Police AssociAtion of novA scotiA 109 Excerpt fromHandbook of Sensitive Practice for Health Care Practitioners Lessons from Adult Survivors of Childhood Sexual Abuse Background Information about Childhood Sexual Abuse Definitions While the sexual exploitation of children and adolescents is a criminal act, legal defi nitions of childhood sexual abuse vary across jurisdictions. There is, however, wide agreement that childhood sexual abuse involves: (a) sexual acts with children and youth who lack the maturity and emotional and cognitive development to understand or to consent; and (b) “an ‘abusive condition’ such as coercion or a large age gap between participants, indicating lack of consensuality.” In general, children and younger adolescents are unable to consent to sexual acts with adults because of their lack of maturity and relative lack of power.* An abusive condition implies a difference in power between the perpetrator and the victim. Children can also be abused by other children or adolescents who have more power by virtue of age, physical strength, life experience, intelligence, authority, or social location. The Canadian Incidence Study of Reported Child Abuse and Neglect tracked eight forms of child sexual abuse: penetration (penile, digital or object penetration of vagina or anus), attempted penetration, oral sex, fondling of the genitals, adult exposure of genitals to child, sexual exploitation (e.g., involving child in prostitution or pornography), sex talk (including proposition of a sexual nature and exposing a child to pornographic material), and voyeurism. An extreme and controversial type of abuse is ritual abuse, which has been defined as psychological, sexual, and/or physical assault on an unwilling human victim, committed by one or more individuals, as part of a prescribed ritual that achieves a specific goal or satisfies the perceived needs of their deity. Childhood sexual abuse survivors The great paradox of childhood sexual abuse is that, while it has become more prominent in the public consciousness, it remains shrouded in secrecy. Media coverage of high-profile disclosures and investigations provide evidence that childhood sexual abuse does exist – in “good” families and “trusted” institutions, at all socioeconomic levels, and among all racial and ethnic groups. Frequently we hear and read stories about survivors who are men and women from all walks of life – students, sports fi gures, clergy, entertainers, educators, police officers, judges, politicians, and health care practitioners. They are our friends and neighbours, our colleagues, and sometimes even ourselves or members of our own families. Despite this prevalence, most childhood sexual abuse survivors are invisible to us, particularly given that it is estimated that fewer than half disclose their abuse to anyone. Some are silent because they fear reprisal from their abusers; others worry they will not be believed or that they will be blamed or even punished. Still others say nothing because they harbour the erroneous belief that they are responsible for their abuse. Perpetrators of childhood sexual abuse Individuals who are sexually abused as children are, in adulthood, men and women of diverse ages, ethnicity, occupation, education, income level, and marital status. Most studies of sexual offending have focused on males as perpetrators. Although the majority of perpetrators of childhood sexual abuse are male, recent research suggests that females engage in sexually abusive behaviour with children more often than has been previously recognized.31,48,60 Common to all perpetrators is that they have more physical strength, social power, and/or authority than their victims. The most recent report of the Canadian Incidence Study of Reported Child Abuse and Neglect – p.53 found that, in contrast to physical abuse of children, non-parental relatives constituted the largest group of perpetrators (35%) of child sexual abuse. Other groups of perpetrators include the child’s friend/peer (15%), stepfather (13%), biological father (9%), other acquaintances (9%), parent’s boyfriend/girlfriend (5%), and biological mother (5%). The dynamics of childhood sexual abuse All sexual encounters with children are intended to meet the needs of the perpetrator, with little consideration for their effect on the child. Some child abusers use physical force or explicit threats of harm to coerce their young victims into compliance, while others develop long-term relationships with their victims and carefully groom them with special attention or gifts. While childhood sexual abuse does not always involve physical injury, it is a violation of body, boundaries, and trust and is typically experienced as traumatic. Public health agency of Canada Childhood sexual abuse survivors are our friends and neighbours, our colleagues, and sometimes even ourselves or members of our own families. continued... An abusive condition implies a difference in power between the perpetrator and the victim.