Running head: CULTURAL INFLUENCES OF CHILDHOOD SEXUAL ABUSE

An Exploration of Cultural Influences of Childhood Sexual Abuse

Zackery A. Tedder
CULTURAL INFLUENCES OF CHILDHOOD SEXUAL ABUSE 2

Abstract

Childhood sexual trauma can result in a lifetime of dysfunction and dysregulation. The current

concerns related to the prevalence of child sexual abuse appear to not be restricted by any one

culture or ethnicity. It is suggested that this is a cross-cultural concern, and while it appears

more prevalent in various cultures, it does not appear to be more restricted by any one more than

the other. Therefore, a literature review to ascertain the cultural influences was conducted to

analyze the propensity within groups. It is important to keep in mind that no one group is more

likely than another to perpetrate sexual abuse; however, attitudes and beliefs do appear to be

different among varying populations and cultures. This analysis hopes to reveal how various

cultural influences affect the likelihood of sexual abuse, while also hoping to identify potential

risk-factors among group members. Explorations of evidenced-based practices for treatment are

also discussed.
CULTURAL INFLUENCES OF CHILDHOOD SEXUAL ABUSE 3

Cultural Influences of Child Sexual Abuse

Introduction

Childhood sexual trauma is a significant concern in society, regardless of race, creed,

religion, country of origin, or sex (Pereda, Guilera, Forns, & Gomez-Benito, 2009b; Aronson

Fontes, Cruz, & Tabachnick, 2001). The confounding problem related to these concerns within

the practice of psychology also presents a question regarding the adequate graduate-level training

to address treatment and identification of childhood sexual trauma, and how maladaptive

behaviors may manifest later in life (Alpert & Paulson, 1990). This paper will explore how

cultural influences affect the experience of childhood sexual trauma, while also identifying

moderate educational perspectives that could adequately address the problem within populations

to better train future generations of clinicians, counselors, and social workers.

Statement of the Problem

Within typical childhood development, experiences throughout the pre- and post-

adolescent period tend to formulate an individuals perspectives and perceptions of the world

(Follette, Polusny, Bechtle, & Naugle, 1996). Disruptions within this period of development,

specifically among very young children in the form of trauma or other significant events, can

have notable negative effects on how these children continue within the developmental process

(Elliot, Browne, & Kilcoyne, 1995; Turner, Finkelhor, & Ormrod, 2006). These effects can

manifest in the form of depressive disorders, self-esteem issues, sexual acting-out behaviors

which can perpetuate a cycle of abuse, gender dysphoria and confusion, along with a number of

other potential outcomes (Jonzon & Lindblad, 2006; Bornstein, Kalplan, & Perry, 2007; Turner,

Finkelhor, & Ormrod, 2006). The potential for perpetration appear to be somewhat varied
CULTURAL INFLUENCES OF CHILDHOOD SEXUAL ABUSE 4

throughout different ethnicities, but also appear to be an equal-opportunity offender within

populations (Lowe, Pavkov, Casanova, & Wetchler, 2005).

Childhood sexual is defined as the following: contact and non-contact sexual

experiences between a person under 18 years of age and an adult or other person at least 5 years

older; or sexual experiences resulting from coercion no matter what the age of the other person

(Pereda, Guilera, Forns, & Gomez-Benito, 2009a, p. 337). This will be the context of discussion

when explaining childhood sexual abuses. This definition is considered somewhat standard,

though an agreement among researchers and clinicians does not appear to be universal

(Bornstein, Kalplan, & Perry, 2007).

It is also important to distinguish a demarcation between rape and childhood sexual

abuse. While rape can occur within childhood, a more measured approach is necessary to

identify why rape and childhood sexual trauma are different. Pereda, Guilera, Forns, and

Gomez-Benito (2009b) report that when these distinctions are made, and when rape and incest

are removed though factor analysis, prevalence of male child sexual perpetration is

approximately 10%, while female prevalence exists between 10% and 20%. Comparatively,

sexual abuse among adult women exists between 30% and 40%. There were also suggestions

that prevalence rates in 21 different countries ranged from 0 to 53% among women, and 0 to

60% for men. Pereda, et al., further posit that these numbers are mostly based on prevalence

within western countries, and distinctions between eastern countries and African countries have

different rates of prevalence. Notably, African countries have shown that abuses among males

was significantly higher, especially among South Africans. The authors also suggest the

following: Given this diversity among both male and female samples, it is difficult to identify

patterns across those countries with similar prevalence rates, and therefore child sexual abuse
CULTURAL INFLUENCES OF CHILDHOOD SEXUAL ABUSE 5

should be regarded as a widespread problem in countries with very different cultural and

economic situations (p. 336).

A further distinction should be discussed between ethnicities regarding how sexual abuse

is defined and treated. Research performed by Lowe, Pavkov, Casanova, and Wetchler (2005)

examined attitudes and reporting-likelihood between Caucasian, African-American, and

Hispanic populations within the United States to attempt to determine any identifiable

differences between them. While the outcome was better than expected, their findings did not

reflect any significant differences between racial groups. However, implications related to how

abuses are perceived within these racial groups were discussed. Notably, minority populations

within the United States were more likely to report sexual abuse compared to Caucasians, and

while previously believed to be disparate, the prevalence of childhood sexual abuse was

considered comparable to Caucasian females. The authors further note that researchers assume

that all ethnic groups view abuse the same; although, this has been proven incorrect through their

analysis (Lowe, Pavkov, Casanova, & Wetchler, 2005).

Pareda, et al., in a further study (2009a), examined different outcomes of research related

to the prevalence of sexual abuse while examining the findings of 22 countries, and cites that

7.9% of men and 19.7% of women had some form of sexual abuse prior to the age of eighteen

(2009a). Interestingly, focus appears to primarily be on the plight of women who have had these

experiences, but the authors also ensured that their findings related to the rate of male

perpetration should not go unnoticed. This difference may be due to the ideas related to male

sexuality, a lack of adeqate reporting, or due to perceptions of what sexual activity is considered

abuse for males. Due to these differences in ideas and definitions, male perpetration may be

something that is considered a right of passage, or not considered abusive due to

CULTURAL INFLUENCES OF CHILDHOOD SEXUAL ABUSE 6

heteronormative ideas of sexuality, assuming the perpetrator is female. This can also lead to a

confounding of reporting standards, as men who are taking the reports may discount the extent of

the abuse (Bornstein, Kalplan, & Perry, 2007).

Research has also shown that exposure to childhood sexual and physical abuse can result

in lifelong, but more specifically, early adulthood problems in relation to adjustment among

indiviudals. Fergusson, Boden, and Horwood (2008) note that a myriad of mental health

concerns were associated with experiences of either sexual or physical abuses, and can result in

the following mental health disorders: depression; anxiety disorders; conduct disorder or

antisocial personality disorder, substance dependence, suicidal ideations, and suicide attempts

between the ages of 16 and 25. Their research suggested that individuals who had been

perpetrated sexually had a prevalence of mental disorders at a rate of 2.4 times higher than those

who had not been perpetrated, and a rate of 1.5 higher when physically perpetrated (Fergusson,

Boden, & Horwood, 2008). They also identified that approximately 13% of individuals

receiving services had some form of sexual abuse in their past, while approximately 5% had

physical abuses.

While abuses are not restricted to one area of the world, researchers have reviewed

numerous publications and millions of participants to identify how data has been analyzed and

formulated in order to define prevalence throughout the worldwide population. A notable

comprehensive meta-analysis reviewed 217 publications with over 9 million participants

spanning almost thirty years of data (Stoltenborgh, van Izendoorn, Euser, & Bakermans-

Kranenburg, 2011). This data was accumulated to review worldwide frequency and prevalence

of childhood sexual abuses. It also reviewed nation of origin reporting to review frequencies

among native populations, and found that the highest rate of perpetration among females was in
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Australia, while boys were more likely to be perpetrated in Africa (2011). What is also noted is

that reporting qualities affect the available data due to varying practices of law enforcement and

governmental accounting of the information. Because of record-keeping differences, there were

significant disparities in information availability. Results suggested that variances between self-

report measures and informant studies created a notable gap in results, but still yielded that

prevalence was found to be at 11.8% at a global level, or 118 children out of 1000 (2011).

Sex tourism has also been a significant cause for sexual abuse among children, primarily

in developing nations worldwide. Research by Newman, Holt, Rabun, Phillips, and Scott

(2011) explain the problem of worldwide sexual tourism related to child sexual exploitation

tends to exist at higher rates among developing nations, and how to minimize and mitigate the

occurrence by enacting meaningful legislation to punish countries that are utilizing children to

entice sex tourism. The UN World Tourism Organizations report, as cited by Newman, et al.,

suggested that child sex tourism is a major international problem (2011). It is also noted that,

prior to recently enacted regulations, travel agencies could and did openly advertise sex tours to

destination countries, and tended to do so in extremely graphic manners. These practices only

served to foment the practice of child sex tourism worldwide, and have created the potential of

developing underground child sex rings. The authors further posit that the growth of the internet

throughout the developed world has significantly contributed to the problem (2011). Other

research referred to within Newman, et al., suggested that individuals who explored internet

solicitations from children either travelled, traded child pornography, or solicited sex from

children through electronic means, and that 41% of 225 perpetrators had travelled domestically

or internationally to engage in these sexual practices (Alexy, Burgess, & Baker, 2005).
CULTURAL INFLUENCES OF CHILDHOOD SEXUAL ABUSE 8

Potential for learning from perpetrators can also be an effective strategy related to

prevention and education. Research by Elliot, Browne, and Kilcoyne (1995) discussed

individually identified influences of perpetrators, and their perceptions of those same influences.

The authors reviewed a number of items related to the practice, type of abuse, and grooming

techniques in order to establish motives and thought patterns related to perpetrating child sexual

abuse. The researched population was comprised of probationers, incarcerated individuals, and

people not under community supervision. The participants particular race or culture were not

listed as research variables, which is suggested to be a historical limitation with this type of

research of the time period. While this research is considered somewhat dated, the information

and findings do not appear to be, as similar techniques are still utilized in current times. The

researchers reported that they interviewed ninety-one child sexual offenders related to their

methods they employed to target children, how they selected their victims, and what they thought

would help alleviate perpetration in the future (Elliot, Browne, & Kilcoyne, 1995). Results

suggested that these perpetrators were able to exploit their child victims through anger, threats,

and bribes to further achieve their victims compliance. Also, discussion related to

desensitization about sexual topics by the perpetrators to their victims were also employed and

explored. Notably, the authors suggest that offenders had no bad feelings about sexually

abusing children (Elliot, Browne, & Kilcoyne, 1995, p. 579), suggesting a reasonable level of

psychopathology was remarkably present. These factors are important in understanding the

realities of perpetration, and the mindset of the abusers, while attention should also be paid to the

outcome of the individuals who have been victimized by the practice.

Because of early trauma, concerns related to female physical and sexual health are often

sources of explored data due to the detrimental effects on victims. Issues related to self-esteem
CULTURAL INFLUENCES OF CHILDHOOD SEXUAL ABUSE 9

and clinical mental health symptoms are often related to histories of abuse. Jonzon and Lindblad

(2006) suggest that that the availability of mental health resources is considered important in

relation to physical and mental health outcomes. The differences related to availability are often

tied to race, class, and culture. Researchers also considered factors such as social support,

coping abilities, and self-esteem, when identifying potential barriers to beneficial outcomes. The

authors found that self-esteem was correlated with health outcomes, suggesting that if the

individuals physical health was impacted, this would likely redefine the individuals overall

perceptions of themselves (Jonzon & Lindblad, 2006). This important factor is noted throughout

the scope of the project, as individual impacts are a marked indicator of how sexual trauma

affects individuals throughout the lifespan; however, positive impacts are also explored, as these

events can create coping strategies that had not been previously employed, suggesting that social

support can be a positive outlet for appropriate development (Feiring, Taksa, & Lewis, 1998;

Runtz & Schallow, 1997; DiPalma, 1994; Himelein & McElrath, 1996; Tremblay, Hebert, &

Piche, 1999, as cited by Jonzon, & Lindblad, 2006). The authors conclude that while child

sexual trauma is more prevalent among women, there are some positive outcomes related to

perceived social support that can be found within this population.

Further implications related to physical outcomes of sexual abuse were explored in

research performed by Maniglio (2009), who found that chronic non-cyclical pelvic pain was

often present in female abuse survivors, and that approximately 50% of childhood sexual abuse

survivors experienced some form of sexually transmitted infection (STI). Another potential

illness was associated with non-epileptic seizures, and were believed to be more attributable to

psychological occurrences than biological factors (Maniglio, 2009). These findings support that

childhood sexual trauma can lead to a myriad of potential after-effects, and while these
CULTURAL INFLUENCES OF CHILDHOOD SEXUAL ABUSE 10

experiences are not cultural in nature, per se, they are suggestive of how these experiences can

lead to life-long complications, regardless of societal or cultural influences.

An article by Lalor (2004a) employed a literature review related to the prevalence of

sexual abuse in the home or community rather than in sexual exploitation practices (i.e., child

slavery, sex trafficking, etc.). While the samples are mainly comprised of clinical cases or

university students, approximately 5% of respondants reported some level of penetrive sexual

abuse in their childhood (Lalor, 2004a). This level of perpetration was believed to be attributed

to familial practices, impacts of social change, AIDS/HIV avoidance, and the dominant male

patriarchy among sub-Saharan African men. The authors note that there has been little in the

form of published studies from within this area of the world, and that samples tend to be more

clinically based, or based on the experience of university students; however, it is still noted that

among these populations, the highest prevalence of perpetration was likely to be by a family

member, relative, neighbor, or others known to the victim (Lalor, 2004a).

Lalor (2004b) further explored the prevalence of a phenomenon that may not actually

exist (but tends to be repeatedly perpetuated in Western countries) is the idea of curing AIDS or

HIV in African countries through the perpetration of virgin females, specifically in Tanzania and

Kenya. Research into this little investigated region of the world related to the frequency and

prevalence of sexual abuse. His findings suggested that little data into this topic had previously

existed, and extant research was conducted in order to explore cultural influences related to

childhood sexual perpetration (Lalor, 2004b). It was reported that the frequency of commercial

sexual exploitation was considered high in this region of the world. Lalor also stated that

childrens first sexual experiences tend to occur at a young age for many children and

adolescents in the region. The author explored insights from academics, governmental
CULTURAL INFLUENCES OF CHILDHOOD SEXUAL ABUSE 11

departments, Non-Governmental Organizations (NGOs), and the United Nation agencies, along

with individal accounts through interviews. Lalor ultimately concluded that increased attention

is being paid to the prevalence of childhood sexual abuse in the region, but noted that

approximately 15% of sexualy active females in Kenya are engaged in prostitution, citing that

the practice of being taken care of by older men, or sugar daddies, was also identified as a

ongoing significant contributing problem (2004b).

While the myth of HIV cleansing (i.e., sexual intercourse with virgins which would cure

HIV or AIDS) among sex offenders in the Malawi region of Africa appears in western ideas of

African beliefs, research by Mtibo, Kennedy, and Umar (2001) found that among 58 participants

in thier research, as taken from interviews of prisoners in Malawis two largest prisons, was that

none of the perpetrators cited HIV cleansing as a motive for engaging in inappropriate sexual

behavior with children. They did, however, cite sexual desires being a motivating factor, or simply

being under the influence of drugs or alcohol, as to the cause of their inappropriate acts. This

finding is important, as the myth appears to be more prevelent than the occurrence, and can be

seen as a negative stereotype among African men. It is noted, though, that the age of offenders

was between 16 and 66, while the age of the victims were between the ages of 2 and 17 (2001).

Prevalence of sexual abuse among Kenyans when compared to western ideals and laws

were studied by Mildred and Plummer (2009). The researchers examined how sexual abuses are

addressed in both the United States and Kenya. While their findings suggested that there were

significant differences related to what approaches are implimented, along with cultural

considerations, by applying what has been discovered in the United States can be related to

ongoing research in the region, and can be applied to Kenyan social scientists and advocates in

continuing to address this concern on a wider scale (Mildred & Plummer, 2009). It was
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suggested that due to the level of knowledge regarding these instances (or lack thereof), sharing

and collaborative efforts appear to be a best approach to continue development of interventions

and prevention. Mildred and Plummer also suggest that while the United States takes a more

criminal justice approach to dealing with perpetraors, and that research has created numerous

data related to perpetration, recovery, and treatment, the legal system does appear to have some

shortcomings when protecting children from sexual abuse, and have not adequately addressed

influences from the internet, engaging in sex work, or how testimony can be discredited in legal

proceedings (2009). It was suggested that only by addressing childhood sexual abuse from adult

survivors that awareness of the potential consequences and outcomes were able to be identified.

Other cultural influences among tribal perspectives across Kenya are also a known factor.

Between group analysis was conducted in research by Plummer and Njuguna (2009), and found

that there were a number of factors which were implimented to help curtail the risk of sexual

abuse, but also endangered the same population. The authors posit, Awareness of traditions and

practices may inform creation of interventions for preventing sexual abuse (Plummer &

Njuguna, 2009, p. 524). Their findings suggest that the problems in Kenya are prevalent, and

under-studied. This may be due to attempting to address these concerns with cultural influences

outside of Kenya, which may have poor application within the population (Plummer & Njuguna,

2009). What is explored is how some cultural or tribal aspects may be a contributing risk-factor,

and it is suggested that addressing this from outside cultural groups may help ameliorate these

tribal practices; however, the authors also noted that much of their information was culled from a

convenience sample, and may not be indicative of generalizable to the typical Kenyan

population (2009).
CULTURAL INFLUENCES OF CHILDHOOD SEXUAL ABUSE 13

Individual Differences

While problems can be myriad regarding outcomes, how these outcomes are measured

can be more delineated in a worthwhile manner. Research by Black, Heyman, and Smith Slep

(2001) explored the prevalence of child sexual abuse, along with frequency and severity, for the

sake of furthering preventative research and application. The article explored the long-term

impact of sexual abuse. The authors posit that there were influences based on identifiable

characteristics related to perpetrators, victims, and families of victims, indicating moderate to

strong risk-factors (2001). The authors also attempted to tease out factors related to intra-family

and extra-familial perpetration, suggesting that because reporting standards do not delineate

these differentiations, it can create data-conflation of the two types of perpetration. A notable

statistic was identified that assisted in developing the need for research and prevention in this

area, specifically that 51% of lifetime rapes occur prior to age 18, while 29% occur prior to the

age 12 (Kilpatrick, Edmunds and Seymour, 1992, as cited by Black, Heyman, & Smith Slep,

2001). Due to this level of prevalence, it is believed that the potential impacts of these events

may vary widely in individuals.

Research by Aronson Fontes, Cruz, and Tabachnick (2001) provide necessary insight into

the educational component of preventing child sexual abuse. Their research discussed how

generic approaches were taken to not include any single culture when identifying the needs of

specific populations related to sexual abuse. The authors further noted how prior research did

not include the race of perpetrators, and why it was, and is, necessary to include this data in

future research articles, as a lack of identifying race can confound data. Therefore, the

researchers sought to explore relations in the African-American and Latin cultures when

discussing sexual perpetration among children. As the authors suggest, The sexual abuse of
CULTURAL INFLUENCES OF CHILDHOOD SEXUAL ABUSE 14

children is prevalent throughout the United States and affects people from all cultural groups in

roughly similar proportions, although characteristics of the abuse may vary with the victims

ethnic group (p. 103). While the ideas of what constitutes sexual abuse may vary between

American subcultures, it is important to understand how these abuses affect the continued

development through the lens of racial or cultural identity.

An interesting phenomenon which appears to only occur within an Afghani population

known as Bacha Bazi and Bacha Posh, and seem culturally bound to this area of the world.

Bacha Bazi (literally translated as boy play) is the sexual exploitation of young boys by older

men (Farooq, 2016; Mondloch, 2013), while Bacha Posh is a much less documented

phenomenon of females dressing as, and disguising themselves as males due to a family not

having any male children (Nordberg, 2014). A lack of male children can cause stigma for the

family in general, and leads to the family having a female child be the protector of her sisters,

while acting in a male role; although this comes with a potentially dangerous outcome, for if she

is caught, there can be terrible consequences (Nordberg, 2014). Recent US military campaigns

resulting in the exiting of the Taliban from the region have led to further increase in exposure of

these practices, and documentation is being created throughout the social sciences. While this

appears to be a more culturally bound practice which exists in the rural areas of Afghanistan,

Bacha Bazi has been reportedly practiced for decades, if not longer (Mondloch, 2013). A further

practice is that these boys are often owned as sexual slaves, and can be sold for as little as 50

rupees (or $0.73 American) per incident (Jones, 2015). An unintended consequence of this

practice appears to be based on the fact that females are more likely to be protected via laws and

regulations versus males, because of the perceptions of childhood sexual trauma on males versus

females (Jones, 2015; Farooq, 2016). This has led to a tacit governmental acceptance of this
CULTURAL INFLUENCES OF CHILDHOOD SEXUAL ABUSE 15

practice, leading to the proliferation continuing within the region, and very little done to stop it

(Jones, 2015). Interestingly, homosexuality between male adults is forbidden under Sharia law

and Muslim doctrine; however, engagement in child sexual practices with pre-adolescent males

is not considered homosexual in nature (Jones, 2015).

Another regionally accepted practice among child sexual exploitation appears in

Thailand, with the so-called Ladyboy phenomenon along with rampant female sexual tourism

and prostitution. Research by Hobbs, Na Pattalung, and Chandler (2011) explored the sexual

tourism industry within Southeast Asia, and found that paradigms related to hegemonic

masculinity were dominant in creating the trend of sexual exploitation of others. They further

cited that due to the involvement of the religious population (mostly comprised of Buddhists)

and law enforcement (who also run sexual tourism and owned prostitutes), these practices, while

technically illegal, are hardly enforced due to the economic value of wholesale prostitution

(Hobbs, Na Pattalung, & Chandler, 2011), or because Buddhism has little to say about the

practice of prostitution. Also, Thai men feel that females who are too feminine tend to be

nymphomaniacs, which creates a disparity of power between the two sexes, and exacerbates to

the exploitation of females for sexual purposes. Further, for those males who practice

transgenderism within the region, known as Ladyboys, are typically not recognized as neither

male nor female to the members of their culture, and can be stigmatized for being overly

feminized (Vasey & Vanderlaan, 2003). This has resulted in employment problems for this

population, as many engage in sex work versus work in office or administrative settings (Vasey

& Vanderlaan, 2003).

India has a population of childhood sexual abuse survivors who later become

transgendered females known as the Hijra. These individuals, who were initially discovered in
CULTURAL INFLUENCES OF CHILDHOOD SEXUAL ABUSE 16

the 1850s by English imperialists were typically eunuchs, and stage performers (Hinchy, 2014).

Their lifestyle was more a reflection of being ostracized by their own tribes, and they were more

utilized as entertainers because they were not considered a part of their own culture and created a

paradigm and sub-culture of their own (Jayadeva, 2017). As they are typically used as sexual

outlets by other men, the frequency and severity of HIV, AIDS, and Syphilis are rampant among

these populations, and are significantly higher than bisexual or versatile gay men from the

same population (Kalra & Shah, 2013). Other forms of stigma among these populations include

marginalization, sexual abuse, infringement of their civil rights, and harassment while accessing

health services (Diehl, et al., 2017). As these individuals grow older, their ability to cope with

these concerns varies greatly; however, many find comfort in creating social circles of support

(Jayadeva, 2017; Diehl, et al., 2017).

Practice Standards

As there are numerous considerations when practicing therapy with adult survivors of

childhood sexual abuse victims, it is important how to proceed with caution when exploring

these issues in a clinical or therapeutic setting. Because numerous cultural influences may be

present from a variety of social inputs, general guidelines related to exploratory practices should

be followed from manualized therapeutic modalities. In a book related to counseling adult

survivors written by Draucker and Martsolf (2006), the authors explore the implications of

disclosure of the experiences of childhood, and how to focus on these experiences through

counselling services. The writers note that focus on ameliorating distress, enhancing

interpersonal exchanges and relationships, and improving physical health are all areas to be

focused on throughout these sessions; however, they also note that no one single treatment

method has been deemed empirically supported (Draucker & Martsolf, 2006). This suggests that
CULTURAL INFLUENCES OF CHILDHOOD SEXUAL ABUSE 17

specific competencies among varying populations should be completed by clinicians prior to

engagement of services for these populations. The authors further suggest that part of the

exploratory therapeutic process should include reinterpretation from an adult perspective how to

best address the history of childhood sexual trauma (Draucker & Martsolf, 2006). By doing so, a

differentiation in perspective can be achieved by not assuming blame for the abuse, as many

survivors often internalize many of the components of the abuse (i.e., the initial interaction with

the perpetrator, feeling they led the encounter to happen, not attributing the abuse on the

perpetrator, etc.) which can result in disparate ideas of self-esteem or self-image (Draucker &

Martsolf, 2006). This is also exacerbated by the ideas of secrecy, or being told by the abuser that

the fault was on them for the abuse, leading to a sense of ego-dystonia within the individual. A

portion of the counseling milieu should incorporate ego-syntonic perspectives to integrate these

maladaptive ideas into a more beneficial perception of the individual. In doing so, the individual

can achieve a more ideal self-perception which can lead to improved overall psychological

functioning (Draucker & Martsolf, 2006).

Other considerations are attributable to the likelihood of the presence of Posttraumatic

Stress Disorder (PTSD). Research conducted by McLean, Morris, Conklin, Jayawickreme, and

Foa (2014) suggests that while childhood sexual abuse experiences are often traumatic, they

appear to have little impact in whether the formation of PTSD was relevant, or that self-

medicating practices, such as substance use, was more prevalent when compared to other

individuals who had experienced mild to moderate trauma (McLean, Morris, Conklin,

Jayawickreme, & Foa, 2014). Notably, the researchers found that approximately two-thirds of

the interviewed subjects (60.7%, n=51) were perpetrated by a family member, and that a

significant portion (40.5%, n=34) were victimized only once. There were approximately a
CULTURAL INFLUENCES OF CHILDHOOD SEXUAL ABUSE 18

quarter of the sample that were repeatedly or chronically victimized (23.8%, n=20). Their

findings indicated that few had experienced suicidal ideations or substance abuse. They further

suggest that rape has a higher prevalence of PTSD versus childhood sexual abuse (McLean,

Morris, Conklin, Jayawickreme, & Foa, 2014). By understanding these prevalence rates among

this population, significantly improved and individually tailored treatment planning should be

established on a patient by patient basis, and the outcomes of treatment should be focused on

how to better address these foundational and ethereal issues, versus trauma-focused treatment or

exploration.

Among Hispanic men, differentiations between bisexual and gay men have been

established for counseling individuals within this population. It is noted that both groups

comprise some of the highest rates of transmission and vulnerability among groups of ethnic gay

men, as they have been identified as engaging in some of the riskiest forms of sexual behaviors

which can result in HIV or AIDS infections and transmissions (Arreola, Neilands, & Diaz,

2009). The researchers posit that many of these sexual practices are believed to be a byproduct

of childhood sexual trauma, and have resulted in increased frequencies of psychological distress

and comorbid dysfunction relating to sexual practices and mental health phenomena such as

depression or self-abuse behaviors (Arreola, Neilands, & Diaz, 2009). The authors note that

between 17 and 39% of gay or bisexual men report a history of sexual abuse, while Hispanic

men are often higher in frequency, and were more likely to have experienced perpetration by an

extended family member, experienced higher rates of genital fondling, were more likely to be

exposed to sexually abusive behaviors, and experienced more severe anal abuses (Moisan,

Sanders-Phillips, & Moisan, 1997; Lindholm & Willey, 1986). It is believed that among Latino

gay men, it is the outlet of sexual gratification that leads to the amelioration of psychological
CULTURAL INFLUENCES OF CHILDHOOD SEXUAL ABUSE 19

turmoil within themselves, and is believed to be a primary cause relating to the practices of

unsafe sex to be as prevalent as it is among this population (Arreola, Neilands, & Diaz, 2009).

Therefore, alternative methods related to confronting psychological turmoil should be explored

in more pro-social manners to achieve a sense of wholeness and completeness without utilizing

an unsafe sexual outlet.

Among female populations, research shows that over 60% of women have reported some

issues related to sexual difficulties (Stephenson, Pulverman, & Meston, 2014). Among those

females, experiences of childhood sexual abuse had been delegated a primary cause for many of

these concerns, and often exhibit significant concerns related to sexual displeasure or impairment

when compared to non-abused females (Leonard & Follette, 2002; Stephenson, Pulverman, &

Meston, 2014). Among this population, it also appears that efficacy related to treatment can

elicit different responses while addressing those concerns related to healthy sexual gratification

when compared to non-abused females, which may suggest that perceptions among this

population can be skewed due to experiencing a history of sexual trauma (Brotto, Seal, & Rellini,

2012). Therefore, approaching treatment within this population should be enacted with specific

training more focused on outcome-based approaches versus integration and acceptance of prior

trauma. This can ultimately result in better outcomes for patients, as work related to processing

may re-open negative feelings of self-confidence and self-efficacy (Draucker & Martsolf, 2006).

Ethical Considerations and Guidelines

It is important to know and understand the laws related to reporting standards among

adult survivors of childhood sexual trauma in the state in which the treating psychologist

practices. While reporting is somewhat universal among populations of minor children, these

standards can be markedly different among adult populations regarding legal consequences for
CULTURAL INFLUENCES OF CHILDHOOD SEXUAL ABUSE 20

perpetrators, if any. It is not believed to be the sole focus of clinicians to explore potential legal

ramifications for the perpetrators of clients, but to instead focus on improving mental health

statuses among individuals who have experienced this level of trauma. While guidance related

to exploring what it would mean to the individual to pursue charges can cause further distress

(Draucker & Martsolf, 2006), the main purpose should be defined as resolution of the concern,

and redefining coping strategies to improve interpersonal relationships and to ameliorate

psychological turmoil. These considerations do not claim one specific cultural influence, and

may be seen as a more ethereal approach to an overall improvement in functioning. Therefore,

specific focus attributable to cultural influences should be explored, as these focuses can change

among differing populations.

Assessing risk-management when working within an abused population should also be

considered, despite cultural influences, as risks related to liability can be heightened, leading to

legal problems, ethics complaints, being sued, or even a potential loss of licensure for

professionals. Potential standards put forth by Knapp and VandeCreek (1997) explore the

likelihood of negative impacts when working within this population, and suggest that if

individuals who seek treatment with a knowledge of prior childhood sexual trauma are less likely

to be discomforted or disrupted when compared to individuals who uncover these prior traumas

in the therapeutic process. The authors further suggest thorough documentation of the content

related to recovered memories of trauma can alleviate potential risks by identifying how these

memories were recovered though the therapeutic process. These processes can be much more

problematic if the patient does not feel that they are making adequate improvements or even

slight gains on their treatment (Knapp & VandeCreek, 1997). It should also be noted that among

most ethics committees and state licensure boards, only a complaint of misdoing is necessary,
CULTURAL INFLUENCES OF CHILDHOOD SEXUAL ABUSE 21

and not a resulting summary of how it potentially impacted the individual, which can cause

significant professional concerns for the provider. This can be a remarkable difference from

malpractice, as the malpractice is more concerned with a lack of duty to the patient, purposely

deviating from professional standards, which results in directly damaging the patient (Knapp &

VandeCreek, 1997). A standard of focus on attempting to prevent these damages would be

necessary to ensure that further damaging patients is not a potential outcome through the

therapeutic process.

An important feature to also consider is with the potential of causing false memories or

memory insertion with individuals. Certain ethical and legal considerations should be made

when working within this population. As numerous federal, state, and local governmental

agencies could potentially be involved with cases that require testimony from licensed

professionals, ensuring that ethical boundaries are followed could be utilized through evidence-

based treatments. There may be concerns related to how quickly treatment is provided for

trauma victims, and may result in worsened or co-morbid symptomology if not adequately

treated in a reasonable time frame (Kessler, Foster, Saunders, & Stang, 1995; Kessler, Rubinow,

Holmes, Abelson, & Zhao, 1997; Wang, et al., 2005). Trauma-Focused Cognitive-Behavioral

Therapy (TF-CBT) appears to have the highest rate of efficacy within this population, and has

shown significant results in research to provide a framework for treatment planning (Swiecicki &

Hollingsworth, 2015). This approach can lead to suitable outcomes for patients who are post-

adolescent or who are young adults.

Finally, satisfaction among patients who seek services can be impacted by a history of

childhood sexual trauma; although this impact is typically attributed to a perception of

satisfaction of treatment received among those who have been through the counseling process
CULTURAL INFLUENCES OF CHILDHOOD SEXUAL ABUSE 22

(Coles, Lee, Taft, Mazza, & Loxton, 2015). As previously discussed, Australian females have a

higher prevalence of sexual abuse (Stoltenborgh, van Izendoorn, Euser, & Bakermans-

Kranenburg, 2011). Research suggests that even within this population, disclosure tends to be

difficult. Coles, et al., further report that among the 80% of Australian women who see a general

practitioner, between 20 and 42% of those women have some form of historical sexual trauma

(2015), and note that survivors often need to feel a sense of safety when interacting with health

professionals. Coles, et al., further suggests that knowledge and treatment modalities for adult

survivors of childhood sexual abuse is a significant component of adequate treatment to address

these overall concerns.

Ultimately, it is up to the psychological, social work, and counseling communities to

record and analyze the prevalence within their own treatment populations of the actual amount of

experienced sexual abuse, and to let others within the mental health community learn from those

experiences, while still maintaining confidentiality and ethical boundaries in servicing patients.

Historically, the idea of childhood sexual abuse was somewhat ignored when documenting prior

experiences that led to psychological turmoil (Alpert & Paulson, 1990), and should be strived to

be improved, as knowledge of this area increases, so too will beneficial treatment protocols,

trauma processing procedures, and manualized care. Also, training in graduate-level programs

related to psychology, marriage and family therapy, social work, and professional counseling,

should strive to address this phenomenon, and not continue to allow this to go unreported and

unnoticed. The impacts related to childhood sexual abuse are profound, and can lead to

significant pathologies which could otherwise be treated effectively. While there are varying

perspectives within cultural communities of how these impacts manifest, what can be ensured is

that by not addressing these impacts, individuals may continue to feel symptoms related to
CULTURAL INFLUENCES OF CHILDHOOD SEXUAL ABUSE 23

interpersonal relationship problems, sexual acting-out behaviors, psychological distress and

turmoil, and even PTSD symptomology. Furthermore, clinicians and those who are training to

become clinicians should also acknowledge and attempt to recognize the potential impacts of

childhood sexual abuse, and how these experiences manifest later in life. It does not need to be a

primary focus among all patients, but can be a secondary or tertiary topic of exploration through

a treatment protocol.

Conclusion

Childhood sexual abuse cannot be a phenomenon that stay in the shadows any longer,

and needs to be discussed to be successfully treated. Clinicians also need to be adequately

trained, even if they are not looking to specialize in this area, but should at least have a

fundamental understanding of etiology and potential outcomes within this population. While

there are numerous after effects of sequalae post-trauma, it can be discerned that childhood

sexual trauma can lead to a lifetime of complications, or may have a relatively small impact,

depending on the individual. These problems may come in the form of sexual problems for

women, or oversexualization in gay men. There are also potentials for self-esteem issues, self-

doubt, or any number of influences that can exacerbate self-efficacy. The resulting outcomes

appear to be somewhat attributed to cultural influences, racial identity, and gender-roles, and are

not inextricably bound to one influence or another. However, it is considered attributable to the

time of the occurrence, age of abuse, and social support of the individual that can assist in

overcoming these traumas.

Finally, it is important for clinicians to be informed and educated with treatment models

known to show efficacy, along with methods to improve self-image and self-esteem, but most

importantly to ameliorate confounding psychological distress. By implementing these

CULTURAL INFLUENCES OF CHILDHOOD SEXUAL ABUSE 24

evidenced-based strategies, professionals can engage with patients what has been shown to be

best practices among this population. Unfortunately, it does not appear this phenomenon will

stop anytime soon; however, through continued research and expression of knowledge, educating

children and adults may see a marked decrease in victimization.

CULTURAL INFLUENCES OF CHILDHOOD SEXUAL ABUSE 25

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