February 5, 2014 11:45am Prevalence

So I got called out by some readers about the incidence of sexual predators in the “normal” population. Good, I wanted to see if you were paying attention. While the incidence of children who are sexually molested in childhood has risen to 1 in 3 for girls and 1 in 4 for boys, no one is able to estimate the number of sexual predators. That seems to be based on the double phenomenon of “who cares” and “I can’t think about it.” Remember when I was in medical school in 1985 and we heard that male birth control was right around the corner because immobilizing sperm would be so simple? Where, I may ask is that male BCP? Nowhere, the same place all the sexual predators aren’t. So if I was wrong to say that when I look out from the choir loft and count, one, two, three and ask which one is victim and which is perpetrator, what pray tell is correct?

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Let me give you a few facts and then my clinical impressions. First, just try to do a web search for this information. Reminds me of the proverbial needle in the haystack Momma was always looking for. Where is this infomation? I did some time as a collaborator on the NIMH twin study on the epidemiology of the concordance rate of mental illness in monozygotic and dizygotic twins as a child fellow in Virginia. I know how to do a literature search and statistal analysis. Basically the information is not there because adults and teenagers who have sex with children don’t check the box, “Yes.”  This makes data collection impossible.

Here are a few statistics that are known. Between 1% and 5% of our population molest children, Dr. Gene Abel from the Child Molestation Research and Preventation Institute. “There are 400,000 registered sex offenders in the United States and an estimated 80 to 100,000 of them are missing. They’re supposed to be registered but we don’t know where they are and we don’t know where they’re living,” Ernie Allen, President of the National Center for Missing and Exploited Children. Now you must know that to be a registered sexual offender you have to be a convicted sexual offender. To be cited as a viewer of child pornography, you have to have been caught and convicted. Statistics estimate that out of 100 rapes less than 40 are reported, 10 arrests made, 8 prosecuted, 4 felony convictions and only 3/100 rapists wil spend even a day in prison. 97 walk free. These statistics come from the Justice Department National Crime Victimization, 2012.

Imagine for a moment how quickly that exponentially expands for child and adolescent rape. 44% of child molesters are under 18 years of age. 2/3 of assaults are committed by someone known to the child. 38% of rapists are a friend or acquaintance. The facts were taken from the Child Molestation Research and Prevention Institute. So how easy is it to exploit a child sexually repeatedly, violently and almost publically and still not appear on any registry. Very easy and if you don’t believe me ask Jerry Sandusky. And then ask yourself how many children you think he really raped in his career as head coach and pillar of the society. How many more than the handful that came forward with his adopted son? Ten, twenty, hundreds?

If these numbers don’t stagger you then this will.  In my twenty years of working with children as Medical Director of a welfare agency, psychiatrist in charge of a 13 bed hospital for chidlren and adolescents, rotating as resident and fellow on adult wards, maintaining a private practice seeing college students, high school students, jeuvenille delinquents and at risk youth, how many do you think presented with a chief complaint of sexual abuse? Guess.

Seriously, if you google the prevalence of asthma, you get lots of information with beautiful colored graphs stating the incidence of asthma in childhood in America at 9.5%. So if you go into the emergency room, short of breath, wheezing, lips a bit blue and pulse high, some doctor is going to come up, place a stethoscope on your chest and bingo, correctly diagnose you with asthma. “Nurse, nebulizer, stat in room 2!” she will yell as she heads for another room, another mystery to solve. Entering room 3, she discovers a 4 year old girl who recently started doing poorly in school, wetting the bed, having nightmares and has buring on urination. Physical exam reveals vaginal and anal irritation, reddness and tearing. The child is petrified to be examined and has to be held down. The mother reports that a new boyfriend has recently moved in and has been taking care of the child while she works the night shift. What is this diagnosis? Urinary tract infection and new onset anxiety. Sexual molestation will most likely not be broached and even if suspected, not treated correctly.

Sadly, this is not the most likely presentation for child sexual molestation. The most common presentation for a child after being raped by an adult or adolescent is that the child will have no change in their behavior or emotional regulation. Let me repeat that. The most common presentation for a child after sexual molestation by an adult is normal behavior. No wonder the statistics aren’t nicely placed in a multi-colored graph. Darkness 2 Light state on their website that less than 30% of children tell someone within the year following abuse. Many never tell.

Let me put this another way. In my twenty plus years of clinical work, I have only had one patient present for treatment of sexual abuse. I have seen patients who can not sleep, who are depressed, who have panic attacks, who are irritable and have mood swings, who pick their skin until it bleeds, pull out their hair, cut, are hypersexual, are anorexic or bingers, who can’t or won’t do their homework and who use any drug available to numb themselves. But only one patient has  walked in and said, “Hey, my aunt had sex with me on our vacation when I was fifteen and I’m having a hard time getting over it.”

It can take months if not years to get patients to understand that oh, yeah, I guess that time my soccer coach asked me to come to his hotel room to go over the game plan and took off his pants and masturbated in front of me, oh yeah, maybe. Or no I’ve never been sexually abused but my Dad did used to get drunk and make me take of my underpants and sit in front of him with my legs open and scream at me to finger myself. And no I’ve never been sexually abused although my piano teacher used to force me to  make out. No, no sexual abuse but my Dad’s best friend used to corner me every time we went to his house, upstairs in the bathroom and press me against the corner while he felt me up. No sexual abuse but after my Dad died, my Mom was so depressed she didn’t notice when my brother brought his friends over and they undressed me while they watched pornography, eventually we had intercourse but only a few times, I don’t think you could call it abuse. No not sexually molested but my parents had us get in the hot tub together. No one had on clothes. We slept together too, naked but nothing every happened. Just five people in the tub or five in the bed. We stopped when I went away to college. No nothing like that ever happened to me. I do remember my cousin five years older, holding me down and sticking his you know what in my butt when I was six years old. I did tell my Mom but she told me not to tallk like that. No one in my family has ever been sexually molested, but my cousin made me suck him off at the family picnic every year. No never sexually molested but my Mom bathed me until I was sixteen and I made her stop. She also inserted my tampons for me until I was sixteen. She was so worried about germs it was crazy. Not really sexually abused but my teacher used to get high with us and we stripped down to our underwear and danced together.

Who in the world is checking the box, “I’m one of the 1/4?” If most of the patients I have treated for sexual abuse don’t know, they can’t be checking the “I’ve been molested” box. Very few of my patients, friends, or family members, even admit that sexual abuse occurred in their childhood. And if you don’t know or can’t remember and the care takers in your life don’t know, who is going to take you for treatment? Who is going to pay for treatment? Research shows that the window for effective treatment for childhood molestation is between 4 and 11 years old. This is when an intervention is most likely to ensure that the victim does not become a perpetrator.

Now look at sexual offenders. I’ve never treated an incarcerated sexual offender who admitted guilt, all deny their crime. Either they are lying or dissociate so that they can not remember. So for sure sexual offenders are not checking the box, “I’m a predator. I’m a sexual offender.”

Just last month a neighbor was caught downloading child pornography in a public place. The library. The computers sit just in front of the circulation desk and a wise person saw and observed, and instead of confronting him, called the police. The police came and also observed, then arrested him. He is out on bail. I’m sure that after several years of postponement, he will get community service and no one will remember this either. He will never make the registry.

Years ago my daughter was rounding the corner on her bike toward the swimming pool in our development when a man walked casually from the shower and jumped over the fence to get into his truck. He was naked. She came racing with her brother towards me, shaking, telling that story. I calmly waited and got his license plate humber. The police found him sitting in a wet towel in the National Park, waiting for his next victim. They had been looking for him for months. He was convicted on her statement and served a few months in jail. He will not be on the registry.

We have had an exhibitionist who has exposed himself over and again for years at the beach. He was finally caught and convicted. He will not make the registry.

An older cousin forcibly violates and sodomizes his six year old cousin. He is twelve. His step-father raped him and taught this behavior. He is in his seventies now and the number of children he molests grows to hundreds. His wife teaches in your middle school. Her role outside of silent observer is not known. He never made the registry.

A college professor aged 26 years old has sex with his eighteen year old student. She makes an A despite nominal effort in his class. He will not make the registry.

A young teenage girl takes photos of herself nude in pornographic positions and sends them to her boyfriend who is two years younger. She is not on the registry.

None of the sexual offenders that abused my patient’s were ever confronted or reported or sought treatment. Not one is on the sexual offenders registry.

You do the math. I can’t.

Julia W. Burns, MD

The Bath- First Place NY Outsider Art Competition

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