Helping male victims of sexual abuse

Why, when and how to ask about childhood abuse

Subscribers to the medical model of the causation of madness and distress emphasise the role of genes and can severely underestimate the impact of traumatic events on the development of the human mind. This bias persists despite the worldwide popular wisdom that mental illness arises when bad things happen to people. Childhood physical and sexual abuse and neglect are extremely common experiences among those who develop serious mental health problems. Unfortunately, victims are typically reluctant to disclose their histories of abuse and practitioners are often reluctant to seek it. We explore the nature and extent of the problem and the apparent reasons for the pervasive neglect of this important area of care. Then, on the basis of our experience in New Zealand, we provide guidelines on asking patients about childhood abuse and describe an ongoing initiative in the UK to further advance our understanding of the impact of abuse and our skills to detect it and treat survivors.

Are mental health staff getting better at asking about abuse and neglect?

This study ascertained the extent to which abuse and neglect are identified and recorded by mental health services. A comprehensive audit of 250 randomly selected files from four community mental health centres in Auckland, New Zealand was conducted, using similar methodology to that of a 1997 audit in the same city so as to permit comparisons. Significant increases, compared to the 1997 audit, were found in the rates of child sexual and physical abuse, and adulthood sexual assault (but not adulthood physical assault) identified in the files. Identification of physical and emotional neglect, however, was poor. Male service users were asked less often than females; and male staff enquired less often than female staff. People with a diagnosis indicative of psychosis, such as 'schizophrenia', tended to be asked less often and had significantly lower rates of abuse/neglect identified. Despite the overall improvement, mental health services are still missing significant amounts of childhood and adulthood adversities, especially neglect. All services need clear policies that all service users be asked about both abuse and neglect, whatever their gender or diagnosis, and that staff receive training that address the barriers to asking and to responding therapeutically to disclosures.

Survivors of Childhood Sexual Abuse Diagnosed with Cancer

The incidence of survivors of childhood sexual abuse (CSA) diagnosed with cancer is unknown. It is estimated that one in three women and one in six men in the United States are survivors of CSA. Survivors of CSA diagnosed with cancer are presented with multiple and potentially accumulating traumas. The re-traumatizing nature of a cancer diagnosis and treatment affects all elements of the CSA survivor's care and may impede her/his treatment. To date, the impact of CSA on the medical treatment of people with cancer has been unexplored with the existing studies on female survivors of CSA with cancer focusing on the post-treatment experience and their higher incidence of sexual dysfunction. This article describes the impact of CSA on the cancer treatment of 18 survivors of CSA and the clinical interventions used to address the unique psychosocial needs of this population. Anecdotal information suggests that the survivors of CSA may find aspects of the cancer experience reminiscent of their history of abuse. All 18 survivors of CSA experienced distressing memories of their abuse during their cancer treatment. Fifteen CSA survivors presented traumatic memories that were inaccessible to conscious thought processes prior to their cancer diagnosis. Psychodynamic interventions address issues of disruption in the cancer treatment, non-adherence, and difficulties in relationships with the health care team. Containment of intense affect and distressing thoughts rather than exploration improved CSA survivors' adherence with cancer treatments. The acquisition of self-comforting skills helped CSA survivors feel less re-victimized by their cancer experience. The establishment of an environment of internal and external safety improved communication with the health care team. Health care/psychosocial clinicians' awareness and use of appropriate interventions can minimize the affects of re-traumatization and enhance the CSA survivor's treatment experience.

Prevalence and denial of sexual abuse in a male psychiatric inpatient population

While the link between sexual abuse and psychiatric morbidity is well established, there are only a few studies that have investigated the prevalence of sexual abuse in male psychiatric populations and these studies have typically employed designs that ignore methodological issues specific to male sexual abuse. The present study aims to contribute to this research using as methodologically sound approach as possible. Seventy-four male inpatients were interviewed using a questionnaire (J. N. Briere, 1992) about childhood sexual experiences. Approximately one third reported incidents that met this study's criteria for sexual abuse. Many of these men did not label such experiences as "sexual abuse." The results suggest that mental health professionals need to be aware that many of their male patients may have a history of sexual abuse and that potential minimization or denial of it is a barrier to disclosure.

Mental health professionals' attitudes and practices towards male childhood sexual abuse

OBJECTIVE

This study aims to test the hypothesis of Holmes, Offen, and Waller (1997) that mental health professionals are not asking male patients about histories of sexual abuse. It also aims to investigate general attitudes and practices of mental health professionals to the issue of male sexual abuse.

METHOD

One hundred and seventy-nine questionnaires were given to nurses, psychologists, and psychiatrists asking 10 questions about their attitudes and practice towards male sexual abuse.

RESULTS

The majority of staff questioned rarely inquire about sexual abuse in male patients; staff are generally using ineffective and unsystematic methods of enquiry when they do ask; knowledge of prevalence rates of male sexual abuse are extremely variable; and 2/3 of staff report having had no specific training in assessment/treatment of sexual abuse and a similar number do not feel sufficiently trained to be able to inquire about sexual abuse in male patients.

CONCLUSIONS

The study provides evidence for Holmes and colleagues' (1997) hypothesis that men are not being asked about sexual abuse histories. It also highlights a need for training professionals about male sexual abuse.

See no evil, hear no evil, speak no evil: why do relatively few male victims of childhood sexual abuse receive help for abuse-related issues in adulthood?

This literature review explores the reasons why comparatively few adult males with a history of childhood sexual abuse are seen by professionals for help with difficulties relating to that abuse. Two potential explanations are discounted as myths-that relatively few males are sexually abused, and that abuse has little effect on males. However, it is suggested that society (including professionals and the victims themselves) has given credence to these myths. Male victims are relatively unlikely to disclose their experience of childhood abuse, and (as a coping strategy) they deny the impact of sexual abuse on their lives. Professionals fail to hypothesise that their male clients may have been abused, and do not create the conditions that would enable males to talk about the abuse. Blumer's (1971) model of the social construction of problems is applied to account for these beliefs and behaviours on the part of victims and clinicians. It is argued that the childhood sexual abuse of males has not yet acquired legitimacy as a problem recognised by society, thus lagging behind the abuse of females. In short, the "evil' of childhood sexual abuse in the male population is not being seen or heard by clinicians, and is not being recognised or talked about by victims. Clinical implications are considered.

Clinicians' hypotheses regarding clients' problems: are they less likely to hypothesize sexual abuse in male compared to female clients?

Sixty-one clinical psychologists completed a questionnaire about a detailed case summary of an adult client which incorporated a number of indicators that the client may have been sexually abused. The gender of the client was manipulated. Significantly more clinicians hypothesized that the female client (compared to the male client) had been sexually abused in childhood. Clinicians who were more recently qualified, and clinicians who identified their predominant theoretical orientation as psychodynamic (rather than cognitive-behavioral), were more likely to hypothesize sexual abuse, although these effects were only statistically significant for the female clients. The majority of clinicians hypothesizing sexual abuse in the female client rated the abuse as the most important issue to address in therapy; this was not the case for the male client. These findings are discussed in relation to the literature suggesting that the apparent low number of male victims of sexual abuse currently being seen by the helping professions may in part be accounted for by a lack of awareness in clinicians as to the possibility that males, including their male clients, are sexually abused.