This is another of those topics I really wish I didn’t have to do. In this interview with Dr. Jennie Noll of Pennsylvania State University, we discuss the impacts that sexual abuse can have on a child (even many years after the event itself!), and we talk extensively about what parents can do to prevent abuse from happening in the first place.
If you want to be sure to remember this info, there’s a FREE one-page cheat sheet of the 5 Key Steps Parents Can Take to Prevent Sexual Abuse available here:
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Jen: 01:26
Hello and welcome to the Your Parenting Mojo podcast. We have a pretty serious topic to cover today and it's what I've been thinking about for a long time now. In 2016 the USA gymnastics sexual assault scandal broke and we learned that Dr. Larry Nassar had been sexually assaulting gymnast for years as he claimed to be providing them legitimate medical treatment. Now obviously there were failings at so many levels here. This was reported and ignored and covered up at many levels. But one thing that stuck in the back of my mind was an interview with gymnast Aly Raisman where she said she really thought this was what medical treatment was like and I want to be 100% clear that I'm not blaming Raisman or any other gymnast who had this awful experience, but I just couldn't get my head around how and why she didn't know she was being sexually abused.
Jen: 02:11
I realized that it's at least partly because we live in a culture where we don't talk about this. We don't teach children to watch for warning signs and we don't look out for them ourselves as parents or we pretend we don't see them. We just stick our head in the sand. So today's episode is probably not one you want to listen to with children around because we're going to be very explicit and discussing sexual abuse and how to prevent it. I also want to give a shout out to listener Christine who helped me to think through some great questions to ask my guest today. I spent a really long time looking for someone to talk with us about this and finally found the right person. Dr. Jennie Noll is Professor of Human Development and Family Studies and Director of the Child Maltreatment Solutions Network at Penn State University.
Jen: 02:52
She earned her Ph.D. in Developmental Psychology and Statistical Methodology from the University of Southern California. The reason I’m so interested to talk with her about this topic is because she has active research projects on two topics that are very important to us, the long-term health outcomes for victims of child sexual abuse and programs for the prevention of that abuse. Welcome Dr. Noll.
Dr. Noll: 03:13
Thank you very much for the opportunity.
Jen: 03:16
So before we get started, I actually also want to mention that I took the training that Dr. Noll studies and it's called Stewards of Children and it's published by an organization called Darkness to Light. I've created a free one page guide to preventing sexual abuse that you can download from this episode's page at YourParentingMojo.com/SexualAbuse. So we're going to talk a lot more about the Stewards of Children program today I imagine. But I wonder if we can get started by looking at the mental health or the general health actually impacts of sexual abuse because I was really surprised to find out how many of these there are. Can you walk us through these and do we have any indication of how likely they are to occur in a child who is chronically abused for years versus one who experiences abuse that it's discovered or reported fairly quickly.
Dr. Noll: 03:58
Yeah, very good. So what we've understood and this has been my work for the last 30 years, what we've understood really well as sort of the mental health and emotional health consequences of abuse. We have pretty good trauma informed treatments for mental health. These are things like persisting posttraumatic stress disorder, other anxiety disorders, depression, other sorts of attachment related disorders in terms of not being able to attach to a partner, relationship difficulties, and substance abuse. These kinds of things that we normally think about as mental health or emotional health. But what we're learning I think in the last decade is something that surprised a lot of us and that is just how we see sort of physical health consequences that we didn't really anticipate when we were just studying mental and emotional health and these are things like physical health disorders, these are heart attacks, obesity, strokes, stress-related diseases like inflammation, interferences with disease processes.
Dr. Noll: 05:04 These are the kinds of things that we see in chronically stressed populations like PTSD Vietnam vets, people who have endured long and chronic stressors in their lives early on. And we think about this as how does stress sort of get under the skin and impact physiology? And we're talking about not just disease process but brain development, right? Other sorts of major organs, systems, the stress response system. So after studying survivors, which I have done for over 30 years and across generations, we're really starting to see a strong causal influence of early sexual abuse on long-term health outcomes because of the early and chronic exposure to stress and the stress hormone cortisol and other assaults on the stress response system.
Jen: 05:57
Wow, that's incredible. So that completely makes sense from the sort of chronically abused perspective, if the stress is ongoing for a really long period of time. Do you see similar effects in people who have this experience maybe once or twice and it's discovered fairly quickly?
Dr. Noll: 06:13
Yeah, that's a great question. It has two parts to the answer and my answer would be it depends. It sort of depends on what outcome you're looking at. For example, when we look at things like, sexual development, promiscuity, teen pregnancy, sort of more sort of sexual outcomes, right? Those are not necessarily tied to physical health, but something to do with the severe sexual boundary violation that has happened in the context of sexual abuse. I actually have some papers that really show clearly that it doesn't matter all that much if it's happened chronically or one time or several times or at what age, but more the fact that there was a sexual boundary violation and some kind of trust that was violated early on. So I don't like to put things on a continuum from mild to severe or one time to chronic. It's more about the interpretation of that violation and how it happened and the context in which it happened that helps us understand the sequelae and how to treat this kind of survivor.
Jen: 07:20
Okay. So that leads me to think about, what's the prevalence of these kinds of problems among children who are sexually abused? We actually did an episode on Intergenerational Trauma and how that's passed down through the generations and it's amazing. Some people can experience incredible trauma and not pass it onto the next generation and the vice versa happens as well. So I'm wondering, do most children manage these transitions to adolescence and adulthood kind of okay, kind of normally as it were or are problems really common?
Dr. Noll: 07:49
I think problems are a lot more common than we initially had thought about because of our work, not just mine, but others in the field where we follow survivors through time and we're able to compare those to kids of a normal developmental trajectory. And what we see is as much more common in survivors than in the normal population. Things like I've talked about and things like sexual outcomes, depression, mental health, and also these physical health outcomes. So much more common, significantly more common than would be accounted for by chance than the general population. But you're right, the road to resilience I think is under studied and under understood. And we are trying to look at models now of those who do not have affects. Those do not seem affected and what can we learn from those trajectories. Those are things like having a really good support system early on in life, having someone who believes in you, having some good evidence based trauma treatment early on, and also revisiting these issues as different developmental transitions happen.
Dr. Noll: 08:53
For example, getting married often triggers some effects of sexual abuse as memories or sort of clarified and uncovered and even experienced differently in the context of a new relationship or a new sexual relationship. Also the birth of a child can trigger a trauma symptoms as well. So we often suggest revisiting of treatment as survivors go through their lives. These are the kinds of success stories that we hear. In terms of intergenerational transmission, let me just say one thing quickly. We don't see necessarily victims of sexual abuse going on to sexually abuse their children. That's not the kind of intergenerational transmission we're talking about. We're talking about sexual abuse victims recreating an environment for their children were adversity persists or where other people have access to their kids who might be exploitive individuals who then pass sexual abuse on to those kids or physical abuse or neglect. So what happens with a survivor when they become a parent, if they have substance abuse issues or other mental health issues, children...
