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Ethical Boundaries & Treating Sexually Abused Boys
10 CEUs Ethical Boundaries & Treating Sexually Abused Boys

Section 21
The Sexual Abuse of Boys & Its Impact on Sexual Orientation

Question 21 | Answer Booklet | Table of Contents | Child Abuse CEU Courses
Social Worker CEU, Psychologist CE, Counselor CEU, MFT CEU

Respondents were asked to categorize their sexual experiences and desires on a 7-point scale ranging from exclusively homosexual to exclusively heterosexual.1 Sixty percent of the respondents indicated thatsexual orientation Ethical Boundaries & Treating Sexually social work continuing education they were mainly or entirely heterosexual, and 36% identified themselves as mainly or entirely homosexual. Clearly, the proportion of homosexual respondents in this study is far higher than in the general population.

Sexual orientation was used as an outcome measure and the relationships between characteristics of the abuse and sexual orientation were assessed. In order to ensure that the apparent predictive relationships between abuse characteristics and outcome measures were not due to differences between homosexual and heterosexual men, sexual orientation was also considered as an independent variable and the relationships between it and the various outcome measures were examined. These relationships are displayed in Table 8.2.

There were no significant differences between homosexuals and heterosexuals in terms of traumatic symptomatology, overall functioning as assessed by the CIF, self-worth, sexual adjustment, or sexual satisfaction.

Table 8.2 Relationship Between Sexual Orientation and Outcome Variables
Outcome Variable Heterosexual
(N = 72)

(N = 43)

Trauma symptoms 2.5669 2.6855 .3422
Benevolent worldview 3.7581 4.2713 .0214
Self-worth 3.3611 3.3895 .9146
Duration of psychotherapy (in months) 41.912 82.631 .0040
Sexual satisfaction (high numbers = dissatisfaction) 4.5429 5.1395 .1334
Sexual adjustment 2.3803 2.2619 .6188
Psychiatric hospitalization
(21% of sample have been hospitalized)
22% 16% .4356
Psychiatric medication
(45% of sample have received medication)
37% 56% .0558
Suicide attempt
(33% of sample have attempted suicide)
25% 42% .0680
Composite Index of Functioning     .7796*

NOTES: * As a composite variable, the CIF cannot meaningfully be expressed as a mean. There were no significant differences in overall functioning between homosexuals and heterosexuals, as assessed by the CIF.
Values are means or percentages. Percentages are indicated by %; p values < .05 are in boldface type.

This finding is itself certainly noteworthy. Two statistically significant differences did emerge. Homosexual men had a more benevolent view of the world than did heterosexuals, and they participated in much more extensive psychotherapy. The average duration of psychotherapy for homosexuals was almost exactly twice that of heterosexuals (6 years, 11 months compared to 3 years, 6 months). There were, in addition, two statistical trends (p < .10): Homosexuals were more likely to have received psychotropic medication and to have attempted suicide, at levels approaching statistical significance.

It is interesting that despite a level of psychological functioning comparable to heterosexuals, homosexuals attempted suicide and received medication more frequently and participated in therapy for a much longer duration than heterosexuals. It is likely that these findings are due in large part to the difficulties inherent in being gay in our society. The majority of suicide attempts occurred between the ages of 16 and 23, and a large percentage of hospitalizations and medications occurred during these life-stages. This is a life-stage during which the struggle for identity is central (Erikson, 1963).

It is likely to be particularly difficult and wrought with psychic pain for young homosexuals who must, on top of the identity struggles that characterize all adolescents, come to terms with a sexual identity different from the norm in a society often unaccepting of such difference. They must navigate this while at the same time struggling to cope with their sexual victimization. It may be that the extensive psychotherapy these individuals have received has resulted in marked psychological growth and recovery since those times.

The source of the difference between homosexuals and heterosexuals in terms of perceived benevolence of the world is unclear, though this is certainly a striking finding. It is possible that these findings are related and that psychotherapeutic experiences may have contributed to a more benevolent world-view. That is, interacting over a long period of time with a therapist or therapists who are benign, supportive, and invested in one's growth and well-being may alter the abuse survivor's outlook on the world so that he sees it as a more friendly, benevolent place.

The relationship between factors associated with childhood sexual abuse and sexual orientation is complex and controversial. The views of the psychological and medical fields with respect to the etiology of sexual orientation have swung between the poles of nature and nurture. The results of several studies have been published thus far in the 1990s documenting differences in brain structure and genetic markers between homosexual and heterosexual men (Hamer, Hu, Magnuson, Hu, & Pattatucci, 1993; LeVay, 1991; Swaab & Hofman, 1990). Studies in the area of child sexual abuse have repeatedly found a higher incidence of victimization among homosexual than heterosexual men (Bell et al., 1981a, 1981b; Finkelhor, 1984; Simari & Baskin, 1982). Similarly, in the current clinical sample of sexually abused men, 34% identified themselves as primarily or exclusively homosexual. This is considerably higher than the 10% (or less) commonly cited as an estimate of the proportion of homosexuality in the population. Other than the finding of higher rates of sexual abuse among homosexual men, little is known about the relationships among abuse characteristics and sexual orientation.

In the current study, factors related to the gender of the perpetrator were the main predictors of sexual orientation. Specifically, men sexually abused during childhood by males were much more likely to identify themselves as homosexual than were men abused by females. The strongest statistical correlation was that between childhood sexual interactions with a brother and homosexual orientation. Men reporting sexual activity with mothers were more likely to be heterosexual, at a level approaching statistical significance. Those abused more severely were more likely to be homosexual. This last finding appears to be the result of the more severe abuse typical of male abusers, however, as regressions indicate only gender of perpetrator independently predicts sexual orientation.

The significant correlations between gender of perpetrator and sexual orientation are striking. They should not, however, be taken to indicate that sexual abuse, sexual abuse by males, or any other environmental variable causes homosexuality. The dictum that correlation does not imply causality should be kept in mind. Several alternate explanations have been suggested for the finding of the high rate of sexual abuse among homosexual men, each of which offers insight into the relationship between abuse by males and homosexual orientation. Simari and Baskin (1982), in discussing their finding that 64% of homosexual men in their study reported sexual activity with a relative during childhood, noted that most of these men indicated that they were already aware of their homosexual orientation at the time of the sexual interaction. In other words, sexual orientation preceded the childhood sexual activity rather than arising out of it. There are several differences between the Simari and Baskin study and the current one. Sexual interactions in their study consisted largely of consensual activity between siblings or cousins that was not perceived by the respondents as abusive, either at the time or in retrospect. Age at the time of sexual activity ranged from 9 to 16 years, which is considerably older than the age reported by men in the current study. In short, Simari and Baskin's study examined the childhood sexual activity of homosexual men and found very high rates of homosexual interaction in the preadolescent and early adolescent years. Though it appears that their research involved a population distinct from that of this study, it is relevant in that the present study found that childhood sexual activity with a brother is the single best predictor of homosexual orientation and that such activity is considered abusive at a relatively low rate. Thus, a large portion of the correlation between same-sex sexual interaction in childhood and adult homosexual orientation may stem from consensual sexual activity among boys, as was the case in Simari and Baskin's study.

Mike Lew (1990a) noted that his clinical practice with sexually abused men includes a high proportion of homosexuals. He speculated that during childhood, even if the victims themselves have not yet identified themselves as homosexuals, they may have discernible characteristics that make them vulnerable to sexual abuse. These features may include such qualities as passivity, a girlish appearance or demeanor, bookishness, and a lack of interest in stereotypically masculine interests such as athletics. In his view, such features are risk factors for sexual abuse and are also disproportionately represented in homosexual populations. Thus these characteristics are predictive of both sexual abuse and homosexuality, rather than the former causing the latter.

Gonsiorek (1993) proposes an explanation similar to that of Lew's, based upon the predatory nature of perpetrators. He argues that child abusers seek out vulnerable children. A child in an abusive or neglectful home or in a substance-abusing family would be vulnerable, as would a child with some sort of narcissistic injury. Gonsiorek asserts that children who later identify themselves as homosexual are aware from an early age (by about the beginning of latency) that they are different in some way from most of their peers and, moreover, that this difference is negatively valued. This sense leads to considerable self-disparagement, or what Gonsiorek terms "internalized homophobia," and leaves the child vulnerable to the sexual offender's predation.

A fourth perspective on the relationship between sexual abuse and sexual orientation was proposed by Finkelhor (1984), who found a four times greater incidence of sexual abuse among homosexuals than among heterosexuals. His view comes closest to being a causal model of homosexuality. Finkeihor argues that the experiences of sexual victimization cause the victimized boy to doubt and to question his masculinity and his sexual orientation. He wonders whether the fact of being victimized, helpless, and passive means that he is gay or feminine. If, as in the studies reviewed by Finkeihor, the perpetrator was male, the victim may conclude that he was chosen for the abuse because of some attribute that signified to the perpetrator that he was gay and thus susceptible to sexual advances. In the wake of the abuse, the victim makes attributions about himself-"I must have wanted it; he must have known I was gay; I'm not a 'real man' "-that contribute to a later identification as homosexual. In addition, the tendency of males to attribute to themselves desire and willing participation in all sexual activity-what Gerber (1990) termed "the myth of complicity"-may also contribute to the victim's assumption that if sexual activity with a male occurred, he must ipso facto be gay.

It is doubtful whether cognitive attributions such as those proposed by Finkeihor are sufficient to explain the etiology of sexual orientation. Recent biomedical research seems persuasive in demonstrating that there is at least a significant physiological component in the development of homosexuality-that nature plays a major role. Moreover, most research on sexual orientation indicates that it is set in place by the beginning of latency, whereas sexual abuse typically does not begin until later (Gonsiorek, 1993). Finkeihor's discussion of the thought processes of sexually abused men is consistent, however, with the comments of the men interviewed here and with the writings of numerous clinicians in this area who find that their clientele almost uniformly express doubts and concerns about the implications of their abuse for their sexual orientation (Bolton et al., 1989; Bruckner & Johnson, 1987; Dimock, 1988; Lew, 1990b). Thus, regardless of whether one identifies oneself as a homosexual or heterosexual, the experience of childhood sexual victimization, particularly by a male perpetrator, is likely to raise profound issues regarding sexual orientation. It is not possible to determine the precise relationship between sexual abuse and sexual orientation on the basis of the present study or with currently available data. Further research on the relationships between childhood sexual abuse and adult sexual orientation would be extremely valuable.
- Mendel, Matthew, The Male Survivor: The Impact of Sexual Abuse, Sage Publications: London, 1995.

Personal Reflection Exercise #7
The preceding section contained information about the sexual abuse of boys and its impact on sexual orientation. Write three case study examples regarding how you might use the content of this section in your practice.

Studies in the area of child sexual abuse have repeatedly found a higher incidence of what among homosexual than heterosexual men? Record the letter of the correct answer the Answer Booklet.

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