The victim-perpetrator cycle of sexual abuse and offending behavior

Abstract

Background: Child sexual abuse (CSA) is highly prevalent in India and a major public health challenge. CSA victims are at a greater risk for developing a range of negative behavioral and psychological outcomes across their life span. In this case report, we highlight the diagnosis and management of a boy who sexually victimized his classmate subsequent to his trauma of being sexually abused by a peer. Clinical Description: A 10-year-old child, was referred for sexual acting out behaviors, wherein he had attempted anal penetration of a classmate. History revealed multiple stressors including the death of his mother, history of sexual abuse by an older boy, prolonged exposure to digital sexualized content, father's remarriage, adjustment problems with stepmother, relocation, and a new school. A comprehensive psychosocial evaluation was conducted including the administration of a risk assessment tool, the Juvenile Sex Offender Assessment Protocol-II. Management: The mainstay of management was psycho-education that focused on guiding his parents on the importance of intensive parental supervision, academic support, restricting the use of the Internet, and promoting healthy friendships. The child was encouraged to have healthy extracurricular interests, especially outdoor physical activities. Regular follow-up for over a year revealed significant behavioral improvement and no repeat of sexual offending behavior. Conclusion: High-risk children need to be provided with supportive family services and linked to child welfare organizations for long-term intervention. Health-care professionals can play a pivotal role in the prevention of inappropriate sexual behaviors and the promotion of healthy development among youth.