CHILDHOOD SEXUAL ABUSE1996), is associated with greater long-
term harm (Browne and Finkelhor 1986;
Gold 1986);- Duration and frequency of abuse. In general,
the greater the frequency and duration of
abuse, the greater the impact on later
psychological and social functioning (Nash
et al. 1993); - Use of force. The use of force or threat of
force is associated with more negative
outcomes (Kendall-Tackett et al. 1993); - Penetration or invasiveness. Penetrative
abuse is generally associated with greater
long-term harm than are most other forms
of abuse (Kendall-Tackett et al. 1993); and - Family characteristics and response to abuse
disclosure. Individuals who have been
abused are more likely to originate from
single-parent families, families with a high
level of marital conflict, and families with
pathology (e.g., parent is an alcoholic,
violence between parents, maternal disbe-
lief, and lack of support); all of which are
associated with a poorer outcome and
greater levels of distress (Beitchman et al.
1992; Draucker 1996; Green 1996; Ro-
mans et al. 1995).
CROSS-CULTURAL ISSUESThis review has focused exclusively on studies
done in the United States. This is important to
keep in mind because the nature of abuse varies
according to one’s cultural belief system (Gough
1996). As a result, attempts to compare societies
on the basis of their care of children or the extent
of violence in family relations are fraught with
problems (Gough 1996b; Levinson 1989). In addi-
tion, methodological factors, such as the questions
asked and how childhood sexual abuse is defined
and measured, hamper the ability to make direct
comparisons among the rates across different coun-
tries. All that can be surmised, to date, is that it is
not a phenomena just of the United States, but is
an international problem (Finkelhor 1994b).
Finkelhor’s synthesis indicates that most countries
have rates similar to those found in the United
States and that females are abused at a greater
rater than males.
Nonetheless, cross-cultural studies can shed
new light on the origins and impact of sexual
abuse (Leventhal 1998; Runyan 1998). Such inves-
tigations may enable us to understand better the
relative importance of different factors that influ-
ence the occurrence of abuse and teach us about
societies that have been successful at protecting
children. Intercultural comparative investigations
can also help us appreciate the range of sexual
behaviors that are, or can be considered ‘‘nor-
mal,’’ and thereby contribute to a better under-
standing of abnormality in childhood sexual be-
havior and adult behaviors toward children.
It is not surprising that definitions of abuse
not only vary within a culture, but also between
cultures. The meaning of ‘‘abuse,’’ especially, de-
pends upon ideas of individual rights and roles
and responsibilities between people and groups
within society (Gough 1996a). How a child is viewed
will influence what is evaluated as abuse. Defini-
tions of child abuse would be quite different, for
example, in a feudal state in which children are
considered to be their parents’ possessions. Cul-
tural expectations about sexual interactions among
adolescents and between different age groups will
also affect whether particular practices are defined
as abuse (Abramson and Pinkerton 1995). Among
the Sambia people of the highlands of Papua, New
Guinea, for example, all young boys are expected
to participate in ritualized fellatio with older boys
as part of their initiation into manhood (Abramson
and Pinkerton 1995). In essence, the younger boys
are forced to submit; thus, this practice fulfills the
two main criteria for childhood sexual abuse as
defined above (coercive sex with a child or adoles-
cent). Nevertheless, the Sambia consider ritual-
ized fellatio to be critical for survival (they believe
that semen is the source of manly strength and that
it must be obtained through ingestion).Definitions of abuse can also be expected to
change over time to reflect societal changes. For
instance, anecdotal evidence suggests that in Vic-
torian England it was considered acceptable for a
nurse or nanny to quiet a male infant by putting his
penis in her mouth (Abramson and Pinkerton
1995). Today, this practice would clearly be con-
sidered childhood sexual abuse. The recent broad-
ening of definitions of abuse has been accompa-
nied by a greater sensitivity to signs of abuse that
fit these changing definitions, and a greater will-
ingness for professionals and others to intervene