Let's begin with the statistics - and they are daunting:
Approx. 1 in 4 girls & 1 in 8 boys are sexually abused before the age of 18. Even the most conservative estimates put it at 1 in 6 girls & 1 in 10 boys.

It is estimated that as many as 40 million Americans - one in six people - experienced sexual abuse as a child.

Child sexual abuse is seldom a one-time occurrence - it lasts an average of 1 - 4 years.
It occurs at every socioeconomic level, across ethnic and cultural lines, within all religions and at all levels of education.

Only 10% of childhood abuse victims are abused by strangers.

Most offenders are acquainted with their victims - they're either family members, friends of the family, babysitters or neighbors. Abuse does run in families and the psychological repercussions of being abused by someone you know and trust are potentially much more severe.

1 in 20 children are physically abused each year.

There aren't any statistics on emotional abuse but it is believed to be much greater than sexual and physical abuse combined. (Florida State U study). And that's because ultimately all abuse is emotional abuse.
We'll talk more about emotional abuse later.

When we talk about working with abuse survivors, we are primarily talking about working with trauma and PTSD. Abuse creates trauma and if an adult survivor is coming to see you - they are most probably still dealing with the psychological effects of childhood abuse - therefore I would say that they are still traumatized and to a lesser or greater degree they are experiencing PTSD - now the PTSD might not be in the form of what we classically think of as PTSD (flashbacks, nightmares or severe anxiety outside of their control) - But if they are experiencing continuous negative thoughts or behaviors that are getting in their way - or if they have traumatic sexual issues or deep rooted intimacy issues. Then In the context of their lives - they are experiencing PTSD. So we need to understand trauma as it presents here and how the mind and body deals with it.

"Every emotionally meaningful experience - whether joyous or painful - is stored in memory and has a lasting impact on a child's developing nervous system. The way our world feels to us as children influences our unfolding personality, emotionality and relating styles profoundly, for the long term."

This leads us to a form of neuroscience known as Neuroplasticity.

Neuroplasticity is a term used to describe changes in the brain that occur in response to experience. We used to think that this "plasticity" of the brain only occurred in the first few years of life - what we now know is that the ability of the brain and the nervous system to alter based on the environment - is ongoing. This discovery dramatically alters the nature/nurture power balance giving one's environment added and continuous weight - both positively and negatively - throughout the life span.

A traumatic event such as any type of childhood abuse changes the chemistry of the brain. What literally happens is that events reshape wiring and responses so that even a small degree of continual stress can produce an overabundance of stress hormones that in turn create anxiety and depression and PTSD - which can last indefinitely.

It is in an area of the brain called the amygdala - that the processing and storing of highly charged emotions, such as abuse, takes place. The amygdala allows us to remember every emotion and physical sensation from our earliest days, even if we have no clarity about the events that took place. These memories are referred to as implicit memories - they are unconscious and they are encoded in emotional, sensory and visceral recall. These are the memories between infancy and 4 years of age - when children are either pre-verbal or beginning to think but can't necessarily articulate thoughts - so any trauma that occurs during that period will be held in the body as a sensory or implicit memory which the abused child/adult will later react to but not understand. Those types of memories are in direct contrast to explicit memories - explicit memories are what we usually mean when we use the word memory - they are conscious memories - ones which we can articulate, describe in story form and make sense of.

Many of the clients I see say they don't have any memories but they know that something happened - many will never recover the exact memories because of either their age when abused or the degree of trauma surrounding the memory. But the body knows!
And it isn't just children who experienced abuse before the age of four who don't remember. As you all know, our minds have the ability to block anything from consciousness that we can't handle, so older children can lose conscious memory as well.

The degree of PTSD that an abuse survivor experiences is often tied to their degree of implicit vs. explicit memory. If it is mostly implicit memory that a survivor carries, then their brain will make associations and something that reminds them of the abuse will trigger an unexpected automatic reaction. Because they have no idea what is happening to them or what set them off, the reaction is very traumatic. If they begin to remember or if they always remembered it, the automatic reaction loses much of its power.
It's important to note again that when the memories are primarily implicit, it is possible that the survivor will never remember, and therefore the trauma may be more difficult to treat.

It is not just fathers or men who sexually abuse, and of course it is not just girls who are abused.
One of the most prominent researchers in the field of childhood sexual abuse is David Finklehor - A study he undertook with Diana Russell concluded that female perpetrators account for 25% or more of those who sexually abuse children.
Who are these women? 80% of these female offenders have been sexually or physically abused themselves as children (Fowler et al, 1893).

July 2000 Justice Dept. report found that women abusers victimize younger children then male abusers accounting for 4% of those who sexually abuse children under 18 years of age but about 12% of those who molest children younger than 6 yrs. And that statistic doesn't include such sexually abusive behaviors as sleeping with children and fondling them, bathing, touching or massaging them inappropriately, undressing and/or dressing them inappropriately, making children touch them and engaging in sexualized talk - all of which - except for engaging in sexualized talk - is much more likely to be done by women - particularly mothers. Because it is so underreported in general - we just have no idea how many women (mothers) sexually abuse
But here's an interesting thought - If current research is correct and more female than male children are sexually abused and most abusers have themselves been abused as children - than it's possible to conclude that more girls may grow up to be abusers, and there's probably a much larger number of female sexual offenders than we would imagine.

Lets make a distinction between mothers abusing sons and mothers abusing daughters - it’s not about sexual preference - In fact, most child sexual abuse is not about sex

Most times, the Son becomes a substitute for the father or another male
This boy is the only male in this woman's or mother's life that she can control and she directs her anger, her rage, her stress and her fears on him.
Son/boy feels protective of mom/woman
And because it is usually not violent or even overly coercive, it is confusing for both the victim and society at large
Boys don't tell - the degree of shame is greater than with girls. But the degree it affects their self-esteem, sense of selves and ability to engage in intimate relationships later on is the same.
As adults these boys/men either become hyper-masculine and angry or they become passive caretakers. Even the passive ones can be hyper vigilant.

The least understood of all types of sexual abuse
Needs to be brought out of the shadows - it is minimized and marginalized.
Can be very subtle but most of the time it is extreme (pornography, sodomy, enemas, performing or watching others, three-ways, etc.) and it usually co-occurs with physical abuse.
Mothers and daughters are just a few heartbeats away from being the same person. They shared the same body.
And perhaps that helps to justify the abuse to the abuser. They are "loving" or "abusing" themselves.
For the daughters, it is psychologically so devastating because their mother is the person who teaches them how to be a woman in the world, how to identify and feel about themselves, and of course, gives them their primary sense of self worth. For daughters, her core relational self, her self-structure has been denied because there is no safe, loving other to model.
There is a complete lack of boundaries in these mothers. No consideration of the daughter except as an extension of herself.
Many of these mothers are substance abusers. But substance abuse isn't the reason they abuse - it simply acts as a disinhibitor for them.
The sex isn't about sex; more often, it is a generational handing down of abusive/incestuous relationships.
And the stereotype of the mentally insane woman who does this is mostly inaccurate. While Female abusers can run the gamut from promiscuous Borderlines to introverted, socially awkward women - just like with men, some of the most respectable appearing women are preying on their children behind closed doors.

For more information about mother/son abuse and mother/daughter abuse - look at my articles

Father/daughter or stepfather/daughter is what comes to mind first when we think of childhood sexual abuse - but it is not the most common form of abuse - and despite the fantasy that it is about men lusting after young female flesh, it is - once again - more about power than it is about sex. Oftentimes it is repressed rage and usually a current stressor sets it off. However when it is the biological father it is more likely that the victim is the unintentional consequence, not the target, of these repressed forces.

Father/son abuse carries specific psychological/emotional baggage. Not only do the victims grow up exhibiting the same problems as female victims - low self esteem, anxiety, guilt, relationship difficulties, sexual difficulties, self destructive and addictive behavior, they can also develop sexual identity concerns. Masculinity is an ideal for men and it is difficult to perceive yourself as both a victim and masculine. Just as there was more shame experienced by boys abused by their mothers. There is more profound shame attached to same sex abuse with boys than with girls. Girls who are abused by their mothers don't necessarily grow up thinking or concerned by the possibility of being Lesbians - boys, however, are concerned they might be Gay or if they are Gay, they wonder if the abuse made them that way.

Over the past few years there has been a spotlight on priests who have abused young boys - some of these priests have been identified as homosexual so I don't want to minimize or misrepresent what is going on in that particular community, but it doesn't alter the research. And that is - that even when there is abuse of boys by men other than their fathers, it’s more about power and control than it is about sex and the abusers aren't necessarily Gay

Some of research findings:
Virtually all male abusers of boys consider themselves heterosexual (Gartner, 1999).
Only 65% of child abusers meet the criteria for pedophilia (Mayo Clinic).

So the notion that this is a way for homosexual men to get sex is slanderous, it's homophobic and it doesn't hold up statistically. Just as most heterosexual men who like younger women don't go around abusing underage girls, most Gay men who like younger men don't go around abusing underage boys.

Sibling Abuse may be as common or more common than other types of incest. Any where from 57%( Goldman & Goldman) to 90% (Finkelhor) of nuclear family incest involves siblings. And that doesn't even include physical and emotional abuse! But it may be the most ignored - if not accepted - form of abuse in families. Why is it minimized? Many times it is swept under the rug as sibling rivalry - no parent really wants to believe that there's a more serious problem going on. Furthermore, parents never report because they don't want to get their children in trouble with the law.
Additionally, sometimes it's in the parent’s interest not to notice because they need to leave siblings alone to take care of each other.
But brother-sister incest may be five times as common as father-daughter incest". (Hart & Brassard - A Major Threat to Children's Mental Health).
And there is evidence that parents are aware of sexual abuse 18% of the time; emotional abuse 69% of the time and physical abuse 71% of the time.

What causes one sibling to abuse another?
Acting out anger - at parents or another sibling who is hurting them
Mirroring parents behavior
Inappropriate expectations of the abuser by the parents - too much responsibility

Long-term effects of sibling abuse:
Lower self esteem and overly insecure
Trouble with relationships
Sexual functioning problems
Self blame and/or anger

Trauma Shapes Sexuality - (write on board)
Often we are dealing with not only the sexual abuse of the past but also the sexual behavior of the client as an adult.

Finklehor & Browne - "theory of sexual traumatization" - through a variety of means, childhood abuse - primarily childhood sexual abuse shapes sexuality creating unusual emotional associations to sexual activities and a repertoire of sexualized behaviors that seem inappropriate or disturbing to many others. These behaviors may have been learned during the period of abuse or in some manner are associated with the abuse and are now used as a strategy for manipulating others or to self stimulate.

What I have noticed is that their particular sexualized behaviors may or may not shame them, but what usually does shame the survivor is the idea that their young bodies may have responded to the sex in a way that was antithetical to how their minds were processing it. I have had more than one client who has confessed that the only person she ever had an orgasm with was her abuser! While I won't get into this subject further today, you can read my article " Sexual Abuse & Sexuality" which is here on the table along with other articles
I have written on some of the topics we have covered.

Finally, I want to return briefly to emotional abuse:
It's impact and pervasiveness cannot be emphasized enough

Emotional abuse is the most common form of abuse, and perhaps the least clearly understood. That's because emotional abuse is not a single or quantifiable act. It is difficult to chronicle or identify.
Because it is not a reportable crime and there are no hard statistics, there is very little research on the psychological repercussions and in general it is minimized. But we do know that emotional abuse has been shown to produce 1.6 x as many symptoms of depression and anxiety among adults as those not abused. And those adults were also twice as likely to have suffered a mood or anxiety D/O. (FSU). Why? - Because survivors of emotional abuse have internalized years of negative messages without any filter and they now believe it. Adults who have been emotionally abused as children are among the most self critical - hence the high degree of depression and anxiety found among this population.
And it is the emotional aspect of sexual abuse that can be the most devastating. I have had clients - fondled by their fathers - who were much more severely traumatized than those who had been sexually penetrated. How can that be when penetration is so much more physically traumatic?
Because emotional trauma lives on after physical trauma fades away.
And because it depends on the emotional impact that that particular abuser had on this particular survivor
And it depends on whether or not the rest of the family compounded the trauma by their denial or reaction to the abuse.
In the end - All abuse is emotional abuse.

Roni Weisberg-Ross LMFT

Author's Bio: 

West Los Angeles based psychotherapist specialized in treating sexual and emotional abuse, trauma and relationship/communication issues.