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Although the terms ‘sexual offences’ and ‘paraphilias’ are often used interchangeably, and there is overlap between them, there needs to be clarity about what each means. Sexual offences are marked by breaches of statute law, determined largely by the justice system (although an individual’s behaviour can place them at risk of law breaking). Only a proportion of sex offenders suffer from paraphilias and not all individuals with a paraphilia are sex offenders. Frequently individuals suffering from paraphilias harbour extreme sexual fantasies and urges only, or their act does not cross the threshold of involving a non-consenting individual or child. The treatment of paraphilias is not solely based on minimising risk, but also can include the aim of reducing the severe distress that an individual can feel about their extreme sexual urges. Whether people with intellectual disability are more likely to offend sexually than the general population is the subject of much research. Exploration of the range of sexual problems and potential treatments are covered.
Most information about the association between childhood maltreatment (CM) and subsequent psychiatric morbidity is based on retrospective self-reports. Findings from longitudinal studies using prospective reports to statutory agencies may be subject to attrition. We therefore compared the prevalence to age 30 of inpatient psychiatric diagnoses in those who experienced agency-reported CM with those of the rest of the cohort using administrative data to minimise loss to follow-up.
Methods
We used linked administrative data for two birth cohorts of all individuals born in Queensland, Australia in 1983 and 1984 (N = 83,050) and followed to age 30 years. This was the entire cohort aside from 312 people who died. Information on CM came from statewide child protection data and psychiatric diagnoses from all public and private hospital admissions in Queensland.
Results
On adjusted analyses, the 4,703 participants (5.7%) who had been notified to the statewide child protection authority had three to eight times the odds of being admitted for any of the following psychiatric diagnoses by age 30 years old: schizophrenia-spectrum disorders, bipolar affective disorders, depression, anxiety and post-traumatic stress disorders (PTSD). There were similar findings for all the CM subtypes. Associations were especially strong for PTSD with between a seven – and nine-fold increase in the odds of admission.
Conclusions
This is one of the largest studies of the long-term effects of CM, covering an entire jurisdiction. All types of maltreatment are significantly related to a range of psychiatric disorders requiring hospitalisation. Early identification, intervention and providing appropriate support to individuals who have experienced CM may help mitigate the long-term consequences and reduce the risk of subsequent mental health problems.
Father Ed Donelan came to New Mexico from Massachusetts. The priest worked as a chaplain at a facility for “juvenile delinquents,” and later ran a home for boys he called the Hacienda de los Muchachos. Donelan sexually abused youth at both facilities. This essay considers how Donelan leveraged New Mexico’s juvenile justice and habilitation systems, and racial inequities baked into them, to abuse young people. Within those systems, a Catholic culture of clericalism granted Donelan unlimited access to youth, and enabled him to move unchecked between spiritual and quasi-parental forms of authority. Donelan’s story shows that clericalism is not a one-size-fits-all problem; it manifests differently in relation to different communities. Here clericalism intersects with place-based power structures of race and colonialism to damage in locally specific ways. Donelan’s case demonstrates that scholars who study clerical sexual abuse need to pay attention not only to priests, but also to church and state institutions that rendered certain populations of children especially vulnerable to their bad actions.
Child-focused education programs have been developed in efforts to prevent child sexual abuse and to provide children who may already be experiencing abuse with strategies for seeking help. The design and delivery of these programs must be based on empirical evidence rather than ideology. Program evaluations have demonstrated that prevention education can provide children with knowledge and skills for responding to, and reporting, potential sexual abuse. Preschool and school-based programs are typically delivered to children in class groups via a series of lessons that convey core concepts and messages, and are best taught using engaging pedagogical strategies such as multimedia technologies, animations, theatre or puppet shows, songs, picture books and games. This chapter outlines the key characteristics of effective child sexual abuse prevention education and identifies directions for future research and practice.
This chapter reflects on the psychological, physical consequences of sexual violence in and beyond Othello—in contemporary times. I argue that the white identity formation process, and allegiance to its ideals, inherently impedes racial equality; the process itself works to reiterate white superiority. This is evident as I apply the intraracial color-line mainly to readings of Iago, the play’s most visible and vocal white other. In conjunction with readings of Othello, I look back at the transatlantic slave trade and examine the trajectory of white violence that has led to Black silence and the de-victimization of Black boys and men, which is one of many reasons psychologists suggest Black males are not always heard, much like Othello, when it comes to their experiences with sexual and non-sexual violence. With historical examples in mind, I return to Shakespeare’s canon to reflect on how early modern texts amplify the “white voice.”
While child maltreatment is a global problem, urban settings highlight the problem due to large concentrations of people, which increase the likelihood that the maltreatment will be noticed and reported; urban Emergency Departments (EDs) are particularly situated for the detection of child maltreatment. The ability of the emergency physician to recognize and respond to child maltreatment is crucial in preventing further harm to the child. Emergency physicians are also mandated reporters, and are required by law to inform child protective services of all suspected cases. There are certain risk factors for child abuse and subtle red flags in the history and physical exam that we must familiarize ourselves with in order to appropriately identify child abuse. These risk factors and rates of child abuse may be unique for the clinician practicing emergency medicine in an urban setting. The evaluation of a child with suspected abuse also requires an extensive workup and detailed documentation, and such cases are prone to medical and legal consequences.
Sexual abuse and bullying are associated with poor mental health in adulthood. We previously established a clear relationship between bullying and symptoms of psychosis. Similarly, we would expect sexual abuse to be linked to the emergence of psychotic symptoms, through effects on negative affect.
Method
We analysed English data from the Adult Psychiatric Morbidity Surveys, carried out in 2007 (N = 5954) and 2014 (N = 5946), based on representative national samples living in private households. We used probabilistic graphical models represented by directed acyclic graphs (DAGs). We obtained measures of persecutory ideation and auditory hallucinosis from the Psychosis Screening Questionnaire, and identified affective symptoms using the Clinical Interview Schedule. We included cannabis consumption and sex as they may determine the relationship between symptoms. We constrained incoming edges to sexual abuse and bullying to respect temporality.
Results
In the DAG analyses, contrary to our expectations, paranoia appeared early in the cascade of relationships, close to the abuse variables, and generally lying upstream of affective symptoms. Paranoia was consistently directly antecedent to hallucinations, but also indirectly so, via non-psychotic symptoms. Hallucinosis was also the endpoint of pathways involving non-psychotic symptoms.
Conclusions
Via worry, sexual abuse and bullying appear to drive a range of affective symptoms, and in some people, these may encourage the emergence of hallucinations. The link between adverse experiences and paranoia is much more direct. These findings have implications for managing distressing outcomes. In particular, worry may be a salient target for intervention in psychosis.
The term trauma comes from the ancient Greek word “titrosko” than means perforate. Sexual harassment and abuse of a person during childhood is an important risk factor for mental trauma.
Objectives
Present the impact of sexual harassment and abuse in the mental health of adolescents and the imprortance of therapeutic relationship.
Methods
From the literature review the child needs love which is demostrated with tenderness. The adult (perpetrator) with a disorder responds to the child’s tenderness with the language of passion. The immature Ego of the child is not strong enough to deal with the adult behavior and this causes anxiety, helplessness, confusion and guilt about the relationship with the adult. During the psychotherapeutic process, 4 main protagonists emerge : the victim, the perpetrator, an absent mother and an omnipotent savior.
Results
Mental trauma can adversely affect the development of the neurobiological system resulting in difficulty coping with stressful events. Untreated trauma can lead to serious psychopathology such as anxiety disorders , depressive disorder, personality disorders, addictions. The creation of a therapeutic relationship, understanding the adolescent and his family potential, the recognition and treatment of transference-countertransference phenomena and the existence of a clinical setting that acts as a restraint mechanism could contribute to the therapy of mental trauma.
Conclusions
The Therapeutic Department for Adolescents could be an environment to contain, process and transform the painful into pleasant emotions, as well as aiming the authenticity of the person with a history of sexual harassment and abuse.
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.
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.
Childhood and adolescence sexual abuse (CSA) is a risk factor for psychological trauma and a strong predictor of lifetime psychopathology, including depression, anxiety, inappropriate sexual behavior, anger, guilt, shame and other emotional and relationship problems.
Objectives
Describe a clinical case of a sexually abused adolescent admitted in a psychiatric unit for young adults and to correlate sexual abuse with trauma and sexual risk behaviors.
Methods
The data was collected through clinical and family interviews. The revision was made with the search terms “trauma”, “child and adolescence sexual abuse”, “sexual risk behaviors” in scientific databases.
Results
16 year-old girl, high-school student, living with her nuclear family, was admitted in a psychiatric hospital with feelings of sadness and anxiety since the previous month, that lead to a voluntary medicine ingestion. She has been continuously sexually abused from the age of 12 to 16 by an older man, and once by her cousin and his friends. Since than, she refers feelings of anger, sadness, dissociative symptoms and intrusive images and nightmares related to the abuses, and continues to seek attention from older men. With medication and individual and family psychotherapeutic interventions, depressive, anxiety and dissociative symptoms have improved.
Conclusions
Literature concludes that there’s a strong correlation between CSA, trauma and sexual risk behaviors throughout adulthood. In fact, our patient met criteria for Pos-traumatic Stress Disorder and has sexual risk behaviors that must be worked through therapy. Due to it’s complexity, treatment of the adolescent and familial system after sexual abuse is multifaceted and requires a biopsychosocial approach.
The sexual abuse of children is well documented in literature. Data on it from Nigeria is rather sparse. The current study examines the prevalence and pattern of sexual abuse with a view to increasing our understanding of it.
Objectives
To determine the prevalence and pattern of sexual abuse of children at home in Ilorin Nigeria.
Methods
A cross sectional survey of secondary school students aged 11-18 years in Ilorin Nigeria using multistage random sampling technique with proportional allocation was done. Respondents completed the ICAST-CH questionnaire which covers child abuse in its several forms including sexual abuse. Prevalence of sexual abuse was computed.
Results
Over a third (586) of participants experienced some form of sexual abuse in the last year. Table 1: prevalence and pattern of sexual abuse at home
Sexual Abuse* (n=586)
Frequency
Percentage
Talked to you in a sexual way
420
71.7
Touched private parts
333
56.8
Showed pornography
149
25.4
Made you look at private parts
136
23.2
Tried to have sex with you (unwilling)
61
10.4
Made a sex video of you
-
-
Conclusions
Sexual abuse of children occurs commonly in Ilorin Nigeria. There is a need for further research towards understnding it determinants towards strengthening systems of safeguarding children against it.
Child sexual abuse is a major public health problem in Sri Lanka, with prevalence rates ranging from 14-44%.
Objectives
We aimed to describe the victim and perpetrator characteristics, pattern of disclosure and psychological consequences of sexual abuse in children presenting to a tertiary care hospital in Sri Lanka.
Methods
This was a retrospective file review study of 164 victims who presented to a Teaching Hospital in Colombo, Sri Lanka, with alleged sexual abuse over a period of 5 years from 2015-2019.
Results
Majority of the victims were female and older than 12 years. Majority (73.6%) have been subjected to penetrative sexual abuse with 58.5% of victims reporting more than one incident of abuse. Almost all (99.9%) of the perpetrators were male, with 94.5% being known to the child. Only 42.7% (n=70) of the children revealed about the incident within the first week. Delayed disclosure (i.e. more than 1 week since the incident) was significantly higher in penetrative abuse (p<0.01), multiple incidents of abuse (p<0.01) and in abuse by a known person (p<0.05). Children who disclosed after one week were significantly less likely to disclose about the incident spontaneously (p<0.01). Psychological sequel was seen in 28.7%, with depression being the commonest diagnosis (8.5%). Psychological consequences were significantly in higher those who had physical evidence of abuse (p<0.01), delayed (after 1 week) disclosure (p<0.05) and in those who did not disclose spontaneously (p<0.01).
Conclusions
The victim and perpetrator characteristics, pattern of disclosure is comparable with previous literature.
Childhood trauma (CT) is associated with an increased risk of mental health disorders; however, it is unknown whether this represents a diagnosis-specific risk factor for specific psychopathology mediated by structural brain changes. Our aim was to explore whether (i) a predictive CT pattern for transdiagnostic psychopathology exists, and whether (ii) CT can differentiate between distinct diagnosis-dependent psychopathology. Furthermore, we aimed to identify the association between CT, psychopathology and brain structure.
Methods
We used multivariate pattern analysis in data from 643 participants of the Personalised Prognostic Tools for Early Psychosis Management study (PRONIA), including healthy controls (HC), recent onset psychosis (ROP), recent onset depression (ROD), and patients clinically at high-risk for psychosis (CHR). Participants completed structured interviews and self-report measures including the Childhood Trauma Questionnaire, SCID diagnostic interview, BDI-II, PANSS, Schizophrenia Proneness Instrument, Structured Interview for Prodromal Symptoms and structural MRI, analyzed by voxel-based morphometry.
Results
(i) Patients and HC could be distinguished by their CT pattern with a reasonable precision [balanced accuracy of 71.2% (sensitivity = 72.1%, specificity = 70.4%, p ≤ 0.001]. (ii) Subdomains ‘emotional neglect’ and ‘emotional abuse’ were most predictive for CHR and ROP, while in ROD ‘physical abuse’ and ‘sexual abuse’ were most important. The CT pattern was significantly associated with the severity of depressive symptoms in ROD, ROP, and CHR, as well as with the PANSS total and negative domain scores in the CHR patients. No associations between group-separating CT patterns and brain structure were found.
Conclusions
These results indicate that CT poses a transdiagnostic risk factor for mental health disorders, possibly related to depressive symptoms. While differences in the quality of CT exposure exist, diagnostic differentiation was not possible suggesting a multi-factorial pathogenesis.
While many children are born into families where parents generally care for their health and education and strive to provide them with safe and happy home lives, other children are not as fortunate and are subject to maltreatment such as abuse or neglect (Australian Government, Department of Social Services, ). Most parents have the capacity to provide love, care and support for their children while others need extra help along the way. There are parents who may appear to neglect their child; however, they may be struggling with a disability and poverty through a work or health situation (Australian Institute of Family Studies, ). Responding to the children in such vulnerable families is an integral focus of Australia’s welfare system (Fernandez, ).
Following the format change to single best answer questions (SBAs) for the Diploma of the Royal College of Obstetricians and Gynaecologists, this excellent resource is fully aligned with the new syllabus and exam style. Topics covered include basic clinical and surgical skills, all stages of pregnancy from antenatal care to postpartum problems, and general gynaecological and fertility concerns. Containing 310 single best answer (SBA) style questions, detailed explanations ensure candidates understand the reasoning and evidence-based decision-making behind each answer. With a recommended reading source also provided readers can explore and revise topics in further detail to reinforce their learning. A further 130 questions are included in two mock exam papers, helping candidates to strengthen their time management skills. Written by an author with many years' experience working on the DRCOG, candidates can be sure of the exact question format and how best to prepare for the actual exam.
Catholic schools have faced a number of hurdles in recent decades, including the sharp decline of vocations among religious sisters who have worked in schools (as much as 90 percent in the last four decades), rising tuition prices for families, the sexual abuse crisis, and questions about institutional commitment to maintaining schools in light of these challenges. These changes affect all students and families, but have special significance for those of lower socioeconomic status, who historically used Catholic schools as an engine of upward mobility.
For this policy dialogue, the editors of HEQ asked Paul Grendler and Carol Ann MacGregor to reflect on the benefits, challenges, and turning points of Catholic-sponsored education from the sixteenth century to the present. Grendler is Professor Emeritus of History at the University of Toronto, the former president of the Renaissance Society of America and the American Catholic Historical Association, and a recipient of the Galileo Galilei Prize. The author of eleven books, he has published widely on education in the Renaissance. His recent work concentrates on Jesuit universities and Jesuit schools, especially in Italy. MacGregor is Associate Professor of Sociology and current Vice Provost at Loyola University New Orleans. She has also been named an Associate Fellow of the Institute for Advanced Studies in Culture at the University of Virginia. Her publications, which have appeared in American Catholic Studies and American Sociological Review (among others), focus on Catholic education policy and practice, and religion and public life.
HEQ Policy Dialogues are, by design, intended to promote an informal, free exchange of ideas between scholars. At the end of the exchange, we offer a list of references to readers who wish to follow up on sources relevant to the discussion.
Contending with Kei Miller’s declaration in ‘A Smaller Sound, A Lesser Fury: A Eulogy for Dub Poetry’ that the genre has died, this essay uses the lens of transition to demonstrate the continued vitality of this Jamaican-rooted performance and neoliterary genre that serves political and aesthetic needs of the variously disempowered. The essay suggests Miller misconceives what dubpoetry is, threatening its vital social work and doing a disservice to the older generation of dubpoets and their inheritors. Providing evidence that the majority of first-generation dubpoets continue to create new work, collaborate, develop new subgenres, and teach, the essay offers close readings of work by dubpoetry’s heirs. Jamaican dubpoetry band The No-Maddz, Jamaican-British spoken word poet Raymond Antrobus and Canadian dub inheritors Klyde Broox, d’bi.young anitafrika and Kaie Kellough are shown to effect presentational, generic, thematic/political and media transitions in and from dubpoetry.
Lisa M. v. Henry Mayo Newhall Memorial Hospital exemplifies the reluctance of many courts to impose vicarious liability in cases of employee sexual abuse, treating cases of sexual abuse differently from other cases. The California Supreme Court in Lisa M. ruled against a pregnant patient who had been sexually molested by a hospital technician under the guise of performing an ultrasound examination. The court determined that the assault was “outside the scope of employment,” not fairly attributable to the employer, and the result only of “propinquity and lust.” The rewritten feminist opinion recharacterizes the assault as an outgrowth of employment, emphasizing that the employee exercised job-created control and power over plaintiff’s body. Because sexual assaults are not uncommon in the healthcare setting, the feminist opinion regards the assault as foreseeable and would allow a jury to determine whether vicarious liability is warranted because the assault was committed within the scope of employment. The accompanying commentary situates the case at the intersection of sexual violence and women’s health and examines how job-created power can make a patient vulnerable to harm by medical professionals.
Child sexual abuse is a serious problem that has received increased attention in recent years. When viewed from an ecological perspective child sexual abuse can be understood as being influenced by factors within individuals, families and broader social systems. Therefore, preventing child sexual abuse involves strengthening capacity to intervene at individual, family, and broader social levels such as via school programs and community initiatives.School-based education programs have been developed in efforts to prevent child sexual abuse before it happens, and to provide children who may already be experiencing it with information about the importance of and strategies for seeking help. This chapter outlines the key characteristics of effective child sexual abuse prevention programs and identifies directions for future research and practice.