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Klafter AB, Impact of Sexual Abuse (Jewish Version)-1

Klafter AB, Impact of Sexual Abuse (Jewish Version)-1

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 The Impact of Child Sexual AbuseNachum Klafter, MDUniversity of Cincinnati College of MedicineDepartment of Psychiatry
Submitted to the Jewish Board of Advocates for ChildrenSeptember 21
st
, 2008
One way to evaluate the morality of a society or community is to examine how it treats andprotects its most vulnerable members. Our children lack the physical power, intellectualresources, political sophistication, and legal standing to advocate for or protect themselves. Assuch, they are certainly among the most vulnerable in our society. They depend on their parents,teachers, physicians, therapists, clergy, communal leaders, police, and government officials tolook after their safety and protection. When these individuals fail to protect them—and all themore so when these individuals victimize them—children have little or no ability to turnelsewhere.I am therefore honored to have been invited by the Jewish Board of Advocates for Children toprepare a synopsis of the impact of sexual abuse on children. It is my hope that this will furthertheir worthy goal of influencing our communities to develop policies and adopt measures thatwill help prevent child sexual abuse.
 
Klafter, Impact of Sexual Abuse
2
Definition and Scope of Child Sexual Abuse:
Sexual abuse of children has occurred in all societies since the dawn of civilization, as testifiedto in ancient literatures from around the world. It should be defined as any sexual contact with achild which is coercive, or which involves an adult or significantly older child taking advantageof the child's naïveté or inability to protest. These sexual activities could include any of thefollowing: exhibitionism; voyeurism; touching genitals, buttocks, or other body parts of thechild for sexual arousal; directing the child to touch the perpetrator; fellatio or cunnilingus; analor vaginal penetration; or any other nonconsensual activity intended by the perpetrator for sexualgratification.The incidence and frequency of sexual abuse are not precisely known. It is believed by mostexperts that sexual abuse of children is vastly underreported. One basis for this belief is the factthat in random surveys of adults, the reported frequency of sexual abuse during childhood is farhigher by many orders of magnitude than the frequency of allegations which are reported toauthorities and substantiated by child protective service agencies. The National Committee toPrevent Child Abuse collects data every year on the incidence of reports of various forms of child abuse. In 1997, the incidence of substantiated sexual abuse allegations was less than twoper thousand children (<0.2%). By contrast, the frequency of sexual abuse reported by adultswho are answering questions about their experiences during childhood varies from 10% to 35%.The wide range of frequencies found in these studies can in part be explained by the criteria usedto define sexual abuse. For example, in some studies only penetration or touching of genitaliawas classified as sexual abuse, where others use a more inclusive definition. The numbers areconsistently two to three times higher for sexual abuse of girls than that of boys. The USSurgeon General's Report in 1999 estimated that 15%-33% of American children have beensexually abused. (A comprehensive and scientific meta-analysis is a very complicatedundertaking, and is beyond the scope of this paper).
Sexual Abuse In the Orthodox Jewish Commity
The prevalence of sexual abuse among Jews, or among Orthodox Jews, is unknown. One study,published in the November, 2007, issue of the
 American Journal of Psychiatry
, surveyedOrthodox Jewish women. Because only a tiny subset of subjects invited to participate in thesurvey actually responded, the sample is not random. Therefore, this study is not comparable tostudies of incidence of abuse in the general population, and does not provide an estimate of theprevalence among Orthodox Jews. Nevertheless, this article generated significant controversy.Individuals in the lay press have cited this study in their attempts to argue that sexual abuse is just as frequent among Orthodox Jews as it is in the general population. Others have cited thisstudy to argue the reverse—that sexual abuse occurs at a much lower rate among Orthodox Jewsthan the rest of the population. The justification for this latter argument, which one should noteis contrary to the conclusions of the authors of the paper, is that the rate of sexual abuse amongwomen in this study who were raised in Orthodox homes was only about one half the rate of sexual abuse among other women in the same sample. In any case, this sample is notrepresentative of Orthodox women and therefore cannot be used to draw such a conclusion. Thisauthor wrote a critique of the study and associated controversy. It is included in the referencesbelow.
 
Klafter, Impact of Sexual Abuse
3There is one thing which is abundantly clear: Even if it could be clearly demonstrated that theincidence of sexual abuse among Orthodox Jews is significantly lower than the incidence in thegeneral population (and, again, this has never been demonstrated), Orthodox Jews are notimmune to sexual abuse. The recognition by Orthodox religious leaders of the existence sexualabuse in the Orthodox Jewish communities has led to creation in several communities of special
 Batei Dinim
(religious courts) which are charged with adjudicating cases of sexual abuse. Theircharge is to hear allegations of sexual abuse, and to censure perpetrators and prevent them fromvictimizing additional children in the future.There are, at present, several highly publicized scandals in Israel and North America involvingOrthodox Jewish educational institutions which failed to report educators who were alleged tohave perpetrated sexual abuse against students, thus enabling them to continue to work withchildren for many additional years, or in some cases decades. Because modesty in sexualmatters is such a prominent religious value in Judaism, it is difficult for many to imagine thatsuch a scenario is possible. In reality, however, mishandling of sexual abuse allegations hasbeen the rule rather than the exception in every society and socio-economic demographic. It isnaive to think that Jewish schools, without training and special procedures, would be any moresophisticated at handling sexual abuse allegations than the rest of the world.
Physical trauma caused by sexual abuse
There may be immediate physical consequences of sexual abuse, which cause suffering for thesurvivor and require medical attention. When sexual abuse involves vaginal or anal penetration,there can be physical trauma for girls or boy which causes significant physical discomfort andpain, and which puts children at risk for bleeding or infection. Problems or pain with urinationor defecation are common consequences of this physical trauma. Children who have beensexually assaulted are also at increased risk for sexually transmitted diseases, including HIVinfection. Medical evaluation is therefore indicated in such cases as the child may requiremedical or surgical treatments, and prompt medical treatment may prevent the child fromcontracting a sexually transmitted disease. Sedation or anesthesia for young children issometimes advisable during these examinations. Such evaluations are also an occasion for thecollection of evidence for eventual criminal prosecution of the perpetrator. In recent years, manyemergency departments have developed specialized evaluation teams so that the evaluation andtreatment of abused children can be integrated with assessments by forensic mental healthprofessionals. The advent of such resources enables children to receive appropriate evaluationand care without being traumatized further, and enables law enforcement officials to obtainphysical evidence and testimony which will be admissible in court. This was not always thecase, as survivors of sexual abuse prior to the 1990's can attest.
Short Term Psychological Consequences
Children who have been sexually abused often show immediate symptoms of the psychologicalimpact of this trauma. Recognition by parents, teachers or other responsible adults of an abruptchange in a child's behavior can lead to a discovery of molestation or sexual assault. Somechildren immediately show signs of psychiatric disorders: depressed mood, anxiety, obsessions,panic attacks, fear of certain locations or people, social withdrawal, severe nightmares,

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