SEXUAL ABUSE – BREAKING THE SILENCE Edited by Ersi Abacı Kalfoğlu and Rehat Faikoğlu Sexual Abuse – Breaking the Silence Edited by Ersi Abacı Kalfoğlu and Rehat Faikoğlu Published by InTech Janeza Trdine 9, 51000 Rijeka, Croatia Copyright © 2012 InTech All chapters are Open Access distributed under the Creative Commons Attribution 3.0 license, which allows users to download, copy and build upon published articles even for commercial purposes, as long as the author and publisher are properly credited, which ensures maximum dissemination and a wider impact of our publications. After this work has been published by InTech, authors have the right to republish it, in whole or part, in any publication of which they are the author, and to make other personal use of the work. Any republication, referencing or personal use of the work must explicitly identify the original source. 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Publishing Process Manager Dejan Grgur Technical Editor Teodora Smiljanic Cover Designer InTech Design Team First published March, 2012 Printed in Croatia A free online edition of this book is available at www.intechopen.com Additional hard copies can be obtained from orders@intechopen.com Sexual Abuse – Breaking the Silence, Edited by Ersi Abacı Kalfoğlu and Rehat Faikoğlu p. cm. ISBN 978-953-51-0425-4 Contents Preface IX Part 1 The Psychology of Sexual Victimization 1 Chapter 1 A Review of Childhood Abuse Questionnaires and Suggested Treatment Approaches 3 Donald J. Levis Chapter 2 Sexual Abuse Histories Among Incarcerated Older Adult Offenders: A Descriptive Study 21 Mary Beth Morrissey, Deborah Courtney and Tina Maschi Chapter 3 A Salutogenic Approach to Healing Following Child Sexual Assault 33 Sheryle Vilenica and Jane Shakespeare-Finch Chapter 4 Do Alexithymia, Dissociation, and CSA Explain the Controversial Topic of Memory Recovery? 57 Peter Paul Moormann, Francine Albach and Bob Bermond Chapter 5 Gender Differences in the Impact of Child Sexual Abuse on Alexithymia, Dissociation and Self 75 Peter Paul Moormann, Francine Albach, Bob Bermond, Annemieke van Dijke, Jakob de Jong, Jaco Wineke, Kalliopi Metta and Argyro Karanafti Part 2 The Physiological Impact of Sexual Assault 93 Chapter 6 Psychobiological Effects of Sexual Abuse 95 Dorie A. Glover, John K. Williams and Kimberly A. Kisler Chapter 7 Risk Factors in Sexually Abused Children Reporting to the One Stop Centre at University Teaching Hospital in Zambia 113 Elwyn Chomba VI Contents Chapter 8 How Do We Recognize Recent Sexual Abuse in Children Less than 10 Years of Age? What Is the Role of Paediatric Wards? Experience in a French Paediatric Hospital 127 G. Picherot, N. Vabres, J. Fleury, E. Launay and C. Gras-Leguen Chapter 9 Childhood Sexual Abuse and Adult Physical and Dental Health Outcomes 137 Kathleen Monahan and Carol Forgash Chapter 10 Child Sexual Abuse and Its Implications for Children’s Health 153 Lia Leão Ciuffo and Benedita Maria Rêgo Deusdará Rodrigues Part 3 Culturally Diverse Attitudes in Coping with Assault 167 Chapter 11 Coping with an Experience of Child Sexual Abuse: Perspectives of Young Female Survivors in South Africa 169 Nareadi Phasha Chapter 12 What Went Wrong at Ohel Children’s Home – and What Can Be Done About Its Failure to Protect Jewish Children from Abuse? 183 Amy Neustein and Michael Lesher Chapter 13 Researching Sexual Abuse in Societies in Which Sexuality Is Regarded as Taboo: Difficulties and Proposed Solutions 201 Murat Topbaş and Gamze Çan Chapter 14 Considering the Sexual Harassment as an Equivalent Incestuous 209 Claudio Cohen and Adriana Esturaro Chapter 15 Sexual Abuse of Live-In Care Workers in Taiwan 232 Shu-Man Pan and Jung-Tsung Yang Preface Sexual assault can be considered as expression of aggression through sex. This in turn can have serious negative effects on a survivor’s social and occupational functioning. Unfortunately, it has been experienced in all cultures for centuries. The accumulation of scientific data about this fact, though, is quite new. We started learning about the ways that women, men, and children are victimized and our methods of disclosing this victimization only started since 1970. In reality, we have very limited knowledge of the actual issue. Although the number of published research papers has been very high over the last years and the scientific methodology is quite reliable, the results are far from reflecting the truth, because the actual number of cases is enormous compared to what is reported. Victims do not disclose the assault, and they prefer silence. There are numerous reasons for this kind of refusal, which differ based on the cultural and social environment of the assaulted. It seems that the rhetoric of 'what we know is only the tip of the iceberg' seems to reflect reality. Shame and embarrassment, self blame, fear of exposure, fear of the legal system and the court procedures are some of the international reasons that prevent thousands of sexual assault survivors from reporting the assault. That is certainly a very serious multidimensional problem, the solution of which is complicated. Various parties have to help in facilitating the solution by approaching the issue from their specific angle. The institutional approach should involve all those establishments that are involved in a sexual assault case identification and victim rehabilitation. The victims generally complain about re-victimization following the disclosure of an assault. This notion has to be completely erased. How can we achieve that? The answer is in a correct and effective coordination of the various parties. Coping with sexual assault is a truly multidisciplinary process. Lawyers, judges, doctors, nurses, psychologists, psychiatrists and pediatricians are involved and they all have to be educated on the issue of dealing with sexual assault. Besides, the law enforcement has to be aware of that interdisciplinary need. In any case, an organized, well informed group of people must deal with the victims in a way that will ensure that they will not be hurt anymore. X Preface Secondly, the victims themselves, the vulnerable people but also the general public should be aware of the possibility of sexual assault. Awareness-raising activities should be developed according to various age groups and specific policies should be applied. A real success of such an awareness-raising activity can be the empowerment of the survivors. Their fear may be changed to an accomplishment because following their disclosure, others in the community may be protected from becoming victims. It is known that if the trauma of sexual assault is left unrecognized and unaddressed, a cycle of re-traumatization will always be a high possibility. Therefore, once the case is disclosed or found out, a rehabilitation strategy has to be systematized and psychologists have to be seriously involved. It is also known that there is a risk of developing a perpetrator from a sexual assault victim if not treated properly. We can only have progress in this issue in the light of correctly processed and analyzed scientific data. This book has been organized on that specific approach, by compiling the scientific work of very well-known scientists from all over the world. Three different sections included three different aspects of the issue. The first part examined the psychological victimization of sexual assault. Sexual assault can be considered as an articulation of aggression through sex which can impair. Sexual assault has been associated with post traumatic stress disorder that may be characterized by mood disorders, anxiety disorders, conduct disorders, substance abuse, and suicidal behaviors, chronic headaches, maladaptive sexual behaviors, dissociative behaviors, depression, alcoholism, panic disorder and social phobia, chronic fatigue, gradually developing to asthma and cardiovascular problems and even self-injurious or suicidal behaviors. Is there a possibility for a sexual abuse survivor to use this experience in a positively transformative way? Scientists today say yes. You can find an analytical explanation of this approach in the pages of this book. Prisons are places where extremely valuable information can be collected. The largely neglected prison population is thoroughly analyzed and the information is shared with us in this book. The traumatic experiences in childhood may be converted to organic diseases later in life and the problem is that sexual assault survivors are generally resistant to any kind of treatment because they believe that they do not deserve such care. Thus we have to find ways to approach them effectively. This book, in its second section, deals with this physiological aspect of sexual abuse. . SEXUAL ABUSE – BREAKING THE SILENCE Edited by Ersi Abacı Kalfoğlu and Rehat Faikoğlu Sexual Abuse – Breaking the Silence Edited by Ersi Abacı. Becker-Lausen, 1995). Sexual Abuse – Breaking the Silence 8 The examination of the factor structure of the CAT revealed three factors; negativity of the home environment, sexual abuse; and punishment. history of abuse. The following seven abuse screens are reviewed. (1) The Rape Aftermath Symptom Test; (2) The Scarlett O’Hara v. MMPI Configuration; (3) The Child Abuse and Trauma Scale; (4) The