September 14, 2011

“Incest” traditionally has been defined as sexual activity between close blood relatives who cannot legally marry. The definition has been expanded to include sexual contact in a kinship-type relationship where sexual activity is usually barred, this including non-blood family members, such as stepparents and stepsiblings. Fathers, stepfathers, uncles, and older siblings are the most frequent perpetrators. Girls are more likely to be victimized than boys. Father-daughter incest is the most frequently reported type of sexual abuse and mother-son abuse is the least common type.

Statistics vary on exactly how many girls have been abused. A 1979 study of 900 randomly chosen women in San Francisco showed that 38% had suffered childhood sexual abuse. A Los Angeles Times poll in 1985, involving all parts of the United States, found that 27% of women reported inappropriate sexual contact in childhood. In the same Los Angeles Times poll, 16% of men suffered childhood sexual abuse. The United States in 1997 reported 1 million substantiated cases of child abuse, 22% of these were sexual in nature; the majority of cases were incest as opposed to abuse by a stranger. Guilt and embarrassment by all members of an incestuous family make accurate reporting of cases difficult.

Sociologists often view the prohibition of incest as a means of socialization. Biological factors also support the incest taboo. Childbearing among close blood relatives may unmask hidden recessive genes, which may be harmful or lethal to progeny. Anthropologists state that a person’s culture decides what forms of sexual contact constitutes incest.

Various factors contribute to the breakdown of the incest taboo. All socioeconomic groups are represented. Poverty, overcrowding, rural isolation, alcohol abuse, and mental health issues/mental retardation have long been associated with incest. Higher sociogroups tend to have less contact with reporting officials and may be more likely to conceal this type of sexual abuse.

Children who have suffered abuse may show symptoms that can produce lifelong effects. Anxiety, an overconcern with physical complaints, such as stomach pain and headaches, often becomes a difficulty. Formal posttraumatic stress disorder may develop with nightmares, flashbacks, and hypervigilance against perceived attacks, numbing, and increased startle reflex. Sexual preoccupation and aggression are common. Young children may display knowledge of sexual activity in play. Depression, low self-esteem, and suicidal behaviors are common as well. School performance may drop. A 1986 study by Browne and Finklehor demonstrated that 40% of adults with history of childhood sexual abuse had sequelae severe enough to merit therapy.

The diagnosis of incest can be a clinical challenge. The child may be fearful of the perpetrator, embarrassed, or ashamed and not disclose the needed information. Young children do not have the verbal or cognitive skills to relay information to health care or social workers. Physical signs and symptoms may be present, such as bruises, pain, genital itching, vaginal discharges, urinary tract infections, sexually transmitted diseases, as well as difficulty walking or sitting. Careful sets of interviews with the child, along with a thorough physical exam by a trained physician, are necessary for evaluation of suspected abuse.

Treatment of incest begins by providing protection for the child. Disclosure itself may be protective, as collusion and denial become more difficult. The child may need to be removed from her or his current environment, despite the potential for psychological trauma in doing so. After safety is assured, further psychiatric evaluation should follow. Psychotherapy for the child through play, artwork, or projective techniques can help the victim to come to terms with the trauma. The perpetrator’s psychopathology and prognosis for change must be assessed. Family therapy may help in influencing restraint over inappropriate behaviors and establishing better functioning of the household. Legal agencies may be involved to help enforce appropriate behaviors of the perpetrator. On a larger scale, prevention and early detection programs may assist in lowering the numbers of sexually abused children and giving rapid treatment to those already affected by this common form of child abuse.

SEE ALSO: Child abuse, Depression, Posttraumatic stress disorder, Sexual abuse

Suggested Reading

  • American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.
  • Bass, E., & Davis, L. (1994). The courage to heal: A guide for women survivors of childhood sexual abuse. New York: Harper & Row.
  • Kaplan, H. I., Sadock, B. J., & Grebb, J. A. (Eds.). (1994). Problems related to abuse and neglect. Kaplan and Sadock’s synopsis of psychiatry: Behavioral sciences, clinical psychiatry (7th ed., pp. 786-795). Baltimore: Williams & Wilkins.

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