Psychological Changes following child sexual abuse

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Chapter 1


The UN Children's Fund (UNICEF) mentioned in their released report estimated that up to five percent of boys and up to 10 percent of girls even in rich nations suffered from severe sexual abuse during their childhood on October 6, 2009. Up to three times that proportion experience some form of sexual abuse in industrialized countries. In general it is estimated that throughout the course of their childhood, five to 10 percent of girls and up to five percent of boys suffer penetrative sexual abuse which is the most serious form of sexual abuse.

Accurate statistics on the prevalence of child and adolescent sexual abuse are difficult to collect but the child protection professionals as well as the mental health professionals noticed that the child sexual abuse is very common and also a serious problem currently.

When handling the child sexual abuse cases, there are many silent points or reactions that not only the social worker but also all the stakeholders who are involve in handling the child sexual abuse victims should know. If these points or reactions are not recognized by the adults, it might be more harmful for the victims instead of helping the child.

In this paper, I will try to identify whether the Child Sexual Abuse Accommodation Syndrome (CSAAS), introduced by Dr. Roland C. Summit in 1983, is an applicable model with one case example of sexual abuse victim from Myanmar.

In chapter 2, I would like to discuss about the various definitions of child, child sexual abuse, physical, emotional and behavioral symptoms of child sexual abuse victim, their short term and long term psychological effects. The CSAAS model will also discuss in this chapter.

In chapter 3, I would like to identify the applicability of this model in the country Myanmar with one practical case example as case study. Chapter 4 will comprise the important of understanding CSAAS which can provide the interventions plans at various level and prevention strategies in general.

Chapter 2

Literature Review:

Child, Child Sexual Abuse, Symptoms and Psychological Effects of Child Sexual Abuse Victims

Definition of Child

According to the United Nations Convention on the Rights of the Child (UNCRC), the Article number 1 stated that a child means every human being below the age of 18 years unless under the law applicable to the child, majority is attained earlier.

Definition of Child Sexual Abuse

There is no universal definition for sexual abuse but any abuse that is the dominant position of an adult that allows him or her to force or coerce a child into sexual activity is generally defined as sexual abuse.

Child Sexual Abuse Accommodation Syndrome (CSAAS)

This syndrome was introduced by Dr. Roland C. Summit in the year 1983. He found out that the most of the child victims of sexual abuse face secondary trauma in the crisis of discovery(Summit, 1983).

He explained in his paper that the CSAAS comprises of five categories or reactions. Two reactions are reflective of the basic childhood vulnerability. These two reactions are named as (1) secrecy and (2) helplessness. The other three reactions are defined as sequentially contingent of sexual abuse. These include (3) entrapment and accommodation (4) delayed, unconvincing disclosure, and (5) retraction.

Roland mentioned that his CSAAS is "a simple and logical model for use by clinicians to improve understanding and acceptance of the child's position in the complex and controversial dynamics of sexual victimization. Application of the syndrome tends to challenge entrenched myths and prejudice, providing credibility and advocacy for the child within the home, the courts, and throughout the treatment process".(Summit, 1983)

His CSAAS was also supported by David Finkelhor, and Angela Browne, that "there many literatures which discuss a lot about the clinical observations of the problems which are associated with abuse history, such as sexual dysfunction, depression, and low self-esteem. But such clinical observations cannot provide how and why sexual abuse results in the victims and there is a need of clear models which can specify this".(Finkelhor & Browne, October 1985)

It was also quoted in one conference paper that "CSAAS evidence allows the jury to consider the inconsistencies, recantations and other behaviors that appear to show deceit as behavior explainable by other reasons. The CSAAS is relevant because it allows the jury to better understand a fact at issue-behavior that appears to show deceit on the part of the child".(Garrison, September 22, 1997)

CSAAS provide the general idea upon the reaction of a child sexual abuse victim's individual coping strategies towards following behavioral and psychological symptoms and problems, including implications for specific modalities of treatment.

Chapter 3

Applicability of Child sexual abuse accommodation syndrome model in Myanmar: case study of child sexual abuse victim

In this chapter, I would like to discuss how much the different components of Child Sexual Abuse Accommodation Syndrome comply with one sexual abuse victims, 14 years old Myanmar girl, who has been sexually abused by a 45 years old man when she was age of 11 years.

In the case of Myanmar child sexual abuse victim, she manifests the "secrecy" reaction that mentioned in CSAAS as she wished to keep the abuse as a secret firstly. She might has many variety of reasons but the most prominent one is she is afraid of the abuser. We all later notice that the abuser promised safety to this child if the child keeps it as a secret.

She also undergoes the reaction of "helplessness" as she is emotionally immature and being a child of the rural village level, there is no proper social support system from the authority. These all trigger her to be in a dangerous situation. She has tried her best to protect herself but finally it fail, so she felts that she is helpless at that time. We also observed that eventually she stop trying to protect herself and she might undergone "Dissociation" reaction which is a way in which she survive abuse by escaping mentally while the abuse is happening. According to her re-telling of her experience, her mind and the body mind seems to separate during the abuse. She also mentioned that while her body is being hurt, she no longer feels anything and she believed that her mind manages to escape to a safe place.

While she was also undergoes entrapment and accommodation reaction, she learns to accept her situation and survive. She eventually blames herself and believes that due to her fault, it was happened. Like her, almost all the sexually abused children employ defensive mechanisms such as dissociation or blocking out the memory in an attempt to accommodate to the abuse.

When the child protection case worker asks this girl to disclose abuse, she undergoes acute crisis reaction which is also mentioned in the CSAAS, the delayed, conflicted and unconvincing disclosure. As per the record of the case worker, we observed the initial disclosures with inconsistencies and anxiety. At that reaction stage, the case worker noticed that the girl has used various defensive mechanisms to cope the abuse. Her memory is also fragment at that time and her perceptions are also altered and so the information that the case worker received is scattered and sparse.

After disclosure, she feels guilty, fear and feelings of betrayal or confusion which is also mentioned in the CSAAS under retraction reaction stage.

Even though, many text books mentioned that this just a model describing reactions and is not an absolute but still one practical case that I encountered in the country Myanmar undergoes almost all these reactions of CSAAS.

Chapter 4


Child sexual abuse becomes one of the social problems that affect individuals of all racial and socioeconomic backgrounds. It is important to understand the short-term and long-term psychological effects of sexual abuse victims; particularly the reaction of child sexual abuse mentioned in the model of CSAAS. By understanding these, every social worker can come to understand more about how to provide the therapy towards the victims to provide normalization for their rest of the life. Even though there are universally accepted therapies such as individual psychotherapy, group psychotherapy, and treatments involving the entire family for victims are already present, if the social worker or clinician understands more about the stages and reaction suggested by CSAAS, the therapy towards the victims will be more enhanced.

On the other hand, the social worker or clinician can also conceptualized these stages and reaction of CSAAS while providing the treatment towards the offender of sexual abuse to minimize risk of re-offending by modifying various psychological factors such as cognitive, emotional, behavioral and environmental.

The understanding of CSAAS reaction can be applicable not only in the tertiary prevention of providing the treatment towards the victims, but also in the other two levels of prevention that is in primary preventions- public awareness campaigns to the general population and secondary prevention- child assault prevention programs and safety education taught to children in schools, towards high risk specific groups.

  • Dominquez, R. Z., Nelke, C. F., & Perry, B. D. (2002). Encyclopedia of Crime and Punishment (Vol. 1): Sage Publications, Thousand Oaks
  • Finkelhor, D., & Browne, A. (October 1985). The Traumatic Impact of Child Sexual Abuse: A Conceptualization. American Journal of Orthopsychiatry, 4, 55.
  • Garrison, A. H. (September 22, 1997). Child Sexual Abuse Accommodation Syndrome: Issues of Admissibility in Criminal Trials. Paper presented at the The First Annual New England Conference on Child Sexual Abuse.
  • Summit, R. C. (1983). The child sexual abuse accomodation syndrome. Child Abuse & Neglect, 7, 177 - 193.