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Signs and Symptoms of Child Sexual Abuse

Angela Oswalt, MSW, edited by Mark Dombeck, Ph.D.

Though children may not speak about abuse, they may nevertheless communicate that something significant and disturbing has happened to them in a non-verbal manner. Significant or sudden changes in mood or behavior may indicate a problem. Changes in mood may include signs of depression: sadness, tearfulness, lethargy, anger, or mood swings. Children may also begin isolating themselves, withdrawing from family or friends, spending all of their time outside the home, experimenting with alcohol or drugs when this was not the case in the past, or start acting out at home or at school. The experience of sexual abuse often has the effect of both calling children's attention to the fact that they are seen as sexual objects by others and polarizing their reaction to this fact. Thus, examples of acting out in the wake of abuse out include a new and extreme aversion to being touched (even by completely safe family members) or, conversely, promiscuity or sexually suggestive behavior when this was not characteristic of the child in the past. Sometimes victims of sexual abuse or assault will change their appearance and try to become less attractive: wearing baggy, unattractive clothing, avoiding cosmetics, or failing to style their hair. Or, youth may adopt a more seductive and sexualized manner of dress.

Other behavioral changes which may indicate abuse include: significant changes in sleeping patterns and habits, significant or sudden changes in appetite and eating patterns, or significant weight gain or loss. A heightened sense of vigilance, vulnerability and fearfulness, possibly combined with a new sensitivity to startle, and a desire to withdraw socially may indicate the presence of post-traumatic stress disorder (PTSD).

When children have been sexually assaulted (raped) they may show medical signs of their attack including sexually transmitted infection, urinary tract infection and other hard-to-explain injuries. These conditions could also occur in cases of children's voluntary sexual activity, but parents should not assume that case.

Some abused youth will act out their inner pain by self-harming; often by cutting themselves with a blade in an effort to distract from emotional pain. Such intentional cutting is easy to confuse with a suicide attempt though it is almost never that. It's also important to know that people self-harm for many different reasons, not all of them have to do with abuse. Considered as a symptom, self-harm is most commonly associated with Borderline Personality Disorder which can occur quite independently of past abuse. See our Personality Disorders topic center for more information about BPD.

What to do if your Child Has Been Sexually Abused

Parents who believe their children may have been sexually abused should take quick action. This is particularly the case if children voluntarily report sexual abuse or other inappropriate sexual contact by any adult or caregiver has occurred.

Get Immediate Medical Attention!

If the sexual abuse occurred within the last 24 hours, parents should immediately take their children to an emergency room, urgent care, or local child and family advocacy center, and do so before the child takes a shower, changes clothes or even has a drink. This prompt medical attention will accomplish two important goals. First, visiting the doctor helps ensure that children receive time-sensitive medical assessment and treatment (possibly including pregnancy prevention, early detection and treatment of sexually transmitted diseases, and treatment of injuries). Second, it also allows the collection of physical evidence documenting that abuse has occurred and possibly helping to conclusively identify (through DNA testing and similar technologies) the identity of the perpetrator. Such evidence can then be used in any later court proceedings against the perpetrator. Even if the sexual abuse is less recent, caregivers should still take the youth to a doctor for a full medical assessment and call the police to report the crime.

Talk to a Rape Counselor

In addition to receiving vital medical attention, abused children should strongly consider talking with a supportive rape counselors or social worker whose job it is to help the entire family access the emotional support and treatment they need. Rape counselors or social workers are often on call at emergency rooms and child advocacy centers, so counseling may be accessible from the same place where the child is seen by the doctor.

Some youth and families may feel worried and completely embarrassed about going to their family doctor or emergency room with such a personal and often shameful-feeling issue. It is best to push through these feelings and go to see the doctor anyway. However, in the event that the child or family really does not want to see the doctor, a lesser alternative action to take which may still be helpful would be to call a rape crisis hotline and speak to a telephone counselor on an anonymous basis. Several national abuse and rape hotline resources exist in the United States, including the National Sexual Assault Hotline, freely available at 1-800-656-HOPE. Callers will be directed to the nearest The Rape, Abuse, and Incest National Network (RAINN) support center where they may talk to a trained counselor and receive information about local abuse and rape resources in their area.