Week 7 - Sexual abuse Flashcards
Sexual abuse
Unwanted sexual activities such as exposure to public masturbation, genital touching, or attempted or completed oral, vaginal, or anal intercourse.
Childhood sexual abuse
Before age 16
Sextortion
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)
Non-consensual sexting
Sharing sexual images or/and personal information without consent
Revenge porn
misusing private images with the intension to harm someone
Grooming
adult who makes online contact with a minor, with the aim of sexual abuse
Deep-fake
compiled from someone’s head on to other nude images
Relationship/marital rape or date rape
Sexual minorities (LGBT) vs HS (12-18 years): current relationship LGBT 23% vs HS 12%. Female 16% vs male 8%
Prevalance sexual abuse
Men before age 16: 3.5%
Men after age 16: 9.35
Women before age 16: 16.5%
Women after age 16: 23.8%
Perpetrator of sexual abuse
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
Child sexual abuse and negative consequences
- Mental health problems
- Substance use disorder
- PTSD
- Suicidal behavior
- Lower self-esteem
Resilience in survivors of CSA
12-53% are ‘normal’ functioning
Internal factors: optimism and hope, internal locus of control, active coping, self-esteem
Social support from significant others
Sexual functioning in CSA survivors
- 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
Sexual abuse & consequences for sexual responding
Hypothesis underlying mechanism:
Association sex with harm/fear/disgust –> negative meaning –> impaired sexual response
Evidence from studies on female sexual response
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
Studies on sexual response in CSA survivors
- 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
Sexual response to stimuli with mixed sexual/threat meaning
- Non-consensual sexual stimulation during sexual assault can lead to sexual arousal
- Shame and guilt
- Laboratory studies: genital response to mixed sexual/threat stimuli
Hypothesis: women with a history of CSA respond more negatively to their genital sensations
- Women with a history of CSA and sexual problems reported stronger negative feelings toward their genital sexual arousal sensations
- Negative appraisal of genital sensations was a significant mediator of the relationship between abuse history and sexual dysfunction
Treatment of PTSD
Psychological treatment:
* CBT
* Prolonged and Narrative Exposure
* Eye Movement De-sentisation Reprocessing EMDR
Pharmacological treatment:
* SSRI’s
Core elements of treatment
- Extinction fear
- Restructuring cognitions about situation and own role
- Feelings of guilt and shame
Problems with treatment for PTSD
- The treatment of PTSD after sexual abuse seems not to effect sexual problems by itself
- Current treatment for PTSD from sexual trauma do not appear to be addressing sexual problems
- Only 2 (small) RCT’s addressing sexual problems after CSA
Treatment of patients with sexual problems with a history of sexual abuse
- Same approach as to other dysfunctions, but in general it takes more time and sometimes a more limited goal
- More time spend on psychosexual education
- 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)
- Extra focus on reducing feelings of shame, disgust, anxiety and fear(counter-conditioning)
