Evaluation of Incest Cases: 4-Years Retrospective Study.

Incest is specific type of sexual abuse. The aim of this study was to evaluate the sociodemographic data and examination findings of cases referred to our hospital as forensic court cases of incest, and to measure the effect on mental health disorders of the nature of the sexual abuse. Retrospective examination was made of the records of 40 cases of incest victims. Evaluation was made of the age, gender, incident suffered, the perpetrator, form of abuse, examination findings, and mental status. The cases comprised 36 girls and 4 boys. Without penetration sexual abuse was determined in 25 cases and with penetration sexual abuse in 15 cases. At least one mental health disorder was determined in 20 of the cases of simple sexual abuse and in 11 of the major sexual abuse type cases. The most frequently seen mental health disorder was post-traumatic stress disorder (PTSD) in 21 cases. Mental health disorders were determined in 77.5% of the incest cases in this study, at a greater rate 80% in cases of "without penetration sexual abuse" than in cases of "with penetration sexual abuse" 74.33%. Therefore, all cases of incest must be followed up carefully without differentiation of without or with penetration abuse.

[Sexual violence against women in Tunisia]. / Violence sexuelle exercée sur les femmes en Tunisie.

BACKGROUND: Sexual violence exists everywhere in the world. It depends mainly on the cultural and religious norms conveyed in the various societies. This is a neglected area of research. Available data are insufficient, especially in Arab-Muslim context. METHODS: In this paper, we comprehensively review the scientific literature in order to clarify the cultural, religious and legal aspects of the concept of sexual violence against women in Tunisia, and ask the question of the urgent need to put in place strategies to counter this problem. RESULTS: The National Office for Family and Population published in 2011 the results of the national survey on violence against women in Tunisia, including data on sexual violence and its impact on women's health and well-being. According to this survey, 14.2% of women reported having been sexually abused by an intimate partner during their lifetime and 9.0% reported having experienced it during the last 12 months. One out of every six Tunisian women has been the victim of a sexual violence in a conjugal setting. More men than women legitimized violence against women in contexts where family control, especially conjugal control, is exercised over them. In a study examining the impact of culture and religion on experiences and sexual practice of women in Tunisian society, the majority of respondents thought that sexuality in women was a religious duty and that they do not have the right to refuse their husbands or to rebel. Thus, women would be doubly sanctioned having neither the right to express their desire nor not to respond to their husband's desire. A survey of a representative sample of Tunisian women found that 56.9% of the participants reported being victims of domestic violence, particularly sexual violence (10.7%) consisting mainly of rape and sodomy, at least once in their lifetime. This survey showed that those victims expressed dissatisfaction with overall quality of life. Moreover, contrary to Western literature, sexual violence was the least reported form of violence by teenage girls in Tunisian schools. Indeed, cultural values of modesty, virginity and honor are socially much more demanded for girls, in Arab countries in general, reinforcing staggering silence and inaction around violence experienced by school-aged adolescents. In Tunisian society, the cultural "solution" to rape wants the woman to marry her rapist which safeguards her family's integrity by legitimizing the union. CONCLUSION: Sexual violence has detrimental effects on female victims' physical and mental health. Even if the information on this form of violence is not easy to obtain in our environment, and that rates of subjects reporting sexual violence in their lifetimes are not important, the problem of sexual violence must be considered as a public health problem requiring urgent interventions and a greater institutional will.

Evaluation of social and demographic characteristics of incest cases in a university hospital in Turkey.

BACKGROUND: Incest is defined as any sexual activity between close blood relatives including step relatives and family members who are forbidden by law to marry. It is a problem that can be seen in all the social classes in developed and undeveloped societies. The World Health Organization classifies this problem as a silent health emergency. Father-daughter incest is reported to be the most common incest type followed by the other types like brother-sister, sister-sister and mother-son incest. MATERIAL AND METHODS: Subjects for this study were recruited from a sample of incest cases referred to Forensic Medicine Department of Gaziosmanpasa University Medical Faculty Hospital between 2008 and 2012. Data involved social and demographic characteristics and clinical features of victims, perpetrators and the families. The ethical committee of the faculty of medicine approved the study. RESULTS: The study sample consisted of 43 incest cases (36 females and 7 males) with an age rage 4-40 years. Two third of the victims were under 18 years old. All perpetrators were males. Father - daughter incest (34.9%) was found to be most common incest type followed by brother - sister incest (14%). 75% of the perpetrators were family members and relatives with consanguinity while 25% of them were not consanguineous but faithful and intimate relatives to victims. CONCLUSIONS: Increasing awareness about incest and its damaging effects is so important and clinicians should keep in mind sexual abuse or incest when examining the risky population. Multidisciplinary approach is necessary for determining short term or long term results and preventing the negative consequences of incest.

Forensic evaluation in alleged sibling incest against children.

Sibling incest is a serious form of intrafamilial sexual abuse with health, social, and legal relevance. A retrospective study was conducted through the analysis of forensic medical reports of the alleged sibling incest of victims under 18 years old (n = 68) from 2004 to 2011 as well as the respective judicial outcomes. Results demonstrated that sibling's sexual abuse is associated with several circumstances that might exacerbate its severity such as vaginal, anal, and/or oral penetration. Moreover, the victim's young age, the proximity between victim and abuser, and the fact that it is committed at the victim's and/or abuser's home and by using physical violence and verbal threats justify a late detection of these cases.

Medicolegal study of child sexual abuse in greater Cairo, Egypt, during a 7-year period: 2005-2011.

Child sexual abuse has gained public attention and has become 1 of the most high-profile crimes. This study aimed to determine the demographic and medicolegal aspects of child sexual abuse in greater Cairo, Egypt. This is a retrospective study from January 1, 2005, to December 31, 2011. Data were collected from a Cairo medicolegal department and were statistically analyzed. The total number of cases was 1832 victims; 57.9% were males and 42.1% were females. Most assaults occurred in 2010 (16.2%) and 2011 (17.5%). The age group 6 to 12 years accounted for higher rate (49%), mostly in males (71.8%). A total of 83.3% of the victims belonged to low social class, and 72.3% of the victims were out of school. Only 1.9% of the victims had a mental disability. The crime scene was an unknown place in 78.1%. All offenders were males; most cases had 1 offender (82.5 %); and most offenders were extrafamilial (94.2%), of low social level, illiterate, unemployed, and between 18 and 30 years old. The unmarried offenders assaulted the females more than the males, whereas the married assaulted the males more than the females. A total of 5.8% were intrafamilial offenders; 62.7% of these cases were incest against girls and 37.3% were sodomy against boys. Clothes were normal in 48.8%. Anal assault (52.3%) and incomplete vaginal penetration (32%) were the commonest types. There was no significant relation between findings, investigations, and time. In conclusion, child sexual abuse in greater Cairo represents a problem. Therefore,forensic medicine should be a part of a multidisciplinary approach to prevent, investigate, and treat the problem.

Sister-sister incest: data from an anonymous computerized survey.

Retrospective data were entered anonymously by 1,521 adult women using a computer-assisted self-interview. Thirty-one participants were victims of sister-sister incest, 40 were victims of brother-sister incest, 19 were victims of father-daughter incest, 8 were victims of sexual abuse by an adult female (including one mother), and 232 were victims of sexual abuse by an adult male other than their father before reaching 18 years of age. The rest (1,203) served as controls. The victims of sister-sister incest had significantly more problematic outcomes than controls on many measures as adults. Victims of sister-sister incest were more depressed and more likely than controls to be distant from the perpetrator-sister and to have traded sex for money, experienced an unplanned pregnancy, engaged in four different types of masturbation, and engaged in 13 different same-sex behaviors. Our findings were consistent with other reports of early eroticization and persistent hypereroticization of incest victims.

Variability in laboratory reporting practices for regions of homozygosity indicating parental relatedness as identified by SNP microarray testing.

PURPOSE: Single-nucleotide polymorphism (SNP) microarrays are capable of detecting regions of homozygosity (ROH) that can suggest parental consanguinity or incest. This study was designed to describe the variable reporting practices of clinical laboratories in the United States regarding ROH found on SNP microarray tests, to discuss the follow-up practices of laboratory personnel when findings of ROH indicate consanguinity or incest, and to highlight the legal and ethical dilemmas faced by workers who have discovered these incidental findings. METHODS: A 20-question survey was administered to microarray experts at 18 laboratories offering clinical SNP microarray tests. The results are presented using descriptive statistics. RESULTS: There was variability in laboratory SNP microarray reporting practices with respect to information and interpretation of ROH findings. All the laboratories agreed that they have a duty to inform the ordering physician about results suggesting consanguinity or incest, but the follow-through practices varied among laboratories. CONCLUSIONS: This study discovered variability in reporting practices and follow-up procedures for microarray results that suggest parental consanguinity or incest. Our findings highlight the need for laboratory guidelines to standardize reporting practices for SNP microarray and other tests that are capable of detecting ROH.

Contact sexual offending by men with online sexual offenses.

There is much concern about the likelihood that online sexual offenders (particularly online child pornography offenders) have either committed or will commit offline sexual offenses involving contact with a victim. This study addresses this question in two meta-analyses: the first examined the contact sexual offense histories of online offenders, whereas the second examined the recidivism rates from follow-up studies of online offenders. The first meta-analysis found that approximately 1 in 8 online offenders (12%) have an officially known contact sexual offense history at the time of their index offense (k = 21, N = 4,464). Approximately one in two (55%) online offenders admitted to a contact sexual offense in the six studies that had self-report data (N = 523). The second meta-analysis revealed that 4.6% of online offenders committed a new sexual offense of some kind during a 1.5- to 6-year follow-up (k = 9, N = 2,630); 2.0% committed a contact sexual offense and 3.4% committed a new child pornography offense. The results of these two quantitative reviews suggest that there may be a distinct subgroup of online-only offenders who pose relatively low risk of committing contact sexual offenses in the future.

Sibling sexual abuse: an empirical analysis of offender, victim, and event characteristics in National Incident-Based Reporting System (NIBRS) data, 2000-2007.

Sibling sexual abuse is identified as the most common form of familial sexual abuse. Extant literature is plagued by definitional inconsistencies, data limitations, and inadequate research methodology. Trivialized as "normal" sexual exploration, sibling sexual abuse has been linked to psychosocial/psychosexual dysfunction. Research has relied on retrospective, convenience, and/or homogenous samples. This work drew on eight years of National Incident-Based Reporting System data (2000-2007) to provide aggregate level baseline information. This work extended prior research exploring victim-, offender-, and incident-based characteristics. Results highlight the need for expanded definitional criteria relating to both age and gender to better inform risk assessment and prevention. Findings both corroborate and contrast prior work and suggest victim- and offender-based gender differences.

Unconventional sexual behaviors and their associations with physical, mental and sexual health parameters: a study in 18 large Brazilian cities.

OBJECTIVE: There have been many studies investigating paraphilias and sexual compulsion, but thus far little data about prevalence of unusual sexual practices that are subthreshold for these diagnoses. The associations between unconventional sexual behavior and sociodemographic and health parameters were investigated. METHOD: A cross-sectional study of 7,022 individuals (45.4% of women) was carried out using a self-administered questionnaire that compared individuals carrying at least one reference of unconventional sexual behavior (group 1) with individuals without such reference (group 2). RESULTS: Women's mean age was 35.0 vs. 35.9 years (p < 0.05) and men's mean age was 36.5 vs. 37.8 years (p < 0.05) being lower in group 1 than in group 2, respectively. More men (52.3%) than women (30.4%) (p < 0.001) presented unconventional sexual behavior. Fetishism (13.4%) and voyeuristic behavior (13.0%) were more frequent. Unconventional sexual behavior was associated with male gender, single or separated marital status, black or mulatto race, elementary and high school educational level, history of posttraumatic stress disorder treatment, alcohol dependence, emergency contraception, difficulty at the beginning of sexual life, sexual violence, bisexuality, and performance of anal or oral intercourse. CONCLUSION: Unconventional sexual behaviors are important because they are associated with poorer health status and lower educational levels.

The effect of severe child sexual abuse and disclosure on mental health during adulthood.

This study examined the relationship among severe child sexual abuse, disclosure, and mental health symptoms during adulthood. The sample consisted of 172 adults who were sexually abused in childhood. The multivariate model showed that respondents in their 30s and 40s who were abused by more than one abuser, who were injured by their abusers, who were abused by a biological relative, who told someone about the abuse when it occurred, and who did not discuss their abuse in depth within one year of the abuse had a greater number of mental health symptoms. Abuse severity and disclosure history should be assessed by professionals to identify clients who are at higher risk of mental health symptoms and to focus therapy.

Does victim age differentiate between perpetrators of sexual child abuse? A study of mental health, psychosocial circumstances, and crimes.

To test the theory that sexual offenders who abuse very young children (0-5 years) have more severe mental health and psychosocial problems than those who victimize older children, authors compared psychiatric diagnoses, social circumstances, and crime-related data in all sexual offenders against minors referred to forensic psychiatric investigation in Sweden during a 5-year period. Thirty-one men had committed index crimes involving victims between the ages of 0 and 5 years (Group 1), 90 had 6-to 11-year-old victims (Group 2), and 41 had 12- to 15-year-old victims (Group 3). All three offender groups were characterized by severe mental health problems, in many cases fulfilling American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (4th ed.) criteria for both Axis I and Axis II diagnoses, but these problems did not differ between groups. Neither did social situation or sexual orientation. Offenders with 0- to 5-year-old victims significantly more often abused both boys and girls. Frequencies of retrospectively diagnosed childhood-onset behavior disorders were high in all three offender groups. The authors' data did not support previous findings of increasingly severe mental health problems with decreasing victim age.

Action research improves services for child sexual abuse in one Caribbean nation: An example of good practice.

BACKGROUND: Child sexual abuse (CSA) is a multi-dimensional problem. The search for best practice must consider the complexities surrounding CSA and its management in any particular society. OBJECTIVE: Data previously gathered from service providers on CSA service provision in Trinidad and Tobago identified key deficient issues in policy and practice. In this paper, researchers aimed to bridge the gaps identified, and effect changes to improve services for CSA using an action research methodology. PARTICIPANTS AND SETTING: Service providers from all sectors in governmental and non-governmental organizations in Trinidad and Tobago, who work with children at risk of CSA were involved in the process. METHODS: Researchers led the service providers into an awareness of their own practice through critical discussion of, and reflection on, the key deficient issues. The new knowledge generated, with guided input from evidenced-based best practice, led to the development of guidelines for management. Discussion of the practicability of the guidelines by service providers in multiple sectors generated more new knowledge that refined the management approach. RESULTS: The contextual knowledge obtained from service providers resulted in best practice guidelines for service providers that were culturally relevant and context-sensitive, adaptive and implementable, and allowed a seamless multidisciplinary response to CSA in Trinidad and Tobago within prevailing constraints. CONCLUSIONS: Action research offers an effective approach to improve services for CSA through mobilization of service providers and changes in policy and practice. It is applicable in any setting and likely to be effective in any socio-cultural context.

Female sexual abuse and criminal justice intervention: a comparison of child protective service and criminal justice samples.

OBJECTIVE: The current study compared a sample of female perpetrators reported to Child Protective Services (CPS) to a sample of women from the criminal justice system. Instead of examining a clinical or criminal justice sample in isolation, this comparison allows a more accurate description of female sexual offending. METHODS: Cases were drawn from a Midwestern state's child abuse registry, law enforcement records, and sex offender registry. The CPS sample consisted of 179 women, and the criminal justice system sample consisted of 57 women. All cases were reported to the agencies between 1994 and 2004. RESULTS: Victims ranged in age from 1 to 18 years old (M=9.98, SD=4.37). As hypothesized, there were statistically significant differences between the CPS and criminal justice samples. Specifically, the CPS sample had a majority of victims under age 12 (74.9%), while the criminal justice sample had a majority of victims between ages 13 and 19 (73.8%). The CPS sample had predominantly intrafamilial victims (97.8%), while the criminal justice sample had a majority of extrafamilial victims (63.3%). The CPS sample also showed significantly more female victims (63.7%), while the criminal justice sample had mostly male victims (62.1%). CONCLUSIONS: There were significant differences in the victim's age, the victim's gender and the perpetrator-victim relationship between cases managed in the CPS and the criminal justice system. The results highlight the need for further research into child welfare and law enforcement collaboration.

A typological analysis of behavioral profiles of sexually abused children.

A cluster analysis is used to explore differential outcomes in 123 French Canadian children reporting sexual abuse contrasted with 123 control children. Mothers' reports of behavioral problems on the Child Behavior Checklist, abuse-related variables, personal factors, and family characteristics are used as potential variables discriminating clusters. Results reveal four clusters: (a) anxiety constellation group refers to children displaying behavior problems on a subset of scales, (b) the severe distress group refers to children showing a broader array of behavior problems, (c) victims of less severe sexual abuse (SA) group consists of children disclosing mostly extrafamilial SA, and (d) resilient children refers to children who, while disclosing severe abuse, rely less on avoidance coping. Findings underscore the need to go beyond abuse-related variables to orient treatment for children disclosing sexual abuse and for tailoring interventions to distinct subgroups.

Discriminant factors for adolescent sexual offending: On the usefulness of considering both victim age and sibling incest.

Understanding the pathways and circumstances of juvenile sexual offending is of utmost importance. However, juvenile sexual offenders (JSO) represent an especially diverse group of individuals, and several categorizations have been proposed to obtain more homogeneous subgroups. Victim age-based and family relation-based categorizations are particularly promising because they seem theoretically and clinically relevant. Empirical results however are still inconsistent, and most studies have not considered these two dimensions jointly. The first goal of this study was to further examine the value of subgrouping JSO according to the age of their victim. A second goal was to determine the supplementary value, if any, of considering sibling incest. Based on a sample of 351 male JSO, it was first confirmed that sexual abuse of children was more strongly related to asociality (social skill deficits) than sexual abuse of peers, the latter being more closely associated with antisociality (general delinquency). The relevance of considering mixed-type JSO (with both child and peer victims) separately was also confirmed. More importantly, multivariate statistical analyses demonstrated that adding sibling incest to the equation was useful. JSO of intra-familial child were significantly more likely to have been victimized during their own childhood compared to JSO with extra-familial victims. Nevertheless, adolescents who had committed sibling incest obtained middle ground results on most variables (except for crime severity), suggesting that they constitute a distinct but not extreme, subgroup. This study confirmed the utility of using both the age and the family relation with the victim in characterizing juvenile sexual offending.

Infanticide in female forensic patients: the view from the evolutionary standpoint.

Evolutionary theory predicts that very young mothers would be more likely to kill an infant than older women, given that the younger mother has a much greater ability to "replace" the dead child through subsequent pregnancies and thus to produce offspring for the next generation. Evolutionary theory also predicts that a woman would be more likely to kill a child if the child was obviously defective, the pregnancy was the result of incest or rape, or if the mother's means of supporting the child were severely compromised. The authors hypothesized that mentally ill mothers would behave in a way that differed significantly from evolutionary expectations, i.e., that they would be more likely to kill children who were older than those killed by mothers in the general population and that the mothers themselves would be likely to be older than mothers in the general population when the murders occurred. To test this hypothesis, the authors compared infanticides (both filicides and neonaticides) committed by mentally ill mothers with those committed by mothers in the general population. They examined two samples: 1) all cases of maternal infanticide from the Mid-Hudson Forensic Psychiatric Hospital from 1978 (when the hospital began admitting female patients) through the year 2000 and 2) a general population sample from a 10-year Canadian study reported by Daly and Wilson in 1998. The authors focused on the following variables: ages of the mothers, ages of the child-victims, whether the pregnancy was the result of rape or incest, whether the child had significant behavioral or physical problems, and whether there were problems supporting the child (e.g., having no partner, poverty, mother's lack of education). The results of the analyses supported the authors' hypothesis about ages of mothers and children. The mentally ill mothers in the Mid-Hudson sample were generally older when they killed their children and the children who were killed were generally older than in the Daly and Wilson general population sample (where the majority of the cases involved neonaticide and the mothers were generally younger than 25 years of age). The three factors, poverty, low education level (or low intellectual capacity), and lack of a spouse were common in both samples. Findings concerning cultural factors, motives, and methods used will be presented in separate publications.

Current mental health in women with childhood sexual abuse who had outpatient psychotherapy.

PURPOSE: This study from Norway examines mental health status of women with child sexual abuse (CSA) who formerly had outpatient psychotherapy for anxiety disorders and/or depression. The relative contributions of CSA and other family background risk factors (FBRF) to aspects of mental health status are also explored. SUBJECTS: At a mean of 5.1 years after outpatient psychotherapy, 56 female outpatients with CSA and 56 without CSA were personally examined by an independent female psychiatrist. Systematic information about current mental health and functioning was collected by structured interview and questionnaires. RESULTS: Among women with CSA 95% had a mental disorder, 50% had PTSD, and mean global assessment of functioning (GAF) score was 61.8+/-10.6. In contrast, 70% of women without CSA had a mental disorder, 14% had PTSD, and mean GAF 71.2 + 8.5. GAF and trauma scale scores were mainly determined by CSA, while FBRF mainly influenced the global psychopathology and dissociation scores. DISCUSSION: We have little knowledge on the mental health status at long-term in women with CSA who had psychotherapy. This study found their mental status to be rather poor, and worse than that of women without CSA who had psychotherapy for the same disorders. From the broad spectrum of mental disorders associated with CSA, this study concerns only women treated as outpatients for anxiety disorders and/or non-psychotic depressions. CONCLUSION: Women with CSA showed poor mental health at long-term follow-up after treatment. The fitness of the psychodynamic individual psychotherapy given, or to what extent treatment can remedy the consequences of such childhood adversities, is discussed.

A comparison of incest offenders based on victim age.

The purpose of the present study was to compare incest offenders (IOs) whose victims include infants or toddlers to IOs with adolescent victims on several variables commonly examined in the sexual offender literature. Participants were 48 men whose youngest victim was less than 6 years of age (younger-victim incest offenders; YVs); and 71 men whose youngest victim was 12 to 16 years of age (older-victim incest offenders (OVs). In general, YVs showed more emotional disturbance and pathology than OVs. Compared with OVs, YVs had a greater history of substance abuse and more current problems with alcohol. In addition, YVs reported significantly poorer sexual functioning and were significantly more psychiatrically disturbed. YVs were also more likely to have a male victim, to have victimized a nephew/niece or grandson/granddaughter, and to have denied their offense(s). It was evident that both the YVs and OVs demonstrated clinically significant difficulty with normal sexual functioning and exhibited deviant sexual arousal.