Çocukluk Çağı Cinsel İstismarı

Cinsel istismar, yetişkinlerin çocuk ya da ergeni cinsel arzu ve gereksinimlerini karşılamak için güç kullanarak, tehdit ya da kandırma yolu ile kullanması olarak tanımlanmaktadır. Cinsel istismar; temas içermeyen cinsel istismarlar, cinsel dokunma, interfemoral ilişki, cinsel penetrasyon ve cinsel sömürü şekillerinde olabilir. Çocuklukta cinsel istismara maruz kalma sıklığı %10-40 olarak bildirilmektedir. Kızlarda erkeklere oranla 4 kat daha fazla görülmektedir. İstismarcılar genelikle erkektir, %5-15 suçlu ise kadındır. Kadınların istismarı genellikle erkek çocuğadır. Tanıdık birisi ya da bir yabancı tarafından aile dışı istismar, çocuk ve erişkin arası cinsel temas vakalarının %30-50'sidir. İstismarcılar için bazı kişilik özellikleri içe kapanık kişilik, pedofilik kişilik ve psikopatik kişiliktir. İstismarcıların birçoğu çocukluklarında ya cinsel istismara uğramışlardır ya da ev içerisinde şiddet olgusu vardır. Kanunen evlenmelerine izin verilmeyen iki kişi arasındaki cinsel ilişkiye ensest denir. Ensestin yaşandığı bir aile evrensel olarak düzensiz ve işlevlerini yerine getiremeyen bir aile şeklinde tanımlanır. En sık tanımlanan örüntü, babanın güçlü konumunu kuvvet kullanarak elde ettiği katı ve ataerkil bir aile yapısıdır. Cinsel istismarın klinik özellikleri ve çocuk üzerindeki etkileri; çocuğun istismarcı ile olan ilişkisine, istismarın şekline, süresine, şiddet kullanımına, fiziksel zararın varlığına, çocuğun yaşı ve gelişim basamağına ve travma öncesi psikolojik gelişimine bağlı olarak değişmektedir. Cinsel istismar öyküsü anksiyete, depresyon, madde bağımlılığı, intihar davranışı, borderline kişilik bozukluğu ve posttravmatik stres bozukluğunu içeren psikiyatrik bozukluklarla sonuçlanabilmektedir. Kişiler arası ilişki kurma ve sosyal ilişkileri sürdürme becerisi, benlik saygısı cinsel istismardan olumsuz etkilenmektedir. Çocukluk çağı cinsel istismarı ile cinsel yönden riskli davranış gösterme arasında birliktelik saptanmıştır. Çocuğun cinsel istismarında istismarla birlikte yaşanan travmatik cinsellik, ihanete uğramışlık hissi, güçsüzlük, damgalanma gibi dört travmatik dinamik yer alır. Travma kendisi psikolojik ve davranışsal sonuçlara neden olurken, erken travma ayrıca olumsuz biyolojik etkilere de yol açabilir. Özellikle nöronal plastisite döneminde oluşan travmatik yaşantılar nöroendokrin stres cevap sistemlerini aşırı duyarlı hale getirmektedir. Preklinik ve klinik çalışmalarda erken yaşam streslerinin kortikotropin salgılatıcı faktör sisteminde değişikliklere neden olduğu gösterilmiştir. Cinsel istismarın tedavisinde travmatik anılarla ilişkili duygusal süreçlerin çalışılması gerekmektedir. Bu süreç çocuklarda oyun terapisi içinde gerçekleşebilir. Üst düzey savunma düzeneklerinin geliştirilmesi, ego kapasitesinin arttırılması, sosyal aktivitelere, becerilerine uygun bireysel etkinliklere yönlendirilmesi amaçlanır. Damgalanma ile ilgili suçluluk duygusunun giderilmesi için çocuğun bir cinsel aktiviteye dahil edilmesinin kendi su

Anahtar Kelimeler:

Çocuk, cinsel istismar, ensest

Childhood Sexual Abuse

Sexual abuse is defined as use of child or adolescent by the adults for satisfying of sexual urges and needs with forcing, threatening or tricking. Sexual abuse can be in the form of sexual abuse without touch, sexual touch, interfemoral intercourse, sexual penetration, and sexual exploitation. The prevalence of sexual abuse is reported as 10-40%. It is seen in female four times more than in males. Abusers are frequently male, only 5-15% of them are female. The abuse by females is usually towards male child. Thirty-fifty percent of abuse cases among child and adolescent are outside the family including strangers or familiar person. Some features of abusers are introvert personality, pedophilic and antisocial personality. Most of the abusers have a history of sexual abuse or aggression during childhood. Sexual intercourse between two people who are not allowed to marry by law is called as incest. Family pattern of incest is defined globally as disorganized and dysfunctional. The most commonly reported familial pattern is rigid and patriarchal family pattern with a harsh father using force quite frequently. The clinical features and impacts of the sexual abuse on the child varies according to the relation between abusers and the child, form of abuse, duration of abuse, presence of physical assault, developmental phase, child age and psychological development before the abuse. Sexual abuse history may result in psychiatric disorders including anxiety, depression, substance dependence, suicide act, borderline personality disorder, posttraumatic stress disorder. Abuse negatively affects interpersonal relationships and self esteem of abused individuals. Several studies reported close association between risky sexual behaviors in adulthood and a history of of sexual abuse during childhood. Four traumatic dynamics including traumatic sexuality with abuse, feeling of betrayal, weakness, and stigmatization exist in childhood abuse. Trauma can cause behavioral and psychological results by itself, early trauma may also lead to biological effects. Especially traumas during neuron plasticity phase may lead hypersensitivity of neuroendocrine stress response. Early life stresses are shown to lead changes in corticotrophin releasing factor system in preclinical and clinical phase studies. In the treatment of sexual abuse, emotional process related with trauma should be focused on. This process may be conducted with play therapy. Development of higher level defense mechanism, increasing ego capacity, orientation to social activity and personal activity according to skills is aimed. For the elimination of guiltiness related with stigmatization, the child should be told that it is not herhis fault to incorporate into sexual interaction and the culprit is abuser. It is fairly important for medical staff, school and family to have sufficient information about sexual abuse for prevention and early recognition.

Keywords:

Child, sexual abuse, incest,

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İșeri E. Cinsel istismar. Çetin FÇ, Pehlivantürk B, Ünal F, Uslu R, İșeri E, Türkbay T, Coșkun A, Miral S, Motavallı N, editörler. Çocuk ve Ergen Psikiyatrisi Temel Kitabı. 1.Baskı, Ankara, Hekimler Yayın Birliği. 2008; 470-477.
Glaser D. Child Sexual Abuse. In: Rutter M, Taylor T, eds. Child and Adolescent Psychiatry, 4nd ed., Massachusetts, Blackwell Publishing Company. 2002; 340- 358.
Avcı A, Tahiroğlu AY. Cinsel İstismar. Aysev A, Taner YI, editörler. Çocuk ve Ergen Ruh Sağlığı ve Hastalıkları. 1.Baskı, İstanbul, Golden Print. 2007; 721-736.
Özen NE, Șener Ș. Çocuk ve ergende cinsel istismar. Ege Psikiyatri Sürekli Ya- yınları 1997; 2:473-491.
Prior V, Glaser D, Lynch MA. Responding to child sexual abuse: the criminal justice system. Child Abuse Review 1997; 6:128-140.
Pinera-Lucatero AG, Trujillo-Hernandez B, Millan-Guerrero RO, Vasquez C. Prevalence of childhood sexual abuse among Mexican adolescents. Child Care Health Dev 2008; 35:184-189.
Freidrich WN, Fisher J, Dittner C, Acton R, Berliner L, Butler J et al. Child sexual behavior inventory: normative, psychiatric and sexual abuse comparisons. Child Maltreatment 2001; 6:347-349.
Keskin G, Çam O. Çocuk cinsel istismarına psikodinamik hemșirelik yaklașımı. Yeni Symposium 2005; 43:118-125.
Akbaș S, Turla A, Karabekiroğlu K, Senses A, Karakurt MN, Tașdemir GN ve ark. Cinsel istismara uğramıș çocuklar. Adli Bilimler Dergisi 2009; 8:24-32.
Santos JC, Neves A, Rodrigues M, Ferrao P. Victims of sexual offences: medicolegal examinations in emergency settings. J Clin Forensic Med 2006; 13:300-303.
Pereda N, Guilera G, Forns M, Gomez-Benito J. The international epidemiology of child sexual abuse: a continuation of Finkelhor. Child Abuse Negl 2009; 33: 331-342.
Putnam FW. Ten year research update review: child sexual abuse. J Am Acad Child Adolesc Psychiatr 2003; 42:269-278.
Gorey K, Leslie D. The prevalence of child sexual abuse: integrative review adjustment for potential response and measurement bias. Child Abuse Negl 1997; 21:391-398.
Finkelhor D. The international epidemiology of child sexual abuse. Child Abuse Negl 1994; 18:409-417.
Edgardh K, Ormsatd K. Prevalence and characteristics of sexual abuse in a national sample of Swedish seventeen-year-old boys and girls. Acta Paediatr 2000; 89:310-319.
Çengel Kültür E, Çuhadaroğlu Çetin F, Gökler B. Demographic and clinical features of child abuse and neglect cases. Turk J Pediatr 2007; 49:256-262.
Șahin F, İșeri E, Paslı F, Demiral B, Çepik A, Akar T ve ark. Adolesan ve cinsel istismar. 1. Ulusal Adolesan Sağlığı Kongresi, 28 Kasım-1 Aralık 2006 Ankara, Türkiye. Kongre Özet Kitabı sayfa:266-267.
Koten Y, Tuğlu C, Abay E. Üniversite öğrencileri arasında ensest bildirimi. XXXII. Ulusal Psikiyatri Kongresi, 25-28 Eylül 1996 Ankara, Türkiye. Kongre Özet Kitabı sayfa:154.
Zoroğlu SS, Tüzün U, Șar V, Öztürk O, Kara ME, Alyanak B. Çocukluk dönemin- de ihmal ve istismarın olası sonuçlarının incelenmesi. Anadolu Psikiyatri Dergi- si 2001; 2:69-78.
Tahiroğlu AY, Avcı A, Çekin N. Çocuk istismarı, ruh sağlığı ve adli bildirim zo- runluluğu. Anadolu Psikiyatri Dergisi 2008; 9:1-7.
Alikașifoğlu M, Erginöz E, Ercan O, Albayrak-Kaymak D, Uysal O, İlter O. Sexual abuse among female high school students in Istanbul, Turkey. Child Abuse Negl 2006; 30:247-255.
Baker A, Duncan S. Child sexual abuse: a study of prevalence in Great Britain. Child Abuse Negl 1985; 9:457-467.
Wyatt G. The sexual abuse of Afro-American and White-American women in childhood. Child Abuse Negl 1985; 9:507-519.
Nickel MK, Tritt K, Mitterlehner FO, Leiberich P, Nickel C, Lahmann C et al. Sexual abuse in childhood and youth as psychopathology relevant life occurrence: cross-sectional survey. Croat Med J 2004; 45:483-489.
Syengo-Mutisya CM, Kathuku DM, Ndetei DM. Psychiatric morbidity among sexually abused children and adolescents. East Afr Med J 2008; 85:85-91.
Kaplan SJ. Child and adolescent sexual abuse. In: Lewis M, ed. Child and Adolescent Psychiatry, a comprehensive textbook, 3nd ed, Philadelphia, Lippincott Williams&Wilkins. 2002; 1217-1223.
Polusny MA, Follette VM. Long-term correlates of child sexual abuse: theory and review of the empirical literature. Appl Prev Psychol 1995; 4:143-166.
Whiffen VE, Macintosh HB. Mediators of the link between childhood sexual abuse and emotional distress: a critical review. Trauma Violence Abus 2005; 6:24-39.
Bal S, Van Oost P, Bouurdeaudhuij I, Crombez G. Avoidant coping as a mediator between self-reported sexual abuse and stres-related symptoms in adolescents. Child Abuse Negl 2003; 27:883-897.
Polusny MA, Rosenthal MZ, Follette VM. Experiential avoidance as a mediator of the effects of adolescent sexual victimization on adult psychological distress. Violence Vict 2004; 19:1-12.
Abramowitz JS, Talin DF, Street GP. Paradoxical effects of thought supression: a meta-analysis of controlled studies. Clin Psychol Rev 2001; 21:683-703.
DiLillo D. Interpersonal functioning among women reporting a history of childhood sexual abuse: empirical findings and methodological issues. Clin Psychol Rev 2001; 21:553-576.
Colman RA, Widom CS. Childhood abuse and neglect and intimate relationships: a prospective study. Child Abuse Negl 2004; 28:1133-1151.
Mullen PE, Martin JL, Anderson JC, Romans SE, Herbison GP. Childhood sexual abuse and mental health in adult life. Brit J Psychiat 1993; 163:721-732.
Fleming J. Prevalance of childhood sexual abuse in a community sample of Australian women. Med J Australia 1997; 166:65-68.
Briere J. Methodological issues in the study of sexual abuse effects. J Consult Clin Psychol 1992; 60:196-203.
Ornstein A. Self-pathology in childhood:developmental and clinical considerations. Psychiatr Clin North Am 1981; 4:435-453.
Beitchman JH, Zucker KJ, Hood JE, DaCosta GA, Akman D. A review of the short-term effects of child sexual abuse. Child Abuse Negl 1991; 15:537-556.
Beitchman JH, Zucker KJ, DaCosta GA, Akman D, Cassavia E. A review of the long-term effects of child sexual abuse. Child Abuse Negl 1992; 16:101-118.
Tebbutt J, Swanston H, Oates RK, O’Toole BI. Five years after child sexual abuse: persisting dysfunction and problems of prediction. J Am Acad Child Adolesc Psychiatr 1997; 36:330-339.
Romans SE, Martin J, Mullen PE. Women’s self-esteem: a community study of women who report and do not report childhood sexual abuse. Brit J Psychiat 1996; 169:696-704.
Bensley LS, Van Eenwyk J, Simmons KW. Self-reported childhood sexual and physical abuse and adult HIV-risk behaviors and heavy drinking. Am J Prev Med 2000; 18:151-158.
Browning CR, Laumann EO. Sexual contact between children and adults: a life course perspective. Am Sociol Rev 1997; 62:540-560.
Miller BC, Monson BH, Norton MC. The effects of forced sexual intercourse on white female adolescents. Child Abuse Negl 1995; 19:1289-1301.
Gidycz CA, Hanson K, Layman MJ. A prospective analysis of the relationships among sexual assault experiences. Psychol Women Quart 1995; 19:5-29.
Upchurch DM, Kusunoki Y. Associations between forced sex, sexual and protective practices and sexually transmitted diseases among a national sample of adolescent girls. Women’s Health Issues 2004; 14:75-84.
Johnsen LW, Harlow LL. Childhood sexual abuse linked with adult substance use, victimization and AIDS-risk. AIDS Educ Prev 1996; 8:44-57.
Nelson DE, Higginson GK, Grant-Worley JA. Using the youth risk behavior survey to estimate prevalence of sexual abuse among Oregon high school students. J School Health 1994; 64:413-416.
Raj A, Silverman JG, Amaro H. The relationship between sexual abuse and sexual risk among high school students: findings from the 1997 Massachusetts youth risk behavior survey. Matern Child HLTH J 2000; 4:125-134.
Shrier LA, Pierce JD, Emans J, DuRant RH. Gender differences in risk behaviors associated with forced or pressured sex. Arch Pediatr and Adolesc Med 1998; 152:57-63.
Finkelhor D, Browne A. The traumatic impact of child sexual abuse: a conceptualization. Am J Orthopsychiat 1985; 55:530-541.
Spaccarelli S. Stres, appraisal and coping in child sexual abuse: a theoretical and empirical review. Psychol Bull 1994; 116:340-362.
Evans E, Hawton K, Rodham K. Suicidal phenomena and abuse in adolescents: a review of epidemiological studies. Child Abuse Negl 2005; 29:45-58.
Carey PD, Walker JI, Rossouw W, Seeadt S, Stein DJ. Risk indicators and psychopathology in traumatised children and adolescents with a history of sexual abuse. Eur Child Adolesc Psychiatr 2008; 17:93-98.
Kendal-Tackett KA, Williams LM, Finkelhor D. Impact of sexual abuse on children: a review and synthesis of recant empirical studies. Psychol Bull 1993; 113:164-180.
Hazzard A, Celano M, Gould J, Lawry S, Webb C. Predicting symptomatology and self-blame among child sexual abuse. Child Abuse Negl 1995; 19:707-714.
Friedrich WN. Individual psychotherapy for child sexual abuse victims. Child Adolesc Psychiatr Clin North Am 1994; 3:797-812.
Baccini F, Fallotta N, Calabrese E, Pezzotti P, Corazziari E. Prevalence of sexual and physical abuse and its relationship with symptom manifestations in patients with chronic and functional gastrointestinal disorders. Dig Liver Dis 2003; 35:256-261.
Drossman A, Leserman J, Nachman G, Li ZM, Gluck H, Toorney TC et al. Sexual and physical abuse in women with functional or organic gastrointestinal disorders. Ann Intern Med 1990; 113:828-833.
Sparato J, Mullen PE. Impact of child sexual abuse on mental health. Brit J Psychiat 2004; 184:416-421.
Eckenrode J, Laird M, Doris J. School performance and disiplinary problems among abused and neglected children. Dev Psychol 1993; 29:53-62.
Fleming J, Mullen PE, Sibthorpe B, Bammer G. The long term impact of child sexual abuse in Australian women. Child Abuse Negl 1999; 23:145-159.
Fleming J, Mullen PE, Sibthorpe B, Attewell R, Bammer G. The relationship between childhood sexual abuse and alcohol abuse in women: a case control study. Addiction 1998; 93:1787-1798.
Riggs S, Alario AJ, Mchorney C. Health risk behaviors and attempted suicide in adolescents who report prior maltreatment. J Pediatr 1990; 116:815-821.
Penza KM, Heim C, Nemeroff CB. Neurobiological effects of childhood abuse: implications for the pathophysiology of depression and anxiety. Arch Womens Ment Health 2003; 6:15-22.
McCauley J, Kern D, Kolodner K, Dill L, Schroeder AF, DeChant HK. Clinical characteristics of women with a history of childhood abuse. JAMA 1997; 277:1362-1368.
Mullen PE, Martin J, Anderson J, Romans SE, Herbison GP. The long-term impact of the physical, emotional and sexual abuse of children: a community study. Child Abuse Negl 1996; 1:7-21.
Owens MJ, Nemeroff CB. Physiology and pharmacology of corticotropin- releasing factor. Pharmacol Rev 1991; 43:425-473.
Nemeroff CB. Neurobiological consequences of childhood truma. J Clin Psychiatry 2004; 1:18-28.
Ito Y, Teicher MH, Glod CA, Harper D, Magnus E, Gelbard HA. Increased prevalence of electrophysiological abnormalities in children with psychological, physical, and sexual abuse. J Neuropsychiatry Clin Neurosci 1993; 5:401-408.
De Bellis MD, Lefter L, Trickett PK, Putnam FW. Urinary catecholamine excretion in sexually abused girls. J Am Acad Child Adolesc Psychiatry 1994; 33:320-327.
De Bellis MD, Chrousos GP, Dorn LD, Burke L, Helmers K, Kling MA et al. Hypothalamic-pituitary adrenal axis dysregulation in sexually abused girls. J Clin Endocrinol Metab 1994; 78:249-255.
King JA, Mandansky D, King SM, Fletcher KE, Brewer J. Early sexual abuse and low cortisol. Psychiatr Clin Neurosci 2001; 55:71-74.
De Bellis M, Keshavan M, Clark DB, Casey BJ, Giedd JN, Boring AM et al. Developmental traumatology. II. brain development. Biol Psychiatry 1999; 45:1271-1284.
Herman- Giddens ME, Sandler AD, Friedman NE. Sexual precocity in girls. An association with sexual abuse? Am J Dis Child 1988; 142:431-433.
Brown J, Cohen P, Chen H, Smailes E, Johnson JG. Sexual trajectories of abused and neglected youths. J Dev Behav Pediatr 2004; 25:77-82.
Haviland MG, Sone JL, Anderson DL, Nelson JC, Sheridan- Matney C, Nichols JG et al. Thyroid hormone levels and psychological symptoms in sexually abused adolescent girls. Child Abuse Negl 2006; 30:589-598.

ISSN: 1309-0658
Yayın Aralığı: Yılda 4 Sayı
Başlangıç: 2009
Yayıncı: Psikiyatride Güncel Yaklaşımlar

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