Health : Sexual Abuse: When Men Are the Victims

Hank Estrada knew how to keep a secret. Thirteen years after being sexually abused by a trusted relative, he still hadn’t told anyone in his family.

But when that same man began baby-sitting another young family member, Estrada couldn’t bear the thought of his trauma being repeated. At a family get-together, he confronted his abuser.

“If I ever catch you with anybody . . . ,” sputtered Estrada, too angry to finish his sentence. “. . . Do you understand what I’m saying?”

Yes, replied the relative, who now is supervised by other adults when visiting younger family members, said Estrada, a 33-year-old assistant grocery manager from Norwalk.

Estrada’s story isn’t rare. Childhood sexual abuse, once believed largely a trauma of girls, cuts across gender lines, researchers know now. Some estimate that as many as 15 million American men may have been sexually abused as children.

In a 1985 Los Angeles Times poll of more than 2,600 adults, 16% of the men and 27% of the women reported childhood sexual abuse, defined in that survey as a range of unacceptable behavior, from exhibitionism to intercourse.

‘Probably Closer to 50-50’

“And those who work in the field say it’s probably closer to a 50-50 incidence for males and females,” noted Katie Bond of the Denver American Assn. for Protecting Children, a nonprofit organization dedicated to the improvement of child protective services. Nor is the stereotype of a male abuser always accurate. Some men report sexual abuse by their mothers, sisters, female baby-sitters and other women.

Given that revised profile, some therapists now specialize in treating men, and support groups for them are growing. In the last year, at least two books about sexual abuse have been directed at them, joining a burgeoning bibliography aimed at abused women. And PLEA, a Norwalk-based organization founded and directed by Estrada, offers counseling referrals and a newsletter to male survivors, as some prefer to be called.

While there are many similarities in the ways childhood sexual abuse affects men and women, there also are important differences, researchers report. Like women sexually abused during childhood, men often report feelings of shame and low self-esteem and have a negative body image, according to Mike Lew, a Boston therapist and author of the recently published “Victims No Longer: Men Recovering From Incest and Other Sexual Child Abuse.”

Men’s Reactions May Differ

But men’s reactions to those feelings may differ. “Men who are sexually abused tend to act out their problems, while women internalize,” said Daniel Jay Sonkin, a Sausalito therapist whose book about male sexual abuse is due out this year.

“Women are more likely to have depression, anxiety and phobias; men are likely to be aggressive,” said David Finkelhor, a professor of family research and co-director of the Family Research Laboratory at the University of New Hampshire. Sexually abused men also have higher rates of drug and alcohol abuse than sexually abused women, according to Finkelhor, an expert on family violence.

Anger is often stronger in male survivors than female, finds Richard Embry, a social worker and assistant director of the Child and Adolescent Program at Pacific Clinics in Pasadena. “They (male victims) don’t just say, ‘I’m angry.’ They say, ‘I want to kill (my abuser).’ ”

In a study of 25 men who were sexually abused as children, Minneapolis social worker Peter Dimock found they were sexually compulsive (with a tendency toward one-night stands and multiple affairs), confused about their masculine identity and had trouble forming lasting relationships.

Others became sexually dysfunctional, said Dimock, whose study was published last year in the Journal of Interpersonal Violence. Many said they were confused about sexual preference, particularly if their abuser was male. According to Dimock, heterosexual men often ask, “Does (having been the victim of sexual abuse) mean I’m gay?” And gay men often ask, “Is this why I’m gay?”

Greater Effect on Men

Said one: “I felt that being male, I should have been able to prevent the abuse.”

Sexual abuse has a greater effect on men, “on one’s feeling about oneself as a member of the masculine gender,” Dimock believes. “Abuse of women doesn’t call into question their femininity,” he said.

Both genders have difficulty acknowledging they were sexually abused. In The Times poll, one in three victims said they had never disclosed the abuse.

Society’s expectations may make disclosure especially difficult for men, said Dimock, author of “Adults Molested as Children: A Survivor’s Manual for Women & Men.” “You’re not seen as much of a man if you’re a victim.”

Lew agreed: “We have a place in our culture for women as victims. But men aren’t supposed to be victims.”

Most therapists consider a patient’s acknowledgment of abuse a critical first step to recovery. Survivors need to tell the secret, Dimock writes in his book, “to help us deal with our pain and because we realize that our silence only protects the abuser.”

“Whom you decide to tell is important, but a little less important than deciding to tell in the first place,” said Dimock, who suggests talking to a therapist or initially a hot-line counselor.

Many men wait until their 30s, 40s and 50s to seek professional help, Lew finds. “In their teens and 20s, abuse is often still too fresh (to talk about),” he said.

One man told Lew he first discussed the abuse during his honeymoon. “He had created a new family and didn’t have to protect the abusive family anymore,” Lew said. (It was also concern for a relative that prompted Estrada to confront his abuser and warn his family.)

Once the silence is broken, therapists recommend a variety of other measures and techniques to speed recovery, among them:

Ongoing psychotherapy. If financially feasible, Dimock and others recommend that men continue to seek individual psychotherapy, supplemented if possible by group therapy.

An all-male approach to treatment--with a male therapist and entirely male therapy groups--is best, Dimock said. Other experts prefer a case-by-case approach. “Male therapists might be too frightening (for some men),” Sonkin said.

During therapy, survivors may need to explain to incredulous partners or other family members why they endured the abuse for so long. “As abusive as the attention is,” said Lew, “sometimes it’s the only attention a child gets.”

Said Estrada of his abuser: “He was the man who saved me (from neglect). He’d take me on trips, he’d play ball with me.” (He) was consistent. He said he loved me and he meant it.”

But that consistency had a price, Estrada now knows. “I learned that to be loved--what I thought was to be loved--was to be sexual,” he said.

Confrontation. Verbal confrontation of the abuser is a controversial technique, advocated by some--but not all--therapists. “Confronting the abuser is saying, ‘This never should have happened to me,’ ” said Lew, who advises using this technique cautiously. “It’s saying, ‘I didn’t deserve this. I’m a good person.’ It’s demanding accountability.”

Confrontation need not be direct. Lew sometimes suggests that his clients write a letter to the abuser. One man wrote to his mother, explaining that her sexual abuse had caused him great difficulties, and mailed copies to his minister, father and others.

Altruism. Being sexually abused as a child contradicts the “just world” hypothesis, Lew believes, but altruism--via participating in community service programs, for instance--can restore a victim’s sense of goodness and justice.

Many sexually abused men spend about a year in therapy, Dimock said, followed by on-and-off counseling. “Life changes, such as the birth of a child, often bring up issues,” he explained. Added Lew: “Many men talk about recovery as a lifelong process.”

The extent and type of abuse play a role in how much help is needed. “If force was used, there’s usually a poorer outcome (psychologically) for the victim,” found Anthony Urquiza, assistant professor of family studies at San Diego State University and a sexual abuse researcher.

“And for kids, their relationship with their parents is a major predictor of their outcome psychologically.” The stronger those bonds, he believes, the more likely a child is to bounce back. “But if mom or dad is doing the abuse, that can be particularly traumatic,” he added.

Some men enter therapy and then pull back. “Initially, it’s a scary thing to begin to talk about,” Dimock said. “Men need permission to do the healing, bit by bit.”

What constitutes recovery? Dimock encourages men to view it not as an attempt to return to “normal,” because life was never normal for many victims. “The process (of recovery) is about building a new identity, replacing an old one built on lies, secrets, and shame,” he said. The emphasis should be on “building a sense of ‘normal’ that is entirely new.”

Estrada, who believes he is 98% recovered and is involved in a satisfying monogamous relationship, offered a more personal definition of recovery. “For me, it means being able to love, appreciate and respect yourself--and to let someone else love, appreciate and respect you.”