Almost a quarter of this community-based, probability sample of men reported CSEs meeting investigator-imposed CSA criteria that are routinely used in the sexual abuse literature. Nearly two-thirds of these men with investigator-defined CSA histories self-defined their abusive CSEs to be CSA themselves. This rate of CSA self-definition did not significantly differ by sexual identity. Behavioral but not psychiatric outcomes differed across the two self-definition and No-CSE subgroups, when comparisons were completed for the whole sample. Non-Definers had the highest proportion of men who reported having had sex under the influence and they also had the highest number of lifetime sex partners; the No-CSE subgroup had the lowest proportion of men who reported having had sex under the influence, and they had the lowest number of lifetime sex partners. When outcome comparisons were stratified by sexual identity, however, results indicated that the heterosexual subsample had additional outcome differences across subgroups that were both behavioral and psychiatric: Non-Definers reported STD histories at higher rates than the Definer and No-CSE subgroups, and Definers reported higher PTSD symptom levels than the Non-Definer and No-CSE subgroups.
Though the rate of CSA self-definition appeared to be high, the questions used to capture participants’ abuse histories included the words “sexual abuse” and, thus, a bias toward identifying a higher rate of self-definition existed for this study. Within that context, then, it was somewhat surprising to find so many men who responded affirmatively to case-finding questions containing the words “sexual abuse” and then stated, in response to questions asked only five to 10 minutes later, that they did not consider themselves to have been sexually abused. This may suggest that, despite what initially appeared to be a high rate of self-definition in this study, barriers to self-defining abusive CSEs as CSA still remain for men. Furthermore, given that self-definition rates were not significantly different for heterosexual and gay/bisexual men, these barriers would seem to be at play regardless of a man’s sexual identity. Some of these barriers, as well as the means by which some men avoid them, may be represented by the taxonomy of explanations about abusive CSEs that men provided in this study, explanations that differ substantially by whether men were Non-Definers or Definers.
This study is the first to explore CSA self-definition in a probability sample of community-based, predominantly-heterosexual adult men who are more representative of the general population than prison inmates, college undergraduates, and Navy recruits, samples that have been used in prior studies of heterosexual men’s CSA self-definition. This study also is the first to compare CSA self-definition in heterosexual men to that in gay/bisexual men recruited from the same underlying population. That rates of CSA self-definition are similar across sexual identity subgroups for this study’s sample (mirroring similar findings from the less generalizable samples described earlier in the manuscript) appears to counter claims by those who articulate an exceptionalism argument for gay/bisexual males wherein their abusive CSEs are seen as potentially being more of a benefit to them than a liability (Stanley, Bartholomew, & Oram, 2004
; Steever, Follette, & Naugle, 2001
). When coupled with the finding that all Non-Definers were significantly more likely to engage in sexual risk behavior than the Definer and No-CSE subgroups, findings suggest that regardless of one’s sexual identity there are substantial liabilities not only in experiencing CSA, but also in not defining it as such.
Prior studies have consistently shown that younger age at abuse, larger age difference between victim and perpetrator, and the abuse characteristics of force and coercion are associated with CSA self-definition (Dolezal & Carballo-Dieguez, 2002
; Stander, Olson, & Merrill, 2002
; Stanley, Bartholomew, & Oram, 2004
; Steever, Follette, & Naugle, 2001
). Heterosexual samples have also indicated that they are more likely to self-define abusive CSEs to be CSA when the perpetrator is male or a family member, and when intercourse is involved (Fondacaro, Holt, & Powell, 1999
; Stander, Olson, & Merrill, 2002
). Though none of these variables---except penetration---was associated with CSA self-definition in the quantitative analyses of this study, even when analyses were stratified by sexual identity, Definers did note young age of victim, victim-perpetrator age difference, and perpetrator being a family member as reasons for their self-definition in qualitative explanations. These mixed methods findings suggested similarity between this study’s findings and others’---a good external validity check.
PTSD symptom severity was the only psychiatric outcome that differed across self-definition subgroups (and then only in a statistically significant way for the heterosexual subsample). The finding---that PTSD symptom severity was highest in Definers---also replicated findings reported previously, providing some additional external validation for study results (Fondacaro, Holt, & Powell, 1999
Other findings from this study, however, differed from those reported previously. For example, Non-Definers were found to have the highest rates of sex-under-the-influence and the highest number of lifetime sexual partners. Though this may be similar to the Fondacaro et al. report (about a likely-heterosexual sample) in which Non-Definers had more alcohol problems than Definers, it appears to run counter to the report by Dolezal & Carballo-Dieguez (from a gay/bisexual sample) that noted the reverse: Definers had more alcohol problems and lifetime sexual partners (and risky sex) than Non-Definers (Dolezal & Carballo-Dieguez, 2002
; Fondacaro, Holt, & Powell, 1999
). This may indicate a need to be cautious in drawing firm conclusions from this study, or it may suggest that having used a more generalizable sample for this hypothesis-generating study was beneficial in that it indicated need for future study of self-definition in larger and even more generalizable samples.
Non-Definers appeared to be more likely to have low-care parents, and not to have had siblings. Self-defining abusive CSEs to be CSA may be difficult in the context of uncaring parents who may not have provided clear boundaries for interpersonal contact, and/or in the context of no feedback from siblings who might otherwise confirm perceptions about abusive CSEs about which one otherwise might have been uncertain. These possibilities, however, are entirely conjectural and require future confirmation.
This study also described open-ended explanations for CSA self-definition. The emerging taxonomy indicates that one core determinant of self-definition common to both groups is the issue of consent and/or willingness. Unlike Definers, Non-Definers’ consent-related comments indicated an inaccurate belief that children and adolescents without the cognitive ability to provide consent to sexual relations with an adult are able to do so (at least insofar as their own experience was concerned), a dynamic that has also been reported by Stanley, Bartholomew, and Oram.(2004)
When coupled with the finding that Non-Definers’ had higher rates of penetrative CSEs, one might speculate that CSA self-definitions of abuse could be complicated by experiences of physical pleasure during abusive CSEs. In fact, Okami reported that a majority (91%) of males who described positive reactions to their CSA histories also recalled the experiences to have been physically pleasurable (Okami, 1991
). It is possible that Non-Definers in this study were more likely to have had an erection, if not experienced ejaculation, during abusive CSEs. Such experiences may lead to self-perceptions of complicity, which may lead to self-perceptions of willingness and/or consent.
Men with CSA histories who do not define their abusive CSEs to be CSA also may be engaged in avoidant coping: it may be easier to claim sexual agency than grapple with having been a victim; and/or it may diminish the perceived need to label as a perpetrator someone about whom one has caring feelings and/or who may be a family provider and/or personal mentor. Fondacaro et al. hypothesize that men who employ such coping strategies may be more likely to abuse alcohol or to ignore emotions, both of which result in greater distress (Fondacaro, Holt, & Powell, 1999
). Whether some men do not self-define abusive CSEs to have been CSA because of a perception of complicity or because of avoidant coping or because of other reasons altogether, concluding from this study’s findings and these hypotheses that Non-Definers must be made to perceive their abusive CSEs as CSA is not an obvious deduction. Rather, potential interventions aimed at avoiding/reversing apparent negative outcomes for Non-Definers perhaps can simply address sexual histories and sexual scripts, as well as self-perceptions of, satisfaction with, and potential outcomes related to these histories/scripts, without labeling histories/scripts CSA and CSA-related.
Three study limitations, in addition to those that have already been noted above, warrant specific notice. First, even though study participants did not differ from non-participants on the three variables assessed during the initial telephone screening, no further information about the reasons for non-participation are known; as a result, unmeasured bias may exist. Second, the study sample was non-affluent, urban, and largely minority. Thus, results may not be able to be generalized beyond these groups. In addition, exclusion of potential participants on the basis of language barriers further limits findings to those who speak English, a not-insubstantial concern given the growing population of non-English speakers in the U.S. Third, the study was hampered by small numbers, resulting in many near-significant findings about which no conjectural claims are possible. This highlights the need for future studies to recruit larger samples to achieve subgroups with CSA histories that are more numerous; this, in turn, will lead to Non-Definer and Definer subgroups that are large enough to provide adequate power for comparisons across numerous potentially-important variables. These future studies should be powered to adjust for these other potentially explanatory variables and potential confounders/effect modifiers so as to assess better the possibility that self-definition subgroup differences are driven by other factors than self-definition (e.g., race/ethnicity, sexual identity, parental care, sibling number, abuse characteristics).
In these future studies, a more accurate assessment of self-definition also should occur. This would be done best by collecting information on all participants’ CSEs---without labeling them to be anything other than sexual experiences---some time after which participants would be asked if they believe themselves to have a CSA history. Responses to this CSA question could be compared to the previously enumerated CSEs that have been subjected to an externally-applied, widely-accepted CSA definition.
The potential weakness of the “sex under the influence” measure is another limitation. Although it and variations have been used in numerous studies (Celentano et al., 2006
), it is possible using this approach for a person who has sex one time per week and who always does so while under the influence to be defined inaccurately as higher risk than another person who has sex 30 times per month and does so while high “a little of the time” (say five of those 30 times). Future studies should assess this variable better.
The emerging taxonomy of why participants of this study did or did not self-define their abusive CSEs to be CSA also indicates that future research into CSA self-definition should be approached with more in-depth mixed methods.(Tashakkori & Teddlie, 1998
) Knowing how men’s un(der)explored internal experiences contribute to the apparent difficulties in self-defining abusive CSEs to be CSA appear to be critical. Until such data become available, not only researchers, but also mental health professionals should attend more closely to the personal restrictions boys and men, and their surrounding culture, may impose on CSA self-definitions. These cultural impositions include not only those that might suggest boys cannot be victims, but also moves by some to relax CSA definitions for gay/bisexual youth to the point of considering child-with-adult sexual interactions to be socially normative. Attending to these cultural impositions will mean that researchers and clinicians directly ask men with abusive CSEs whether they self-define them to be CSA, which may provide an opportunity to identify in these men varied internal conflicts about labeling that have clinical relevance