Child maltreatment and its victims. A comparison of physical and sexual abuse.

Although physical and sexual abuse are separate and distinct types of victimization, their impact on children is quite similar. Both of these forms of maltreatment involve the exploitation or misuse of a child by a parent or caretaker in the context of a pathologic family system. Physical and sexual abuse constitute an acute traumatic event for the child, generating phobic responses and anxiety-related symptoms including post-traumatic stress disorder. The long-term traumatic elements stemming from the chronic stigmatization and scapegoating contribute to problems of depression and low self-esteem and distortions in character formation. Betrayal by a primary caretaker leads to mistrust of others and difficulties with object relationships. Perhaps the most striking similarity between physical and sexual abuse of children is the tendency of the children to re-enact and recreate their victimization with others, leading to a transmission of violence in the next generation. Like their parents who were frequently victimized during childhood, they repeat and perpetuate an "aggressor-victim" interaction in their subsequent relationships. Both physical and sexual abuse are embedded in a deviant family structure, which adds to the psychopathology of the children. The contrast between physical and sexual abuse can be demonstrated by their specific impact on aggression and sexuality, respectively. The physically abused child has difficulty in experiencing and modulating aggressive impulses, whereas the victim of incest is often impaired in his ability to experience and integrate sexual feelings. The physically abused child is also at greater risk for cognitive and CNS impairment. Intervention with the abusing parents is the first step in protecting the children from further damage, but treatment of the child victims is necessary not only to diminish their psychopathology and emotional distress, but to prevent the cycle of violence in the next generation.