Uncovering symptoms of child abuse and sexual violence: a medico-legal and psychosocial perspective.

Abstract

Child abuse is a pervasive problem in South Africa, with many cases neither disclosed nor reported. Identifying symptoms of sexual and physical abuse in children can be difficult. This study, therefore, sought to uncover symptoms of sexual violence and child abuse from a medical, legal and psychosocial perspective. The primary objectives were, firstly, to establish presenting symptoms of sexual violence and child abuse; secondly, to highlight the associated risk factors; thirdly, to ascertain factors that influence the impact of sexual violence and abuse on the child; and, lastly, to gather knowledge that will assist in developing an evidence-based screening tool for sexual violence and child abuse. The study adopted a qualitative and interpretive approach, drawing mainly on betrayal trauma theory in the discussion of findings. Data were collected through interviews with six participants, namely a medical doctor, a criminologist, two psychologists, and two social workers. Data were then analysed using thematic analysis, in which themes and subthemes were identified in relation to the research questions. The findings suggested that indicators of child abuse are linked to a range of notable physical symptoms as well as sudden behavioural, emotional and psychological changes. Participants noted parent intrinsic characteristics that put children at risk of abuse included the detached parent with avoidant attachment style, and the inconsistent parent with anxious attachment style. Risk factors identified included family and environmental factors such as family discord, parental stress, and parents or caregivers with unresolved trauma. Furthermore, protective factors, which influence the impact of sexual violence and abuse on the child, were identified as family and environmental support, where the family listens to and believes the child, and takes the necessary steps to protect them; access to services such as medical, legal and psychosocial support for the child; and the child’s own resilience. From these results, a diagram was developed to help parents and practitioners to screen for symptoms of child abuse. This diagram could assist other sectors to take suspicions or reports of child abuse more seriously, which could encourage more timely interventions.