To acknowledge that Sexual abuse is common It is also frequent in men , which is left under reported To identify and counter the patient’s negative cognitions To improve the patients Social Support . Group therapy or other support by women who have faced similar abuse may be helpful. Mandatory reporting of all cases of sexual abuse is necessary to help to stop the further abuse.

1. CHAIR PERSON : Dr. Shabeeba kailash
Presenter : Dr. Penubarthi Sravanthi
1

2. INTRODUCTION
 World Health Organization defines ‘‘sexual violence’’ as any coerced
sexual act , involving: any sexual act , attempt of a sexual act, sexual
comments, or acts directed against a persons’ sexuality using
coercion, by any person regardless of his relationship to the victim, in
any setting, including home and work.1
 Prevalence rates of sexual abuse in the general population range from
4.0% to 21.4% in adults and from 3.0% to 33.2% in children 2
** Bott S. Sexual violence and coercion: implications for sexual and reproductive health. In Social Determinants of Sexual and Reproductive Health. WHO; 2010.
2

3. 3

4. 4

5.  There is wrong idea that all adult sexual abusers were sexually abused as
children, but only 50% of child molesters were abused as children.3
 In majority of the cases , victim knows the abuser.
 Even in India , according to the National Crime Records Bureau in 2011, of
the reported rapes, 93% were committed by someone the victim knew. 4
 Recent study had found that physical and sexual abuse can lead to mood
and anxiety disorders. 5
5

6. INDIVIDUAL FACTORS
woman
young
abuse in childhood
prior sexual abuse
using drugs or alcohol and
working in the sex trade.
COMMUNITY FACTORS
tolerance of sexual assault and
weak sanctions against sexual assault
RELATIONSHIP FACTORS
Multiple Sexual partners
SOCIETAL FACTORS
Norms regarding gender roles
Male Dominance
weak legal sanctions against sexual assault
social norms that support sexual assault.
RISK FACTORS OF
ABUSE VICTIMS 6,7
6

7. Risk factors of Perpetrators
8
 Prior sexual victimization or perpetration
 Substance use
 Difficulty with empathy
 Aggressiveness and acceptance of violence
 Different sexual issues (early initiation, coercive fantasies, and impersonal sex)
 Hostility toward females
 Frequent exposure to pornography
7

8. IPC Section 354 A
SEXUAL HARRASMENT
A man committing any of the following acts— physical contact and advances
involving unwelcome and explicit sexual overtures; or
a demand or request for sexual favours; or
showing pornography against the will of a woman; or
making sexually coloured remarks, shall be guilty of the offence of sexual
harassment.
8

9. 9

10. Risk Factor For Developing Psychiatric
Disorders In Sexual Harrasment victims9
 Unemployment
 Parental Marital Disharmony(Adolescents)
 Low Socio-economic status
 Immigrants
10

11. Psychological Effects10
 Anxiety
 Depression
 Negative body image
 Low self-esteem
 Social Withdrawal
 Poor academic / work performance
11

12. A man is said to commit "rape" , if under the circumstances falling under any of the following seven
descriptions (Sec 375 IPC)
1. Against her will.
2. Without her consent.
3. With her consent, when her consent has been obtained by putting her or any person in whom she is
interested, in fear of death or of hurt.
4. With her consent, when the man knows that he is not her husband and that her consent is given
because she believes that he is another man to whom she is or believes herself to be lawfully married.
5. With her consent when, at the time of giving such consent, by reason of unsoundness of mind or
intoxication or the administration by him personally or through another of any stupefying or
unwholesome Substance, she is unable to understand the nature and consequences of that to which
she gives consent.
6. With or without her consent, when she is under eighteen years of age.
7. When she is unable to communicate consent
RAPE
12

13. Sn Includes Punishment
376A Death / Persistent vegetative state 20 years to lifetime
376B Husband during separation 2-7 years
376C By person in authority 6-10 years
376D Gang rape 20 years to life time
376E Repeat offenders Lifetime
13

14. Psychiatric manifestations 11
Immediate
• Anxiety
• PTSD
• Depression
• Sexual Dysfunction
• Obsessional thoughts
• Refusal to cooperate
Long-term
• Depression
• Mistrust of Men
• Marital discord
• Sexual Dysfunction
• Phobia and other Anxiety
disorders
• Suicidal Attempts
• Eating disorders
• Dissociative disorders
14

15. ROLE OF PSYCHIATRIST
 The five-step emergency intervention for rape victims12
1. restoring the patient to psychological safety
2. providing information
3. correcting misattributions
4. restoring and supporting effective coping
5. ensuring social support
 Psycho education about common symptoms after rape
 Discussing about the impact of rape on intimacy and the potential for sexual
hypersensitivity .
 Helping the patient to recognize the catastrophic nature of his or her post rape beliefs,
correct misattributions, and define the rape experience more realistically decreases
anxiety, guilt, and anger.
15

16. DOMESTIC VIOLENCE
 Domestic violence is defined as a pattern of abusive behavior in any relationship with the
intent to gain power or control.
 Domestic violence directed at a partner by a current or former partner or spouse is referred to
as intimate partner violence (IPV) 13
 Lifetime Prevalence of physical and /or sexual abuse by intimate partner violence in India is
around 37% , with women being suffered in most cases.14
 Significant harmful effects of IPV are unwanted pregnancy , gynecological disorders and
physical injuries to private parts , besides long-term mental health impacts .15
 Perpetrators – Emotionally dependent
Anti-social / Narcissistic
16

17. Sequelae of Domestic Violence16
Physical Complaints Psychiatric Sequalae
• Bruises
• Pain in the pelvic or genital area
• Vaginal Discharge
• Fainting
• Breast Pain
• Headache
• Difficulty in Micturition
• Constipation
 PTSD
 Depression
 Anxiety
 Low self-esteem
 Substance abuse
 Sexual dysfunction
 Somatization disorder
 Nightmares
 Suicidal risk
17

18. ROLE OF PSYCHIATRIST
 Helpful interventions 17 for Domestic Violence :
1. Psycho education (causes and consequences of DV and its traumatic effects)
2. Safety of the patient (risk of suicide / homicide )
3. cognitive and emotional skill development (address trauma-related symptoms
and other life goals and concerns)
4. Focus on survivors individual and cultural strengths
 Helping them with knowledge of legal and social support available
18

19. THE PROTECTION OF WOMEN FROM
DOMESTIC VIOLENCE ACT, 2005 5 chapters and 37
sections
(ACT NO. 43 OF 2005)
As per this act - sexual abuse” includes any conduct of a sexual nature that abuses, humiliates, degrades or otherwise
violates the dignity of woman;
Protectn order Sec-18 - (a) committing any act of domestic violence; (b) aiding or abetting in the commission of acts of
domestic violence; (c) entering the place of employment of the aggrieved person or, if the person aggrieved is a child, its
school or any other place frequented by the aggrieved person; (d) attempting to communicate in any form, whatsoever,
with the aggrieved person, including personal, oral or written or electronic or telephonic contact; (e) alienating any assets,
operating bank lockers or bank accounts used or held or enjoyed by both the parties, jointly by the aggrieved person and
the respondent or singly by the respondent, including her stridhan or any other property held either jointly by the parties
or separately by them without the leave of the Magistrate; (f) causing violence to the dependants, other relatives or any
person who give the aggrieved person assistance from domestic violence; (g) committing any other act as specified in the
protection order.
Monetory reliefs Sec-20 - (a) the loss of earnings; (b) the medical expenses; (c) the loss caused due to the destruction,
damage or removal of any property from the control of the aggrieved person; and (d) the maintenance for the aggrieved
person as well as her children
Custody Sec-21 – Right to keep the children under the aggrieved person and schedule visits to the abuser
Compensation order Sec22 – on application , pay compensation and damages for the injuries, including mental torture
and emotional distress, caused by the acts of domestic violence committed by that respondent.
19

20. CHILD SEXUAL ABUSE (CSA)
Standing Committee on Sexually Abused Children (SCOSAC, 1984) defines
“Any child below the age of consent may be deemed to have been
sexually abused when a sexually matured person has engaged or
permitted the engagement of that child in any activity of a sexual nature
which is intended to lead to sexual gratification of the sexually mature
person “
Incest is a statutory crime, often classified as a felony
20

21. CHILD SEXUAL ABUSE (CSA) Contd…
 Child abuse sensitizes the neural circuits mediated through hippocampus
and HPA18 . When sexual abuse occurs in childhood, it can hinder normal
social growth and be a cause of many different psychosocial problems 18
 However, In India most of the abuse remains under-reported .
 The earlier the experience of abuse, the weaker the coping mechanism
for dealing with it, thus increasing the likelihood of developing a mental
illness later on in life 19
21

22.  Prevalence of Child Sexual Abuse in India , as per WHO , is around 10% 20
 Highest sexual abuse was reported in Assam (57.27%) followed by Delhi (41%),
Andhra Pradesh (33.87%) and Bihar (33.27%) 21
 A study conducted by Virani and coworkers (1985) in Mumbai found that 30% of
females and 10% of male adults had history of CSA. 22
 Almost 2/3rd of CSA cases have some psychological problems with depression
being the most common , other common once being interpersonal problems ,
conduct problems and sexualized behavior.23
INDIAN SCENARIO
22

23. INDIVIDUAL FACTORS
Female
Age (6-11yrs/12-17yrs)
Prior physical or sexual abuse
having special needs
RELATIONSHIP FACTORS
limited supervision by parents
use of drugs and alcohol by parents
Parents with mental health problems
Living with stepfather family
SOCIETAL ROLES
Hyper sexualization of young people
History of denial in a society that child
sexual abuse occurs
COMMUNITY FACTORS
tolerance of sexual assault and
weak sanctions against sexual assault
RISK FACTORS
FOR
CHILD SEXUAL ABUSE
VICTIMS24,25
23

24. Immediate
• Sudden change in the behavior
• Trust issues
• Self-harm attempts
• PTSD & other anxiety symptoms
• Social withdrawal
• Low self-esteem
• Hyper vigilant
Long-term
• Depression
• Eating Disorders
• Body Dissatisfaction
• Somatization disorder
• Anxiety spectrum disorders
• Girls can be a victim of IPV in
future
Psychiatric Effects 26
24

25. ROLE OF PSYCHIATRIST
 Child’s protection is the primary concern .
 Child sexual abuse must be fully assessed with a view to develop an appropriate
management plan.
 Psychiatrists should collaborate with multidisciplinary team that deals with CSA
 Intervention by Psychiatrists is necessary to minimize the initial effects and long-term
consequences of child sexual abuse.
 Proper instructions to family members to strengthen the support system and reduce the
chance of further incidents.
 An effective response requires coordination between protective, legal and therapeutic
systems. Failure to establish that result in further harm to the child.
25

26. The Protection Of Children From Sexual
Offences (POCSO) Act , 2012
(ACT NO. 32 OF 2012)
 This act contains 9 chapters and 46 sections
sn Type of Assault Punishment
4 Penetrative Sexual Assault 7 years to lifetime and fine
6 Aggravated penetrative sexual Assault 10 years to lifetime and fine
8 Sexual Assault 3-5 years / fine / both
10 Aggravated Sexual Assault 5-7 years / fine / both
12 Sexual Harassment Up to 3 years / fine / both
14 Using Child for pornographic purposes First – up to 3 years / fine / both
Subsequent – up to 5 years / fine / both
15 Storage of Pornographic material involving
child
Up to 3 years / fine / both
21 Fails to report / record a case Up to 6 months (or 1 year ) / fine / both
22 False complaint / information Up to 6 months / fine / both
26

27. 27

28. SEX TRAFFICKING
HUMAN TRAFFICKING 27 can be defined as
‘The recruitment, transportation, transfer, harboring or receipt of
persons, by means of the threat or use of force or other forms of
coercion, of abduction, of fraud, of deception, of the abuse of power or
of a position of vulnerability or of the giving or receiving of payments or
benefits to achieve the consent of a person having control over another
person, for the purpose of exploitation.’
** UN. Protocol to prevent, suppress and punish trafficking in persons, especially women and children, supplementing the United Nations convention against
transnational organized crime. General Assembly resolution 55/25. New York, NY, United Nations General Assembly, 2000.
28

29. 29

30. • Follow-up interviews with the women revealed that mental health symptoms
persisted longer than most of the physical health problems.29
CONSEQUENCES OF SEX TRAFFICKING
PHYSICAL SYMPTOMS 28 PSYCHOLOGICAL SYMPTOMS 29
Fatigue
Headache
Sexual and reproductive health
problems (e.g. STIs)
Back pain
Significant weight loss.
Depression
Imposed social isolation ,
PTSD & other anxiety spectrum
disorders.
Suicidal Thoughts
Multiple Somatic complaints
30

31. RISK FACTORS FOR DEVELOPING PSYCHIATRIC
DISORDERS IN SEX-TRAFFICKING VICTIMS 30
 Childhood sexual abuse
 longer duration of trafficking
 Poor social support
 Low educational status
 Low Socio-economic status
31

32. ROLE OF PSYCHIATRISTS
 Try to build the rapport.
 Crisis care with little background information , accepting that patients may not
come for follow-up 31
 Inform about the local and national services available.
 Enquire about current and historical experiences of abuse
 Careful risk assessments and safety planning, including risk of re-trafficking.
 Explore common post-trafficking reactions.
 Discussing ways to improve their social and legal support. 32
 Non-pharmacological management like CBT or EMDR were proven effective to
fully process the traumatic events. 33
32

33. HUMAN TRAFFICKING LAWS IN INDIA
 Trafficking in Human Beings or Persons is prohibited under the Constitution of
India under Article 23
 Protection of Children from Sexual offences (POCSO) Act, 2012, is a special law
to protect children from sexual abuse and exploitation.
 The Immoral Traffic (Prevention) Act, 1956 (ITPA) is the premier legislation for
prevention of trafficking for commercial sexual exploitation with prescribed
penalty of 7 years to life imprisonment.
 Section- IPC 366(A) – prohibits kidnapping
IPC 370 -- Prohibits selling of minors into prostitution
both of which have a penalty of maximum 10 years imprisonment and fine.
33

34. • Male sexual abuse is defined as any non-consensual act of sexual coercion
and/or domination which threatens the physical and/or psychological well being
of a boy or male adolescent or adult.
• In Men , often the abuse 34 is
 Physical along with sexual abuse
 often by a gang
 Oro-genital abuse is more common
• Retrospective studies show that between 3 and 7 percent of men report a history
of sexual assault occurring during adulthood of which , 18 to 74 percent, involve
oral or anal penetration35 .
SEXUAL ABUSE IN MEN
34

35. MALE CHILD SEXUAL ABUSE
 Ministry of Women and Child Welfare (2007), found that 53.22% children faced one or more forms of
sexual abuse; among them, the number of boys abused was 52.94% and of girls was 47.06% .
 Study done by Government of India , CSA equally prevalent in both boys and girls , but under-
reported and under-treated in boys. 36
 In any child protection service rendered by nongovernmental organization or hospital, utilization of
services is more by girl victims than boys
 Unlike females , males tend to be abused by men leading to confusion in the sexual orientation of
the Victims .
 In a study conducted, 22 % of men in the study sample reported sexual experiences with other men,
of which, 18 % of them had childhood sexual abuse 37
 Boys tend to blame themselves more than girls for not being able to stop the abuse. 38
35

36. PSYCHIATRIC MANIFESTATIONS 39
 Substance Use
 Risk taking behavior
 Anti-social Personality
 PTSD and other Anxiety Disorders
 Depression
 Homophobia
36

37. LEGAL SUPPORT
 No separate law for men
 Section 377 of IPC- Unnatural offences
37

38. WORK PLACE ABUSE
QUID PRO QUO HARASSMENT - is when employment
and/or employment decisions for an employee are based
on that employees's acceptance or rejection of unwelcome
sexual behavior. For example, a supervisor fires an
employee because that employee will not go out with him
or her.
HOSTILE WORK ENVIRONMENT - work environment
created by unwelcome sexual behavior or behavior
directed at an employee because of that employee's sex
that is offensive, hostile and/or intimidating and that
adversely affects that employee's ability to do his or her
job. For example, pervasive unwelcome sexual comments
or jokes that continue even though the recipient has
indicated that those behaviors are unwelcome.
38

39. WORK PLACE ABUSE Contd…
• Regardless of victims gender , around 80% of workplace abuse is committed by
men
• Unlike other sexual abuses , It is more by the strangers rather than known /
intimate people.
• The common reason for the abuse being high efficiency of women in work when
compared to their counter men
• Survey conducted by Indian National Bar Association (INBA) found that 38% of
people face sexual harassment at work place , of which around 70% were
unreported.40
39

40. Sequelae of Work place Sexual Abuse 41
 Poor job performance and job satisfaction
 Financial problems
 loss of self-esteem
 Interpersonal relationship issues
 Anxiety
 Long-term exposure can cause Depression
40

41. ROLE OF PSYCHIATRIST 42
 Providing employees with criteria for acceptable and non-acceptable behavior.
 Improve social support from colleagues and supervisors(If harassment is by
clients)
 Educating employees in avoiding and handling risk situations
 Providing information about the legal support available.
 One study indicates that confidence in responding to sexual harassment can be
considered as a resource that prevents development of negative mental health
consequences 43
41

42. (ACT NO. 14 OF 2013)
Contains 8 chapters and 30 sections
42

43. TAKE HOME POINTS
 To acknowledge that Sexual abuse is common
 It is also frequent in men , which is left under reported
 To identify and counter the patient’s negative cognitions
 To improve the patients Social Support .
 Group therapy or other support by women who have faced similar abuse may
be helpful.
 Mandatory reporting of all cases of sexual abuse is necessary to help to stop
the further abuse
43

44. • STALKING.
• VOYEURISM.
• SOCIAL WELFARE GOVT AUTHORITY IN THE DISTRICT.
• SEXUAL ABUSE IN TRANSGENDER.
• GOOD TOUCH , BAD TOUCH FOR KIDS.
• HOVERING AND GAS LIGHTING.
• SEXUAL ABUSE W.R.T PERSONALITY DISORDERS.
• RISK OF SEXUAL ABUSE IN PSYCHIATRISTS
44

45. THANK YOU
45