Journal of Disability and Oral Health

cover art

Cover Date:
April 2007
Print ISSN:
1470-8558
Electronic ISSN:
1754-2758
Vol:
8
Issue:
1

A report on the development of a dental service for adult survivors of childhood sexual abuse

It is difficult to say exactly how many children are sexually a b u s e d , due to under reporting, and to the different research methods used when collecting data. Finkelhor (1994) reports that one in five girls and one in ten boys may be sexually abused in childhood. His earlier work in 1990 (Finkelhor et al., 1990) estimates from one quarter to one third of females before the age of 18 had been sexually abused. An extensive study of child sexual abuse in 1983 reported that among adult Canadians, 53% of women and 31% of men were sexually abused when they were children (Bagley, 1998), although these high prevalence rates have not been replicated in other studies. In 1999, the United States Department of Health and Human Services survey of recent epidemiological studies, found that 15–33% of females and 13–16% of males were sexually abused in childhood. Clearly, these figures vary greatly. Children who have disabilities are especially vulnerable to sexual abuse (Sobsey and Varnhagen, 1991; Graham, 1993). A 1993 report by the United States National Center on Child Abuse and Neglect goes on to state that the rate of sexual abuse of children with a disability is higher than the rate of children with no disability. The long-term effects of child sexual abuse persist into adulthood. It is a significant factor in adult mental health (Goodman et al., 1997; Harman, 1992) with higher levels of mental health symptoms in survivors (Banyard et al., 2001; Moeller and Bachmann, 1993). In particular, depression, anxiety, self-harm, suicidal thoughts and acts, earlier onset of bipolar illness, increased alcohol and drug abuse and low self esteem (Beitchman et al, 1992; Bagley et al, 1994; B o u d e w y n and Liem, 1995; Hays and Stanley, 1996; Wenninger and Heiman, 1998; Leverich et al, 2002). The duration, severity and frequency of abuse are directly related to a greater impact in adult life (Boudewyn and Liem, 1995; Callahan et al., 2003). Sur vivors are more likely to develop an eating disorder such as bulimia or anorexia; one study claimed 61% of girls with eating disorders had reported sexual abuse (Miller, 1996; The Royal College of Psychiatrists, 1999). Survivors may also suffer from a complex post-traumatic stress disorder with extreme anxiety, dissociation, or flashback (Hays and Stanley, 1996; Willumsen, 2001). A Medline search using the keywords “sexual abuse and dentistry” listed 32 articles. Most articles primarily covered the use of bitemarks in rape cases and oral signs and symptoms of abuse. In the lone European article that specifically covered dental fear and sexual abuse (Willumsen, 2001), the author noted that knowledge of the consequences of sexual abuse on dental anxiety is limited. This Scandinavian study looked at the anxiety levels towards dentistry experienced by 99 women who had undergone sexual abuse. All the women had higher scores on the dental fear scale used than the female Norwegian population; interestingly, approximately half had not previously linked the dental phobia with their abuse. Several individuals had reported that successful treatment helped them regain feelings of control over their mouth and helped their psychological health. Abuse-related crises in adult life could be triggered by dental treatment (Hays and Stanley, 1996; Willumsen, 2001). Triggers can be the physical contact or more specific similarities, for example silver instruments and a knife being held at someone’s throat. Symptoms of the complex p o s t - t r a u m a t i c stress disorder mentioned earlier can occur. Two further articles on sexual abuse and dental fear (Hays and Stanley, 1996; Walker et al., 1996) expand on the difficulties experienced by these patients. Such patients have fears of being trapped in the dental chair, being in a horizontal position, feeling claustrophobic, being alone with someone more powerful, loss of control, having objects placed in their mouth, being unable to breathe or experiencing choking or severe gagging that interferes with treatment. Essentially, the impact of childhood sexual abuse can cause difficulty later with oral health care due to a symbolic re-creation of the experience. An American study (Riley et al., 1998) found that female patients who had a history of sexual abuse had a tendency to amplify and over-interpret somatic symptoms when they

This paper was awarded the BSDH – Special Award, given in 2003 in The European Year of People with Disabilities.

Article Price
£15.00
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Page Start
41
Page End
44
Authors
Elizabeth Williams

Articles from this issue

  • Title
  • Pg. Start
  • Pg. End

  1. Editorial
  2. 2
  3. 2

  1. Assessment of malocclusion and orthodontic treatment need in disabled children in Nigeria
  2. 3
  3. 8

  1. An analysis of the pattern of dental treatment provided for patients with disabilities requiring treatment under general anaesthesia
  2. 9
  3. 12

  1. A longitudinal study of palatal plate therapy in children with Down syndrome. Effects on oral motor function
  2. 13
  3. 19

  1. Dyslexia and errors of left-right discrimination in undergraduate dental and postgraduate orthodontic students
  2. 23
  3. 27

  1. Management of Riga-Fede disease: a case report
  2. 28
  3. 30

  1. Delayed replantation of avulsed incisors in a child with cerebral palsy and epilepsy – a case report
  2. 31
  3. 33

  1. Using large numbers can overwhelm efforts to secure care for children with special health care needs. A case study in the USA
  2. 34
  3. 36

  1. A maxillary obturator for a cocaine induced oronasal defect
  2. 37
  3. 40

  1. A report on the development of a dental service for adult survivors of childhood sexual abuse
  2. 41
  3. 44

  1. Preparing a child with autism for dental prophylaxis using structured and instructional methods: a case report
  2. 45
  3. 47

  1. Diary Dates 2007
  2. 48
  3. 48

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