Ethical Boundaries & Treating Sexually Abused Boys

Studies that assess the relationship between perpetrator and victim have examined the following questions: How frequently are boys abused by strangers as opposed to someone they know? What proportion of the abuse of boys is intrafamilial and what proportion extra familial? What is the specific role relationship between perpetrator and victim?

One notion that appears to have been adequately dispelled by the research is that boys are predominately sexually assaulted by strangers. Though many studies indicate a high rate of extrafamilial abuse (e.g., Finkelhor, 1979; Finkelhor et al., 1990; Rogers & Terry, 1984), in the vast majority of cases the perpetrator is known to the victim prior to the onset of sexual activity (Faller, 1989; Farber et al., 1984; Finkelhor, 1979; Fromuth & Burkhart, 1987, 1989; Neilsen, 1983; Risin & Koss, 1987; Rogers & Terry, 1984; Showers et al.,1983; Spencer & Dunklee, 1986). In Fromuth and Burkhart's two college samples (1987, 1989), for example, strangers perpetrated the abuse in only 17% and 4%, respectively, of the cases.

The only exceptions to this pattern of findings appear to be Ellerstein and Canavan's (1980) and Dejong et al.'s (1982) hospital-based studies and Finkelhor et al.'s national survey (1990). Ellerstein and Canavan found strangers to constitute 44% of the perpetrators in cases involving boy victims. Dejong et al. do not provide data by gender of victim in terms of familiarity with the perpetrator. Sexual assault was perpetrated by strangers in 53.9% of the cases in their study, however, and they state that no significant gender differences were found for this variable, indicating that a high proportion of boys as well as girls were abused by strangers.

Both of these studies were conducted with child victims who had arrived in hospital emergency rooms due to sexual assault. It is likely that the high rate of perpetration by strangers is due to this factor. Finkelhor et al. (1990) found that 40% of victimized boys versus 21% of girls had been abused by strangers. This study looked only at sexual activity considered by the respondent to be abusive, however, which is likely to inflate the relative frequency of reported sexual interactions with strangers. These findings are presented in Table 3.6.

Intra- Versus Extrafamilial
Like most aspects of the sexual abuse of boys, studies that assess the ratio of intrafamilial to extrafamilial abuse have produced a mixed bag of results. A number of studies have found that boys are more likely than girls to be abused by a nonfamily member (American Humane Association, cited in Finkelhor, 1984; DeJong, 1982; Farber et al., 1984; Faller, 1989; Finkelhor, 1979; Rogers & Terry, 1984). Several additional studies, although not comparing the rate with that for girl victims, found that extrafamilial abuse constituted the majority of sexual victimization experiences in samples of boy victims (Farber et al., 1984; Risin & Koss, 1987; Showers et al., 1983).

Several studies, however, indicate equivalent proportions of intra- and extrafamilial abuse or a preponderance of the former. The Al-IA data cited by Finkelhor (1984) indicate that 23% of sexually victimized boys are abused outside the home. Finkelhor argues that because these figures reflect only abuse by caretakers, they are likely to understate the prevalence of extrafamilial abuse considerably.

Spencer and Dunklee (1986) found that 49% of abuse was perpetrated by a relative. Pierce and Pierce (1985) found that only 20% of perpetrators were nonfamily members. Faller (1989) found that 3 6.8% of perpetrators were nonfamily members. Olson's (1990) clinical study of 44 sexually abused men found that 30 had been abused by a family member and 31 by someone outside the family (most of the men in the study recorded abuse by more than one perpetrator).

Thus, there is a wide range of findings with respect to the relationship of perpetrator and victim. Estimates of the proportion of extrafamilial abuse of boys extend from 89% (Finkelhor et al., 1990) to 20% (Pierce & Pierce, 1985). The studies that found the highest rates of intrafamilial abuse were conducted on samples from child protective services or other sources focused on in-home, or caretaker abuse. The AHA data (in Finkelhor, 1984) explicitly concern abuse related to a child's caretaker, whereas Pierce and Pierce's study (1985) was based on calls to a child abuse hot line.

A large percentage (43.7%) of Faller's sample (1989) came from child protective services. The two remaining studies indicating high percentages of intrafamilial abuse (Olson, 1990; Spencer & Dunklee, 1986) each found approximately equal proportions of intra- and extra-familial victimization. It cannot be stated with certainty what the relative proportions of these two types of abuse are in the population of abused men. It appears, however, that boys who are abused are in fact more likely than girls to be victimized by a nonfamily member and that a high proportion of male sexual abuse is extrafamilial.

It is significant that studies that relied on self-report rather than reported cases (Finkelhor, 1979; Risin & Koss, 1987) found higher proportions of extrafamilial abuse, 83% and 78% respectively. It is unfortunate that Fromuth and Burkhart's (1987, 1989) large self-report study of college men did not provide data on intra- versus extrafamilial victimization. Studies providing data regarding the proportions of intra- and extrafamilial perpetration are presented in Table 3.7.

- Mendel, Matthew, The Male Survivor: The Impact of Sexual Abuse, Sage Publications: London, 1995.

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Personal Reflection Exercise #3
The preceding section contained information about the relationship between the victim and the perpetrator. Write three case study examples regarding how you might use the content of this section in your practice.

Peer-Reviewed Journal Article References:
Reed, R. A., Pamlanye, J. T., Truex, H. R., Murphy-Neilson, M. C., Kunaniec, K. P., Newins, A. R., & Wilson, L. C. (2020). Higher rates of unacknowledged rape among men: The role of rape myth acceptance. Psychology of Men & Masculinities, 21(1), 162–167.

Seabrook, R. C., Ward, L. M., & Giaccardi, S. (2018). Why is fraternity membership associated with sexual assault? Exploring the roles of conformity to masculine norms, pressure to uphold masculinity, and objectification of women. Psychology of Men & Masculinity, 19(1), 3–13.

Sell, C., Möller, H., & Taubner, S. (2018). Effectiveness of integrative imagery- and trance-based psychodynamic therapies: Guided imagery psychotherapy and hypnopsychotherapy. Journal of Psychotherapy Integration, 28(1), 90–113.

QUESTION 17
According to Spencer and Dunklee, what percentage of sexually abused boys are sexually abused by a relative? Record the letter of the correct answer the Test.