Week 7 - Sexual abuse

Question 1

Sexual abuse

Answer 1

Unwanted sexual activities such as exposure to public masturbation, genital touching, or attempted or completed oral, vaginal, or anal intercourse.

Question 2

Childhood sexual abuse

Answer 2

Before age 16

Question 3

Sextortion

Answer 3

Is online exploitation, which refers to threats to expose sexual images with the goal of coercing victims to provide more pictures, engage in sex or money.

12-17 years:
* 5% victim and 3% offender
* Often women than men
* Often sexual minorities (LGBT)

Question 4

Non-consensual sexting

Answer 4

Sharing sexual images or/and personal information without consent

Question 5

Revenge porn

Answer 5

misusing private images with the intension to harm someone

Question 6

Grooming

Answer 6

adult who makes online contact with a minor, with the aim of sexual abuse

Question 7

Deep-fake

Answer 7

compiled from someone’s head on to other nude images

Question 8

Relationship/marital rape or date rape

Answer 8

Sexual minorities (LGBT) vs HS (12-18 years): current relationship LGBT 23% vs HS 12%. Female 16% vs male 8%

Question 9

Prevalance sexual abuse

Answer 9

Men before age 16: 3.5%
Men after age 16: 9.35

Women before age 16: 16.5%
Women after age 16: 23.8%

Question 10

Perpetrator of sexual abuse

Answer 10

Majority male perpetrator (94%)

Mostly perpetrator was known (83%)

Before age 16: most often a person from the neighborhood, family member, or ex-boyfriend

Before age 16: 7.7% father, 5% brother

Question 11

Child sexual abuse and negative consequences

Answer 11

• Mental health problems
• Substance use disorder
• PTSD
• Suicidal behavior
• Lower self-esteem

Question 12

Resilience in survivors of CSA

Answer 12

12-53% are ‘normal’ functioning

Internal factors: optimism and hope, internal locus of control, active coping, self-esteem

Social support from significant others

Question 13

Sexual functioning in CSA survivors

Answer 13

• More risky sexual behavior
• More likely sexual re-victimization in adulthood
• More sexual problems
• Less sexual pleasure, lower sexual self-esteem
• More severe CSA, dysfunctional family dynamics, age > 5

Question 14

Sexual abuse & consequences for sexual responding

Answer 14

Hypothesis underlying mechanism:

Association sex with harm/fear/disgust –> negative meaning –> impaired sexual response

Question 15

Evidence from studies on female sexual response

Answer 15

Repeated pairing of a sexual stimulus with disgust results in diminished sexual arousal and stronger disgust

Diminished sexual arousal can restore through extinction or counterconditioning, although disgust seems more persistent

Repeated aversive sexual experiences may indeed result in impaired sexual responding

Question 16

Studies on sexual response in CSA survivors

Answer 16

• Most studies do not show impaired sexual responding in women with a history of CSA in the lab situation
• Indications for higher negative affect preceding exposure to sex

Question 17

Sexual response to stimuli with mixed sexual/threat meaning

Answer 17

• Non-consensual sexual stimulation during sexual assault can lead to sexual arousal
• Shame and guilt
• Laboratory studies: genital response to mixed sexual/threat stimuli

Question 18

Hypothesis: women with a history of CSA respond more negatively to their genital sensations

Answer 18

1. Women with a history of CSA and sexual problems reported stronger negative feelings toward their genital sexual arousal sensations
2. Negative appraisal of genital sensations was a significant mediator of the relationship between abuse history and sexual dysfunction

Question 19

Treatment of PTSD

Answer 19

Psychological treatment:
* CBT
* Prolonged and Narrative Exposure
* Eye Movement De-sentisation Reprocessing EMDR

Pharmacological treatment:
* SSRI’s

Question 20

Core elements of treatment

Answer 20

1. Extinction fear
2. Restructuring cognitions about situation and own role
3. Feelings of guilt and shame

Question 21

Problems with treatment for PTSD

Answer 21

1. The treatment of PTSD after sexual abuse seems not to effect sexual problems by itself
2. Current treatment for PTSD from sexual trauma do not appear to be addressing sexual problems
3. Only 2 (small) RCT’s addressing sexual problems after CSA

Question 22

Treatment of patients with sexual problems with a history of sexual abuse

Answer 22

1. Same approach as to other dysfunctions, but in general it takes more time and sometimes a more limited goal
2. More time spend on psychosexual education
3. Strong focus on one’s own boundaries (create safe environment, important to stay in the here and now, sensate focus with eyes open, or soft talking)
4. Extra focus on reducing feelings of shame, disgust, anxiety and fear(counter-conditioning)