Adult retrospective studies show that 1 in 4 women and 1 in 6 men in the United States were sexually abused before the age of 18. This means that there are more than 42 million adult survivors of child sexual abuse in the USA. Child sexual abuse involves a wide range of sexual behaviours taking place between a child and an adult (or an older minor) that bring sexual pleasure to the latter without consideration for their impact upon the former and his/her reactions or choices (PTSD).
Child abuse isn’t always easy to be established as some sexual behaviours against a child are difficult to be detected because they don’t cause physical damage, e.g. genital exposure. It’s also hard to estimate the accurate number of child sexual abuses because there are cases that have never been reported, because numbers are reported for different time periods (some data are based on how many children were abused in a particular year, some on how many children have ever been abused), and because some cases don't clearly fall within the definition of child abuse, e.g. a 12-year-old child abusing a 10 year-old (UNH). Still, it’s established that in the U.S., about 60% of child sexual abusers are non-family members, 30% are in the child’s family and only 10% are total strangers. Men are perpetrators in most cases of child sexual abuse regardless of the victim’s sex, while women are in about 14% of cases when boys are victims and 6% of cases when girls are (PTSD). According to the Child Health USA 2014 report, sexual abuse constitutes 9.3% of all child maltreatments - the most common kind of abuse after neglect and physical abuse.
Children who were sexually abused may (but don’t have to) show behavioural and emotional changes that might be also characteristic for other kinds of trauma: an increase in nightmares, other sleeping difficulties, eating disorders, withdrawn behaviour, emotional outbursts, anger, anxiety, depression, bed wetting, and knowledge, language or behaviour related to sexual activities that aren’t appropriate for the child’s age (NCTSN.org). Lack of effective treatment may result in future problems such as Post-Traumatic Stress Disorder (PTSD), anxiety, depression, suicidal thoughts, sexual disorders (for instance promiscuity), difficulties with building social bonds or relationships, low self-esteem, drug/alcohol addiction, or self-mutilation. Kara Rodriguez, who was abused by her father in her early childhood, recollects her adolescence in My Father's Shadow:
The fear was too much, so I consequently shut off my heart to the world and numbed my fear with self-loathing, alcohol, nicotine, and association with the kind of men I was convinced I deserved. After all that was done to me and all that I had experienced, I was most certain that I was unattractive and all ‘used up’.
As Sam Vaknin enumerates in his book, PTSD victims try to avoid thoughts, feelings, conversations, activities, situations or people that remind them of the traumatic experience, they may suffer from constant hypervigilance or sleep disorders, and they are unable to concentrate and complete even relatively simple tasks:
The first phase of PTSD involves incapacitating and overwhelming fear. The victim feels like she has been thrust into a nightmare or a horror movie. She is rendered helpless by her own terror. She keeps re-living the experience through recurrent and intrusive visual and auditory hallucinations ("flashbacks") or dreams. In some flashbacks, the victim completely lapses into a dissociative state and physically re-enacts the event while being thoroughly oblivious to her whereabouts.
PTSD victims may suffer also from fatigue, numbness, emotional detachment, feelings of alienation and estrangement, automatism and may even fall into a near-catatonic state.
It seems that in the U.S., the rate of child sexual abuse has been declining over the last two decades. The overall number of cases dropped more than 60% between 1992 and 2010: from 23 sexual abuses per 10,000 children under 18 to 8.6 (New York Times and UNH). According to the Minnesota Student Survey, the number of reported abuses committed by a family member has decreased to 28% and by a non-family member 29% (Health State Minnesota). It’s hard to establish the exact reasons for this decrease: it may result from a raised public awareness and better education, national policies and introduced prevention methods, the work of child advocacy centers (for instance National Child Alliance) or the higher risk of being prosecuted (see more on New York Times). A change is also visible in the case of reported sexual abuses – according to a survey from 2008, their number has increased to 50% of cases compared with just 25% in 1992. Still, child abuse is a rife problem in the US as in 2012 62,939 cases of child sexual abuse were reported and it’s estimated that probably only 38% of children disclose the fact that they have been sexually abused (Darkness to Light).