Introduction
Child sexual abuse can be defined as an action where an adult takes advantage of their dominant position to use a child to attain sexual pleasure, arousal, or satisfaction (Sánchez-Meca, Rosa-Alcázar, & López-Soler, 2011). Such actions may also be considered abuse when there are imbalanced circumstances between the injured party and the assailant. An example of disproportion constitutes an age difference of five years when the child is 12 years or younger or a ten-year difference if the child is above 12 years. The second form of imbalance is if the offender has a form of authority over the injured party or differences in social skills between the two parties resulting in manipulation. Using different forms of coercion such as gifts to persuade the victim to yield to the sexual advances also constitutes abuse. Backdated parent reports show that approximately 20% of women and 5 to 10% of men have undergone sexual abuse in the course of childhood and teenage years (Sánchez-Meca et al., 2011).
The two main forms of sexual abuse are intrafamilial and extrafamilial. Intrafamilial abuse occurs when the perpetrator is a well-known member of the family or close relative. Extrafamilial abuse, on the other hand, involves offenders who are not related to the victim. A large number of girls report intrafamilial abuse from the age of seven to eight years, whereas extrafamilial abuse is commonly experienced by boys from the age of 11 to 12 years (Seto, Babchishin, Pullman, & McPhail, 2015). Incest, which is sexual activity between relatives, often happens in secret. Hence, only about 2% of such instances are uncovered (Morrill, 2014). Only about 50% of sexual abuse among children is discovered. 15% of such instances are reported, whereas 5% of the cases are settled in court. Furthermore, heterosexual men of all ages are more likely to perpetrate sexual offenses in children than women (Sánchez-Meca et al., 2011).
Sexual abuse leads to physical, emotional, and mental problems in the victim. Survivors of sexual abuse can experience a range of painful emotions following the abuse, including mistrust, anger, detachment, confusion, fear, low self-esteem, a sense of defenselessness, self-blame, and shock (Domhardt, Münzer, Fegert, & Goldbeck, 2015). The mental effects of sexual abuse include depressive disorders, post-traumatic stress disorder (PTSD), suicidal ideations, and a lack of focus on everyday activities (Kim, Park, & Park, 2017). Conversely, the physical consequences of sexual abuse include soreness, vaginal or anal bleeding, unwanted pregnancies, problems walking, sexually transmitted infections, bruising, and dislocated bones (Domhardt et al., 2015). The purpose of this proposal is to examine the relationship between childhood sexual abuse, which is the independent variable, and self-esteem (dependent variable) in adolescents.
Literature Review
To determine the relationship between childhood sexual abuse and self-esteem issues in adolescents, it is necessary to examine previous studies that have explored this problem. Saewyc, Pettingell, and Magee (2003) studied the incidence of incest and extrafamilial abuse in 2 groups of teenagers in Minnesota. Sexual abuse was prevalent among boys and girls as well as pupils of all ethnicities. About 10% of teenagers reported incidences of sexual abuse in each category. However, the likelihood of reporting abuse was fivefold higher in girls than in boys.
Turner, Finkelhor, and Ormrod (2010) used the two waves of the Developmental Victimization Survey (DVS) to study the impact of various types of child ill-treatment on alterations in self-concept among adolescents. A nationwide sample consisting of 11- to 18-year-old teenagers was used. The authors evaluated the unbiased effects of sexual harassment, nonsexual child mistreatment, peer oppression, and non-victimization hardships in the previous year on alterations in mastery and self-esteem. The impact of these factors on the magnitude of depressive indications was also examined. The findings showed that only sexual violation lowered self-esteem independently. There were no substantial modifications in mastery due to exposure to victimization. Reductions in self-worth, to some extent, arbitrated the connection between previous exposure to sexual abuse and intensities of depressive indications. The findings implied that sexual violation experiences might have strong influences on self-esteem, which are not noticeable for other forms of abuse and trauma (Turner et al., 2010).
Karakuş (2012) studied the link between childhood abuse and self-confidence in adults to ascertain the potential impact of childhood maltreatment on self-esteem. About 915 high school students were chosen randomly, out of which 583 were females, and 382 were males (Karakuş, 2012). The findings of the investigation revealed that there was a substantial negative association between childhood ill-treatment and self-image. Regression analysis showed childhood abuse was a significant predictor of self-esteem. It was noted that even minor forms of emotional abuse had the potential to affect the self-worth of an individual.
Joslyn and Shivakumara (2013) investigated the magnitude of the link between self-esteem and mental suffering between sexually molested and sexually non-abused teenagers. The authors also aimed at assessing dissimilarities in self-esteem and emotional distress. A total of 80 teenagers from Goa, out of which 40 had undergone sexual abuse, were included in the study. Three instruments were used in the investigation. The Self-Esteem Scale, Personal Data Sheet, and the Brief Symptom Inventory were used in the collection of data. Data analysis consisted of a t-test and Pearson’s Product Moment Correlation. The findings showed that self-esteem decreased with an increase in psychological distress in sexually molested and non-abused subjects. However, the self-esteem between the two groups differed considerably, with the sexually abused teenagers reporting lower self-esteem compared to sexually non-abused adolescents. In addition, the sexually abused teenagers reported higher psychological distress than the sexually non-abused adolescents.
Bankole and Arowosegbe (2014) examined the impact of child abuse on the self-esteem of secondary school learners in Ekiti State, Nigeria. The researchers determined leading causes of child abuse by collecting data from 150 high school children below the age of 18. The Child Abuse Self Report Scale (CASRS), which measures different forms of abuse, including physical, sexual, psychological, and neglect abuse, was used to identify abuse. The Coopersmith self-esteem inventory was used to assess the self-esteem of the participants. The findings showed that neglect abuse had a significant effect on the self-esteem of children. The authors recommended that parents and guardians ought be informed about the deleterious upshots of child abuse on the self-worth of their children. It was also important to discourage neglect abuse by educating parents about children’s rights.
Jacob and Ravindranadan (2017) studied the influence of sexual abuse on the self-esteem and mental health of teenage girls. The sample included 75 teenage girls aged between 12 and 18 years. Sexually molested girls from a public rehabilitation center constituted one-third of the sample, non-abused girls from a children’s homemade up one-third, and 25 girls living with their parents comprised the remaining fraction. The Self-Esteem Scale (SES-DSDU) tool was used to evaluate self-esteem, whereas the Psychological Well-Being Scale (PWBS-SDCP) assessed mental well-being. The findings showed that sexual abuse resulted in a significant reduction in the self-confidence and mental health of adolescent girls (Jacob & Ravindranadan, 2017).
From the review of the literature, it is evident that all forms of abuse have a negative impact on the well-being of the affected victims. The studies reviewed over the years have indicated that sexual abuse in the early phases of life leads to self-esteem issues in the later stages of life. Therefore, it is hypothesized that there will be a positive correlation between childhood sexual abuse and low self-esteem.
Methods
Participants
Convenience sampling will be done in this study. Participants will be selected from the researcher’s caseload at their private practice. About 60 high school students (30 males and 30 females) aged between 13 and 17 years will be selected from the group of patients receiving help at the private practice. No preference will be given to any ethnic group. Therefore, there will be a likelihood of recruiting African Americans, Caucasians, Asians, and Latinos. Additionally, there will be no preference for specific religions. This sample will be representative of adolescents in the community. Consequently, the findings of the study will apply to the understanding of self-esteem issues in teenagers.
Procedures
The goal of the study is to determine the impact of sexual abuse on the self-esteem of adolescents. Therefore, the independent variable is sexual abuse, whereas the dependent variable is self-esteem. Self-esteem is defined as the assurance of one’s own value or capabilities (Brown, 2014). The definition of sexual abuse has been provided in the introduction section of this proposal. Participants of the study will be selected from the patient population at the principal investigator’s practice. This population will comprise self-referrals for psychiatric support. Therefore, likely participants will be chosen following the completion of a self-report showing that they need extra help to enhance their self-perception. The participants will complete questionnaires, which will be administered by the principal investigator, to facilitate data collection for the study. The integrity of the study will be assured by using the data provided by the participants in unaltered forms. A correlation analysis using Pearson’s Product Moment Correlation will be used to determine the relationship between childhood sexual abuse and self-esteem. Statistical conclusions will be made at α= 0.05 level of significance.
Measures
Two standardized measures will be used in data collection to maintain the objectivity of the investigation. The Traumatic Events Screening Inventory (TESI) will be used to interview the participants to determine their childhood traumatic experiences associated with sexual abuse. This tool evaluates traumatic experiences on four main domains of witnessing grisly accidents, sicknesses or calamities, family conflict or aggression, and sexual abuse. The questions are organized to facilitate the recounting of experiences in an order that exposes the child to the least trauma of divulging disturbing experiences. The interview consists of 16 questions. Every item regarded as “yes” is followed by inquiries to determine the child’s and assessor’s opinion of the danger involved and three probes stimulating the child’s evaluation of the potentially upsetting experience.
The Rosenberg Self-Esteem Scale will be used to determine self-worth by measuring positive and negative feelings about the self (Kim et al., 2017). This tool consists of a 10-item uni-dimensional scale with elements that are answered using a 4-point Likert scale ranging from “strongly agree” to “strongly disagree” (Rosenberg, 1965). These two measures are criterion-referenced tests because they associate with a set unit of measurement.
The validity of the Rosenberg Self-Esteem Scale has been scrutinized using the item response theory (Gray-Little, Williams, & Hancock, 1997). The test of significance showed that the 10 items included in the instrument differentially relate to self-esteem. Therefore, this measure assesses the variable under investigation and yields generalizable findings. On the other hand, the validity of the TESI instrument has been ascertained by at least three studies (Strand, Sarmiento, & Pasquale, 2005; Stover, Hahn, Im, & Berkowitz, 2010; Collins et al., 2017).
Ethical Considerations
An informed consent document will be drafted and presented to the subjects before the commencement of the study. The document will state that the study will be voluntary and that the subjects will be free to leave the study at any time if they felt uncomfortable. The subjects will be informed about any possible risks involved in the study. The participants will also be provided with debriefing forms that will explain the purpose of the study and encourage them to seek clarification concerning any areas that were unclear. The principal investigator’s contacts will also be provided for the participants to contact them following the conclusion of the study.
Results
The proposed hypothesis was that there would be a relationship between childhood sexual abuse and self-esteem. The results of the study would find that childhood sexual abuse would have a negative correlation with self-esteem. The self-esteem scores would be lower for individuals who were sexually abused than those who did not undergo sexual abuse during their childhood. P-values greater than 0.05 would lead to the rejection of the null hypothesis and conclude that there is a significant relationship between childhood sexual molestation and self-esteem.
Discussion
The findings of the investigation would indicate that significant differences exist in self-esteem levels with respect to childhood sexual abuse. It would be evident that teenagers who underwent any type of sexual abuse as a child would have lower self-confidence than adolescents who did not experience sexual molestation. These observations would be attributed to the adverse effects of sexual violence on the victims (Brown, 2014). These effects are magnified during adolescence because this is a life stage where individuals experience a range of emotions and challenges concerning self-identity and self-worth (Asgeirsdottir, Gudjonsson, Sigurdsson, & Sigfusdottir, 2010). These findings are backed by numerous studies that highlight the longstanding consequences of sexual abuse, including depressive symptoms, guilt, poor self-worth, and feelings of inadequacy. The findings of this proposal would be useful in directing treatment approaches for young survivors of sexual cruelty. These findings also provide information that fills a gap in the research about sexually molested adolescents, thus providing uninterrupted care.
An educational implication of these findings is that school nurses should assess for a history of sexual abuse in teenagers regularly and provide support as well as appropriate referrals for molested students and their families (Saewyc et al., 2003). Educators should also consider incorporating aspects of the cognitive theory and the impact of sexual exploitation on the development of self-image in the treatment of victims of sexual molestation (Underwood, Stewart, & Castellanos, 2007). Counselor educators should also reconsider relating theoretical applications to the experiences of sexual abuse victims in counseling training packages. This attempt would empower future counselors to handle the large numbers of teenage and adult survivors of sexual ill-treatment.
These findings have clinical implications in that they inform treatment modalities to enhance self-esteem in abused patients, for example, the use of the art treatment to improve self-esteem (Brooke, 1995; Hartz & Thick, 2005). Survivors of sexual abuse may have undergone single or repeated incidents of violence, which could alter their bodily, interactive, intellectual, or mental functioning. Overall, teenage victims of sexual abuse experience higher degrees of oppression than adult victims do. Hence, teenage survivors have higher chances of developing psychological disorders such as PTSD following disturbing events (Underwood et al., 2007).
Implications for Future Studies
Future studies should focus on improving the generalizability of the findings by including diverse socio-demographic variables such as the age of the victim when the first instance of abuse occurred, gender, and socioeconomic standing into studies that examine childhood sexual abuse. Also, studies have a tendency to grouping sexual mistreatment into abused- or non-abused classes. Therefore, future research should target the type of abuse, for instance, single or multiple occurrences, the culprit involved, and the age-related time of cruelty. This process entails clarifying whether the subjects were abused during infancy, as young children, or during puberty. Each of these attributes is crucial when understanding the victims’ experiences and their advancement through treatment. Additionally, the counseling procedure may be influenced by these factors. For example, counseling strategies and the number of sittings may differ from a single case of rape by an outsider to numerous abuse incidents by a relative. Studies that highlight these specific features may support highly focused treatment in psychotherapy. Future studies could also examine factors such as emotional capability, social aptitude, achievement drive, and coping strategies. It is also necessary to investigate the distinguishing factors of sexual abuse and its effect on psychotherapy.
Limitations of the Study
One possible limitation of the study will be the sampling procedure, which will limit the generalizability of the findings to the overall population. The study will use self-referred participants to the principal investigator’s private practice. Self-referrals are uncommon in the general population. Studies show that a large fraction of patients with psychological disorders are unaware of their condition and the few who are aware of their mental health status shy away from seeking professional help (Corrigan, Druss, & Perlick, 2014). Since surveys in the form of questionnaires will be used in data collection, it is likely that some participants may be unwilling to read and complete all elements of the questionnaires, thus complicating the analysis of data.
Confounding variables that will not be captured in the analysis include a history of substance abuse by family members and parental support. Studies show that children brought up in a family setting that is marked by substance abuse are more likely to experience some form of abuse compared to children raised in families without a history of substance abuse (Cook et al., 2017). Conversely, parental support following abuse is known to promote healing and restore self-worth in children with a history of sexual molestation (Godbout, Briere, Sabourin, & Lussier, 2014). This study will not capture these elements, which may have an impact on the accuracy and reliability of the self-esteem scores of the participants.
Conclusion
There is a negative correlation between childhood sexual abuse and the self-worth of adolescents. This proposal shows that a history of childhood abuse leads to a reduction in the self-worth of the victim of sexual maltreatment. Knowledge of various dynamics that affect this relationship is crucial because it directs the provision of appropriate psychotherapy to survivors of sexual abuse to improve their self-image. Therefore, future studies should consider factors such as socio-demographic variables, coping strategies, and parental support.
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