Sauzier M
Harvard Medical School, Cambridge Hospital, Massachusetts.
Psychiatr Clin North Am. 1989 Jun;12(2):455-69.
The data presented here offer a longitudinal perspective on sexually abused children. Disclosure data are postulated to be important variables in the short-term and long-term victim-to-patient process. Fifty-five per cent of the 156 children seen purposefully disclosed their sexual abuse, most frequently to their mothers. Children who never told, but were seen after accidental disclosures, showed less distress, whether hiding minor or major forms of sexual abuse. This finding support the clinical impression that disclosure adds extra stress on children and cannot be expected of every victim. A history of past mental health intervention did not seem to enhance the child's ability to tell. Education of all professionals is critical. Approximately 18 months after the end of the crisis intervention offered at intake, 115 of the 156 cases were re-evaluated. Overall, most children showed improvements on standardized tests, but 24 per cent got worse. Specific symptoms were found to cluster in four groups: acute anxiety, characterologic, family dynamics, and specific symptoms related to sexual abuse (sexual maladjustment, prostitution, revictimization, sexually assaultive behavior). Although the data seem to support the notion that crisis intervention by trained clinicians is helpful, it is too early to tell if the ominous findings described in adult survivors can really be decreased. The impact of disclosing child sexual abuse on entire families should not be underestimated, even in cases of extrafamilial abuse. The poor ratings parents gave law enforcement, judicial, and Child Protective Service professionals may be linked to the reluctance of victims to disclose their abuse and underscores the need to review current procedures and practices. Overall, a great majority of parents did see the sexual abuse as harmful to the child and to the family, but they were evenly divided about whether the disclosure was harmful or helpful to the child and family. A final word of caution comes from the 19 per cent of adolescents who regretted their disclosures. For clinicians and for researchers, the data presented here lead to further questions. A longer follow-up period is needed to assess whether these victims will be similar to the adults described in the literature or will become survivors with less pathology and less pain.
此处呈现的数据提供了关于遭受性虐待儿童的纵向视角。据推测，披露数据在短期和长期的受害者到患者转变过程中是重要变量。在特意前来就诊的156名儿童中，55%主动披露了他们遭受的性虐待，最常告知的对象是他们的母亲。那些从未主动透露但在意外披露后前来就诊的儿童，无论是隐瞒轻微还是严重形式的性虐待，表现出的痛苦都较少。这一发现支持了临床印象，即披露会给儿童增加额外压力，不能期望每个受害者都这样做。过去接受心理健康干预的经历似乎并未增强儿童主动诉说的能力。对所有专业人员进行教育至关重要。在 intake 时提供的危机干预结束约18个月后，对156个案例中的115个进行了重新评估。总体而言，大多数儿童在标准化测试中有所改善，但24%的儿童情况变差。特定症状被发现集中在四组：急性焦虑、性格方面、家庭动态以及与性虐待相关的特定症状（性适应不良、卖淫、再次受害、性侵犯行为）。尽管数据似乎支持受过训练的临床医生进行危机干预有益的观点，但现在判断成年幸存者中描述的不祥发现是否真的能够减少还为时过早。即使是在家庭外虐待的情况下，披露儿童性虐待对整个家庭的影响也不应被低估。家长对执法、司法和儿童保护服务专业人员的评价较低，这可能与受害者不愿披露虐待情况有关，并凸显了审查当前程序和做法的必要性。总体而言，绝大多数家长确实认为性虐待对儿童和家庭有害，但他们在披露对儿童和家庭是有害还是有益上存在分歧。最后要谨慎提及的是，19%的青少年后悔自己披露了此事。对于临床医生和研究人员来说，此处呈现的数据引发了进一步的问题。需要更长的随访期来评估这些受害者是否会与文献中描述的成年人相似，或者是否会成为病理情况和痛苦较少的幸存者。
