Dilemma In Child Abuse Abdulwahab M A Telmesani Associate Prof. Of pediatrics Umm Al-Qura University

Disclosure of Child Sex Abuse

Aspects of disclosure The victim disclose the incidence The victim disclose the incidence M.D report a clear and proven case M.D report a clear and proven case M.D reporting a suspected case M.D reporting a suspected case Influence of the child age on reporting Influence of the child age on reporting

To report or not to report?

The Child How about if I am wrong and it is not abuse case? How about if I am wrong and it is not abuse case? What harm and psychological trauma I am going to inflect on the child and his family? What harm and psychological trauma I am going to inflect on the child and his family? Am I going to affect the boy/girl future? Am I going to affect the boy/girl future?

The M.D Who is going to support me? Who is going to support me? Would it fire back at me? Would it fire back at me? Am I at risk of being physically harmed? Am I at risk of being physically harmed?

The Culture/Society Rigid. Rigid. Too many redlines. Too many redlines. Follow a wide safety margin. Follow a wide safety margin. Stigmatizing. Stigmatizing. No clear abuse legislations. No clear abuse legislations.

Boy X

Hx 12 y boy. 12 y boy. Problem of defecation. Problem of defecation. Passing whitish mucous material and sometimes blood. Passing whitish mucous material and sometimes blood. Weight loss. Weight loss. Academic deterioration. Academic deterioration.

Hxcont. Chaotic family background. Chaotic family background. Father is cruel as per the boy. Father is cruel as per the boy. The boy shakes when speaking about his father. The boy shakes when speaking about his father. Father appeared as nice and concerned re his son. Father appeared as nice and concerned re his son.

Hxcont. Parents got separated during the time of clinic visits. Parents got separated during the time of clinic visits.

P/E Wt and Ht below 5 %ile Wt and Ht below 5 %ile Patulous anus Patulous anus Unusually large anal fissure Unusually large anal fissure Rectal prolapsed Rectal prolapsed

Dx Picture consistent with sexual abuse.( suggested by 3 other physicians) Picture consistent with sexual abuse.( suggested by 3 other physicians) Other pathology was R/O Other pathology was R/O

The existing legal framework for confidentiality protections is also a complex patchwork of state and federal law. Additional complexity is associated with the lack of clarity regarding how various confidentiality requirements apply to minors The existing legal framework for confidentiality protections is also a complex patchwork of state and federal law. Additional complexity is associated with the lack of clarity regarding how various confidentiality requirements apply to minors

The protection of confidentiality is a significant concern for adolescents who are seeking care and for health care professionals who are providing it. The protection of confidentiality is a significant concern for adolescents who are seeking care and for health care professionals who are providing it.

Thus, prompt disclosure buffered the influence of more severe abuse. Disclosure also had a main effect on the likelihood of further victimization. Thus, prompt disclosure buffered the influence of more severe abuse. Disclosure also had a main effect on the likelihood of further victimization. Participants who told an adult promptly after the abuse were less likely to report additional unwanted sexual experiences. Participants who told an adult promptly after the abuse were less likely to report additional unwanted sexual experiences. Kogan SM Kogan SM Journal of Child Sexual Abuse Journal of Child Sexual Abuse

Disclosure of childhood sexual abuse: Links to emotion expression and adult attachment “Earlier disclosures were associated with extra- familial perpetrators, childhood emotional expressiveness, and disclosures to immediate family” “Earlier disclosures were associated with extra- familial perpetrators, childhood emotional expressiveness, and disclosures to immediate family” Distel, Nancy E Distel, Nancy E DISSERTATION DISSERTATION

Disclosure of childhood sexual abuse: Links to emotion expression and adult attachment “Later disclosures were associated with incest, withdrawal and distraction emotion coping strategies, disclosure to persons outside the immediate family, and self-reported dismissing-avoidant attachment behaviors” “Later disclosures were associated with incest, withdrawal and distraction emotion coping strategies, disclosure to persons outside the immediate family, and self-reported dismissing-avoidant attachment behaviors” Distel, Nancy E Distel, Nancy E DISSERTATION DISSERTATION

Social reactions to child sexual abuse disclosures: a critical review Most studies assessing social reactions in detail have concerned adult survivors retrospectively reporting on their disclosures of child sexual abuse. Most studies assessing social reactions in detail have concerned adult survivors retrospectively reporting on their disclosures of child sexual abuse. Ullman SE Ullman SE Journal of Child Sexual Abuse Journal of Child Sexual Abuse

Social reactions to child sexual abuse disclosures: a critical review Clear evidence shows that negative social reactions are harmful to survivors' well-being Clear evidence shows that negative social reactions are harmful to survivors' well-being Ullman SE Ullman SE Journal of Child Sexual Abuse Journal of Child Sexual Abuse

Disclosure of childhood sexual abuse: Links to emotion expression and adult attachment Distel, Nancy E Distel, Nancy E DISSERTATION DISSERTATION

Disclosure of childhood sexual abuse: Links to emotion expression and adult attachment “exploratory analysis of the victim's self-reported emotional responses to the abuse revealed high levels of experienced fear, sadness, and shame, as well as elevations in surprise, guilt, and anger” “exploratory analysis of the victim's self-reported emotional responses to the abuse revealed high levels of experienced fear, sadness, and shame, as well as elevations in surprise, guilt, and anger” Distel, Nancy E Distel, Nancy E DISSERTATION DISSERTATION

Boy X F/U

Father and mother counseled Father and mother counseled Father sent to psychiatrist Father sent to psychiatrist Mother sent to psychologist Mother sent to psychologist Family reunited Family reunited The boy is better physically and psychologically The boy is better physically and psychologically