Shattered Innocence – Fragile Lives: The Mental Health Implications of Child Sexual Abuse

In the wake of unspeakable trauma, this article delves into the profound mental health repercussions endured by survivors of child sexual abuse, illuminating the intricate complexities of shattered innocence and the enduring journey towards restoration.

Introduction: Child Sexual Abuse

Today, Child Sexual Abuse (CSA) is one of the ghastliest crimes in the world. It is a gross violation of their fundamental rights, a betrayal of their credibility, and a breach of our commitment to safeguard the innocent from the worst forms of child abuse. Throughout the world, many children have been raped, forced into prostitution, killed, fondled, severally beaten, psychologically and sexually abused, and exposed to harmful viruses.

For some, the short-term or long-term effects of CSA will carry into adulthood, which results in diminishing the quality of life including mental health forever. It originates from within society due to its culture of silence and is recognized as a problem of epidemic proportions.

Society continues to witness an extravagant statistical increase in CSA cases despite the existing international legal instruments and growing national concern for this hideous crime. Most of the cases of CSA are either underreported or unreported. It is generally believed that children in different corners of the world face the risk of exposure to various forms of sexual abuse, irrespective of their gender, race, class, ethnicity, or other factors. Non-indulgent socio-cultural attitudes, family disorganization, poverty, acquaintances, entrapment, and the insensitive attitude of the police and medical fraternity are often associated with CSA.

By and large, children are considered toys, and many perpetrators may turn to children for gratification. As a result, they treat them cruelly and unjustly. To address the prevailing issue, various measures have been introduced over the past two decades, including the Protection of Children from Sexual Abuse Act, 2012, to safeguard the innocent from sexual abuse and sexual offences.

However, India has been battling against the CSA through various policies and measures for more than decades, but there has been very tardy development in effective implementation. Ironically, the mental health implications of CSA have received less attention than they deserve. Any effort to address the implication of CSA on mental health requires a greater understanding and in-depth analysis of this issue. Amidst this, it is imperative to expound on the short-term effects and long-term impacts of CSA on adults concerning mental health.

What is Child Sexual Abuse? 

Child Sexual Abuse is a universal phenomenon. It is difficult to grasp the magnitude of the problem because it implicates deep-seated social and cultural assumptions. There is no unanimous consensus among researchers for the exhaustive definition of CSA. Still, various expressions have been used to define CSA, such as child sexual exploitation, child sexual victimization, and child sexual assault. These concepts, however, make it more difficult to assess and measure the prevalence of this evil.

CSA, in common parlance, postulates any sexual relationship of a child with a major person for sexual stimulation. The most widely accepted definition of CSA is the

“involvement of a child in sexual activity that he or she does not fully comprehend, is unable to give informed consent to, or for which the child is not developmentally prepared, or else that violates the laws or social taboos of society. Children can be sexually abused by both adults and other children who are—by their age or stage of development—in a position of responsibility, trust, or power over the victim.”

It is, therefore, the involvement of a dependent, immature child in sexual activity with an adult wherein the child cannot fully comprehend. This definition tries to reflect the comprehensive image of CSA and cover different forms of CSA.

Some usual forms of CSA may include but are not limited to physical intercourse with a minor, including anal, vaginal, or oral, frottage, incest, being forced to touch private parts, being forced to touch exhibit parts, being photographed in the nude, pornographic material exposed to children, sex tourism, verbal sexual abuse, obscene video calls, and institutional abuse of children. These acts or conducts continue to persist today but in varying degrees and forms.

Many researchers have defined the CSA in three aspects:

(i) the identity or relational power position of the person;

(ii) different acts that constitute CSA; and

(iii) consent.

It is to be noted that abuse can also be caused by both adults and children or even family members.

As a valid pre-requisite, some researchers have emphasized the gratification of abusers. Neither lawmakers nor researchers have laid down a detailed list of specific acts concerning different acts or illegal omissions. As far as consent is concerned, the details of the circumstances are not mentioned, under which the consent of the child is not granted. The researchers, therefore, must expound on and evolve a conceptual model of CSA.

Scale of CSA

It is important to note that the cases of CSA are not well reported. Approximately 1 billion children have experienced some form of sexual, physical, or emotional violence, as per the World Health Organization (WHO). A collaborative study between the Centre for Disease Control and the US Department of Justice found that 1,750 children died of abuse or neglect in 2020. About 1 in 5 children have been sexually abused in Europe. It has been estimated that the prevalence of CSA varies from 2.2–94% for girls and 1.7–49.5% for boys in Asia.

Approximately 20% of women and 8% of men have been sexually victimized as children in high-income countries, whereas, the figures vary from 4 to 41% of women and 10 to 55% of men in India. As per the National Family Health Survey (2019–2021), 1.5% of young women in the age group of 18–29 have experienced sexual violence before 18 years of age.

Besides these figures, 53,874 out of 1,49,404 cases relating to crimes against children were registered under the POCSO (Protection of Children from Sexual Offences) Act, according to the data released by the National Crime Records Bureau (NCRB). Most of the cases are either unreported or underreported, as noted earlier, so, likely, the figures do not reflect the actual number of cases. These cases are merely the tip of the iceberg even if they are reported.

At present, there is no reliable data about the mental health implications of CSA, but the scale of the problem is widespread because of the weak support of social institutions like family.

Risk, Factors, Signs and Symptoms

CSA is a highly complex issue. Given the availability of literature and data, there are various risk factors associated with CSA that are believed to increase the exposure of risk to various forms of CSA, including physical and psychological control by abusers, mentally abusive homes, child gender and age, emotional abuse within the family, dependent on drug or alcohol, single parenthood (separated or divorced parents or parents in process of separation), bullying, living on the streets, previously abused either sexually or non-sexually, childhood trauma, living with a mother or father who has a live-in partner, and cultural norms that glorify the heinous crime.

With advancements in society and lifestyle, parents usually spend time on their work, leaving children with no choice and therefore often unattended. In this state of rejection, they always try to find love, whereby they become the victims of this evil.

Additionally, the WHO has identified other risk factors for children, such as having a guardian who is involved in any form of violence, having a guardian who suffered abuse as a child, living in a society with a high rate of unemployment or a high tolerance for violence, and having socio-economic health policies that result in poor quality of life. By behavioural signs, psychosocial, emotional, and physical symptoms a history of CSA can often be identified.

The physical symptoms may include sexually transmitted infections, urinary tract infections, gastrointestinal complaints, skin lesions, urological complaints, irritation in the genital area, pain or burning while urinating, and bruises around the mouth.

Bedwetting, guilt or regret, social withdrawal, having nightmares, sleep disturbances, running away from home, and mood changes are some of the commonly observed signs. Victims, in most cases, do not show any kind of symptoms or signs of abuse. Its solution is, therefore, apparent from a medical examination of the child by professional medical officers.

Impact of Child Sexual Abuse on Mental Health 

A child who is being subjected to sexual abuse reacts differently. It depends on different factors. The act, age of the child and abuser, duration of abuse, the environment in which the child lives, and relationship of the child with the abuser are some of the common factors.

Throughout his or her life, these factors can have a profound effect on the child’s life. Several studies conducted over the past decade have shown that the prevalence of CSA can leave either short-term or long-term psychological scars.

Before we venture into the impact of CSA on mental health, it is pertinent to note that the primary psychological impacts are believed to take place in at least three stages:

• sudden reactions to victimization, i.e., immediate;
• adaptation to ongoing abuse, i.e., intermediate; and
• long-term impacts. While the repercussions of initial reactions to CSA may fade away with time, the reality is that these initial reactions, along with other reactions, can continue well beyond the commission of ghastly crime. To put it simply, a child who has been sexually abused may continue to experience the impact of CSA in his or her adulthood.

Short-Term Impacts

The guilt, shame, anxiety, panic disorder, depression, anger, hostility, bingeing on food and purging via vomiting, feeling of helplessness, poor self-image, inaccurate attributions, somatic and psychological problems, lack of control over emotional regulations, learning disability and hate themselves, attention deficit hyperactivity disorder (ADHD), violent behaviour, post-traumatic stress disorder (PTSD), suicidal thoughts, substance abuse, obesity, and dissociation are some of the potential adverse short-term impacts of this evil.

Children do not often reveal the truth in adolescence, even to their parents, due to social stigma, family honour, victim-blaming, the victim’s reputation, and being ostracized from within society. In the end, all these issues further aggravated the impacts of CSA on mental health.

Long-Term Impacts

After years of abuse, the above-mentioned short-term impacts will eventually be considered long-term impacts on the mental health of adulthood. Post-traumatic stress disorder (PTSD), traumatic sexualisation, betrayal, stigmatisation, revictimization, integrational transmission of abuse, borderline personality disorder, and unhealthy coping mechanisms are the different impacts to which most of the survivors are susceptible.

Additionally, the victim can also struggle with implications such as intrusive recollections, hyperarousal, schizophrenia, conversion disorder, somatoform disorder, persistent depressive disorder, genital trauma, and eating disorders. 

The survivor, in some cases, may catch infections such as STIs, STDs, or HIV/AIDS. These implications, therefore, may result in long-term struggles with psychological issues that could be potentially harmful to the survivor’s mental health.

Reversing Adverse Mental Health Impacts: POCSO Act

The POCSO Act was enacted in 2012, with the intent to criminalize heinous acts against those below 18 years of age, including penetrative sexual assault, sexual assault, sexual harassment, aggravated sexual assault, and aggravated penetrative sexual assault. In a way, the government has accepted the failure of successive policies and measures concerning CSA.

The nomenclature of the 2012 Act, along with its rules, shows a holistic approach to dreadful crime. The different acts provided under the Act, eventually be considered as aggravated when such acts cause the child to become mentally ill.

To prevent re-victimization, the Act also provides a child-friendly atmosphere at every stage of the judicial process. It also provides for the establishment of special courts. Failure to report the commission of an offence shall make a person liable for a maximum of 6 months of imprisonment or a fine. For instance, in the case of Dr Chandrashekar T B v. State of Karnataka, Writ Petition No.8789 of 2023, the Karnataka High Court refused to quash an FIR against a medical practitioner for failure to report an offence under Section 21 of the Act. The intent behind the mandatory reporting is to ensure that no one escapes from the clutches of the law.

Further, the Act also makes provisions for medical practitioners in the form of medical treatment and psychological support under Section 27. The stepwise approach includes immediate first-aid, informed consent for examination and evidence collection, detailed medical history, physical and sexual examination, collection of evidence for medico-legal aspects, treatment of injuries, psychological support, and counselling.

The involvement of mental health services can be called upon when a child is referred to mental health services by officials for adequate treatment or when the judge may require assistance from mental health experts under Section 38 of the Act. Concerning the penalty part, the Act provides stringent punishment for violations of those provisions, including the death penalty.

It is very well acknowledged that the Act gives more teeth for proper implementation, but there are certain inadequacies in the Act. Issues of consent in medical examination, absence of women during medical examination, issue of consented sexual intimacy, absence of the role of mental health professionals, and insensitive attitude of police or medical fraternity are some of the lacunas in the Act.

Suggestions & Recommendations

After considering the impact of CSA in childhood on the mental health of adults, the following are some suggestions that should go a long way in providing relief to the victims of CSA.

1. State Government should develop holistic programmes to eliminate the various socio-economic issues that are associated with CSA.
2. Government needs to ponder more epidemiological information to assess the true picture of the mental health of the victims of other diseases.
3. Parents/Caregivers should maintain a friendly vigil for their children. They must observe emotional and behavioural responses from time to time.
4. States must conduct public awareness programmes regarding the signs, risks, factors, symptoms, and mental impact of CSA.
5. Police personnel and judges should be sensitized to the psychosocial assistance process to handle cases of CSA.
6. During the medical examination of the child, doctors must ensure that the child has been evaluated carefully for pregnancy, STDs/STIs, or HIV. The VDRL test or serology must be repeated at the end of 4 weeks, 4 months, or 6 months.
7. Agencies dealing with this unfortunate segment of society should set up counselling facilities based on psychosocial and mental health assessments for children and their parents/caregivers. Following the counselling, mental health interventions like pharmacotherapy, first-level responses, or depth therapeutics should be initiated.
8. It is also imperative to address the loopholes in the POCSO Act that hinder justice for the victims of CSA.
9. To minimise the trauma of substance abuse, appropriate amendments must be made to the Narcotic Drugs and Psychotropic Substance Act, 1985, to regulate the supply of drugs to the victims of CSA.

After all, children are considered an important national asset of our country. Their growth and development are our responsibility. They determine the future of the country. Therefore, we must put them on the right track.

References

[1] Alankaar Sharma, Disclosure of Child Sexual Abuse: Experiences of Men Survivors in India, Available Here

[2] Child Sexual Abuse, Psychopathology, Trauma and Attachment Beliefs and Interpersonal Functioning among Young Adult Survivors Attending Psychiatric Services in India, Available Here

[3] Shivangi Talwar, Carlos Osorio, et.al., What are the Experiences of and Interventions for Adult Survivors of Childhood Sexual Abuse in South Asia?, Available Here

[4] S. Tyagi, S. Karande, Child sexual abuse in India: A wake-up call, Available Here

[5] VKS Subramaniyan, Praveen Reddy, et. al, Silence of Male Child Sexual Abuse in India: Qualitative Analysis of Barriers for Seeking Psychiatric Help in a Multidisciplinary Unit in a General Hospital, Available Here

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