Introduction and Literature Review
Childhood sexual abuse is widely recognized as one of the most deleterious and injurious forms of abuse. CSA is found to have a significant impact on the psychological, social, emotional, and spiritual development of an individual. There is much literature examining the risk factors, symptomatology, and interventions for this population (Briggs et al., 1997; Fergusson et al., 2008; Rumstein-McKean, 2001). One emerging outcome of CSA is the commercial sexual exploitation of children. There is limited but growing research in this are as political and societal views on this issue shift. This paper will examine the broad topic of childhood sexual abuse with a focus on commercial sexual exploitation of children as an outcome, and the gaps in research in the area of CSEC.
I. Outcomes for Female Survivors of Childhood Sexual Abuse
The Encyclopedia of Psychology defines sexual abuse as, “unwanted sexual activity, with perpetrators using force, making threats or taking advantage of victims not able to give consent. Most victims and perpetrators know each other. Immediate reactions to sexual abuse include shock, fear or disbelief. Long-term symptoms include anxiety, fear or post-traumatic stress disorder” (Encyclopedia of Psychology, as cited in “Sexual abuse,” n.d.). Sexual abuse that occurs during childhood is often identified as a particularly harmful type of abuse, which can impact a child’s psychological, emotional and cognitive development.
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Childhood sexual abuse can severely impact an individual’s development and functioning in a myriad of ways. CSA has long been linked to a number of mental health concerns. A seminal longitudinal study, following a cohort of 1,000 young adults in New Zealand, found that those who had experienced childhood sexual abuse, and particularly very severe abuse, were at a higher risk for a number of psychiatric disorders than their peers. The study found that those who had experienced CSA were 2.7-11.9 times more likely to present with at least one psychiatric disorder, including mood, anxiety, conduct, and substance use disorders (Fergusson et al., 2008, p.1372). A second New Zealand study sampled 73 woman receiving treatment from a sexual abuse counseling program. All participants had experienced some form of CSA. Of these participants, a majority exhibited symptomatology consistent with post-traumatic stress disorder. The study also found that higher rates and intensity of reported symptomatology correlated with higher levels of general psychopathology. The extent and severity of the abuse, particularly the involvement of intercouse, had a strong correlation with the severity of symptoms (Briggs & Joyce, 1997, p. 579).
In addition to mental health concerns, childhood sexual abuse also deeply impacts psychosocial development and functioning. Rumstein-McKean and Hunsley (2001) found a link between CSA and a number of interpersonal deficits, including challenges in relationship intimacy, sexual functioning, marital functioning, and attachment (Rumstein-McKean & Hunsley, 2001). CSA is also linked to intergenerational attachment challenges for survivors who become mothers. One study found that mothers who were survivors of CSA were more likely to experience insecure and anxious forms of attachment, though it should be noted that low socioeconomic status was a potential confound for anxious attachment. Additionally, children with mothers who experienced CSA were more likely to exhibit acute self-protective strategies, including coercive anger or desire for comfort (Kwako, Noll, Putnam, & Trickett, 2010).
One study looked at the effects of CSA on educational achievement, which was measured by meeting high school academic requirements, graduating high school, pursuing higher education, and completing a degree. CSA was significantly correlated to the underachievement of meeting these educational milestones. However, covariate factors included SES, parental adjustment, family functioning, and individual characteristics (Boden, Horwood, & Fergusson, 2007).
Despite the overwhelmingly negative prognosis for CSA survivors, there is a common experience for those who are able to recover. Noll (2008) examines the distinguishing features of childhood sexual abuse on development, as compared to other forms of abuse. Noll found that one unique characteristic of CSA survivors was their resilience in being able to leverage their social, economic and personal resources as a way towards recovery (Noll, 2008).
II. CSEC as an outcome of CSA
An emerging outcome issue linked to CSA is the commercial sexual exploitation of children (CSEC). A special report by the U.S. Department of Justice defines CSEC as, “sexual abuse of a minor for economic gain. It involves physical abuse, pornography, prostitution, and the smuggling of children of unlawful purposes”. The DOJ identifies three types of organization of CSEC, which include local exploitation by one or a few person(s), regional networks that involves the exploitation of several children and additional criminal activity, and national or international sex crime networks (U.S. Department of Justice, 2008).
An in-depth collaborative report conducted by the Human Rights Project for Girls, the Georgetown Law Center on poverty and equality, and the Ms. Foundation for Girls identifies the link between sexual abuse among adolescent girls and their involvement in the juvenile and criminal justice systems. Those particularly at risk are girls of color, particularly African American and Native American girls, and LGBT youth. Both populations are overrepresented in the juvenile justice system. Even more troublesome is that these girls experiencing CSEC and trafficking are often criminalized as “prostitutes”, instead of being identified as part of vulnerable and exploited populations. In a prison setting, ill-equipped to address issues of complex trauma, these are retraumatized, leading to a cycle of “victimization-to-imprisonment for marginalized girls”, also identified as the “sexual abuse-to-prison pipeline” (Saar, Epstein, Rosenthal, & Vafa, 2015).
This terminology is an outgrowth of the term “school-to-prison pipeline”, which has traditionally been used to recognize the relationship between “zero tolerance behavioral policies” in schools and the systemic and systematic incarceration of low-income boys of color (McCarter, 2016). Further research has shown the unique characteristics in the circumstances surrounding the entrance of other marginalized youth into the juvenile justice system. Research has shown that minority youth including LGBT youth and youth with disabilities are disproportionately represented in the juvenile system (McCarter, 2016). Many LGBT youth are over-monitored and policed, especially when they don’t conform to gender norms. Additionally, LGBT youth are given unequal punishment and lack social and emotional support, which further contributes to victimization (Snapp, Hoenig, Fields, & Russell, 2015). Unfortunately, for girls, entrance into the juvenile justice system is linked to childhood sexual abuse and commercial sexual exploitation as children (Saat et al., 2015).
III. Effective Intervention for CSA and CSEC
The effects of childhood sexual abuse and commercial sexual exploitation of children is complex and therefore the effectiveness of interventions and treatment are varied. One form of treatment found to be effective is group therapy. One study examined 14 female prisoners who had experienced some form of sexual violence. The intervention focused on therapeutic techniques centered around exposure. The treatment was found to be effective in decreasing clinically significant depressive and GAD symptoms. Many women also self-reported to have recovered, which was measured by reduction of symptoms that placed women below the threshold for post-treatment depression (Karlsson, Bridges, Bell, & Petretic, 2014).
Other treatments that have been found to be effective include interventions that focus on the cognitive process, such as cognitive-behavioral therapy and other forms of psychotherapy (Saars et al., 2015). However, there is limited research on the interventions that address the particular concerns of CSEC.
IV. Future areas of study
Childhood sexual abuse is a topic that has been thoroughly and systematically researched. However, there are many gaps in research in the area of the commercial sexual exploitation of children. One particular need is exploring effective treatment options that have been shown to reduce clinical symptoms that are uniquely related to CSEC. One study looking at CSEC survivors in residential and group home settings, was the first study to systematically look at particularly needs of CSEC survivors compared to other youth engaged with the child welfare and juvenile justice systems. This study identified that one of the barriers to identifying effective and generalizable interventions for CSEC are state policies around the issue. The extent of services and manner by which CSEC is addressed largely related to a state’s protection or criminalization of this vulnerable population. There are still several states that have no legal protections, such as “safe harbour” laws for this population (Hickle & Roe-Sepowitz, 2018).
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Broadly, there are general gaps in research systematically examining the risk factors, symptoms and effects, and interventions for this population. Though research in this area has been growing within the last decade, there are still many related issues that have gone unexamined. This is due, in part, to public and societal perception and knowledge around the topic of the commercial sexual exploitation of children. Social Work research is a discipline that should not fall under the same deleterious notions, whether consciously or otherwise.
Purpose of the Study
The purpose of the study is to complete an exploratory analysis of the unique risk factors, symptomatology and interventions available for young adult survivors of commercial sexual exploitation, age 18-30, who retrospectively examine their experience. The study will focus on the perception and narrative of survivors. Intersecting aspects of race, socioeconomic status, and family functioning will also be considered.
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- McCarter, S. (2017). The school-to-prison pipeline: A primer for social workers. Social Work, 62(1), 53-61. http://dx.doi.org.csulb.idm.oclc.org/10.1093/sw/sww078
- Rumstein-McKean, O., & Hunsley, J. (2001). Interpersonal and family functioning of female survivors of childhood sexual abuse. Clinical Psychology Review, 21(5), 471-490. https://doi.org/10.1016/S0272-7358(99)00069-0
- Saar, M. S., Epstein, R., Rosenthal, L., & Vafa, Y. (2015). The sexual abuse to prison pipeline: The girls’ story. Retrieved from Georgetown Law Center on Poverty and Inequality: http://rights4girls.org/wp-content/uploads/r4g/2015/02/2015_COP_sexual-abuse_layout_web-1.pdf
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- Snapp, S. D., Hoenig, J. M., Fields, A., & Russell, S. T. (2015). Messy, Butch, and Queer: LGBTQ youth and the school-to-prison pipeline. Journal of Adolescent Research, 30(1), 57-82.https://doi-org.csulb.idm.oclc.org/10.1177/0743558414557625
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