Sexual abuse of children and adolescents.

Parents, relatives, and friends may inflict their passions on children of the same or opposite sex. This is often initiated by sleeping together. Sexual abuse contributes to and causes emotional trauma, although the child's turmoil, confusion, wish for acceptance, and anxiety may be overlooked by the parent and professional. Mutual silence aided by threats adds to the anxiety. Despite the notion that reports of parental sexual exploitation of their children are usually fantasies, there appear to be increasing data that incest and sexual abuse are frequent traumata. At present, there is increased risk of lowering the incest barrier because of increased rates of divorce and step- or surrogate parenthood, since they provide additional potential for being sexually and emotionally traumatized. Sexual abuse seems to be part of a constellation involving neglect and a pathological symbiosis. That sexual abuse is emotionally traumatic is apparent, but it needs emphasizing. Children's defensive reactions may cloud this, and it may be years before such incidents are connected to symptomatic behavior, even when the child is in intensive therapy. In the reported cases, there appears to be a pattern of reactions and defenses related to the traumata that are embedded in imprinting and identification with the aggressor. This leads to sexual abuse being a legacy passed on to the next generation of victims, as the victim becomes the molester through identification. Adolescent self-destructive behavior may stem from guilt about sexually abusing younger children. Therapists may be better able to understand and deal with some of their patients' symptoms if sexual abuse is considered as a possible factor in one or both directions.