Abuso sexual en pediatría: factores epidemiológicos / Sexual abuse in pediatrics: epidemiologics factors

Introducción. Objetivo: dar a conocer los antecedentes, dinámica familiar, cuadro clínico y repercusiones del abuso sexual en un grupo de niños víctimas de abuso sexual. Material y métodos. Se incluyeron en forma prospectiva 153 pacientes que tuvieron el diagnóstico de abuso sexual en cualquiera de sus formas y que fueron atendidos en el HOspital General Dr. Manuel Gea González, durante el período de un año. Resultados. Existió predominio del sexo femenino (70.5 por ciento) y se afectó principalmente al grupo de preescolares. La mayoría de las familias eras disfuncionales o se encontraban desintegradas y sólo el 34 por ciento de los padres se encontraban casados. El abuso se dio en repetidas ocasiones y se llevó a cabo en mayor frecuencia en el domicilio de la víctima (49.7 por ciento), siendo el vecino el principal agresor (29.4 por ciento), seguido del padrastro (17.6 por ciento). El reporte del abuso por parte de la víctima se dio tardíamente en la mayoría de los casos, ya que sólo el 39 por ciento lo hizo en el primer mes. La respuesta de los padres al evento fue principalmente de preocupación (43.2 por ciento) y de sobreprotección (22.8 por ciento). Las manifestaciones clínicas en el paciente fueron principalmente: irritabilidad (18.9 por ciento), agresividad (14.4 por ciento) y masturbación (10.4 por ciento). Conclusión. Existen indicadores en los niños que deben hacer sospechar abuso sexual; se resalta la impotencia del diagnóstico temprano para brindar un tratamiento oportuno y limitar el daño

Condiloma acuminado en niños; forma de adquisición: informe de 64 casos / Condilomata acuminata in children; acquisition way: report of 64 cases

Se estimularon 64 pacientes niños y adolescentes. Un 64 por ciento del sexo femenino y 6 por ciento de varones. El 40 por ciento correspondió a preescolares. En el 90 por ciento se encontraron datos positivos de contacto sexual, siendo un familiar o persona relacionada con la familia el responsable de esta situación

Dissociative phenomena in women with borderline personality disorder.

OBJECTIVE: This study was conducted to determine whether trauma variables and certain behavioral correlates are differentially prevalent in borderline personality disorder patients with greater and those with lesser dissociative experience. METHOD: Subjects were 62 female inpatients, all meeting DSM-III-R criteria for borderline personality disorder, 14 of whom also had a concomitant dissociative disorder diagnosis. Structured interviews and published scales were used to collect data addressing a priori hypotheses. RESULTS: Univariate analyses supported hypotheses that patients with borderline personality disorder and greater dissociative experience are characterized by more self-reported traumatic experiences, posttraumatic symptoms, behavioral dyscontrol, self-injurious behavior, and alcohol abuse. Multivariate analyses suggested that scores on the Dissociative Experiences Scale were predicted particularly by adult sexual assault, behavioral dyscontrol, and both sexual and physical abuse in childhood. CONCLUSIONS: These results support the use of the Dissociative Experience Scale as a brief screening instrument to aid in the identification of borderline personality disorder patients with prominent posttraumatic and dissociative disorders. Patients with borderline personality disorder seem to be characterized by somewhat different life experiences, treatment histories, and behavioral presentations depending on their level of dissociative experience, even though they meet the same DSM-III-R criteria. Neither extreme view of the overlap in diagnostic populations was supported.

Somatization in patients with dissociative disorders.

OBJECTIVE: This study attempted to determine the prevalence of somatic symptoms, somatization disorder, and medical interventions in patients with dissociative disorders. METHOD: Fourteen psychiatric inpatients with a DSM-III dissociative disorder were matched for age and gender with a comparison group of inpatients who reported few dissociative symptoms. All subjects were interviewed in a blind manner with the Dissociative Disorders Interview Schedule (this semistructured interview schedule includes a section on somatization disorder), and their hospital charts were reviewed to determine somatic symptoms and medical histories. RESULTS: Sixty-four percent of the patients with dissociative disorders met DSM-III criteria for somatization disorder and reported an average of 12.4 somatic symptoms. None of the comparison patients met DSM-III criteria for somatization disorder, and these patients reported an average of 3.1 somatic symptoms. These differences between the two groups were significant. Significant differences were also found in the number of medical hospitalizations and consultations between the two groups. A significant correlation was found between the degree of dissociation and degree of somatization in patients with dissociative disorders. CONCLUSIONS: The authors conclude that somatization disorder is a frequent and serious comorbid disorder among patients with dissociative disorders.

Proneness to dissociation and traumatic childhood events.

Several researchers have proposed that proneness to dissociation in adulthood is linked developmentally with experiences of traumatic events in childhood. Past investigation of this hypothesis, however, typically has focused on very narrow samples of childhood trauma. In this study, dissociative experiences in adulthood were analyzed in relation to a broad measure of childhood trauma. Standard regression analysis revealed three predictors of dissociation, namely familial loss in childhood, intrafamilial sexual abuse, and extrafamilial sexual abuse. The data call for greater cognizance of childhood loss in the investigation of the origins of dissociative defenses.

Risk factors for borderline personality in male outpatients.

The purpose of the study was to examine the role of several psychological risk factors--childhood sexual abuse (CSA) and its parameters, childhood physical abuse and its parameters, early separation or loss, and abnormal parental bonding--in male patients with borderline personality disorder (BPD). Subjects with personality disorders were divided into BPD (N = 61) and non-BPD (N = 60) groups. The risk factors were measured by a developmental interview and the Parental Bonding Index. The BPD group had a higher frequency of CSA, more severe CSA, a longer duration of physical abuse, increased rates of early separation or loss, and a higher paternal control score on the Parental Bonding Index. CSA and separation or loss were significant in the multivariate analysis. The risk factors suggest that trauma and loss, as well as problems with fathers, are important for the development of BPD in males.

Are children at risk for sexual abuse by homosexuals?

OBJECTIVE: To determine if recognizably homosexual adults are frequently accused of the sexual molestation of children. DESIGN: Chart review of medical records of children evaluated for sexual abuse. SETTING: Child sexual abuse clinic at a regional children's hospital. PATIENTS: Patients were 352 children (276 girls and 76 boys) referred to a subspecialty clinic for the evaluation of suspected child sexual abuse. Mean age was 6.1 years (range, 7 months to 17 years). DATA COLLECTED: Charts were reviewed to determine the relationships of the children to the alleged offender, the sex of the offender, and whether or not the alleged offender was reported to be gay, lesbian, or bisexual. RESULTS: Abuse was ruled out in 35 cases. Seventy-four children were allegedly abused by other children and teenagers less than 18 years old. In 9 cases, an offender could not be identified. In the remaining 269 cases, two offenders were identified as being gay or lesbian. In 82% of cases (222/269), the alleged offender was a heterosexual partner of a close relative of the child. Using the data from our study, the 95% confidence limits, of the risk children would identify recognizably homosexual adults as the potential abuser, are from 0% to 3.1%. These limits are within current estimates of the prevalence of homosexuality in the general community. CONCLUSIONS: The children in the group studied were unlikely to have been molested by identifiably gay or lesbian people.

The relationship between treatment goals and recidivism among child molesters.

Preliminary findings from a longitudinal outcome study of sex offender treatment are presented. Ss included 76 child molesters who were treated in a comprehensive relapse prevention program, and 79 molesters who were randomly assigned to a control (no treatment) condition. Three sets of findings are reported: survival analyses of time to reoffense; in-treatment change data relevant to the program's treatment goals; and the relationships between treatment measures and risk of reoffense. Over an average followup period of 38 months, there was a trend for treatment Ss to be at lower risk for both sex and violent crimes than were controls. Treatment Ss showed significant progress towards treatment goals of increased acceptance of personal responsibility for their crimes and decreased levels of deviant sexual arousal. Measures of personal responsibility, however, were not related to risk of rearrest for new sex crimes. Treatment Ss with high levels of both deviant and nondeviant sexual arousal were more likely to commit new sex offenses, but not other violent offenses. The strongest predictor in the study was a measure of the Ss' skills in applying the relapse prevention model, with highly skilled Ss being less likely to commit new sex crimes.

The international epidemiology of child sexual abuse.

Surveys of child sexual abuse in large nonclinical populations of adults have been conducted in at least 19 countries in addition to the United States and Canada, including 10 national probability samples. All studies have found rates in line with comparable North American research, ranging from 7% to 36% for women and 3% to 29% for men. Most studies found females to be abused at 1 1/2 to 3 times the rate for males. Few comparisons among countries are possible because of methodological and definitional differences. However, they clearly confirm sexual abuse to be an international problem.

[The incidence of sexual abuse in women with eating disorders]. / Zur Häufigkeit sexuellen Missbrauchs bei essgestörten Frauen.

The literature is contradictory concerning a possible connection between sexual abuse and the development of eating disorders. In the present study, the medical records and psychotherapeutic courses of all female patients (n = 127) were reviewed for the years 1987-1989 in the Department of Psychosomatics and Psychotherapy at Steglitz Medical Center in Berlin in order to record any reported incidences of pre-onset sexual abuse as well as the age at the time of abuse. The women were subdivided into four diagnostic groups: obesity (n = 14), bulimia (n = 18), anorexia (n = 22) and others without eating disorders (n = 73). Altogether, sexual abuse was reported in 19% with and 10% without eating disorders (difference not statistically significant). Comparison of the individual diagnostic groups unexpectedly revealed a significantly higher frequency of sexual abuse among obese patients than among those without eating disorders (36% vs. 10%, p = 0.028).

Sexual abuse and incest. What can you do?

The problem of child sexual abuse is of increasing relevance to family physicians. Apart from the need to recognize and manage child victims and their families, it is important to be aware of the incidence and nature of the many sequelae of childhood sexual exploitation. Common signals include physical, psychosomatic, and psychiatric disorders. Some physicians must deal with their own childhood victimization if the best interests of their patients are to be served.

Sexual victimization and substance abuse in psychiatrically hospitalized adolescents.

This article investigates the relationship between substance abuse and sexual abuse in a population of 260 psychiatrically hospitalized adolescents. Seven hypotheses are set forth to test a model that uses parental alcohol abuse, sexual abuse status, and gender as exogenous variables, perceived benefit of alcohol or drugs as an endogenous mediating variable, and substance abuse as the dependent variable. Using these variables, a path model was constructed and revised based on empirical testing. The revised model achieved an adjusted R2 of .38, thus explaining 38 percent of the variance in this sample's abuse of alcohol or drugs. The model suggests that within clinical populations, sexually abused adolescents should be screened for substance abuse, and attention should be given to parental alcohol abuse as well as the degree to which adolescents perceive benefits from their alcohol or drug use.

Childhood sexual abuse and bulimia nervosa: a comparison of American, Austrian, and Brazilian women.

OBJECTIVE: This study was designed to assess the prevalence of childhood sexual abuse among women with bulimia nervosa in three countries: the United States, Austria, and Brazil. In addition, it assessed whether bulimic subjects might have experienced more severe sexual abuse than women in the general population and whether bulimic subjects who report abuse might display greater psychopathology than those who do not report abuse. METHOD: Thirty-three university students in Innsbruck, Austria, 33 university students in Boston, and 25 women in São Paulo, Brazil, all meeting DSM-III-R criteria for bulimia nervosa, were recruited by advertisement. Detailed histories of sexual abuse, obtained at the conclusion of a comprehensive evaluation interview, were prepared, translated into English, and rated by an investigator who was blind to the nationality of the subject. Subjects were compared on frequency of eating binges, history of major depression, body mass index, and satisfaction with body image. RESULTS: Narrowly defined childhood sexual abuse was reported by 24%-36% of women in the three countries, although only 15%-32% of women reported abuse before the onset of bulimia nervosa. There were no significant differences between countries in rates of abuse. Overall, these rates appear no greater than those reported in comparable studies of women in the general population. The data also did not support the hypothesis that bulimic subjects had endured more severe sexual abuse than other women, nor was there a significant association between history of childhood sexual abuse and severity of bulimic symptoms. CONCLUSIONS: These findings add to the weight of evidence suggesting that childhood sexual abuse is not a risk factor for bulimia nervosa.

A case-control study of the sequelae of childhood sexual assault in adult psychiatric patients.

OBJECTIVE: To determine if there is any association between childhood sexual assault and maladaptive coping behaviour in adult life. DESIGN: A case-control study. SETTING AND PATIENTS: Data from 707 psychiatric patients consecutively examined by one psychiatrist in a rural practice were analysed. Forty-four female patients who were victims of childhood sexual assault were identified and were age matched in a random manner with 88 control patients who denied being sexually assaulted as children. RESULTS: The two groups were similar in occupational level, employment and marital status, and the only diagnostic difference between them was that there was a trend in the sexually assaulted group for more of these patients to be diagnosed as having personality disorder. On a variety of other outcome factors, however, the two groups differed widely. The sexually assaulted women were more frequently victims of domestic violence (odds ratio [OR], 6.4), made suicide attempts (OR, 3.4) and abused alcohol (OR, 3.0) or tranquillisers (OR, 4.6) more often than the non-assaulted women. There was a definite association between childhood sexual assault and maladaptive coping behaviour in adult life, although the association is not necessarily causal, and the childhood sexual assault may, in fact, be a symptom of familial neglect. CONCLUSION: This study provides clear evidence of the need to follow up victims of childhood sexual assault and reinforces the importance of enquiring about this trauma.