Tamara G J Leech and Marci Littlefield

Social support plays a central role in breaking the connection between sexual abuse and trauma symptoms. To illustrate this role, various scholars have argued that the existence and severity of negative outcomes among abuse survivors result from two different webs of events. The first web is concerned with the stressors among survivors, where the severity, frequency, duration, and timing of sexual abuse determine the intensity of the resultant psychological and social stress.1-3 The second, and more important, web shows how this stress can be buffered if the survivor has social support, positively appraises the abuse, and develops active coping mechanisms.3-6

The stress-buffering potential of the second web of influence is particularly important because it can empower survivors and the people who care about them. Social support, in the form of both emotional support and tangible support, can directly lead to positive outcomes among survivors. Emotional support constitutes showing care or concern, and tangible support represents the provision of information or resources to help survivors navigate their situation. Both of these types of support have the potential to sway survivors toward positive appraisals and active rather than avoidant coping, thus indirectly buffering the effect of initial abuse.4 When all of these considerations are combined, the role of social support can be depicted by figure 1. This model makes it clear that the amount of social support itself is partially dependent on the severity of abuse exposure and the age of onset of abuse.7-9 Nonetheless, social support primarily serves as a safeguard in the nexus between sexual abuse and quality-of-life issues.

For this reason, Prati10 discusses social support as an important precursor to both post-traumatic general growth (e.g. an alteration of priorities,

Frequency

Frequency

Aspects of abuse that determine Potential Buffers to Trauma Survivor's level of trauma Quality of

Life

Aspects of abuse that determine Potential Buffers to Trauma Survivor's level of trauma Quality of

Life spiritual development, etc.) and personal growth (in the form of adaptation and coping). A variety of empirical investigations establish social support as a significant factor in the progression from sexual abuse victimization to positive psychological adjustment.11 For example, at the most basic level, family connectedness is associated with half the odds of suicide attempts among sexual abuse survivors.12 Furthermore, social support from family and/or others erases the association between sexual assault and outcomes like loss of self, loss of childhood,11 depression, low self-concept,2 and post-traumatic stress disorder.13 In this way, social support empowers the survivor and those close to him/her to positively affect their outcomes. Consequently, it also empowers professionals to assist survivors because it is related to two factors that can be modified through clinical intervention: appraisals and coping.

Appraisals refer to an individual's understanding of an event (especially concerning the cause of the event). There is strong evidence that internal causal appraisals (i.e., self-blame) of sexual abuse are associated with negative symptoms and behavioral outcomes, including post-traumatic stress disorder (PTSD).14-16 Additionally, negative appraisals are connected to coping strategies that lead to undesirable outcomes.4 Thus, when social support leads to more positive appraisals, it can decrease the odds of negative outcomes associated with both appraisal and coping.

Two styles of coping are primarily associated with sexual abuse. The first, engagement (or active) coping, involves problem solving, expressing emotions, cognitive restructuring, and so on. The second, disengagement coping (or avoidance coping), is characterized by problem avoidance, wishful thinking, social withdrawal, and so on. Engagement coping leads to more beneficial social and mental health outcomes than disengagement coping.13,17 Furthermore, a large amount of research suggests that individuals with more social support are more likely to exhibit engagement coping behaviors.4,5,17

In Domitrz's Voices of Courage,18 one survivor, Shirley, provides a short description of the forty-fourth year of her life: the year when she found and utilized the social support she needed to deal with sexual abuse experienced during childhood.18 Her writing is indicative of the power of social support:

Forty-four—I discovered where my childhood went. I discovered that my father is a pedophile. Beyond difficult. But supportive people were in my life. Gone were Shame, Depression and Anger. Everything I needed to recover had been put in my path. I was told, "You are only as sick as your secrets." And out they poured. A turning point: I gave up the hope of a different childhood. Why do we hold on to such things? I have discovered what nourishes me. I have learned to release that which does not serve my highest good. I have learned that I can be open and honest and still be loved.

Shirley's experience reinforces research indicating that the general path between social support and positive outcomes is both direct and indirect. Yet the specific aspects of this process of recovery largely depend on survivors' social situations. For example, boys and men survivors who report seeking out emotional support are actually less likely to engage in positive coping behaviors.6 In the next sections, we investigate this and other subgroup-specific relationships between social support and paths of recovery. We first turn to life course considerations and show that the social networks that are most salient to everyone in that particular stage—parents/family during childhood, peers and schools during adolescence, friends and intimate partners during adulthood, and social services during late adult-hood—also have the greatest effect on sexual abuse survivors' outcomes. We then move on to discuss gender and the ways that social support systems are altered yet can be responsive to masculinity issues. We end with a brief consideration of the way in which racial and ethnic context modifies the effect of different sources of social support.

LIFE COURSE CONSIDERATIONS

Childhood

Research indicates that between 12% and 35% of girls and 4% and 9% of boys are sexually abused during childhood.1 There is no officially recog nized disorder specific to the aftereffects of childhood abuse, but aggressive behavior, social isolation, anxiety, depression, and inappropriate sexual-ized behaviors are some of the most commonly reported symptoms. Many of these items are similar to symptoms of PTSD, and it is estimated that around 40% of sexually abused children exhibit PTSD symptoms.1

Seventy to eighty percent of these children disclose the abuse before they are adults, but typically less than half of cases are acted upon.19 Parents and family members are the most likely recipients of these disclosures,19,20 despite some children's fears that sharing the information with others might break up the family or lead to the loss of a parent.6 Actually, a substantial amount of research shows that disclosure and the associated support from family protects childhood sexual assault survivors from various negative psychological responses.1,2,20-22 Although various other factors—including cognitive variables, family stability, and neighborhood characteristics2,23— interact to ultimately determine children's outcomes, parental support may be the key factor associated with positive outcomes.

Various studies show that the large majority of mothers are supportive following a child's disclosure of sexual abuse.6 However, these studies differ in their definition of "support." In general, parental support encapsulates four factors: (a) believing the allegations; (b) providing emotional support (e.g., showing the child that the parent wants to hear about their problems, cares about their feelings, etc.);2 (c) seeking out professional services such as therapy; and (d) acting against the perpetrator.21 The first three types of support are especially important, as they can defend against the potentially negative responses of the child's personal involvement in the fourth form: taking action against the perpetrator.2,20 Again, despite these high standards of support, most mothers are found to be supportive of their children, even if that support is inconsistent.6,24

Parents' ambivalence toward their children's experience should not be confused with lack of support. Ambivalence is recognized as "a phenomenon that occurs when one is conflicted, either consciously or unconsciously, in attitude or thought."24 It is a normative expression of internal conflict that—at some point—manifests among nearly all parents. For example, many parents who value spending time with their children need "adult time" on occasion. In a similar way, ambivalent parents of sexual abuse survivors might have moments when they fail to provide emotional support, doubt their child's allegations, fail to enforce action against the perpetrator, or miss a therapy session. As long as these thoughts or feelings are recognized and addressed in a safe manner (e.g., discussed with other adults, do not lead to contexts that place the child in further danger, etc.), ambivalence does not constitute neglect.

A possible explanation for this ambivalence may be that the mothers' level of support is often influenced by their social situation at the time when the abuse is disclosed. Because of psychological and social constraints, mothers tend to offer less support if they are financially dependent on the perpetrator, live in the same house as the perpetrator, when the abuse involves penetration, or if the abuse is not confirmed by other sources.2 It is understandable, then, that levels of support would vary if and when these social factors change; for example, if the mother becomes gainfully employed or if another survivor reveals abuse from the same perpetrator. More typically, overall inconsistency takes the shape of gradually increasing support, strengthening as parents have more time to psychologically digest their child's reports.20,21 Given government agencies' oversimplified conception of "guardian support" as present or lacking,6 it is important to recognize this convincing empirical evidence that nonoffending parents can be both ambivalent and supportive.24

Also related to ambivalence is the common feeling of incompetence among parents. Many parents and their children feel that parents are emotionally overwhelmed by information about the abuse or just do not have the training and knowledge to help their children.8 There have been efforts (called filial therapy) to train parents as therapists,8 but placing parents in the role of therapist may not relieve their anxiety about dealing with their children's experiences.25 Instead, professional intervention that trains parents in supportive responses26 and/or includes parents in their child's therapy sessions8,27 seems to increase parental supportiveness.

However, the strongest and most influential parental support seems to originate from parent and child attachment. Bowlby28 argues that the bond formed between a parent and child in the first several years of a child's life determines his/her level of security and affects his/her future social ties and relationships. Securely attached children have a caregiver (and in the long term other friends and family) to whom they can turn for care and protec-tion.22 Thus, secure attachment can facilitate resilience following abuse in several ways. For example, securely attached children are more likely to disclose sexual abuse.20 This disclosure is likely to be directed toward a parent, but securely attached children are also more likely to develop social skills that lead to strong peer friendships and positive relationships with nonfamilial adults (especially within the school setting).22 Finally, strong attachment to parents may even lead to more successful therapy, as parents may be able to help children feel secure and safe before, during, and/or after sessions.8

In this way, attachment is a powerful form of social support for child survivors of sexual abuse. However, all is not lost if a child does not form attachment to his/her parents in the early years of life. Positive, supportive relationships with nonfamilial adults29 or nonabusing siblings23 are also associated with resilience. Similarly, living in a stable situation—regardless of whether that is with biological parents or a foster family—increases an abused child's odds of resilience threefold.23 In the end, despite the extensive documentation of the importance of parental (or more precisely, maternal) social support, the key factor that seems to buffer negative outcomes among child sexual abuse survivors is support from a consistent caregiver.

Adolescence

Whereas the literature on childhood sexual abuse is dominated by research on maternal support, the resilience perspective is salient in scholarship on adolescent sexual abuse. In general, the concept of resilience describes positive adaptation among adolescents who are faced with significant hardships,30 such as sexual abuse. Originally, resilience was thought of as a personality characteristic, but more recent scholarship has shown that it is better described as a continual developmental process that is affected by the adolescent's personality, his/her family, and his/her social environment.30 Three types of resilience are generally acknowledged: performing better than expected, adapting well when faced with challenging circumstances, and recovering after experiencing trauma.31 The third type of resilience is most applicable to survivors of sexual abuse. Although their levels of resilience may grow and wane over time,23 adolescent survivors of sexual abuse report that they view their recovery process as an ongoing progression that is often spurred by a "second chance" provided by someone in their support network.32

Compared to other teens, adolescent sexual abuse survivors have higher rates of mental health and behavioral problems such as anxiety, post-traumatic stress disorder, and substance abuse.30 However, if adolescents have access to social support, traumatic experiences like sexual abuse can also spur emotional growth.33 Actually, research shows that, although they have higher rates of problematic outcomes, the majority of adolescent survivors of sexual abuse are resilient. In one study, over half of the adolescents had no psychiatric disorder, two-thirds had no alcohol or drug dependence, and more than 80% had never participated in violent behavior.23

Parents and other caregivers may play a significant role in placing adolescents on the path toward resilience,12 but the evidence is not as clear cut or consistent as that regarding the influence of parental support on child sur-vivors.30 In line with the ecology of the life course, supportive relationships with other social contacts seem to be particularly important for adolescents. Teen sexual abuse survivors with strong connections to school personnel tend to have lower levels of stress or mental health problems.30 These survivors report less negative trauma effects if they receive support from friends and/or professionals.6 Finally, strong associations with and support from church or religious organizations are also likely to be a vehicle toward resilient growth.10,30 In general, adolescent sexual abuse survivors have the opportunity and likelihood to follow a developmental path toward resilience if they become involved in various socially supportive relationships outside the family.

Adulthood

In the United States, it is estimated that approximately 1.5 million women fall victim to sexual abuse by an intimate partner each year.17 In addition to these women, many other women begin to deal with sexual abuse from earlier in their lifetime, as many disclosures of child sexual abuse occur in adulthood, not childhood.6 These women who delay disclosure are at increased risk of revictimization by the same or different perpetrators.32 This issue of revictimization is important, as more frequent and intrusive abuse is more likely to result in negative outcomes.19 Regardless of whether or not the victimization is repeated, adult survivors have to deal with issues that do not apply to other groups such as a decline in work productivity and/or increased economic pressures due to health care costs.17 Due to the direct trauma from abuse, as well as these increased economic pressures, adult survivors of sexual abuse are especially likely to suffer from depression and suicidal behavior.19

However, as in all life stages, the effects of trauma can be buffered by social support. For adult survivors of sexual abuse, both emotional support (perceived availability of others to participate in social activities) and tangible/instrumental support (availability of material resources) are related to more positive outcomes among survivors, with emotional support being particularly important during the early crisis stages.10,17 Some adult survivors of sexual abuse have reported feeling distressed or anxious because of having no one to confide in and are especially relieved when someone— even a professional—validates their choices and feelings.19 Complemen-tarily, tangible support seems to empower adults to take criminal action against their perpetrator.17

Adult survivors of sexual abuse are distinct from children or adolescents in that the reciprocity of supportive relationships becomes significant. For these survivors, "communal mastery"—shared connections that lead to a sense of self-competence—is of principal import.32,34 Adults are more likely to disclose abuse to friends than to family, and a positive response from these friends seems to be less important than a shared sense of experience (Ullman, 2003).

Various adult survivors of sexual abuse report that helping others through community involvement or peer groups played an important role in their paths toward resilience.32 Women who have been subjected to sexual abuse have more access to resources and/or are empowered to change their situation if they are part of a strong community of peers.17

Yet this community of peers, especially if it consists of other survivors, also provides the opportunity for advocacy efforts that can build survivors' self-esteem.6 Thus, it may be particularly important for adult survivors of sexual abuse to actively engage in peer relationships that require and/or establish a sense of community.

In addition to these community ties, relationships with intimate partners are essential to the adult experience of sexual abuse. The effect of intimate partner relationships is obvious when one partner serves as the abuser. In these cases, the survivor may find it difficult to leave the situation because of financial dependence, fear, and/or love.20 However, the relationship between a nonabusive partner and survivor particularly shapes the relationship between social support and outcomes. Often, the intimate partner fails to provide social support by responding negatively to instances of dis-closure—e.g. displaying sexual intrigue, replicating dynamics of the sexual abuse, or pressing sexual interaction.35 In this and other ways, disclosure of sexual abuse leads to more relationship stress than social support, and there is evidence that subsequent breakups serve as triggers for negative behaviors among sexual abuse survivors.19

Other studies show that a positive response to disclosure from a romantic partner is one of the key determinants of positive adult health.9 These positive responses may be most impactful if they take on the form of communal experience as discussed above. For example, reactions could take the form of sharing previous struggles with addiction, disclosing family members' experiences with abuse, or relating to the experience through their own professional training. Regardless of the method, this support from romantic partners plays a pivotal role in the healing process of adult survivors.32,3

Seniors

Elder mistreatment can be divided into six categories: sexual abuse, physical abuse, psychological abuse, financial exploitation, neglect, and violation of rights. Despite the fact that many of these forms of abuse overlap, sexual assault is the least common form.36 Various sources estimate that around 6% of the senior population falls victim to elder sexual abuse, the large majority being women.37-39 Romantic partners are unlikely to be the perpetrator of these assaults (less than one-third of the abuse is committed by these individuals),37 perhaps because seniors' physical and social situation places them at risk from various assailants. Declining health, financial struggles, and housing situations make seniors vulnerable to abuse from individuals outside of intimate partner relationships.40

Declining physical condition also amplifies the consequences of sexual assaults, as they have more severe physical ramifications for elderly survivors than other age groups.41 Depression and shame/guilt is also amplified within this population, perhaps because of the cultural and social standards of the time in which they grew up.37 Of course, mistreatment and these additional, negative outcomes are less likely to occur among seniors who are involved in systems of social support.42 Low social support triples the likelihood of victimization among the elderly. Social and physical isolation can also contribute to the continuation of abuse, as survivors may be reluctant to leave an abusive caregiver if they perceive no other available support.38,43 These social factors can exasperate existing limitations—for example, physical disabilities, mental limitations, residence in unsafe neighborhoods—on seniors' ability to take actions to end sexual abuse.40,43,44

In all, studies indicate that elder sexual abuse relies heavily on the disem-powerment that results from the social isolation of seniors in U.S. society. Sexual abuse from marital partners may be influenced by the historic sense of male privilege and wives as sexual property that dominated cultural beliefs at the time of seniors' unions,43 but this is probably not dominant because of the previously noted low rate of abuse originating from the spouse. Instead, it is more helpful to recognize the deterioration of elders' social networks—due to mortality, retirement, relocation, and so on—that leads to disempowerment directly and also indirectly by contributing to cognitive and functional decline.39 Along these same lines, the seniors' location within social networks and cultural depictions may also weaken survivors' voices. Given that sexual abuse is often misunderstood by professionals and laypeople alike as an act of sexual desire (instead of as a weapon of violence to establish power) and our culture does not consider seniors as sexual or sexually attractive, senior sexual abuse is likely to go unrecognized and untreated.39,44

The cultural myth that seniors are unlikely to be victims of sex crimes makes their family members and other informal support groups unlikely to recognize abuse when it occurs.37,44 Furthermore, this misunderstanding extends to medical professionals—often the only other consistent social connection for many elderly individuals—who may not think to look for signs of abuse nor recognize their responsibility to report the abuse in the same way they would for child abuse.37,39,40 Given that seniors may have definitions of abuse that do not match present-day standards37 and that they may be conflicted about reporting victimization if they have a dual role as victim and caregiver (in the case of being victimized by individuals who were previously their dependents),43 the most prevalent and most empowering form of social support is likely to come from senior services professionals.

Senior service providers are the professionals most likely to recognize the fact that—due to growing up in a time where there was no permission to discuss sexuality or sexual activity—elders may feel more shame and guilt than any other group of sexual assault survivors.40,44 Given that our society has moved toward institutionalized support of the elderly in the form of nursing homes, assisted living facilities, Social Security, and so on, these individuals are most likely to have consistent, meaningful social interactions with senior sexual assault survivors.39 They are, therefore, in the position to provide the most meaningful and effective social support for senior survivors.

At the same time, the tangible resources that they provide as part of their agencies' mission serve as an additional source of social support that buffers the trauma associated with sexual assault. Addressing transportation problems, assisting with hearing or vision issues, and fixing problems with the built environment (e.g., lighting, door lock, and window issues) can serve to decrease fear and anxiety after an assault.40 Providing opportunities for community interaction as well as initiating public awareness campaigns can alleviate associated distress and increase the likelihood of reporting/recognizing sexual assault.37,42 In sum, due to the social and cultural situations of seniors in our society, adult service providers may be the most likely and most effective sources of social support.

Hence, it is important to recognize the various sources of adult services for sexual assault survivors. Adult protective services (APS) is perhaps the most commonly recognized and easily accessible service, but it came to focus on sexual assault late and is underfunded relative to child protective services.37,39 Today APS can provide various, tangible forms of social support from securing housing to serving as a client advocate. In addition to APS, several national agencies, including the National Center for Elder Abuse, Clearinghouse for Abuse Neglect of the Elderly, and the National Clearinghouse on Abuse in Late Life, can provide information and materials necessary for outreach campaigns. These elder-focused agencies may be more helpful in providing social support specific to the senior context than the typical social services agencies geared toward sexual abuse. (Women's shelters have staff with expertise in domestic and intimate partner abuse, but shelters specifically for abused elders are rare and therefore may lack specialized resources and accessibility.37,39) The rape crisis movement has yet to fully incorporate seniors' unique situation as adults who may not have the agency to fully adhere to professionals' or organizations' recommendations and requirements.44

On a final note, if we are going to rely on senior service providers for the tangible and emotional support of sexual abuse survivors, the potential deleterious effects on this population should be recognized and addressed. Familial caregivers of victimized seniors have been known to display anxiety and depression,36 and professional caregivers are not immune to these effects. APS agents, social workers, and nurses can fall victim to "compassion fatigue" if faced with being the only form of social support for many survivors of these crimes.45 Although all individuals providing social support to survivors run this risk, the nature of these occupations means that these agents are more likely to support more individuals simultaneously and/or deal with these issues more often than other, informal sources of support. If they are not integrated into their own system of social support, they can fall victim to the same negative outcomes of many sexual assault survivors—PTSD, depression, anxiety, and so on.45 If this occurs, it not only leads to a new set of negative outcomes among an additional population; it also erodes the primary source of social support that can buffer traumatic effects of sexual abuse on senior survivors.

GENDER CONSIDERATIONS

Men as Survivors

Women and girls are 7.5 times more likely to be sexually abused or assaulted over their lifetime than men or boys, and therefore much of the information discussed to this point has focused on the experience of women.19,44,46 However, recently scholars have established the existence and importance of sexual assault among men and boys. Much of this literature focuses on men's victimization in prison or in childhood sexual assault,47 but this focus does not capture the experience of all male survivors. According to official statistics for 2006, 26% of the rapes/sexual assaults reported to police involve a male survivor.47 In the United States, one out of every seven boys can expect to be sexually assaulted by the age of 18;6 furthermore, one study found that in one year, 3,635 adult men sought professional help for sexual assault.47 These statistics indicate that male survivors of sexual assault are neither rare nor abnormal.

The long-term implications of experiencing sexual abuse are generally similar for men and women, but they show some important marked differences. There is consensus that men share the risk of mental health problems (e.g., low self-esteem, decreased self-worth, emotional maladjustment) with women survivors.13,48 Yet perhaps due to influence on their masculine identity and the experience of severe guilt, men are more likely to use avoidance coping such as substance abuse and to exhibit aggressive behaviors.13,49 Of particular concern is suicidal behavior. Due to many of these gender-specific responses, men survivors of sexual abuse are more likely to successfully commit suicide (although suicidal behavior is more common among women survivors of sexual abuse).12,19,47 These differences in coping and the associated outcomes lead to a greater probability of resilience among women.23 Nonetheless, there is strong evidence that young men survivors who receive social support can enter into a positive emotional growth path.

The first step toward this path involves disclosing the abuse. Disclosure is simply the process of attempting to convey the experience of abuse to another person;49 yet research shows that this process is anything but simple. The process of disclosing sexual assault involves a difficult choice: go without social support in order to avoid possible negative reactions and additional distress, or tolerate some negative reactions in a continued effort to find that support.6,35 Similar to so many other aspects of surviving sexual abuse, disclosure should not be considered a one-time event, but a complex, continual process of reaching out for support.

Our societies' gender norms make it difficult for both men and women to disclose abuse. Women and girls who attempt to disclose abuse may run the risk of being labeled a tease or be accused of playing games. Thus, disclosure may not be more difficult for men than women, but men face unique barriers applied due to gendered social messages. First, masculine socialization leads to expectations of enjoying sexual experiences, acceptance of precocious activity as "initiation," and a demand for stoicism and strength; all of which make it more difficult for men and boys to disclose their abusive experiences.46,49 Second, for some of these same reasons, men are less likely to be supportive if they are the recipient of disclosure.6,23 Men's socialization teaches them to devalue relationships and intimacy,49 so this limits the possibility of disclosing or being supportive of disclosure. Third, these cultural issues mean that men risk being labeled homosexual or being accused as the perpetrator to a greater extent than women survivors.49 Fourth, and finally, because of men's physical strength and the cultural myth that they should be able to protect themselves, they may be accused of not trying to avoid the victimization.23,47,48 The effects of all of these aspects of gender socialization may be even further enhanced within the senior population, as these cultural beliefs and standards were even stronger during their childhood.44 For all of these reasons, boys and men may be reluctant to disclose abuse and start the process of obtaining social support.

Few victims are likely to report a sexual assault, but men are 1.5 times less likely than women.50 It becomes increasingly disheartening, then, when men report feeling abandoned or judged by members of the medical profession. Male sexual abuse survivors state that they are met with disbelief from some medical professionals, reprimands from others, and are discouraged from reporting the abuse by still others.47 At the same time, these boys and men may be unable to turn to parents or family members to adjust for this lack of support. Boys who experience sexual abuse are likely to come from dysfunctional households and/or family relationships where they feel unsafe and isolated.46,48 Depending on the cultural beliefs about male roles and responsibilities, the family members may discourage boys and young men from discussing these issues and even punish them when they do.49 These experiences with physicians and family members contribute to a sense of isolation among male survivors.47,48

Other social connections, then, become markedly important for male survivors of sexual abuse. To compensate for these familial relationships, recovery is often facilitated by the initiation of "safe" relationships where the survivor feels empowered.46 Sometimes these relationships are with children or pets because they are nonthreatening. More often, men survivors are greatly (and positively) affected by gentle, caring adults. These relationships are often with individuals who have maternal characteristics and can even be characterized by seemingly mundane behaviors (e.g., providing chicken soup or brushing a child off after he falls).46

While individual relationships may help men survivors feel secure, belonging to a group allows these survivors to address their feelings of isolation. Sharing and interacting with other individuals who are survivors of sexual abuse provides men survivors a sense of belonging and connectedness to a community.48 However, these connections do not have to be specific to sexual abuse. Men who survive sexual abuse can also develop positive, influential relationships with survivors of other violent or traumatic events.46 In these situations, men might find a way to rectify their masculinity with their past experience because men are socialized to be providers and protectors.43 Thus, if men are able to (eventually) take the role of counselor or sponsor, for example, they are especially likely to benefit emotionally and mentally from the situation.46

RACE AND ETHNICITY CONSIDERATIONS

The available information regarding racial and ethnic differences in exposure to sexual abuse is inconsistent, leading some scholarly reviews to determine that no particular race is at increased risk of sexual abuse,51,52 while others suggest otherwise. For example, one study finds that white women are most likely to be the victim of forcible rape at very young ages,51 but African American women experience forcible rape at a rate of 50% higher than white and Latina women.53 This type of nuanced difference is common in the literature on sexual abuse according to race and ethnicity, providing very detailed depictions of sexual abuse events by race and ethnicity. Thus, the literature indicates that young black girls are more likely to be subjected to abuse by family members and perpetrators of the same race.54 White women are more likely to experience noncontact abuse in public and prolonged contact abuse.55,56 Asian and Hispanic women are more likely to experience abuse at older ages.57

Scholars suggest that some of these differences are related to ethnic variations regarding the definition of sexual abuse and also are influenced by whether researchers take socioeconomic status into consideration.58 Regardless of these differences, survivors of all races encounter physical and psychological coercion as part of the experience of sexual abuse,56 and this commonality in experience leads to few differences in response to abuse incidents.51 Yet the differences that do exist have important implications for the role of social support. Research has progressed substantially from initial studies finding that "non-white" survivors have higher rates of depression and negative behaviors, and lower rates of self-esteem59 to disentangle the effects of minority status from race and ethnicity. As a result, we have come to understand that all survivors of sexual abuse run the risk of these outcomes, but symptoms seem to vary according to cultural context:

• Asian survivors are less likely to externalize (exhibit developmentally inappropriate sexual behavior and anger), and instead tend to internalize (have suicidal thoughts and attempt suicide) more often than other groups.57,60

• The magnitude of severe abuse (e.g., penetration, victimization by a stranger, etc.) is consistently greater for Latinas (specifically Mexican women) than any other group and is more likely to be manifested in depression and behavioral problems.2,55,61

• For African American survivors, sexual abuse is less likely to result in psychological problems (e.g., depression and PTSD) than are other forms of abuse such as physical or emotional abuse from an intimate partner.61 Instead, black sexual abuse survivors are more likely to experience problems with sexual functioning, to engage in high-risk sexual practices, and to participate in problem drinking behavior.51,62,63

These specific manifestations of the abuse experience highlight the need to take into account the culture-specific norms, values, attitudes, expectations, and customs of each group before potential sources of social support can be properly identified.65

For this reason, the sociopolitical and cultural context experienced by ethnic minority women is an important factor in understanding domestic violence and sexual assault victimization. As was previously discussed, the highest levels of social support are unattainable if the abuse is not disclosed. Therefore, the risk factors associated with abuse among minority women and the internal and exterior barriers to help-seeking behavior are especially important for social support.58

The external barriers can be best understood in the sociopolitical environment, which places all minority groups in a historical context of oppression and makes minority women more vulnerable to negative reactions to their abuse experience. Scholars suggest that the history of racial oppression is unique for minority women for a number of reasons. Their bodies have been systematically and routinely objectified and devalued,66 and the interaction of multiple oppressions of race, ethnicity, and class make them more vulnerable to more lethal forms of violence and greater severity of violence than other groups of women.58

Their structural circumstances also place greater limitations on their abilities to disclose sexual abuse. For example, African American girls are more likely to have a stepfather (or stepfather figure) in the home, and stepfathers have been associated with greater risk of victimization and a lower likelihood of maternal support.56,67 Similarly, traditional Asian family roles dictate an unquestioning respect for elders and men, which may help to explain high rates of abuse by male relatives and lower rates of reporting the abuse to authorities.60

Furthermore, when they become adults, evidence suggests that minority women are more likely to have their children removed from the home, and some even experience discriminatory treatment during the intervention.68 Scholars have also noted that Asian American women are discouraged from disclosing, hold negative attitudes toward seeking help from formal services, and are more likely than white women to believe that women are responsible for preventing sexual assault.58 If early in the acculturation process, distrust of the government and limited English language skills and education must also be taken into consideration;69 and these issues tend to extend to other ethnic groups such as Native American tribes and immigrant Latinas.58 Thus, the ways that disclosing sexual abuse is contextualized for minority girls and women is important in addressing the availability of social support mechanisms.

Yet these constraints and the experience of oppression are not completely owned by women. One influential study reports that men survivors' sources and extent of social support are also shaped by their racial and ethnic con-text.70 Specifically, the study finds that parents of young men often worry that sexual abuse will compound the amount of discrimination facing their child. Fathers of various ethnicities support their male child survivor by encouraging them to re-create their masculinity through athleticism, emotional detachment, and heterosexual behavior. Yet, African American and Puerto Rican parents emphasize this re-creation of masculinity more than any other group and see their sons' racial authenticity as inseparable from their masculinity.70

As a result, parents of these young men take action—initiating play dates, joining clubs, even moving residences—to increase same-race interaction between their sons and other boys.70 These efforts at providing social support are evidence of a larger phenomenon. Latino and African American communities are similar in that that both rely on informal support networks in response to family crisis and their cultural norms foster a strong sense of communalism and familism.69 While white, adult survivors are likely to utilize friends and authority figures for support,51 their Latina peers are likely to seek maternal support, and their African American peers are more likely to reach out to extended family members.57 Because of the previously discussed social, political, and cultural contexts, members of these ethnic groups are more likely to use informal sources of social support even though they may be aware of formal sources. Informal sources of support are by far the most helpful and protective factors for African American trauma survivors.58,62

In contrast, formal sources of support may be most helpful for Asian American survivors of sexual abuse. Even when experiencing emotional distress, members of Asian cultures tend to underutilize mental health services because mental illness is seen as less legitimate than physical illness. For this reason, mental health services are underutilized, but not physical health services.60 Thus, medical doctors may be an important source of social support for Asian American survivors of sexual abuse.

For all minority groups it is important to utilize culturally sensitive methods and programs, which will take into account their unique experiences and worldviews. Whether minority groups distrust formal social services or have a preference for medical doctors, each community has unique needs when seeking social support to deal with sexual violence. Furthermore, it should be recognized that survivors in every culture have developed systems of social support to buffer the effects of sexual victimization. One study finds that the large majority of adult sexual abuse survivors report high levels of nonpartner social support (76% of white, 77% of African American, 71% of Latina, and 79% of other races).71 Efforts to improve the quality of that support should recognize these existing assets and develop culturally relevant programs to enhance these formal or informal resources.

CONCLUSION

Social support can serve as a powerful buffer between the experience of sexual abuse and negative emotional, psychological, and behavioral outcomes. Providers of social support help to shape survivors' appraisals of the experience as well as their coping strategies. Various survivors report that these individuals' and/or groups' actions can represent an important juncture that leads survivors toward resilience trajectories. Thus, all sources of social support—whether emotional or tangible—are potentially beneficial, yet the potency of specific types of sources depends on the survivor's social characteristics.

The previous review reveals that the survivor's gender, ethnic/racial background, and location in the life course help to determine the salience of certain sources and types of support. It is important for the survivor, as well as their potential sources of support, to recognize these cultural-specific considerations and use them to guide help-seeking and help-providing efforts. It is equally important for interventionists and policy makers to be aware of these cultural-specific sources so they can bolster, augment, and/ or further develop existing assets.

To recap, we provide the following brief overview of sources of social support that are most salient to subpopulations.

Children: Child survivors of sexual abuse respond most positively when they are in a prolonged, caring relationship with a primary caregiver. Most of the literature focuses on mothers, but there is strong evidence that any stable, caring adult who provides both expressive and instrumental support can have a strong positive effect.

Adolescents: Adolescence represents the first time in the life course when the power of the familial social setting is rivaled by other social groups. For adolescent survivors of sexual abuse, support from community members—schools, churches, and so on—may be as important as support from family members.

Adults: Adult survivors are most heavily influenced by support from their peers and nonabusive romantic partners. Communal mastery—shared connections that lead to a sense of self-efficacy—seems to be the defining characteristic of these relationships, as adult survivors (compared to children or adolescents) benefit from the associated feeling of self-competence and empowerment.

Seniors: In U.S. society, we have developed institutions—Social Security, Medicare, nursing homes, and so on—that serve to formalize the care of seniors. As a result, formal forms of social support are particularly important for seniors who experience sexual abuse. It is very important, then, to support senior service providers so they do not succumb to compassion fatigue.

Men: Boys and men who survive sexual abuse benefit greatly from nonthreaten-ing sources of social support, especially if these sources help them to tackle a daunting hurdle for this group: disclosure. The essential element seems to be social relations that do not challenge their physical or masculine power (e.g., relationships with children, pets, and caring adults).

Race/ethnicity: Different worldviews and access to resources serve to influence the forms of support that minority survivors are likely to recognize, appreciate, and benefit from. For example, Latino and African American sexual abuse survivors find informal support to be particularly beneficial (for Latinos, this tends to originate with mothers, but for African Americans it involves the extended family). Yet the cultured worldview of many Asian Americans makes formal support—especially from medical doctors—more desirable and influential.

Thus, anyone attempting to provide social support to sexual abuse sur-vivors—whether a family member, friend, or practitioner—should take the survivor's social location into consideration. Of course, these categories are not mutually exclusive, and many survivors may simultaneously fall into several categories. This fact should be seen as a benefit, increasing the number of potential sources of support for any individual survivor.

If there is one consistent finding across all of these subpopulations, it is that more social support will increase the already large percentage of survivors who report positive life outcomes following their experience of sexual abuse.

Survivors of sexual abuse can draw strength from this fact. Sexual abuse is painful and can be quite challenging; however, if you are in this situation, you have choices:

1. Understand sexual violence is sex obtained without the other person's consent. There is no justification for violence.

2. Choose to disclose your abuse. You are not being disloyal to anyone if you report abuse. It is common to feel anxious about the possibility of a negative response, but the value of potentially positive responses is tremendous.

3. Seek assistance from at least one member of a support system. Social support can provide an outlet for expressing emotions and can educate you in different coping mechanisms. Even untrained friends and family members may be able to provide the support that you need.

4. Do not hesitate to utilize formal support services. Formal support services may be obtained from a variety of locations: local hospitals, clinics, schools, shelters, places of worship, and so on. Approach a professional you trust and he or she may be able to provide or direct you to appropriate sources of support.

5. Consider joining a support group. These groups improve self-esteem, help you feel empowered, provide a supportive environment, and encourage relationships with others in similar situations. These groups also foster an environment of respect and freedom of expression and allow you to learn new strategies for dealing with issues.

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