.g., attempts, thoughts), disordered eating, and frequent alcohol use.
When considering how gender and child sexual abuse intersect, trans-gender individuals are often an ignored and misunderstood group. Trans-gender people are those whose sex assigned at birth (female or male) is not in alignment with their internal sense of gender identity and expression. Although the literature with transgender people and child sexual abuse is nascent, there is some evidence that transgender youth and adults of color experience high rates of abuse.25-26
Race/ethnicity. There are several important considerations related to race/ ethnicity and child sexual abuse. A primary factor in this regard is that if rates of child sexual abuse are underreported in general, with regard to racial/ethnic minorities underreporting is exacerbated.27 Researchers have found an inconsistent relationship between child sexual abuse and race/ ethnicity across various studies. For instance, Ullman and Filipas28 examined the relationship between race/ethnicity and child sexual abuse for 461 female college students and found significant differences across ethnicity for the severity and prevalence of abuse—in addition to differences in the survivor-perpetrator relationship and healing from child sexual abuse. A study of White American, African American, and Hispanic American child sexual abuse survivors found no significant differences in terms of reporting or recognizing child sexual abuse.16 Despite inconsistent findings regarding child sexual abuse and race/ethnicity, there appears to be commonality across racial/ethnic groups that child sexual abuse survivors often know their perpetrators.29
An additional consideration with regard to race/ethnicity is that research has indicated the disclosure of child sexual abuse by child survivors during forensic interviews can be a racialized experience. Researchers, for instance, examined the influence of race/ethnicity of the interviewer and child in disclosing child sexual abuse in an urban setting and found higher rates of disclosure among cross-race than same-race pairs.30 However, issues of racism may become a major factor influencing other components of child sexual abuse. For example, researchers have postulated that African Americans have long histories of interacting with unjust legal and social service organizations, which may deter them from seeking help for child sexual abuse, as there may be more severe consequences for survivors, families, and perpetrators.31 In addition, the primacy of collectivistic values in many diverse racial/ethnic groups (e.g., Asian American/Pacific Islander, Latino/a, African heritage, Native American) may become a major factor in how child sexual abuse survivors who are people of color experience and heal from child sexual abuse.32 Survivors may not disclose their abuse because of their fear of how their family may be viewed negatively as a result—or fear that they may be ostracized by their family and/or community. For instance, if a family is already struggling with the deleterious effects of racism, a survivor who was abused by a family member may not want to bring additional stress or "shame" to the family.
Sexual orientation. Lesbian, gay, and bisexual (LGB) individuals experience higher rates of child sexual abuse than their heterosexual counterparts.33-34 Researchers suggest that this increased prevalence requires further investigation, especially examining how sexual orientation and potential related gender identity variance may become risk factors for abuse.35 Scholars have noted that LGB adolescents are at higher risk in general for violence and homelessness due to the "hazard of stigma" in the form of homophobia.36 For many LGB survivors of child sexual abuse, there is the added pressure of negotiating misinformation that somehow their abuse history "caused" them to be LGB. In addition, LGB adolescents are more likely than their heterosexual counterparts to attempt suicide related to internalized homophobia and experiencing societal heterosexism. The Massachusetts 2006 Youth Risk Survey suggested these youth are almost four times more likely to attempt suicide than their heterosexual counterparts, so LGB adolescents who may have a child sexual abuse history face additional barriers to their healing—from family rejection and homelessness to increased rates of depression, drug abuse, and engaging in unprotected sex.37
Socioeconomic status (SES). Research is mixed in terms of child sexual abuse and SES. For instance, in a recent study examining male- and female-perpetrated child sexual abuse in terms of family structure, 40% of victims of female-perpetrated sexual abuse came from households where the total annual family income was less than $15,000.38 However, 20% of victims of female-perpetrated sexual abuse came from households with incomes more than $58,000 compared to 6.8% for male-perpetrated violence. According to the Third National Incidence Study of Child Abuse and Neglect,39
children from the lowest-income families were eighteen times more likely to be sexually abused. Based on these conflicting findings, further study of this issue is needed to determine the relationship between SES and child sexual abuse.
Disability. Increased occurrences of sexual abuse among children with disabilities are well documented.40,22,41,18 The literature suggests children with disabilities experience sexual abuse at higher rates than those children in the general population.40-41 Sullivan and Knutzon41 found that children with disabilities were three times more likely to be sexually abused than children without disabilities. In addition, Sullivan and Knutzon found that preschool-age disabled children experience significantly more sexual abuse than disabled children in elementary, middle, and secondary school age groups. In the same study, differences by gender and type of disability were found, with significantly more females than males with disabilities and those identified as having behavior disorder most likely to experience child sexual abuse.
Child sexual abuse and intersecting identities. Attention has increased for the importance of investigating how the various identities (e.g., race/ethnicity, gender, etc.) intersect and influence mental health.42 These intersections of identities are complex to consider but are a critical component of understanding the experience of child sexual abuse—especially for those who have multiple historically marginalized identities. For instance, recent studies have explored the relationship between sexual orientation and race/ethnicity as mitigators of post-traumatic stress disorders (PTSD) for child sexual abuse survivors.43 Balsalm et al.44 examined the relationship between race/ethnicity and sexual orientation for 669 child sexual abuse survivors who were LGB and found Latino American and Asian American participants experienced higher rates of abuse than their White American and African American counterparts. In another study of intersecting identities, Tonmyr, Mery, and MacMillan45 examined the rate of child sexual abuse among women living with disability for a community sample of 4,243 women between fifteen and sixty-four years old and found 40% had experienced child abuse, although child sexual abuse was not significantly related to physical disability for the women in this study.
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