Male Child Sexual Abuse and Future Offending: A Discussion of Assessment, Treatment, and Recommendations for Further Study

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RUNNING HEAD: Male Child Sexual Abuse
Male Child Sexual Abuse and Future Offending: A Discussion of Assessment, Treatment, and
Recommendations for Further Study
Melanie Cabrera, M.A.

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Author’s Note:
The author is a recent graduate of Forensic Psychology at Argosy University. Correspondence
concerning this article should be addressed to Melanie D. Cabrera, M.A., PO Box 637,
Woodstock, CT 06281. E-Mail: Cabreram4321@gmail.com
Draft version, 1/26/2011. This paper has not been peer reviewed. Please do not copy or cite
without author's permission.

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Abstract
According to one study, 377 sex offenders admitted they had competed 48,297 acts of
extrafamilial child sexual abuse with 27,416 victims (Salter, 1995). One in seven child victims
in which the acts were reported to law enforcement agencies were under the age of six at the time
of the act (Lovett, 2007). Male child sexual abuse (MCSA) is a serious issue that has to potential
to result in psychological disorders, revictimization, and criminal offending for the victim. A
community approach is beneficial in the prevention, intervention, and treatment of child sexual
abuse. Unfortunately, research pertaining to early intervention and prevention of MCSA is
sparse. There is considerable disagreement as to the prevalence of MCSA. However, it is clear
adult survivors of male child sexual abuse are overrepresented in correctional facilities and
institutions on charges involving sexual offenses. Therefore, to understand the offender and stop
the cycle, we must also understand the victim and the impact child sexual abuse may have
through the victim’s lifespan.

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Male Child Sexual Abuse and Future Offending: A Discussion of Assessment, Treatment, and
Recommendations for Further Study
According to one study, 377 sex offenders admitted they had competed 48,297 acts of
extrafamilial child sexual abuse with 27,416 victims (Salter, 1995). One in seven child victims
in which the acts were reported to law enforcement agencies were under the age of six at the time
of the act (Lovett, 2007). To improve prevention and treatment methods, it is imperative the
psychological effects of the acts on male victims are understood. Moreover, adult survivors of
male child sexual abuse (MCSA) are overrepresented in correctional facilities and institutions on
charges involving sexual offenses. Therefore, to understand the offender and stop the cycle, we
must also understand the victim and the impact child sexual abuse may have through the victim’s
lifespan.
The available research in the area of MCSA is significantly limited, as most attention has
been directed towards the abuse of girls. Of what research is available, there is contradiction as
to the prevalence and incidence of MCSA. Two studies indicate prevalence rates of MCSA at
7.9% in the general population (Putnam, 2003; Gorey & Leslie, 1997). If we look at specific
populations, such as institutionalized persons, the rate jumps to a significant 39% for juvenile sex
offenders (Ryan, Miyoshi, Metzner, Krugman & Fryer, 1996) and 76% of serial rapists
(McCormack, Rokous, Hazelwood, & Burgess, 1992). One should be cautioned, however, the
prevalence rate for the general population might be much higher. There are varying definitions
of sexual abuse that may distort statistics. Moreover, men are less likely than women to report
incidences of MCSA (Alaggia & Millington, 2008).
Assessment and impact
According to Alaggia and Millington (2008), distinct themes commonly emerge during

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childhood and adolescence as a result of the male child victims’ experiences. Many use forms of
denial to block out the sexual abuse, resulting in repressed memories that may emerge later in
life. They suffer from confusion surrounding their role and responsibility in the abuse,
particularly if their body reacted during the acts. Many describe feelings of specialness, a sense
of being wanted. As the child ages, however, anger and rage replace the feelings of specialness
and belonging. In fact, increased aggressiveness in young children in a school setting is often
indicative of abuse (Lovett, 2007).
Perhaps the most traumatizing aspect is the male child’s fear of disclosure, which
exacerbates as the child ages. “Some boys and men have difficulty disclosing sexual abuse or
seeking treatment for it when it does occur because they perceive that socially-defined gender
roles cast males as strong, tough and not in need of protection” (Alaggia & Millington, 2008, p.
265). Members of society may subscribe to the myth of the all-powerful male, meaning the boy
must have consented or must be gay if he became aroused or ejaculated. Equally disturbing,
society (and even some therapists) minimizes the effects of abuse on a male child, falling into the
stereotype that male rape is not on the same level as female rape.
According to Salter (1995), the “harsh self-punitive thinking patterns of adult survivors
[of child sexual abuse] can be traced to an internalization of the thinking errors of sex offenders”
(p.2). Self-punitive thinking patterns, stemming from the disruption and distortion of normal
sexual development transcends into intimacy and behavior problems throughout the lifespan. As
adults, victims may find they have great difficulty maintaining an intimate relationship. Failing
to acknowledge and correctly treat victims of MCSA can result in a host of potentially
destructive disorders including depression, suicide, addictions, post-traumatic stress disorder
(PTSD), stress disorder, anxiety disorders, antisocial personality disorder, dissociation, sexual

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identity disorder, or sexual offending behavior (Alaggio & Millington, 2008; Boeschen, Sales, &
Koss, 1998; Brown, Brack, & Mullis, 2008; Lovett, 2007).
Adolescents and young adults may be become self-destructive given the confusion
surrounding their sexual identity. Given the societal myth that their body reaction must mean
they enjoyed the act, thus they are gay, victims may exude extra effort to prove their
heterosexuality. “Some men may behave in a really macho way, for example, have sex with a
number of women, try to get a woman pregnant, or harass gay men” (Munro, 2000). Fear, anger
and the feeling of helplessness may cause the adolescent victim to look for ways to regain a
sense of control. One victim, who had turned to sexually abusing others to mitigate the feeling
of helplessness that pervaded his life.
“The joy of seeing other people hurt, maybe not hurt…It’s hard to describe.
Feeling that I was in control of dominating somebody. I had control over them,
and they were below me” (Lisak, 1994, 534)
Many adolescents and young adults turn to substance abuse to cope with the shame, self-
blame, confusion, and anger they feel. Once study reported that sexually abused boys are more
likely than non-abused boys to report alcohol use by the age of 10, marijuana by the age of 12,
and multidrug use through adulthood (Holmes & Slap, 1998). The maladaptive coping styles put
the victim of MCSA at risk of legal and health implications.
Prevention
Most literature to date has focused on early intervention, assessment, and treatment of
child sexual abuse. Literature pertaining to the prevention of MCSA in the first instance is
severely lacking. “Although sex offenders may seem an unlikely source of information on
prevention of child sexual abuse, they can make valuable suggestions” (Sattler, 1998, p. 842).

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Elliot, Browne, and Kilcoyne (as cited in Sattler, 1998) interviewed known chronic sex offenders
to determine how they gain the opportunities to abuse children. From the interviews, they
gleaned numerous suggestions for children, parents, and teachers aimed to prevent sexual abuse.
The offenders suggest that children be involved in programs to teach them about sexual abuse.
Further, children should not be allowed to play alone in quiet areas. Instead, children should go
out to play or walk to school with other children in groups. Children need be taught not to be too
trusting if someone is unusually nice or offering special favors. Particularly disturbing,
offenders suggest that children should have someone accompany them to public restrooms:
“A great place to hang out is in a toilet in a kiddies’ hamburger type restaurant.
Little boys, especially go into the toilets alone and they aren’t expecting someone
to try to touch them. Most of the time they are too embarrassed even to shout” (as
cited it Sattler, 1998, p. 843).
Parents should be educated about MCSA and not hold to the belief that only strangers can
harm their children. “Parents are so naïve; they’re worried about strangers and should be
worried about their brother-in-law” (as cited in Sattler, 1998, p. 843). Moreover, parents need to
be more involved with their children, encourage them to talk about their day and facilitate a more
open relationship. Secrecy within the family can produce tragic results when the child feels their
parents cannot be approached.
Finally, schools should have sex education and encourage frank discussions about child
sexual abuse starting at an early age. Prevention programs for the very young children should
include role-play on what to do if someone tries to touch them in an inappropriate manner. Most
important, the programs cannot focus solely on stranger danger and other stereotypes as the child
may not be able to link the education to what is happening at home.

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Treatment
Early intervention and treatment “using multiple modalities has the potential to make
significant changes in a young, sexually abused child’s life (Lovett, 2007, p.586). Lovett (2007)
suggests play therapy become an integrate part of therapy for young victims as it allows the child
to express thoughts and feelings regarding the offender and the act the child may not be able to
express through the spoken word. Through play, an active therapist may help the child reshape
his mental representations of self and others. Perhaps most important is the confusion regarding
complicity. The child requires reassurance that an automatic physical response to the act did not
mean he was responsible.
Individualized therapy is crucial and must correlate with the child’s symptomology and
stage of development. A child who has learned to dissociate as a way to escape from anxiety
must learn coping skills prior to reconnecting with the traumatic event. A child suffering from
PTSD may adamantly deny the act occurred during the avoidance phase of the disorder. In such
cases where PTSD is present, implosive therapy, or flooding, should be used with great care as it
may drastically intensify the symptoms (Putman, 2009). For children reenacting the trauma
through sexualized play, the potential for the child to become an adolescent or adult sex offender
must be addressed. It is imperative the child learn ways to cope with future feelings of
powerlessness and helplessness, while mitigating the distorted cognitions of specialness,
complicity, and sex as a means of achieving power.
Adolescents may require a combination of therapeutic techniques, including cognitive
behavioral therapy, anger management, coping skills training and group therapy. Integrating the
family or caregivers is crucial, particularly for the adolescent whose abuse began during early
childhood. The adolescent may view the non-offending parent with contempt. How could she

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not love him enough to protect him? It is quite possible she did not know the abuse was taking
place. Acknowledging she did not know, if this is the case, may provide the victim with a much
needed sense of being loved. Moreover, “an unknowing parent also will find it easier to side
with the survivor rather than the perpetrator” (Salter, 1995, p.123).
Lovett (2007) also suggests the non-offending parent be included in the treatment to
provide stability when not in therapy. “Given that many sexually abused children present with
symptoms of attachment concerns, involving the primary, non-offending caregivers in the
treatment will be of most importance” (Lovett, 2007, p. 587). Including family in the therapy
also lessens the chance of revictimization. “Numerous studies have shown how [familial] denial,
rage, guilt, and blame responses to [child sexual abuse] disclosure serve only to reinforce the
sense of stigma, betrayal, and vulnerability typically experienced…” (Graham, Rogers &
Davies, 2007, p. 235). Further, as insecure attachment between caregiver and child is a precursor
to abuse, strengthening the bond may serve as a protective factor in preventing revictimization
(Reid & Sullivan, 2009).
In adults who have learned to block the memories of the abuse, treatment may resemble
the modalities used in the treatment of PTSD. The victim should be taught deep relaxation
techniques, which allows the victim to use mental imagery to “turn off” the intrusive images or
thoughts when they become overwhelming (James, 2008). While in therapy, the victim is also
encouraged to explore the deeper meanings of the images or thoughts as the only way to begin
the healing process is to confront and conquer the fears behind the images and come to terms
with the reality of the traumatic event. Cognitive behavioral therapy is also beneficial in
restructuring an internal sense of self (Putman, 2009).
For the adult survivor of MCSA engaged in sexual offenses, cognitive behavioral therapy

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is a viable option. In 1989, W.L. Marshall published his ideas regarding the underlying intimacy
problems and loneliness prevalent amongst sex offenders. He explained that some sexual
deviants failed to secure bonds with parents or guardians during childhood because of abuse and
were thus unable to learn the skills and trust essential in forming meaningful intimate
relationships (Mann, 2004). Such a theory provides an explanation as to why most sex offenders
have “little experience of adult intimate relationships or they have engaged in relationships that
are superficial or volatile” and explains why sex offenders view sexual activity as an “overly
important aspect of intimacy” (Mann, 2004, p.142). It is logical to conclude that MCSA victims
who sexually offend may exhibit such cognitive/behavioral distortions regarding the importance
of sexual relations – even against another person’s will – due, in part, to their own victimization.
Distortions in cognitive information processing combined with behavioral flaws due to the lack
of parental bonding allow the offender to justify his actions. CBT is essential in such cases as it
will aid the offender in recognizing the distortions concerning the substitution of sexual activity
for affection and provide coping strategies to effectively deal with loneliness and frustration
(Mann, 2004). One problem with cognitive behavioral therapy, like most psychological
interventions, is that substantial progress takes time to develop.
Conclusion
MCSA is a serious issue that has to potential to result in psychological disorders,
revictimization, and criminal offending for the victim. A community approach is beneficial in
the prevention, intervention, and treatment of child sexual abuse. Unfortunately, research
pertaining to early intervention and prevention of MCSA is sparse. As Lovett (2007) points out,
“given the importance of the environment to young children, it may be necessary for a preschool
teacher or other child care providers to be connected in some way to the treatment [of a child

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victim]” (p.587). For purposes of prevention and intervention, preschool teachers, elementary
school teachers, and day care providers may be the best line of defense for MCSA, if provided
with the education and resources necessary to detect the early signs of abuse. As play therapy
may assist the child in expressing his thoughts or feelings, play behaviors may also act as
warning signs of abuse. For example, the child may reenact the trauma repeatedly through play,
become aggressive, dissociate during play, or become overly nurturing to dolls (Brown et al,
2008). The abused child may have an inability to concentrate in a school setting, achieve low
grades, miss or refuse to do homework, routinely lie, place blame on others, and consistently
become angry with the teacher or other authority figures (Brown et al, 2008).
The similarities between indicators of MCSA and childhood disorders such as
Oppositional Defiant Disorder or Attention Deficit-Hyperactivity Disorder (ADHD) are
astounding. According to the DSM-IV-TR, Oppositional Defiant Disorder is marked by a
“recurrent pattern of negativistic, defiant, disobedient, and hostile behavior toward authority
figures that persists for at least six months” (American Psychiatric Association, 2000, p. 100).
The child loses his temper quickly, is argumentative with adults, blames others for his behaviors
or mistakes, and is angry, resentful, and vindictive. For MCSA victims, such acting out may also
occur, particularly in cases where the abuse has been ongoing for a long period of time. ADHD
of the primary inattentive type, which is marked by at least six months of 1) failure to pay
attention to details that results in careless mistakes, 2) difficulty sustaining attention, 3) not
appearing to listen when spoken to directly, 4) failing to finish homework or chores, 5) difficulty
organizing tasks, and 6) forgetful in daily activities may correlate to the confusion and disruption
a MCSA victim experiences (American Psychiatric Association, 2000). To date however,
literature exploring these similarities appears to be non-existent. Further research is needed in

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this area to determine whether male children are routinely misdiagnosed, thus their victimization
remain a horrible secret.

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References
Alaggia, R. & Millington, G. (2008). Male child sexual abuse: A phenomenology of
betrayal. Clinical Social Work Journal. 36(3), 265-275. Retrieved September 14, 2009
from PsycNet database.
American Psychiatric Association. (2000). DSM-IV-TR. APA: Washington, DC
Boeschen, L, Sales, B., Koss, M. (1998). Rape trauma experts in the courtroom.
Psychology, Public Policy and Law, 4(1-2), 414-432. Retrieved September 20,, 2009
from PsycArticles database.
Brown, S., Brack, G., & Mullis, F. (Aug. 2008). Traumatic symptoms in sexually
abused children: Implications for school counselors. Professional School Counseling.
11(6), 368-379. Retrieved September 13, 2009 from ProQuest Psychology Journals.
Gorey, K. & Leslie, D. (1997). The prevalence of child sexual abuse: Integrative review
adjustment for potential response and measurement bias. Child Abuse and Neglect. 21,
391-398. Retrieved September 19, 2009 from PsycNet.
Graham, L., Rogers, P., & Davies, M. (2007). Attributions in a hypothetical child sexual
abuse case: Roles of abuse type, family response, and respondent gender. Journal of
Family Violence. 22, 733-745. Retrieved September 15, 2009 from PsycNet database.
Holmes, W & Slap, G. (1998). Sexual abuse of boys: Definition, prevalence, correlates,
sequelae and management. Journal of the American Medical Association. 280(21),
1855-1862. Retrieved September 26, 2009 from
http://www.jimhopper.com/pdfs/Holmes_&_Slap_1998.pdf
James, Richard. (2008). Crisis Intervention Strategies. (6th ed). Belmont, CA: Thomson
Brooks/Cole.

14. Male Child Sexual Abuse 14
Lisak, David. (1994). The psychological impact of sexual abuse: Content analysis of
interviews with male survivors. Journal of Traumatic Stress. 7(4), 525-546. Retrieved
September 26, 2009 from http://www.jimhopper.com/pdfs/Lisak_
(1994)_Male_Survivor_Interviews.pdf
Lovett, Beverly. (2007). Sexual abuse in the preschool years: Blending ideas from
Object Relations Theory, Ego Psychology, and Biology. Child Adolescence Social Work
Journal. 24, 579-589. Retrieved September 13, 2009 from ProQuest Psychology
Journals.
Mann, Ruth. (2004). Innovations in sex offender treatment. Journal of Sexual
Aggression, 6(2), 141-152. Retrieved September 20, 2009 from ProQuest Criminal
Justice Database
McCormack, A., Rokous, I., Hazelwood, R., & Burgess, A. (1992). An exploration of
incest in the childhood development of serial rapists. Journal of Family Violence. 7(3),
219-228, Retrieved September 19, 2009 from PsycNet.
Munro, K. (2000). Male-to-Male Child Sexual Abuse in the Context of Homophobia.
Retrieved September 26, 2009 from
http://www.kalimunro.com/article_malesurvivors.html
Putman, Stacie. (2009). The monsters in my head: Post-Traumatic Stress Disorder and
the child survivor of sexual abuse. Journal of Counseling and Development. 87(1), 80 –
89. Retrieved September 14, 2009 from PsycNet database.
Putnam, F.W. (2003). Ten-year research update review: Child sexual abuse. Journal of
the American Academy of Child and Adolescent Psychiatry. 42(3), 269-278. Retrieved
September 20, 2009 from PsycNet.

15. Male Child Sexual Abuse 15
Reid, J. & Sullivan, C. (2009). A model of vulnerability for adult sexual victimization:
The impact of attachment, child maltreatment, and scarred sexuality. Violence and
Victims. 24(4), 485-501. Retrieved September 15, 2009 from PsycNet database.
Ryan, G., Miyoshi, T.J., Metzner, J.L., Krugman, R.D., & Fryer, G.E. (1996). Trends in
a national sample of sexually abusive youths. Journal of the American Academy of Child
and Adolescent Psychiatry. 35, 17-25. Retrieved September 20, 2009 from PsycNet.
Salter, Anna. (1995). Transforming Trauma: A Guide to Understanding and Treating
Adult Survivors of Child Sexual Abuse. Thousand Oaks, CA: Sage Publishing
Sattler, Jerome. (1998). Clinical and Forensic Interviewing of Children and Families:
Guidelines for the Mental Health, Education, Pediatric, and Child Maltreatment Fields.
San Diego, CA: Jerome M. Sattler, Publisher Inc.