Nonsexual Symptoms of Sexual Abuse

Nonsexual symptoms are less definitively linked to sexual victimization because they are more likely than sexual symptoms to derive from other experiences and traumas. For example, while such behavioral and emotional symptoms can come from being sexually victimized, they can also be the result of physical abuse, neglect, divorce, auto accidents, or natural disasters. Nevertheless, Table III lists nonsexual symptoms and, where relevant, their possible relationship to subgroups of victims.

Table III Psychosocial Symptoms of Sexual Abuse:

Nonsexual Behavioral and Emotional Indicators of Distress

1. Sleep disturbances

A. Night waking

B. Nightmares

C. Night terrors

D. Refusal to go to bed (in some cases, because it is the site of the sexual abuse)

E. Refusal to sleep alone

F. Inability to sleep

2. Toileting disturbances

A. Previously toilet trained (more common in young victims)

1. Enuresis

2. Encopresis

Table III Continued

B. Refusal to go into the bathroom (in some cases, because it is the site of the sexual abuse)

C. Smearing feces (more common in very disturbed victims)

D. Hiding feces (more common in very disturbed victims)

3. Eating disturbances

A. Anorexia (characteristic of adolescent girl victims)

B. Bulimia (characteristic of adolescent girl victims)

4. Avoidant reactions

A. Fear of the alleged offender

B. Fear of persons of the same sex as the alleged offender

C. Refusal to be left alone

D. Fear of particular places that may be associated with abuse

5. Somatic complaints

A. Headaches (associated with nondisclosure)

B. Stomach aches (associated with nondisclosure)

C. Pelvic pain (may be related to affect or injury)

6. Behavioral problems

A. Firesetting (more characteristic of boy victims)

B. Cruelty to animals (more characteristic of boy victims)

C. Aggression toward more vulnerable individuals (younger, smaller, more naive, retarded individuals)

D. Delinquent behaviors (characteristic of older victims)

1. Incorrigibility

2. Running away (may be an adaptive response to avoid the offender)

3. Criminal activity

E. Substance abuse

F. Self-destructive behaviors (characteristic of adolescent girl victims)

1. Suicidal gestures, attempts, and successes

2. Suicidal thoughts

3. Self-mutilation

7. School problems

A. Inattention

B. Sudden decline in school performance

C. School truancy

8. General disturbances of affect

A. Low self esteem

B. Anxiety

C. Fear

D. Anger

E. Dissociation

F. Posttraumatic stress disorder

Caveat: A determination of sexual abuse cannot be made based upon the presence of these factors alone; however when noted in conjunction with sexual indicators and other positive findings, they increase the likelihood of sexual abuse.

Child Sexual Abuse

The array of possible impacts is considerable. However, not every child is seriously affected. In fact in a 1993 survey of 45 comparative studies of the impact of sexual abuse, Kendall-Tackett, Williams, and Finkelhor found that about a third of the victims of child sexual abuse were reported to be asymptomatic. In addition, about two-thirds of children showed recovery during the first year to year-and-a-half after the abuse. Although children with a history of child sexual abuse had more symptoms than both clinical and nonclinical comparison groups—fear, PTSD, behavior problems, sexualized behaviors, and low self-esteem being the most frequently noted, no single symptom characterized the majority of children.

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