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Disclosure of Child Sexual Abuse Among Adult Male Survivors

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Men who were sexually abused during childhood are a stigmatized, under-studied, and marginalized population that is at risk for long-term mental health problems. However, many mental health practitioners feel under-prepared and ill-equipped to effectively treat male survivors of child sexual abuse. Furthermore, little is known about factors that may impact the mental health of male survivors such as disclosure of the sexual abuse. The purpose of this study was to (a) describe the disclosure process of male survivors using a lifespan approach, (b) identify disclosure differences based on age and type of abuser, and (c) explore relationships between disclosure attributes and current mental health. Using a large, purposive sample of male survivors (N = 487), the study found that, on average, men delayed telling (M = 21.38 years) and discussing the abuse (M = 28.23 years) for many years. Older age and being abused by a family member (i.e., incest) were both related to delays in disclosure. Most participants who told someone during childhood did not receive emotionally supportive or protective responses and the helpfulness of responses across the lifespan was mixed. Several variables (e.g., timing of disclosure, discussing with a spouse, response to disclosure) were related to current mental health problems. These findings are helpful for clinical social workers who practice with clients from this population. Specific suggestions for improving clinical practice (e.g., assessment, treatment, professional training) are discussed.
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ORIGINAL PAPER
Disclosure of Child Sexual Abuse Among Adult Male Survivors
Scott D. Easton
Published online: 12 October 2012
ÓSpringer Science+Business Media New York 2012
Abstract Men who were sexually abused during child-
hood are a stigmatized, under-studied, and marginalized
population that is at risk for long-term mental health prob-
lems. However, many mental health practitioners feel under-
prepared and ill-equipped to effectively treat male survivors
of child sexual abuse. Furthermore, little is known about
factors that may impact the mental health of male survivors
such as disclosure of the sexual abuse. The purpose of this
study was to (a) describe the disclosure process of male
survivors using a lifespan approach, (b) identify disclosure
differences based on age and type of abuser, and (c) explore
relationships between disclosure attributes and current
mental health. Using a large, purposive sample of male
survivors (N=487), the study found that, on average, men
delayed telling (M=21.38 years) and discussing the abuse
(M=28.23 years) for many years. Older age and being
abused by a family member (i.e., incest) were both related to
delays in disclosure. Most participants who told someone
during childhood did not receive emotionally supportive or
protective responses and the helpfulness of responses across
the lifespan was mixed. Several variables (e.g., timing of
disclosure, discussing with a spouse, response to disclosure)
were related to current mental health problems. These find-
ings are helpful for clinical social workers who practice with
clients from this population. Specific suggestions for
improving clinical practice (e.g., assessment, treatment,
professional training) are discussed.
Keywords Child sexual abuse Disclosure
Male survivors Clergy abuse Treatment Mental health
Introduction
In the past two decades, several highly publicized scandals
(e.g., Catholic Church, Boy Scouts of America, Penn. State
University) have raised public awareness of the sexual
abuse of boys. During this period, researchers have con-
firmed that child sexual abuse (CSA) is a reality for a large
percentage of boys and have identified many of the long-
term, mental health problems associated with CSA for male
survivors (Dhaliwal et al. 1996; Holmes and Slap 1998;
Spataro et al. 2001). Nonetheless, the knowledge base for
this population remains under-developed (Spataro et al.
2001). As a result, many mental health practitioners feel
under-informed and ill-equipped to effectively treat men
with histories of CSA. To strengthen the knowledge base
and improve clinical practice, more research is needed that
examines predictors and processes through which CSA can
affect the mental health of survivors (Merrill et al. 2001).
One factor that has emerged in the literature is the role
of disclosure (e.g., Ullman 2007). Telling someone about
the sexual abuse can, in theory, lead to a cessation of the
abuse, prosecution of the abuser, and connection to mental
health services for the survivor (Paine and Hansen 2002).
The author received financial support from the John A. Hartford
Foundation (Geriatric Social Work Initiative) and support during
recruitment from the following organizations and individuals: the
Survivors Network of those Abused by Priests, MaleSurvivor,
1in6.org, and Dr. Jim Hopper. The author is grateful for the useful
comments of Dr. Carol Coohey and Dr. Thanh Tran during
manuscript development and for the generosity and courage of the
men who participated in this study.
S. D. Easton (&)
Department of Health and Mental Health, Graduate School
of Social Work, Boston College, McGuinn Hall, Room 207,
140 Commonwealth Avenue, Chestnut Hill, MA 02467, USA
e-mail: scott.easton@bc.edu
123
Clin Soc Work J (2013) 41:344–355
DOI 10.1007/s10615-012-0420-3
However, boys who are sexually abused (and men with
CSA histories) face a host of disclosure barriers including
stigma, fear of not being believed, or fear of being labeled
a homosexual (Alaggia 2005; Holmes et al. 1997; Sorsoli
et al. 2008). Beyond the basic rates of telling, the literature
provides little information about disclosure patterns for this
population. Thus, the purpose of this study was to describe
the disclosure process more fully, identify factors that
explain variation in disclosure rates, and examine rela-
tionships between disclosure variables and long-term
mental health. Knowledge of disclosure patterns can, in
turn, be useful in developing clinical interventions with
male survivors of CSA.
Disclosure Rates and Timing
Delayed disclosure and avoidance coping are common
behaviors among both boys and girls who have been sex-
ually abused (Alaggia 2005; Hershkowitz et al. 2007;
Ullman and Filipas 2005). However, retrospective studies
of adults with histories of CSA have found significant
gender differences regarding rates of early disclosure.
O’Leary and Barber (2008) evaluated disclosure patterns in
a non-clinical sample of 296 adults with CSA histories
(151 women, 145 men). Only 26 % of male respondents
(compared to 63.6 % of female respondents) told someone
at or around the time of the sexual abuse. Two other studies
found lower disclosure rates during childhood for male
survivors compared to female survivors (Boudewyn and
Liem 1995; Roesler and McKenzie 1994). These findings
are consistent with a major review of studies on the sexual
abuse of boys which found that early disclosure rates
ranged between 10 and 33 % (Holmes and Slap 1998).
The low rates of disclosure may continue into adult-
hood because many men with histories of sexual abuse
delay disclosure or do not disclose at all. In a national
survey, Finkelhor et al. (1990) found that the percentage
of male survivors who reported that they never told
someone about the sexual abuse was higher than for
female survivors (42 vs. 33 %). In a small study of incest
cases (N=78; 59 women, 19 men), male respondents
reported that they kept the sexual abuse a secret for an
average of 26.8 years compared to 19.5 years for female
respondents (Sigmon et al. 1996). O’Leary and Barber
(2008) found that men took longer to discuss CSA in
adulthood than women and that 44.9 % of males survivors
waited more than 20 years to discuss the sexual abuse.
Among a large sample of college students (N=733;
71 % female), Ullman and Filipas (2005) found that the
rates of ever disclosing the abuse were lower for male
survivors than for female survivors (46 vs. 71 %). Overall
the available data suggest that male survivors delay dis-
closure well into adulthood.
Differences in Disclosure Rates Among Male Survivors
Some studies have examined factors that can influence
decisions to disclose CSA among sexually abused children
and adult survivors of CSA (for a review, see Paine and
Hansen 2002). Survivors of sexual abuse by a family
member are less likely to disclose (Hershkowitz et al.
2005; Smith et al. 2000) or report the abuse to authorities
(Arata 1998; Hanson et al. 1999) than survivors who were
abused by a non-family member or a stranger. For incest
survivors, issues of power, shame, stigma, responsibility,
and fears of negative repercussions can reinforce secrecy
(Paine and Hansen 2002). In a qualitative study of adult
incest survivors (N=20; 12 women, 8 men), Alaggia and
Kirshenbaum (2005) found that family dynamics such as
violence, indirect communication patterns, and social iso-
lation inhibited disclosure.
In recent years, the clergy abuse scandal has raised
awareness about the sexual abuse of boys by members of
the clergy (Roman Catholic Church 2011). Qualitative
studies have found that clergy abuse survivors often
struggle with a complex array of reactions such as deep-
seated rage, shame, and spiritual distress (Fater and
Mullaney 2000). Using data from the first large-scale study
of clergy abuse in the Catholic Church (John Jay College of
Criminal Justice 2004), Smith et al. (2008) found that 90 %
of the incidents of clergy abuse reported in 2002 had
occurred more than 20 years earlier. They also found that
between 1990 and 2002, only 4.3 % of the cases were
reported within 1 year of the incident. Although delayed
disclosure is common among clergy abuse survivors, we
know little about how disclosure patterns of this subgroup
compare to those of other survivors of CSA.
The current age of the survivor may also impact dis-
closure patterns among male survivors. Historically, CSA
was a taboo subject that was not discussed as a public
health or policy concern until the 1970s (Finkelhor 1984).
At that time, most discussions focused on intra-familial
abuse of girls, and people believed that sexual abuse of
boys was rare (De Francis 1969). Since that time, scholars
have accumulated evidence that boys are frequently abused
(Briere and Elliot 2003; Dube et al. 2005; Fergusson and
Mullen 1999). Starting in the late 1980s, there was a
noticeable increase in the availability of resources to assist
boys and men recover from CSA (Easton 2011). Historical
events, including mass media coverage of institutional
scandals (e.g., Catholic Church, Boys Scouts of America,
Penn. State University) and improvements in school-based
prevention programs (Araji et al. 1995; Finkelhor and
Dziuba-Leatherman 1995), have raised public awareness
about the sexual abuse of boys, thereby reducing some
barriers to disclosure. To date, however, few studies have
included male survivors over the age of 50 and thus have
Clin Soc Work J (2013) 41:344–355 345
123
not examined the possibility that age may influence dis-
closure patterns.
Effects of Disclosure
An underlying assumption of many sexual abuse preven-
tion programs is that early disclosure is inherently helpful
to the well-being of the abused child (Alaggia and Kir-
shenbaum 2005; Paine and Hansen 2002). Early disclosure
can lead to intervention by a trusted adult or authority
figure (e.g., child protection services, law enforcement),
clinical treatment services, and social support. Although
some evidence indicates that early disclosure is related to
improved short-term mental health for CSA survivors
(Broman-Fulks et al. 2007), other studies have found that
early disclosures can have negative results such as non-
supportive or disbelieving responses (Berliner and Conte
1995; Malloy et al. 2007), continuation of the abuse (Sas
and Cunningham 1995), physical abuse and violence
(Jonzon and Lindblad 2004), and even greater psycholog-
ical distress (Feiring et al. 2002).
An important factor that may determine whether early
disclosure is helpful is the quality of response that the
survivor receives. In their traumagenic dynamics model,
for example, Finkelhor and Browne (1988) emphasized
that a positive response to disclosure is essential in con-
taining the negative effects of CSA. When a child receives
a non-supportive, non-believing, or hostile response, this
can add to the shame and trauma surrounding the sexual
abuse and contribute to mental health problems (Feiring
et al. 2002). A substantial body of research has confirmed a
positive relationship between the level of parental support
following disclosure and the mental health of the sexually
abused child (for reviews, see Elliott and Carnes 2001;
Spaccarelli 1994). Researchers have identified maternal
protection and support, in particular, as important factors
(Broman-Fulks et al. 2007; Kendall-Tackett et al. 1993;
Lovett 2004). Some of the characteristics of a helpful
maternal response include believing the child, providing
affective support, and taking behavioral action (Alaggia
2002). Although these characteristics have been included in
frameworks by other researchers (e.g., Coohey 2006), little
is known about parental response to disclosure during
childhood for sexually abused boys.
In recent years, researchers have examined the rela-
tionship between the timing of disclosure and the long-term
mental health of survivors of CSA. Studies with mostly
female CSA survivors have found that delayed disclosure
was related to more symptoms of post-traumatic stress
disorder (PSTD) in adulthood (Ruggiero et al. 2004; Ull-
man 2007). Arata (1998) found that early disclosure was
related to fewer PTSD symptoms, but not to overall func-
tioning for adult women with histories of CSA (N=204).
Sigmon et al. (1996) examined the effect of coping styles
on mental health among adult CSA survivors (N=78; 59
women, 19 men) and concluded that although avoidance
coping during childhood may temporarily serve as a pro-
tective factor, avoidance coping in adulthood was associ-
ated with more psychological symptoms. However, not all
of the evidence is consistent. For example, O’Leary et al.
(2010) found that disclosure around the time of the CSA
was related to more long-term mental health problems for
adult survivors of CSA (N=172; 80 % female), possibly
due to unhelpful responses to disclosure in childhood.
Because most of these studies were based on female sur-
vivors of CSA, more research is needed on the relationship
between timing of disclosure and long-term mental health
for men.
Little is known about the disclosure of CSA across the
lifespan and its effect on the mental health of adult survi-
vors of CSA, especially for male survivors (Ullman 2003).
Exploratory, qualitative studies have found that early dis-
closure (Harvey et al. 1991) and a supportive response to
disclosure (Harvey et al. 1991; Orbuch et al. 1994) were
associated with successful adjustment for adult survivors of
CSA. Although Ullman and Filipas (2005) did not find a
relationship between the length of time to disclosure and
PTSD symptom severity for men, they did find that the
level of detail provided in the disclosure and negative
social reactions were related to more PTSD symptoms for
both male and female participants with histories of CSA.
Beyond merely telling someone about the CSA, O’Leary
et al. (2010) found that CSA survivors who waited longer
than 1 year to discuss their abuse in-depth had more mental
health symptoms in adulthood. Because research is mixed
on the effects of disclosure on mental health, more research
is needed with male survivors.
Overall, very little is known about disclosure patterns
for men with histories of CSA including factors that may
explain differences in disclosure rates or responses to dis-
closure. Most studies of adult survivors of CSA have relied
on small, convenience samples or samples with mostly
female survivors. Furthermore, most studies have narrowly
focused on disclosure in childhood (i.e., telling/reporting)
and have not assessed the dimensions of response to dis-
closure (i.e., belief, support, protection) or the relationships
between disclosure and long-term mental health. Studies
are needed that include more complex measures of dis-
closure beyond dichotomous variables of telling (Paine and
Hansen 2002) and more differentiated measures of
response to disclosure (Lamb and Edgar-Smith 1994). The
results could be useful for clinical assessment and treat-
ment of male survivors of CSA. Using a broader concep-
tualization of disclosure as a multi-dimensional process
that unfolds across the lifespan, the current study was
guided by three research questions:
346 Clin Soc Work J (2013) 41:344–355
123
1. What is the nature of disclosure of CSA for male
survivors?
2. Does disclosure differ based on type of abuser (e.g.,
clergy member, family member) or the current age of
the male survivor?
3. Are aspects of disclosure related to the long-term
mental health of male survivors?
Methods
Data Source and Sample
This study used a cross-sectional survey design with pur-
posive sampling from three national organizations devoted
to raising awareness of CSA among men: the Survivors
Network of those Abused by Priests (SNAP), MaleSurvi-
vor, and 1in6.org. Both SNAP and MaleSurvivor posted a
study announcement on their website home page; due to an
ongoing website redesign effort at 1in6.org, the study
announcement was posted on the website of one of their
founding board members, Dr. Jim Hopper, an expert on
child maltreatment. SNAP also sent recruitment emails to
its members. After reading the announcement, potential
participants were directed to a survey website with a wel-
come message, consent letter, and eligibility screening
questions. Participants were eligible for inclusion in the
study if they were male, 18 years of age or older, and had
been sexually abused before the age of 18. Interested, eli-
gible participants then completed an anonymous, internet-
based survey during an 8-week period in the summer of
2010.
The study received human subjects approval from the
Institutional Review Board at a Midwestern university.
Due to the sensitive nature of the survey topics, several
safeguards were instituted to protect the safety and privacy
of the participants. Prior to implementation, the survey was
pre-tested in three phases over a 2-year period with input
from national sexual abuse and trauma experts, clinicians,
and graduate students in social work. The final survey
consisted of 137 items; the current study utilized a subset
of items from the general survey.
Participants
The final sample consisted of 487 men with histories of
CSA ranging in age from 19 to 84 years (l=50.4 years).
The majority of participants identified their race as Cau-
casian (90.9 %). The remaining participants (9.1 %) indi-
cated that they were bi-racial (2.9 %), African-American
(1.0 %), Native-American (1.0 %), Asian (0.4 %), Pacific
Islander (0.4), or belonged to another race (3.3 %).
A separate question measured ethnicity; 5.6 % of partici-
pants indicated that they were Hispanic. The level of
education was measured on an 8-point Likert scale ranging
from less than high school diploma (1) to doctorate or
professional degree (8). The mean level of education was
5.33 (associate’s degree). Most participants were currently
living with a spouse or partner (69.2 %) and were members
of a national survivor organization (81.8 %). The mean
household income level was between $60,000 and $69,000.
The mean age at which participants were first sexually
abused was 10.3 years. Most participants were abused by a
clergy member (62 %), and nearly one in 10 participants
(11 %) was abused by a biological family member. With
regard to the duration of the CSA, 43 % of participants
reported that the sexual abuse lasted 1 year or less.
Approximately one-third of participants (36 %) indicated
that the abuser used force during the sexual abuse, and a
majority of participants (61 %) reported that the sexual
abuse involved penetration. The mean for mental distress in
this sample was 12.5 (range =0-25).
Measures
Mental Distress
The measure for mental health problems was the General
Mental Health Distress Scale (GMDS; Dennis et al. 2007),
a component of a reliable and valid health screening
instrument, the General Assessment of Individual Needs
(GAIN; Dennis et al. 2007). The GMDS is a symptom
count of internal sources of distress that were experienced
in the past 12 months. The GMDS has high internal con-
sistency (a=.90), generally increases with age, and has
demonstrated an ability to detect differences in symptom
patterns by gender, race, and age (Chan et al. 2008; Conrad
et al. 2009). For this study, the measure included 25 items
related to internalizing disorders (depression, anxiety,
somatization, and suicidality). Participants selected yes (1)
or no (0) for each symptom. The measure was scored by
adding the endorsed symptoms for each participant
(range =0–25) with higher scores indicating more mental
distress. The Cronbach’s alpha for the index was .904.
Disclosure Variables
Several items focused on telling someone about the sexual
abuse. Participants were asked whether they had ever told
someone in their lifetime about the sexual abuse (no =0,
1=yes). Participants who responded yes were asked a
series of follow-up questions that included the helpfulness
of the response to first telling. Response choices were
based on a 5-point Likert scale that ranged from very
unhelpful (1) to very helpful (5). Another item asked about
Clin Soc Work J (2013) 41:344–355 347
123
the relationship to the first person that the participant told.
The original set of 15 response choices was collapsed into
eight categories: parent, other family member, spouse/
partner, friend, clergy member, mental health professional,
another survivor or survivor organization, and other. Three
subsequent items asked whether the sexual abuse was
reported to authorities (e.g., police, child protection ser-
vices), whether the participant told someone in childhood,
and whether the participant told a spouse/partner in adult-
hood (no =0; yes =1). An open-ended item asked par-
ticipants to estimate the number of people whom they had
told in their lifetime. Finally, participants were asked to
assess the overall level of helpfulness of responses that
were received after telling others about the sexual abuse.
Response choices were based on a 5-point Likert scale that
ranged from very unhelpful (1) to very helpful (5).
In addition to telling about the abuse, several items
focused on discussing the sexual abuse in depth with
another person. Participants were asked if they had ever
discussed the sexual abuse in depth (no =0, 1 =yes).
Another item asked if the participant had ever had an in-
depth discussion about the sexual abuse with a spouse or
partner (no =0, 1 =yes). The next two items asked the
participant to think of the person with whom they had their
most productive discussion of the sexual abuse. Partici-
pants were asked about their relationship to that most
supportive discussant. The original list of 15 response
choices were collapsed into eight categories as described in
an earlier item. An item asked about the helpfulness of the
most supportive discussant; responses were based on a
5-point Likert scale ranging from very unhelpful (1) to very
helpful (5).
Several items focused on the timing of telling and dis-
cussing the sexual abuse. Participants were asked to esti-
mate their age at the time that they first told someone, first
had an in-depth discussion, and first had a helpful in-depth
discussion about the sexual abuse. All three responses were
then subtracted from the participant’s current age to create
three additional variables: years until first told, years until
first in-depth discussion, and years until first helpful
in-depth discussion.
Composite Support Measures
Participants were asked if they told their mother during
childhood (i.e., before the age of 18) about the sexual
abuse. Participants who responded yes were then asked if
their mother believed them, provided emotional support,
and tried to protect them (no =0, 1 =yes). Responses
were then added to create the maternal support index
which ranged from 0 to 3 with higher scores indicating
more support. Participants were also asked if they told
another person (besides their mother) during childhood
about the sexual abuse. Participants who responded yes
were then asked three questions about belief, emotional
support, and protection. The responses were added to cre-
ate other childhood support index (range =0–3). Finally,
participants were asked if they told someone in adulthood
(i.e., 18 years or older) about the sexual abuse. Participants
who responded yes were asked whether anyone that they
told in adulthood believed, supported, or protected them.
The responses were added to create the adulthood support
index (range =0–3).
Data Analysis
Data were cleaned and imported into a data file in SPSS
19.0. The few missing data in this study (\3 %) appeared
to be missing at random. Additional analysis found that the
level of missing data was not related to mental distress,
allowing the use of listwise deletion as a remedy for
missing data. For missing data due to skip filters or in
composite variables, mean substitution was used. Diag-
nostic tests conducted prior to inferential testing found that
assumptions were met for statistical tests. After performing
univariate analyses, bivariate tests were conducted (Chi-
square test of independence, independent sample t-tests,
Pearson’s product-moment correlation, simple logistic
regression).
Results
Table 1presents the univariate results for disclosure his-
tory. The vast majority of participants (97 %) told someone
about the sexual abuse at some point in their lifetime.
However, on average, it took participants more than two
decades from the time of the sexual abuse (M=21 years)
to tell someone, and the mean age at the time of first telling
was 32 years. Approximately one-half of the participants
first told about the sexual abuse to a spouse/partner (27 %)
or to a mental health professional (20 %). The mean score
for helpfulness of response to first telling was 3.25. One-
fourth of participants told someone about the sexual abuse
in childhood (26 %) and only 15 % reported the sexual
abuse to authorities. Eighty-six percent of participants told
a spouse or partner during adulthood. Across the lifespan,
the mean number of people told was 32. The mean score
for helpfulness of overall lifetime response to telling was
3.45.
Beyond telling, more than three-fourths of participants
(77 %) had discussed the sexual abuse in-depth with
someone during their lifetime. On average, it took partic-
ipants nearly three decades from the time of the sexual
abuse (M=28 years) to have an in-depth discussion, and
it took even longer to have a helpful in-depth discussion
348 Clin Soc Work J (2013) 41:344–355
123
(M=30 years). Two-thirds of participants (67 %) had an
in-depth discussion with a spouse or partner. However,
many participants reported that their most helpful discus-
sion was with a mental health professional (42 %).
Table 2presents more detailed data for the response to
disclosure in both childhood and adulthood. Among those
who told their mother about the sexual abuse during
childhood (n=63), 57 % reported that their mother
believed them, 29 % reported that their mother supported
them, and 36 % reported that their mother protected them.
Among those who told another person about the sexual
abuse during childhood (n=92), the percentages for
believed, supported, and protected were, respectively, 79,
34, and 31 %. During adulthood, most participants reported
that someone believed (97 %) and provided support (84 %)
following disclosure. The mean scores for indices assessing
maternal support, other childhood support, and adulthood
support were, respectively, 1.25, 1.47, and 2.30.
For research question #2, bivariate analyses were con-
ducted to examine the relationships between each disclo-
sure variable and three other variables: clergy abuser,
incest, and age. Among the many relationships examined
between clergy abuser and disclosure variables, only one
relationship was significant. The percentage of participants
who reported the sexual abuse to authorities was higher for
clergy abuse survivors (20 %) than for non-clergy abuse
survivors (8 %), x
2
(1, N=461) =12.51, p\.001.
Between incest and each disclosure variable, five rela-
tionships were significant. Compared to survivors who
were not abused by a biological family member, a lower
percentage of incest survivors reported the sexual abuse to
authorities (6 vs. 16 %; x
2
(1, N=461) =4.26, p\.05),
told anyone about the sexual abuse in childhood (15 vs.
27 %; x
2
(1, N=483) =4.03, p\.05), told their spouse
or partner about the sexual abuse (77 vs. 87 %; x
2
(1,
N=467) =13.68, p\.01), and discussed the sexual
abuse in-depth with a spouse or partner (57 vs. 68 %; x
2
(1,
N=355) =8.84, p\.05). Additionally, incest survivors
took longer to first tell someone about the sexual abuse
(M=24.86, SD =12.02) than survivors who were sexu-
ally abused by someone other than a family member
(M=20.90, SD =15.09) (t[71] =-2.16, p\.05).
Age was related to seven different disclosure variables.
In a simple logistic regression, age predicted whether
a survivor reported the sexual abuse to authorities (B=
-0.04, O/R =.963, p\.01). For each additional year,
participants were approximately 14 % less likely to have
reported the sexual abuse to authorities. Age was positively
correlated with many different disclosure variables that
Table 1 Univariate results for disclosure variables
Variable % Mean (SD) Range
Telling
Ever told in lifetime (% yes) 97.3
Relationship to first person told
Parent 13.1
Other family member 7.0
Spouse/partner 27.3
Friend 17.6
Clergy member 9.3
Mental health professional 20.1
Another survivor/organization 1.1
Other 4.4
Helpfulness of response to first telling 3.25 (1.50) 1–5
Told anyone in childhood (% yes) 25.7
Reported to authorities (% yes) 15.1
Told spouse or partner in adulthood
(% yes)
86.0
Total persons told (lifetime) 32.07 (37.43) 1–100
Helpfulness of overall response to
telling (lifetime)
3.45 (1.05) 1–5
Discussing
Ever discussed in-depth (% yes) 77.1
Discussed with spouse (% yes) 67.2
Helpfulness of response of most
supportive discussant
4.45 (0.86) 1–5
Relation to most supportive discussant
Parent 1.7
Other family member 3.9
Spouse/partner 24.9
Friend 17.4
Clergy member 1.9
Mental health professional 42.0
Another survivor/organization 3.0
Other 5.2
Timing of disclosure/discussion
Age first told 31.72 (14.21) 4–72
Years until first told 21.38 (14.88) 0–63
Years until first in-depth discussion 28.23 (12.88) 0–72
Years until helpful in-depth
discussion
29.98 (12.07) 0–73
Table 2 Detailed measures of support after disclosure
Variable Childhood Adulthood
Mother
(n =63)
Another
(n =92)
(n =448)
Believed (% yes) 57.4 78.8 96.9
Supported (% yes) 28.6 33.7 83.5
Protected (% yes) 35.6 30.8 48.1
Support index
(mean/SD)
1.25 (1.28) 1.47 (1.12) 2.30 (0.80)
Clin Soc Work J (2013) 41:344–355 349
123
focused on telling: total number of people told in lifetime
(r(466) =.119, p\.05), age at the time of first telling
(r[466] =.381, p\.001), and number of years until first
telling (r[464] =.328, p\.001). Additionally, age was
also positively correlated with years until first in-depth
discussion (r[354] =.547, p\.001) and years until
helpful discussion (r[356] =.570, p\.001). Finally, age
was negatively correlated with total support in adulthood
(r[381] =-.173, p\.01).
For research question #3, bivariate analyses examined
relationships between each disclosure variable and current
mental health (see Table 3). Several of the variables sur-
rounding response to disclosure/discussion were related to
mental distress. Response to first telling (r[448] =-.124,
p\.01), maternal support (r[50] =-.323, p\.05), over-
all response to telling in lifetime (r[457] =-.251, p\
.001), and response of most supportive discussant (r[360] =
-.135, p\.05) were negatively related to mental distress.
Additionally, the number of years until first telling was
positively related to mental distress (r[465] =.119,
p\.05). Survivors who discussed the sexual abuse with
their spouse had less mental distress (M=11.29, SD =
6.17) than survivors who did not discuss with their spouse
(M=13.97, SD =6.05) (t[191] =3.72, p\.001).
Discussion
Men with histories of CSA are at risk for several long-term
mental health problems such as major depressive disorder,
anxiety disorders, substance abuse, anger management
problems, and, ultimately, suicide (Dhaliwal et al. 1996;
Holmes and Slap 1998; Spataro et al. 2001). One factor that
can promote or undermine a survivor’s mental health is
disclosure of the CSA. Although there is a growing body of
knowledge on the disclosure of CSA for female survivors,
little is known about this topic for men with histories of
CSA. Thus, the purpose of this study was to understand
disclosure patterns for male survivors of CSA and their
relationship to current mental health. The results have
numerous implications for social workers in clinical prac-
tice who may serve clients from this population.
Implications for Clinical Practice and Training
First, clinical social workers can adopt a lifespan approach
to disclosure history during assessment. Rather than a one-
time event during childhood (e.g., reporting or telling), the
disclosure process is often a complex phenomenon that
unfolds across the life course (Easton 2011) and is influ-
enced by factors such as a survivor’s life stage, social
network, and personal resources. It is not enough to ask
whether the survivor told someone around the time of the
sexual abuse, a commonly asked question in previous
research studies. Participants in the current study, on
average, waited more than two decades to first tell someone
about the CSA and nearly three decades to have an in-depth
discussion of the CSA. Also, only 26 % of participants told
someone in childhood and 15 % reported the CSA to
authorities. These results are consistent with other studies
on disclosure rates and self-silencing among this popula-
tion (O’Leary and Barber 2008; Sigmon et al. 1996). By
using a broader historical framework, clinical social
Table 3 Relationship between disclosure variables and mental health
(range =0–25)
Variable Mean (SD) Pearson’s r
Telling
Ever told (lifetime)
Yes 12.52 (6.27)
No 11.00 (6.11)
Response to first telling -0.12**
Reported to authorities
Yes 13.40 (5.55)
No 12.19 (6.42)
Told anyone (childhood)
Yes 11.60 (6.65)
No 12.81 (6.12)
Told spouse (adulthood)
Yes 12.44 (6.28)
No 12.86 (6.01)
Total told (lifetime) -0.07
Overall response to telling (lifetime) -0.25***
Discussing
Ever discussed in-depth
Yes 12.24 (6.31)
No 13.50 (6.14)
Discussed with spouse/partner
Yes 11.29 (6.17)***
No 13.97 (6.05)
Response most supportive discussant -0.14*
Timing of disclosure/discussion
Age first told 0.09
Years until first told 0.12*
Years until first in-depth discussion 0.02
Years until helpful in-depth
discussion
0.03
Support
Maternal support (childhood) -0.32*
Other childhood support -0.15
Adulthood support 0.06
*p\.05, ** p\.01, *** p\.001
350 Clin Soc Work J (2013) 41:344–355
123
workers can obtain a more complete personal history of
how the survivor managed the secret of being sexually
abused and a more comprehensive understanding of the
timing, circumstances, and responses to disclosure across
the lifespan of the survivor.
Using a lifespan perspective is important not only for
gathering information during assessment, but it can also be
useful for treatment of male survivors of CSA. The results
of this study indicated that delays in disclosure are highly
problematic; the length of time before first telling someone
about the sexual abuse was positively related to mental
distress including symptoms of depression, anxiety,
somatization, and suicidality. Although it can be a pro-
tective mechanism at times, maintaining secrecy about the
CSA across decades can heighten feelings of stigma and
isolation for survivors. In clinical work with this popula-
tion, a social worker can help the client understand that he
is not alone, that telling will not inevitably lead to being
labeled or ostracized, and that discussing the CSA in-depth
may be helpful in connecting the CSA to current mental
health and psychosocial/environmental problems (i.e.,
Axis-4).
Second, clinical social workers can help clients under-
stand the impact of unhelpful responses to disclosure on
their current mental health. Because disclosure is an
interpersonal process, the quality of the responses received
after disclosure can be critical to the survivor’s well-being.
On average, participants in the current study received a
mixed response (i.e., both helpful and unhelpful) to first
telling. Furthermore, bivariate results indicated that
unhelpful responses to disclosure were related to more
mental distress. Receiving an unhelpful response to first
telling may impair future disclosures and could explain the
long delays before discussing the abuse in-depth. Also,
receiving an unhelpful response to telling may undermine
the survivor’s ability to process and understand the abuse,
thereby contributing to negative feelings (e.g., guilt, shame,
isolation, anger) which should be addressed in treatment.
In addition to measuring the overall helpfulness of dis-
closure responses, this study was one of the first studies to
examine the different dimensions of disclosure responses
(i.e., belief, emotional support, protection) for male survi-
vors of CSA. For example, among those who told their
mother about the CSA in childhood (n =63), more than
half (57 %) reported that their mothers believed them.
However, a much smaller percentage reported that their
mothers provided emotional support following disclosure
(29 %) or protection (36 %). Consistent with existing lit-
erature with female survivors (Broman-Fulks et al. 2007;
Kendall-Tackett et al. 1993; Lovett 2004), less maternal
support following disclosure in childhood was related to
more mental distress in adulthood. By providing language
and specific dimensions (belief, support, protection) to
assess disclosure responses, this framework may be useful
in clinical treatment of male survivors of CSA. Clinical
social workers can help clients gain a deeper understanding
of how prior inadequate responses to disclosure may have
contributed to feelings of invalidation or shame. Con-
versely, this framework identifies some of the important
qualities of a supportive, empathetic, and helpful response
to disclosure.
Third, clinical social workers can help male survivors
assess and, if necessary, expand their current support net-
work. Because of the long delays in telling, for example,
many participants indicated that the first person whom they
told about the abuse was a spouse or partner (27 %) or
close friend (18 %) in adulthood. Furthermore, the results
of this study indicated that a supportive response from a
spouse or partner was related to better mental health.
However, many male survivors struggle to form and
maintain stable intimate relationships (Dhaliwal, et al.
1996; Holmes and Slap 1998; Spataro et al. 2001) due, in
part, to the egregious breach of trust involved in most cases
of CSA. Clinical social workers can help clients better
understand how an early traumatic experience such as CSA
can inhibit and undermine the quality of current relation-
ships with intimate partners or close friends. Beyond pro-
moting an understanding of the impact of CSA on
relational security, clinical social workers can empower
clients by strengthening their relationship skills. This pro-
cess may entail identifying a trusted person within the
social network (who might be able to provide a helpful
response) and supporting the client as he manages future
disclosures.
Fourth, clinical social workers should recognize and
treat the unique needs of sub-populations within the pop-
ulation of male survivors of CSA including incest survivors
and older survivors. Consistent with previous research
(Arata 1998; Hanson et al. 1999; Hershkowitz et al. 2005;
Smith et al. 2000), this study found that being abused by a
biological family member can inhibit disclosure for male
survivors including lower rates of reporting to authorities,
telling someone in childhood, and discussing with a spouse
or partner in adulthood. Intrapersonal concerns (e.g.,
heightened shame, family loyalty, fear of breaking up a
family) coupled with family dynamics (e.g., family vio-
lence, social isolation, closed communication patterns;
Alaggia and Kirshenbaum 2005) may explain why incest
survivors are prone to silencing (O’Leary and Barber
2008). The results of the study also found that current age
was related to many of the disclosure variables. Older
survivors were, for example, less likely to have reported
the CSA to authorities during childhood, took longer to tell
someone about the CSA, and reported less support fol-
lowing disclosure in adulthood than younger survivors.
These findings could be due to different generational norms
Clin Soc Work J (2013) 41:344–355 351
123
or to more recent historical events that have increased
awareness of the sexual abuse of boys (e.g., media cover-
age of institutional scandals, school-based prevention
programs, national survivor organizations). Nonetheless, it
is important for clinicians to recognize that male survivors
are not a homogenous group; some sub-populations (i.e.,
incest survivors, older survivors) may have an especially
difficult time with disclosure of CSA and feel an additional
layer of isolation or stigma that needs to be addressed in
treatment.
Finally, the field of social work could increase the
profession’s capacity to effectively treat male survivors in
clinical settings by improving professional education and
training programs. For example, social work graduate
programs should be infused with information on male
survivors of CSA and continuing education workshops
should offer opportunities for licensed clinicians to
improve their treatment skills with this population. The
results of this study underscored the pivotal role of mental
health professionals in the recovery of male survivors from
CSA. Participants reported that therapists were often their
most supportive discussant (42 %), and the helpfulness of
the most supportive discussant was negatively related to
mental distress. It is highly possible that a therapist was the
first person in the survivor’s life to provide a caring,
empathetic response to disclosure in a safe, supportive
environment. However, researchers have found that clini-
cians may hold biases that impede the identification,
assessment, and treatment of male survivors (Holmes and
Offen 1996; Lab et al. 2000; Spataro et al. 2001); are less
likely to rate sexual abuse as an important treatment issue
in male clients versus female clients (Holmes and Offen
1996); and work in agencies that may be ill-equipped or
organized to offer helpful service provision (Hooper and
Warwick 2006). Improving education and professional
development opportunities for clinical social workers
might address some of these limitations and increase the
availability of much-needed treatment services for male
survivors.
Limitations
In interpreting the results of the study, several limitations
should be considered. The purposive sample was recruited
through research announcements posted by national sur-
vivor organizations and consisted of a large percentage of
clergy abuse survivors (82 %). Although this technique
was extremely useful in reaching a hidden, stigmatized
population, it introduced sample bias that limits the gen-
eralizability of the results. For example, compared to one
of the few studies based on a nationally representative
sample of male survivors (Finkelhor et al. 1990), a higher
percentage of participants in the current study told
someone in their lifetime (97 vs. 58 %), were abused for
more than 1 year (57 vs. 8 %), and were abused using
physical force (41 vs. 15 %). However, the current sample
was very similar to Finkelhor et al.’s (1990) sample on
other CSA characteristics (e.g., age at the time of first
abuse, abuse by a family member, penetration). Addition-
ally, clergy abuse survivors differed from other survivors
on only one of the many disclosure variables. Nonetheless,
the recommendations of this study should be considered
preliminary and the results should be generalized to male
survivors who experienced severe forms of CSA and who
were familiar with national survivor organizations. Future
research should build on these findings and explore dis-
closure among a probability sample of male survivors from
the general population.
A second limitation was the inclusion criteria that
required participants to have internet access and be profi-
cient in the English language. Researchers have found that
internet access and use are related to socio-demographic
factors such as race, household income, education level,
and household location (Hoffman et al. 2000; NTIA 1999).
In the current study, male survivors from lower education
and minority groups (including non-English speaking
communities) were underrepresented. Because disclosure
patterns may be influenced by cultural factors, future
studies should examine disclosure among a more diverse
sample of male survivors. A third limitation was the use of
retrospective self-report data. Because several of the vari-
ables measured events that occurred many years prior to
the study, it is possible that memory deterioration reduced
the accuracy of responses. Due to privacy and logistic
concerns, it was not possible to triangulate the data through
other sources (e.g., spouses, therapists) in the current study.
However, the survey items were reviewed by a panel of
experts and written to elicit meaningful responses in light
of the retrospective design.
Implications for Future Research
This study advanced our understanding of disclosure pat-
terns for male survivors of CSA. However, several questions
remain and more research is needed to inform and improve
clinical practice. For example, future research should
explore the barriers to disclosure for men with histories of
CSA. Although a few qualitative studies have provided
valuable insights into reasons men decide to keep CSA a
secret (Alaggia 2005; Holmes et al. 1997; Sorsoli et al.
2008), studies with larger samples could strengthen the
knowledge base. Additionally, few studies have involved
experts in the field who work with members of this popula-
tion in clinical practice on a daily basis. Studies that incor-
porate the valuable experiences and clinical wisdom of
practitioners who specialize in treating male survivors would
352 Clin Soc Work J (2013) 41:344–355
123
be useful for general practitioners who also may treat men
who have histories of CSA. Finally, future studies can utilize
more advanced statistical models to explore how attributes of
disclosure may impact mental health for male survivors.
Building upon the bivariate findings in the current study,
researchers can use multivariate models to evaluate the
influence of disclosure variables on mental health while
controlling for factors such as sexual abuse severity and other
adverse childhood experiences. Approaches such as struc-
tural equation modeling may be useful in identifying the
pathways through which disclosure may influence mental
health. All of this research should then be translated into
practical guidelines for clinical social workers and mental
health practitioners. Ultimately the findings could lead to
more evidence-based, culturally sensitive interventions for
men with histories of CSA.
By examining disclosure of CSA as a dynamic process
that unfolds across the lifespan, the current study utilized a
framework that can be applied in clinical practice with
male survivors of CSA. More specifically, the study
addressed a large gap in our knowledge base by describing
important features of disclosure (e.g., timing of disclosure,
telling/discussing, dimensions of a supportive response)
among a large, non-clinical sample of men ranging in age
from 18 to 84 years. As such, it provided a more com-
prehensive understanding of disclosure for this vulnerable
population. On average, male survivors remained silent
about the sexual abuse long into adulthood. Among sur-
vivors who told someone in childhood, many of them were
not supported or protected. Additionally, several disclosure
variables (e.g., response to telling, discussion with spouse,
years until first told) were related to current mental distress
and provide opportunities for clinical intervention and
treatment. Clinical social workers can use these findings to
help clients understand how unhelpful responses to dis-
closure may have negatively impacted their mental health.
Conversely, by providing a safe, supportive environment to
discuss the CSA and by helping the survivor expand his
support network, clinical social workers can play an
important role in improving the mental health of members
of this underserved, marginalized, and vulnerable
population.
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Author Biography
Scott D. Easton is an Assistant Professor in the Department of Health
and Mental Health at the Boston College Graduate School of Social
Work. His research interests include mental health, aging, sexual
abuse, and trauma recovery.
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... Although a substantial number of youths, both inside and outside of the sport context, have been victims of CSA, studies suggest that many do not disclose their experience during childhood (London et al., 2008;Collin-Vezina et al., 2015;McElvaney, 2015;Jeong and Cha, 2019). For many victims, it takes more than two decades from the beginning of the abuse to tell someone about it and nearly three decades to have in-depth discussions (Easton, 2012). Delayed or lack of disclosures are alarming since studies have shown that the healing process usually starts with disclosure (Chouliara et al., 2014;Jeong and Cha, 2019). ...
... It took the athlete 20 years to disclose her complete experience of abuse. This timeline aligns with research demonstrating that many children do not disclose their experience before adulthood (Hébert et al., 2011;Easton, 2012;Collin-Vezina et al., 2015). Through thematic analysis, the authors identified three major themes in the survivor's narrative: (a) the pathway to understanding, (b) the pathway to disclosure, and (c) the pathway to healing. ...
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Denunciations of child sexual abuse (CSA) in the sport context have been increasing in the last decades. Not least than 14% to 29% of athletes have been victim of at least one form of sexual violence in sport before the age of 18. However, studies suggest that many do not disclose their experience of CSA during childhood. This finding is alarming since studies have shown that the healing process usually starts with disclosure. Moreover, little is known about the healing process of CSA experienced in the sport context. The aim of the study is to present a single case study of a CSA in sport to better understand the global experience over time from the perspective of the athlete. A narrative inquiry approach was adopted. Three non-structured interviews were conducted with the participant. Three pathways in the survivor journey have been identified through inductive thematic analysis: (a) pathway to understanding, (b) pathway to disclosure and (c) pathway to healing. These pathways represent distinct processes but are intertwined as they are dynamic and iterative. Indeed, the survivor explained how she had been, and is still, going back and forth between them. Results are consistent with those found in the literature on CSA in the general population. It suggests that theoretical models of CSA in the general population could be applied to CSA in sport. Practical implications include a need for education and clearer boundaries in the coach-athlete relationship. Sport stakeholders also need to be better equipped to recognize the signs of sexual violence in sport. Our results indicate that qualitative research could be a potential avenue to help victims heal from CSA. It gives them the chance to talk about and make sense of their abuse in a safe space. Finally, our results demonstrate the importance of reviewing the current justice system for victims. It should be based on a trauma-informed approach that places the victim at the center of the judicial process.
... For example, there is scientific evidence showing that the number of female children abused by adult males is higher than the male counterpart. It should be noted, however, that females are more likely to report the experience of abuse than young males, so an underestimation is assumed especially in the institutional sphere (Easton, 2013). In the context of faith-based organizations the statistics seem to be the opposite, with a prevalence of male victims. ...
... This would also explain why the literature is now widely agreed that child sexual abuse in institutional settings is greatly underestimated. Indeed, there is evidence suggesting that up to one in seven children will be sexually abused in childhood, taking into account of course that these figures are influenced by the under-representation of CSA in general and on children in particular (Easton, 2013;McElvaney et al., 2012). ...
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The report “Child abuse: definitions, intervention and actions carried out by faith led organizations” highlights the various forms of child abuse with an analysis of the risk factors and the abuse prevention strategies, including the adoption of codes of conduct and protection policies by the different Catholic institutions and ecclesial associations.
... Disclosing CSA is a difficult process as it may bring out painful emotions and memories (Gagnier & Collin-Vézina, 2016). Delayed disclosure and avoidance coping are common behaviours among both male and female survivors of CSA, with some studies concluding that girls have a disclosure rate of roughly 1 in 5, while boys have a disclosure rate of about 1 in 10 (Easton, 2013;Sivagurunathan et al., 2019b). With that being said, male survivors of childhood trauma face the particular challenge of having to adhere to strict gender norms that deny men the "victim" status, potentially making the disclosure process even more difficult (Gagnier & Collin-Vézina, 2016). ...
Technical Report
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This online conference explored diverse perspectives on men, masculinities, and victimization, identifying needs that arise for men because of violence as well as helpful interventions. The event was funded by the Department of Justice as part of Victims and Survivors of Crime Week and included a panel discussion with professionals who research or provide direct service to male survivors of different types of violence including impaired driving, intimate partner violence, gun violence, and the experiences of fathers and boys in armed conflict and resettlement. Following the discussion, there was a training session offering clinical perspectives on supporting male survivors of child sexual abuse. This report includes a link to the recorded event, as well as summaries of panelist presentations and short research summaries with recommended resources.
... Relative to girls and women, boys and men are less likely to: disclose sexual abuse at the time, accurately label experiences as sexual abuse and receive acknowledgement or validation of sexual abuse experiences from clinicians and/or parents. 2 It is commonplace for men to defer initial disclosure for upwards of three decades. 3 Best estimates regarding the latency of sexual abuse disclosure among men reasonably suggest a proportion of these men never experience sufficient safety 4 to speak of their abuse experience(s), with the psychosocial impacts silently concealed and suffered or self-managed. ...
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The spectrum of adverse mental health trajectories caused by sexual abuse, broadly defined as exposure to rape and unwanted physical sexual contact, is well-known. Few studies have systematically appraised the epidemiology and impact of sexual abuse among boys and men. New meta-analytic insights (k = 44; n = 45 172) reported by Zarchev and colleagues challenge assumptions that men experiencing mental ill health rarely report sexual abuse exposure. Adult-onset sexual abuse rates of 1–7% are observed in the general population, but for men experiencing mental ill health, adult lifetime prevalence was 14.1% (95% CI 7.3–22.4%), with past-year exposure 5.3% (95% CI 1.6–12.8%). We note that these rates are certainly underestimates, as childhood sexual abuse exposures were excluded. Boys and men with a sexual abuse history experience substantial disclosure and treatment barriers. We draw attention to population health gains that could be achieved via implementation of gender-sensitive assessment and intervention approaches for this at-risk population.
... not disclosing during childhood) is a prominent theme in the literature regarding experiences of childhood sexual abuse (Hershkowitz et al., 2007;Schönbucher et al., 2012). Research suggests that boys disclose less frequently in childhood than girls (Boudewyn & Liem, 1995;Easton, 2013a;Gries et al., 1997;O'Leary & Barber, 2008). The findings of the current study also contribute to our understanding of why boys are less likely to disclose abuse; those men that did disclose early in life described encountering a negative response with little support or guidance, and other men may well have anticipated negative responses and chose not to disclose. ...
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There is increasing recognition of the occurrence and frequency of male childhood sexual abuse (MCSA). Quantitative and qualitative research has demonstrated a number of adverse outcomes associated with MCSA in terms of mental health, physical health and difficulties in behavioural, social or interrelationship functioning. The present study gives voice to male survivors of childhood sexual abuse by exploring themes around the impact of MCSA over the course of their life. Interpretative phenomenological analysis (IPA) of semi-structured interviews with nine male survivors of childhood sexual abuse identified a single overarching theme of control and six related superordinate themes of: (i) responsibility, blame and shame; (ii) development of knowledge about sex and abuse; (iii) avoidance of coping with abuse; (iv) effects on relationships as adults; (v) disclosure of abuse to others; and (vi) gaining a sense of meaning of the abuse. The findings showed that being sexually abused defines and controls a person’s life, and that despite the difficulties experienced by victims to move past the abuse, some experienced a degree of personal growth. The findings illustrate the way in which individuals can create meaning around their abuse experiences and take back control.
... Importantly, there is evidence men do not disclose CSA for decades, over 30 years on average after the event happened. 84 Eventual disclosure to a mental health professional however, was linked with better health and functional outcomes. There is no evidence to contradict either finding for adult sexual abuse. ...
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Background Sexual abuse is a broad category of traumatic experiences that includes rape and any unwanted sexual contact with a body part or foreign object, whether penetrative, oral or otherwise. Although patients with mental illness have a higher risk of becoming victims of sexual abuse in adulthood, few studies investigate the proportion of male victims in this population. Their underrepresentation in research is a barrier to understanding the negative outcomes associated with sexual abuse in men. Aims We estimated the prevalence of recent (past year) and adulthood sexual abuse perpetrated by any perpetrator and separately by intimate partners in males diagnosed with a mental illness. Method To model the prevalences and heterogeneity arising from reports, we used Bayesian multilevel models. Prevalences were estimated for mixed-diagnosis, substance misuse, intellectual disability and post-traumatic stress disorder samples, and studies reporting specifically on intimate partner violence. This review was registered through PROSPERO (CRD42020169299) Results Estimated adult sexual abuse was 5.3% (95% Credibility Interval 1.6–12.8%) for past-year abuse and 14.1% (95% Credibility Interval 7.3–22.4%) for abuse in adulthood. There was considerable heterogeneity of prevalence between studies and diagnosis groups. Conclusions Our analyses show that the prevalence of sexual abuse of males diagnosed with a mental illness was much higher than for men in the general population. This has important implications regarding the proportion of undetected or untreated sexually abused men in clinical practice.
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Childhood sexual abuse is a prevalent problem, yet understanding of later‐in‐life outcomes is limited due to unobservable determinants. I examine impacts on human capital and economic well‐being by estimating likely ranges around causal effects, using a nationally representative U.S. sample. Findings suggest that childhood sexual abuse leads to lower educational attainment and worse labor market outcomes. Results are robust to partial identification methods applying varying assumptions about unobservable confounding, using information on confounding from observables including other types of child abuse. I show that associations between childhood sexual abuse and education outcomes and earnings are at least as large for males as for females. Childhood sexual abuse by someone other than a caregiver is as influential or more so than caregiver sexual abuse in predicting worse outcomes. Considering the societal burden of childhood sexual abuse, findings could inform policy and resource allocation decisions for development and implementation of best practices for prevention and support.
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Introduction For child sexual abuse (CSA) victims, disclosure can be helpful or harmful depending on how recipients respond. Despite a growing body of literature examining reactions to disclosure, little is known about the experiences of current CSA victims, particularly those abused by family. Objective We aimed to describe and explore the initial disclosure experiences of intrafamilial CSA victims, and whether reactions varied based on the type of disclosure recipient. Participants and setting This study utilized anonymous, archival data from the US-based National Sexual Assault Online Hotline (NSAOH), and focused on a sample of 224 intrafamilial CSA victims who had previously disclosed to one type of recipient. Methods NSAOH staff summarized children's disclosure experiences via an open-ended survey field. Data were independently coded using the Social Reactions Questionnaire. Results Nearly three-fourths (73%) of children described receiving a negative reaction to disclosure. Negative reactions included distracting or dismissing the victim (33%), not believing the victim (29%), or retaliating or responding violently following disclosure (10%). Children most frequently disclosed abuse to non-offending family (66%), friends (17%), and formal support providers (12%). Relative to friends and intimate partners, victims were more likely to discuss negative reactions from family (49% v 87%, respectively, Cramer's V = 0.33, p < 0.001). Conclusions Disclosing to non-offending family may be unproductive and potentially harmful for some children. This study has implications for disclosure-related planning protocols on anonymous hotlines. Findings underscore the importance of educating the public, and parents in particular, about how to respond to CSA disclosures.
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While gang violence, community violence, and domestic violence have been recognized as contributing factors to Central American migration, less is known about the intersection between child maltreatment and migration. This article uses secondary data from United Nations High Commissioner for Refugees (UNHCR) interviews with unaccompanied minors from Central America and Mexico to examine child maltreatment. It provides information on the abused children, their abusers, and the questions that led to their disclosure of maltreatment. It finds that girls reported maltreatment at higher rates than boys; only girls in this sample reported sexual abuse and intimate partner violence; and boys experienced physical abuse more than any other form of maltreatment. Overall, girls experienced all forms of abuse at higher rate than boys. Fewer than half of this sample described maltreatment as an explicit reason for migration, even those who viewed it as a type of suffering, harm or danger. In addition, some disclosures suggest that childhood transitions, such as in housing, schooling, or work status, warrant further inquiry as a potential consequence of or contributor to maltreatment. The article recommends that professionals engaged with migrant children in social services, legal services, or migration protection and status adjudications should inquire about maltreatment, recognizing that children may reveal abuse in complex and indirect ways. Protection risks within the home or family environment may provide the grounds for US legal immigration protections, such as Special Immigrant Juvenile Status (SIJS) or asylum. Practitioners working with unaccompanied migrant children should use varied approaches to inquire about home country maltreatment experiences. Maltreatment may be part of the context of child migration, whether or not it is explicitly mentioned by children as a reason for migration. Policy Recommendations US Citizenship and Immigration Services (USCIS) should update SIJS regulations to reflect changes in the law, and modify application procedures to incorporate research knowledge on the impact of trauma on children. The US Departments of Homeland Security (DHS), Justice (DOJ), and Health and Human Services (HHS), should ensure that all children in immigration proceedings receive legal representation through public-private partnerships overseen by the HHS Office of Refugee Resettlement (ORR). Passage of Senate Bill 3108, the Fair Day in Court for Kids Act of 2021, ¹ would at least guarantee legal representation for unaccompanied minors. Codify legal standards (via USCIS regulation, or Congressional statute) for granting asylum based on gender and gender-based violence, and include standards for children and youth. Adjudicators from USCIS, Asylum Offices, and the Executive Office for Immigration Review (EOIR) should consider new information about painful, traumatic, or shame-inducing experiences—such as child maltreatment—as part of the gradual process of disclosure, rather than negatively reflecting on the credibility of the applicant. Federal agencies with immigration responsibilities such as USCIS, Immigration and Customs Enforcement (ICE), and ORR, should be included in the federal government’s Substance Abuse and Mental Health Services Administration’s (SAMHSA) Interagency Task Force for Trauma-Informed Care. These agencies should require new trainings for immigration adjudicators, including immigration judges, asylum officers, Border Patrol agents, and Customs and Border Patrol (CBP) officers, on interviewing and making decisions related to children. Legal service providers should adopt a holistic approach to service provision that includes social workers as part of the child’s legal team.
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Sexual violence is a significant public health problem with long-term health implications. Previous investigations of male victimization have often relied on nongeneralizable samples to examine the health consequences of rape. Furthermore, made to penetrate (MTP) victimization has received very little attention as a specific form of sexual violence. Using data from the 2010 to 2012 National Intimate Partner and Sexual Violence Survey, we examined negative impacts (e.g., injury) and health conditions associated with experiences of rape and MTP among male victims in the United States. Results indicate that approximately 1 in 4 victims of rape-only and 1 in 12 victims of MTP-only reported physical injuries. An estimated 62.7% of rape-only victims and 59.8% of MTP-only victims reported at least one impact due to the perpetrator’s violence. Rape victims were significantly more likely than non-rape victims to report 2 of 11 health conditions measured, while MTP victims had greater odds of reporting 6 of 11 health conditions measured compared to non-MTP victims. This article fills gaps in understanding the impacts of rape and MTP on male victims, and it is the only study to do so using a large, nationally representative sample. Sexual violence is linked to serious health effects but is also preventable. Screening for violence victimization and preventing male sexual violence before it happens are both important to reduce the risk for immediate and chronic health impacts.
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Background/Purpose: Men who were sexually abused during childhood (MSAC) represent a highly stigmatized, marginalized population at risk for a variety of psychological problems across the lifespan (Draper et al., 2008; Talbot et al., 2009). Child sexual abuse (CSA) has the potential to negatively affect numerous dimensions of a survivor's life (e.g., mental health, relationships, work history). Researchers have found that CSA increases the risk of depression, anxiety, substance abuse, divorce, suicide, and others (Holmes & Slap, 1998; Putnam, 2003). However, few researchers have examined why some MSAC incur mental health problems and others do not. The purpose of this study was to identify which factors are related to mental distress among MSAC using a psychosocial trauma processing model: account-making (Harvey et al., 1991). Methods: Using a cross-sectional survey design, the researcher collected data through an anonymous, online, 150-item survey. Participants were recruited through an email campaign and a web page announcement through three national survivor organizations: the Survivors' Network of those Abused by Priests, MaleSurvivor, and 1in6.org. The sample consisted of 487 MSAC, one of the largest studies to date on this population. Most participants were Caucasian (90.9%), were living with a spouse/partner (69.9%), and had a college degree (58.1%). The major domains that were examined included abuse severity, disclosure and account-making, conformity to masculine norms (Mahalik et al., 2003) post-traumatic growth (Tedeschi & Calhoun, 1996). Data were analyzed using multiple regression analyses (OLS). Results: Multivariate analyses for the final direct effects model revealed that high conformity to masculine norms, account-making stage, and two disclosure variables (told after one year, overall response to disclosure) were related to higher levels of mental distress. Three control variables were also related to mental distress: older age, childhood stressors, and current stressors. Posttraumatic growth moderated the relationship between abuse severity (force, penetration) and mental distress. Conclusions and Implications: As one of the first studies to examine disclosure across the lifespan, use standardized measures of PTG and masculinity, and apply account-making theory to this population, this study advanced our knowledge of the mental health of MSAC. Beyond generating knowledge, this study also had important practical implications. For example, mental health practitioners should assess clients for adherence to traditional masculine norms, and help deconstruct rigid, exaggerated norms. The results of this study also indicate that practitioners should concentrate on Axis IV stressors as they have a particularly negative effect on the mental health of MSAC. Other practice, policy and research implications are also presented.
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Purpose. The purpose of this report is to provide a brief psychometric analysis of the Internal Mental Distress Scale using the Rasch measurement model. The 43-item IMDS is a count of past-year symptoms related to internalizing disorders, including somatic, anxiety, depression, traumatic stress and suicide thoughts. It is based on the DSM-IV-TR, the Hopkins Symptom Checklist 90 (HSCL-90), the Mississippi Scale of Post Traumatic Stress Disorder (PTSD) and common screening items for suicide risk (homicidal thoughts, suicidal thoughts, plans, means, attempts). Methods. Data were analyzed on 7,435 persons who presented for substance problem screening. Rasch analysis included an examination of: person and item reliabilities; construct validity including item and person fit statistics; and differential item functioning (DIF) across subgroups. DIF analysis allowed us to determine if the relative item estimates (i.e., item difficulty estimates) remained invariant across subgroups of persons. Results. The IMDS performs well as a measure of the construct of internal mental distress. Both items and scales form the theoretically expected hierarchies with a person internal consistency reliability of .89 and an item reliability of 1.00. The persons' responses generally conformed to the expectations of the Rasch model. Of the 43 items in the IMDS, significant DIF (i.e., > .5 SD = .58 logits) occurred in 3 items for males vs. females, 11 items for youth vs. adults, 4 items for race when using African American as the reference group, and 17 items for primary substances when using alcohol as the referent. In terms of person fit, over 86% of the persons exhibited person infit and outfit that were low or moderate (LMI/LMO) and were thus regarded as fitting the Rasch model expectations well from a clinical perspective. The group termed, Atypical Type 1, (10 %) consisted of persons with low/moderate infit and high outfit (LMI/HO), where the overall score may underestimate severity since these tended to be people who were having suicidal thoughts (higher risk items) but were unexpectedly low on depression, about moderate on somatic, low to moderate on anxiety, except for the three highest anxiety items where they were higher, and low to moderate on trauma (which all tended to be lower risk than suicide). The HI /LMO group, Atypical Type 2, consisted of only 11 people (.1%). This group was characterized by low depression but was especially high on trauma, stress, and anxiety while being somewhat higher on somatic complaints and suicidal ideation. The HI/HO group, Atypical Type 3, (3.4%) tended to be valid high scorers who also had an overall measure that may underestimate severity somewhat and tended to have higher anxiety, higher trauma and higher suicidal ideation while their depression and somatic symptoms were moderate. These persons misfit because they strongly endorsed most of the higher risk items but only endorsed some of the lower risk items at moderate levels. Conclusion. The IMDS functioned well as a unidimensional measure with good person and item reliability. In terms of item quality, there were no items with both infit and outfit values outside of our criterion of .75-1.33. While there were several items with high outfit values, these indicated that a few people endorsed these items
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