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Rights of Child Victims of Sexual Assault in Mental Health

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Rape is the most underreported crime in America. Significant changes to improve the treatment of sexual assault victims have occurred in the last two decades. The impact of reforms, led by the women's movement, can be seen in the legal, mental health, medical, and victim services arenas. During the 1970s, the first rape crisis center was established. The treatment of victims in the criminal justice system was questioned, and hundreds of laws were passed to protect rape victims in the courts. Medical protocols have been developed and widely accepted. The mental health impact of rape is well documented in the literature, and the practices of mental health professionals have improved

Although the treatment of rape victims today is vastly different from three decades ago, many victims still do not receive the assistance and treatment they need.

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Sexual violence occurs throughout the world. Although in most countries there has been little research conducted on the problem, available data suggest that in some countries nearly one in four women may experience sexual violence by an intimate partner, and up to one-third of adolescent girls report their first sexual experience as being forced. Sexual violence has a profound impact on physical and mental health. As well as causing physical injury, it is associated with an increased risk of a range of sexual and reproductive health problems, with both immediate and long-term consequences. Its impact on mental health can be as serious as its physical impact, and may be equally long lasting. Deaths following sexual violence may be as a result of suicide, HIV infection or murder – the latter occurring either during a sexual assault or subsequently, as a murder of ‘‘honour’’. Sexual violence can also profoundly affect the social wellbeing of victims; individuals may be stigmatized and ostracized by their families and others as a consequence. Coerced sex may result in sexual gratification on the part of the perpetrator, though its underlying purpose is frequently the expression of power and dominance over the person assaulted. Often, men who coerce a spouse into a sexual act believe their actions are legitimate because they are married to the woman

Rape of women and of men is often used as a weapon of war, as a form of attack on the enemy, typifying the conquest and degradation of its women or captured male fighters. It may also be used to punish women for transgressing social or moral codes, for instance, those prohibiting adultery or drunkenness in public. Women and men may also be raped when in police custody or in prison.

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The heterogeneity of definitions of child sexual abuse is also reflected in the widely varied reactions, ranging from severe psychological impact to no evidence of negative psychological sequelae

For those who are affected, the mental health effects of childhood sexual abuse are varied. Child survivors of sexual abuse are at increased risk for anxiety, inappropriate sexual behavior and preoccupations, anger, guilt, shame, depression, posttraumatic stress disorder (PTSD), and other emotional and behavioral problems throughout their life span. Research shows that survivors of child sexual abuse are more likely to experience social and/or health problems in adulthood, such as alcohol problems, use of illicit drugs, suicide attempts, and marriage/family problems (Noll J, Trickett P, 2003). Numerous studies show that CSA survivors are vulnerable to later sexual revictimization in both adolescence and adulthood. Finally, CSA has a clear correlation with high-risk sexual behaviors (eg, multiple sexual partners) and may have a connection with later abuse on others. The effects of CSA are often compounded by other types of co-occurring abuse and dysfunction, producing a cumulative effect on risk factors for negative health outcomes, including adult diseases such as heart, lung, and liver disease, and cancer. Although much of this literature focuses on the outcomes for girls, a meta-analysis of the impact of childhood CSA on boys shows similar outcomes. Although the design limitations in CSA research often preclude causal inference, twin studies have demonstrated that the association between CSA and such adverse health outcomes is independent of other risk factors in the home environment (Nelson EC, Heath AC, 2002).

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Briefly, in resource poor settings, most efforts to strengthen responses to survivors of sexual violence have so far focused on the training of specialised staff based in hospitals or crisis centres who administer limited services – immediate care and, a forensic exam – before referring patients on to mental health practitioners or social workers for mental health interventions, if the latter are available. In many cases there is no capacity to provide psychological interventions.

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Noll J, Trickett P, Putnam F. A prospective investigation of the impact of childhood sexual abuse on the development of sexuality. J Consult Clin Psychol. 2003;71:575–86.

Homma Y, Wang N, Sawyc E, et al. The relationship between sexual abuse and risky sexual behavior among adolescent boys: a meta-analysis. J Adolesc Health. 2012;51(1):18–24.

Felitti VJ, Anda RF, Nordenberg D, et al. Am J Prev Med. 1998;Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: the adverse childhood experiences (ace) study.14:245–58.

Nelson EC, Heath AC, Madden PA, et al. Association between self-reported child sexual abuse and adverse psychosocial outcomes: results from a twin study. Arch Gen Psychiatry. 2002

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