(Philadelphia, PA) -- Sexual abuse of boys appears to be underrecognized, underreported, and undertreated, according to a new study by researchers at the University of Pennsylvania School of Medicine. Such wholesale societal shunning of the magnitude of the problem may contribute, in part, to the development of long-term psychosocial problems in the adult male victims of childhood sexual abuse, conclude the researchers. Some of those psychosocial effects include mild to severe psychiatric disorders, substance abuse involving multiple drugs, and serious sexual problems -- including intimacy and sexual-identity problems, the early adoption of high-risk behaviors, and the circular transformation of the child victim into an adult perpetrator. The study appears in the December 2 edition of the Journal of the American Medical Association.
"Based on our results, we urge all medical professionals -- but especially mental-health experts -- to ask specifically of new male patients about any history of childhood sexual abuse," says William C. Holmes, MD, MSCE, lead author of the study and Assistant Professor of Internal Medicine at Penn. "Then, comcommitant with patient disclosure, the provider should help that patient receive some form of counseling so that he may begin to deal effectively with negative emotions and behaviors linked to the previous abuse."
For their study, the researchers sought to clarify the definition of sexual abuse of boys, and also to help determine the prevalence of such abuse in the nation. To that end, they reviewed and compared 166 previously-published studies of the topic. One of the most glaring deficiencies noted among the studies was the wide variance that existed for the definition of sexual abuse: indeed, while some studies used objective questions to determine abuse, others used subjective questions, and still others used no questions at all (relying, instead, on unstated methods of documentation). "The breadth of any given problem cannot be accurately measured until there is agreement on the definition of the problem," explains Holmes, who also serves as Senior Scholar in Penn's Department of Biostatistics & Epidemiology. "A prerequisite to improving research in this field is clarification and standardization of how investigators ask subjects about and define male sexual abuse. Objective questioning should be the norm, with terms for sexual organs clearly used (e.g.,penis) and acts described in simple, graphic language."
Notwithstanding the problem of definition, the researchers found 8-16% of the general male population had a history of sexual abuse, and that boys at highest risk for sexual abuse were younger than 13 years, nonwhite, of low socioeconomic status, and not living with their fathers. Perpetrators tended to be known, but unrelated, males. Abuse frequently occurred outside the home, involved penetration, and occured more than once.
Equally disturbing are the far-reaching consequences to the long-lasting emotional health of sexually-abused adolescent boys. In terms of psychiatric problems, there are higher rates of borderline personality disorder, depression, and suicide attempts in men who have been victims of sexual abuse versus those who have not. Drug use begins earlier for male victims of sexual abuse, and typically involves multiple substances. "Perhaps, for these men, substance abuse is a way of self-medicating; a way to blunt that side of reality," suggests Holmes.
Long-lasting sexual problems are in evidence, as well, for victims. One of the most concerning is that the sexual abuse of boys may contribute to the evolution of young victim to adult perpetrator. "I think a lot of people would find that connection quite damning, but I look at it more sympathetically," says Holmes. "Our culture does not encourage boys to speak about abuse, so they hold it inside themselves. Then, later on, what more powerful way for these men to rid themselves of 'victimhood' than by becoming perpetrators?"
Given that boyhood sexual abuse manifests itself in so many negative outcomes, the researchers call for the development of interventions that are focused and effective. "Sexual abuse of boys is happening, and we need to address it more aggressively as a society," emphasizes Holmes.
"We must become as vigilant with our boys as we are with our girls," he adds. "Parents must be equally concerned about where their sons are, who they're with, and ask them how they are. They must also create an environment that allows their sons to feel safe talking about any sexual abuse or potential abuse they may have suffered."
Editor's Note: Dr. William Holmes may be reached directly at 215-898-8188.
Journal
JAMA