מתוך medicontext.co.il
NEW YORK (Reuters Health) – A "cycle" of child sexual abuse seems to exist for only a minority of male victims, but not at all for female victims, report investigators at the Tavistock and Portman NHS Trust in London.
Dr. I. Kolvin and colleagues conducted a clinical case note review of 843 randomly selected subjects attending a forensic psychotherapy clinic for sexual deviants and offenders. Two women and 225 men were found to be child abusers, out of a total of 96 women and 747 men.
Forty-one of the women were victims of sexual abuse, one of whom became a perpetrator, the investigators report in the British Journal of Psychiatry for December. Seventy-nine of 135 male victims became perpetrators.
Homosexual men and transvestites were significantly less likely to be perpetrators than were heterosexual men and men who were not transvestites (p < 0.001 for both). The authors observed no significant associations between status as a child molester and voyeurism, fetishism, obscene phone calls, or other sexually deviant acts.
Ten perpetrators and eight nonperpetrators used pornography compulsively, suggesting this as a possible risk factor. In addition, 19 of 24 men molested by a female became perpetrators compared with 60 of 111 molested by males. Thus, victimization by a female may contribute more to a male becoming an abuser than victimization by a male. However, the authors caution that the numbers may be too small to establish causation.
"Although the data do not provide strong support for a cycle of sexual abuse encompassing a substantial proportion of male perpetrators, prior victimisation may have some effect in a minority of perpetrators, and can be viewed as one mediating factor which enhances the probability of subsequent perpetrator behaviour," the authors summarize.
Two invited commentaries accompany the report by Dr. Kolvin's team. Dr. Mary Cannon, of the Institute of Psychiatry in London, cautions against blaming the victim, which could lead to further stigmatization and stress for individuals who have been molested in childhood. She does praise the study for exposing "psychoanalytic theory to epidemiological scrutiny."
Dr. Susan Bailey, of Mental Health Services of Salford in Manchester, UK, notes that "for each individual, dispositions conditioned by childhood abuse are subject to many different kinds of combinations of motivating and mediating factors that ultimately determine whether or not and in what circumstances being abused can lead on to abusing."
She maintains that the real challenge for society is to develop treatment programs that are then evaluated by long-term follow-up.
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