Child Sexual Abuse in Turkey: An Analysis of 1002 Cases

This study investigated the characteristics of abuse suffered by children, the dimensions of the psychiatric effects associated with abuse, and the factors affecting these. One thousand two cases aged under 18, exposed to sexual abuse, and referred over a 7‐year period were assessed. Girls represented 80.8% of cases, and the numbers rose with age. The aggressors were all male, and 88.2% were known to their victim. Approximately half the children were exposed to sexual abuse involving penetration. Psychological pathology was identified in 62.1%. Female gender, the presence of penetration, physical violence, and incest significantly increased the development of psychological pathology. Levels of awareness in people close to and trusted by the child must be raised to minimize the adverse effects of trauma in the long term, preventive measures must be taken, and medical and social support units from which victims can receive assistance need to be established.     

The Role of Fantasy in a Serial Sexual Offender: A Brief Review of the Literature and a Case Report

Abstract: Extensive research has attempted to elucidate the role of fantasy in sexual offending. In this paper, the authors summarize the main results of the literature, especially the contents, themes, dynamics, etiopathogenesis, and potential functions of fantasy in sexual offending. Further, the authors analyze the case of a serial sexual offender who assaulted 39 women. The forensic‐psychiatric assessment revealed that his fantasies of forced sex, sexual coercion, and dominance, which were linked to narcissistic personality organization and functioning, were the primary drive mechanism in his crimes, because he imagined himself in the role of the aggressor, identified with the power associated with the role of perpetrator, and was sexually aroused by such images of omnipotent control of the victim. In conclusions, the authors suggest that fantasies of sexual aggression, coercion, and dominance of women may stimulate grandiosity and omnipotence and, in a minority of cases, may lead to sexual offending.     

Trichobezoar in Vagina: Assessment for Child Sexual Abuse and Diagnostic Result of Forensic Science

Vaginal discharge and bleeding in children require a through and thoughtful evaluation to diagnose the underlying problem including infections, sexual abuse, and vaginal foreign bodies. We report a 6‐year‐old girl presenting with bloody vaginal discharge, carefully evaluated for sexual abuse, and finally diagnosed as a vaginal foreign body after vaginoscopy. A rolling hair ball was extracted from the vagina and was diagnosed as trichobezoar pathologically without any endo–ecto‐mesodermal residual tissue. The hair ball was genetically detected and diagnosed to belong herself by containing no foreign structure. Child sexual abuse was ruled out by forensic interview at CAC and report of forensic science that reported genetic structure belonging to the child. Medicolegal assessment helped in final diagnosis to exclude child sexual abuse.     

Somnophilia and Sexual Abuse Using Vaginal Administration of Triazolam

Somnophilia is a rare paraphilia, a form of sexual fetishism which is characterized by the desire to have sex with an unconscious human object who is unable to respond. To the author's knowledge, this is the first case study concerning somnophilic sexual abuse associated with vaginal administration of triazolam. The perpetrator video‐recorded his sexual acts with two unconscious female victims with whom he also had normal sexual intercourse and who were unaware of his paraphilic activities. His Internet conversations with other persons whom he thought to be interested in somnophilic sex and his plans to kidnap a child were recorded by the police. It was evident that sex with an unconscious object played a specific fetishistic role for this man. He obviously used a combination of drugs mixed with alcoholic drinks to make his victims fall sleep and videotaped vaginal administration of triazolam used to deepen the victim's unconscious state.     

From Victim to Offender: Female Offenders of Child Sexual Abuse

Historically, women have been seen to have a much lower recorded rate of crime than men. In the area of child sexual abuse, women have figured prominently in official statistics as victims but have had virtually no official recognition as offenders. It is difficult for many people to accept that women do sexually abuse children and this can result in discounting by personnel in child protection services and police. This article discusses female offenders of child sexual abuse and the way in which these cases are processed by the criminal justice system.     

Death From Butane Inhalation Abuse in Teenagers: Two New Case Studies and Review of the Literature

The ready availability of butane makes butane abuse frequent. Fatalities are rare. This study presents two cases of death by butane overdose. The postmortem analyses were carried out using headspace gas chromatography–mass spectrometry. It revealed femoral blood butane concentrations of 18 and 22 mg/L, respectively, as well as specific combinations of adjuvants in each victim. In one of the victims, brain and fatty tissue also contained butane, pointing to chronic consumption. The originality of this study is to show that the identification of specific combinations of adjuvants can be helpful for identifying the brand of deodorant used. Also, sampling the skin and mucosa can help identify the method of drug delivery. The histological examination documented both the direct toxic effect of the gas on the respiratory mucosa and signs of chronic abuse. Volatile substance intoxications should be systematically considered in case of sudden death in a teenager.     

Fatal Child Abuse Presenting with Multiple Vertebral and Vascular Trauma

This case study involves the unexplained death of a previously healthy 30‐month‐old child. Reportedly, she was found unresponsive by her foster father following a 2‐hour nap. She was transported to the hospital and died in the emergency room of unknown causes. Blood drawn in the ER showed hemoglobin of 4.3 mg/dL. Postmortem skeletal survey, magnetic resonance imaging (MRI) of the brain, and retinal examinations were negative. The medical examiner assumed jurisdiction of the body. The autopsy showed massive retroperitoneal hemorrhage, transections of the abdominal aorta, and inferior vena cava, and complete tears of the anterior longitudinal ligament of the spine at C5/C6 and L1/L2 with diastases of the vertebral bodies at the corresponding intervertebral disk spaces. The case is believed to be extraordinary due to both the extent of injury that does not match the reported history and the mechanism of vertebral and vascular injuries.     

Improving Decision Making in Forensic Child Sexual Abuse Evaluations

Mental health professionals can assist legal decision makers in cases of allegations of child sexual abuse by collecting data using forensic interviews, psychological testing, and record reviews, and by summarizing relevant findings from social science research. Significant controversy surrounds another key task performed by mental health professionals in most child sexual abuse evaluations, i.e., deciding whether or not to substantiate unconfirmed abuse allegations. The available evidence indicates that, on the whole, these substantiation decisions currently lack adequate psychometric reliability and validity: an analysis of empirical research findings leads to the conclusion that at least 24% of all of these decisions are either false positive or false negative errors. Surprisingly, a reanalysis of existing research also indicates that it may be possible to develop reliable, objective procedures to improve the consistency and quality of decision making in this domain. A preliminary, empirically-grounded procedure for making substantiation decisions is proposed.     

Malingering by Proxy: A Literature Review and Current Perspectives

Malingering by proxy (MAL‐BP) is a form of maltreatment that involves a caregiver who fabricates or induces signs or symptoms in a child, dependent adult, or pet in pursuit of external, tangible incentives. Rarely studied, MAL‐BP has an unknown prevalence, and is a challenging diagnosis for healthcare professionals. Therefore, a comprehensive computer literature search and review was conducted. The review uncovered a total of sixteen case reports of MAL‐BP (eleven human, five veterinary). The motive for malingering was financial in all human cases and medication‐seeking in all veterinary cases. Although the strategies employed differed among the identified cases, common themes regarding the best approach to identification of MAL‐BP cases became evident. A comprehensive workup including a thorough history, physical examination, appropriate neuropsychological testing, and relevant collateral information forms the basis of an effective identification strategy. The optimal method of management is currently unclear due to a relative paucity of data and guidelines. However, management of these cases would likely include a team‐based approach with a prudent assessment of safety for the proxy and a low threshold for referral to appropriate services. Long‐term follow‐up is essential and should be approached from a biopsychosocial perspective. Attention, research, and guidance on this topic are needed to develop further evidence‐based guidelines for the identification and management of MAL‐BP.     

Among a German Sample of Forensic Patients,Previous Animal Abuse Mediates Between Psychopathy and Sadistic Actions

In an attempt to explain the relationship between psychopathy and severe violent behavior, this study associates previous animal abuse, psychopathy, and sadistic acting in forensic patients. Two topics are addressed: (i) whether previous animal abuse can be identified by a patient's Psychopathy Checklist profile and (ii) whether animal abuse statistically mediates between psychopathy and sadistic acting. In a German forensic hospital, 60 patients were investigated. Animal abuse was assessed using face‐to‐face interviews and the Psychopathy Checklist: Screening Version (PCL:SV), and sadistic acting was identified by file records.Discriminant analysis separated previous animal abuse (10/60) by high adolescent antisocial behavior, superficiality, lack of remorse, lack of empathy, and grandiosity. The mediation from psychopathy to sadistic acting (6/60) through animal abuse was found to be complete.The results, although sample size is limited and base rate of animal abuse and sadistic acting are low, fit with a model suggestive of animal abuse as a causal step toward sadistic crimes. Animal abuse correlates with callous, unemotional traits, and a development of sadistic crimes.     

Ethnicity and Sexual Orientation as PTSD Mitigators in Child Sexual Abuse Survivors

Purpose and Potential benefits: Research, to our knowledge, has not examined the effect of demographic variables on PTSD symptoms among adult survivors of childhood sexual abuse (CSA). This study explores the relationship between demographic variables and scores of CSA survivors on the Impact of Scale (IES). Participants were 257 women CSA survivors entering outpatient treatment at a university-based mental health center. All participants reported a CSA history and presented with psychological difficulties associated with CSA. The demographic variables investigated were relationship status, religious affiliation, ethnicity, educational level, spousal educational level income, and sexual orientation. Significance tests were used to examine each variable and scores on the Total IES and Avoidance and Intrusion Subscales. Total IES and Intrusion scores differed for sexual orientation and ethnicity in accord with conventional standards of significance ( < .05). Self-reported asexuals indicated fewer intrusive and total PTSD symptoms than heterosexuals, lesbians, and bisexuals. Likewise, Hispanics reported less intrusive PTSD symptoms than Non-Hispanic Caucasians. Our findings invite further exploration of the relationship between ethnicity and sexual orientation and the long-term effects of CSA. A question for empirical investigation is whether asexuality shields against the triggering of CSA memories by a sexual relationship. Another possible area of inquiry is whether particular characteristics of Hispanic culture as a whole serve to moderate the detrimental effects of CSA.     

Suicide Pacts: Six Cases and Literature Review

A suicide pact is the decision of two or more people to die together. This event is rare. The majority of suicide pacts victims are married, socially isolated, with a serious physical illness in one or both partners. We performed a retrospective study of all cases of suicide pacts leading to death between January 1, 2003 and December 31, 2010 referred to the Forensic Medicine Department of Tours (France). Six cases were recorded as suicide pacts. Firearms were the preferred means of death. Five suicide notes were discovered. For some cases, it was difficult to establish whether death was the result of a suicide pact or of a homicide–suicide without the consent of the victim. An objective element, such as a suicide note and motive, is required to prove that a suicide pact is involved. The prevalence of mental disorders is hard to assess. In France, psychological autopsies are not performed in such cases, as the investigation is usually very sparse after the death of both individuals.     

Degrees of Memory of Childhood Sexual Abuse Among Women Survivors in Therapy

Past and current memory for childhood sexual abuse reported by a clinical sample of 160 women survivors was assessed utilizing a structured clinical interview. Response alternatives for memory were ordered along a continuum. To minimize treatment effects, participants were interviewed as early in therapy as possible. Fairly complete recollection both in the past and currently was reported by 26.3% of the sample, 36.9% apparently lost and subsequently recovered sexual abuse memories, and 36.9% endorsed intermediate degrees of memory. Only 2.5% indicated a decrease in degree of recollection over time. Age at onset was the only abuse characteristic found to differentiate participants with fairly complete memory from the rest of the sample. Findings are interpreted as illustrating that conclusions about memory for abuse are highly dependent on the way inquiries are conceptualized and worded.     

Cardiac Ventricular Laceration Due to Child Abuse: Abusive Ventricular Laceration

Traumatic cardiac ventricular ruptures in children are rare. Only a single case of left ventricular rupture due to child abuse has been reported. We report a child who sustained a fatal left ventricular apical rupture. It appeared to have resulted from hydrostatic forces resulting from abusive blunt thoracic injury. That he was being abused was previously missed when he was presented to the emergency department with facial pyoderma. It was not noted that he also had lip and oral mucosal injury, sites not affected by staph toxins. As a result, his underlying, abusive and secondarily infected, facial flow type scald burn was not appreciated. Within a week thereafter his fatal injury occurred, accompanied by extensive and obvious associated abusive injuries. Postmortem high‐detail whole body computed tomography scanning aided the autopsy. Although rare, ventricular rupture from abusive blunt thoracic injury can occur.     

Somnophilia and Sexual Abuse through the Administration of GHB and GBL

Somnophilia, the desire to have sex with an unconscious, sleeping, or comatose person who is unable to respond, is a sexual paraphilia that is seldom reported. The underlying desire is often overshadowed by the act of sexual violation and when using GHB or GBL to induce unconsciousness, as in the case presented here, the victim might not even be able to recall, for certain, that they have been sexually violated. A case study is offered of a somnophile who adulterated drinks to render young men unconscious, so he could rape them in that state, before progressing to administering drugs anally on the pretext of applying lubrication to the anus to facilitate sexual intercourse. The offender's fetishistic compulsion to have sex with unconscious men propelled him to experiment with the means by which he surreptitiously administered drugs to his victims in order to deepen their comatose state.     

Child Abuse-Related Homicides in New Mexico: A 6-year Retrospective Review

Abstract:  We retrospectively reviewed autopsy records at a statewide medical examiner's office in order to identify and characterize deaths due to child abuse. In a 6-year period in New Mexico, the medical examiner investigated 45 deaths determined to be child abuse-related. Decedents were predominantly male (68.9%), Hispanic White (53.3%), and all were 5 years of age or younger, with a median age of 1 year. Head injuries were the most common cause of death (44.4%), followed by battered baby syndrome (15.6%). Relatives were involved as alleged perpetrators in 80% of the cases, with the father most often implicated (36.1% of cases), and 88.9% of child abuse injuries resulting in death occurred in the family's residence. Toxicology was positive in 26.7% of cases, but only two cases had substances of abuse present. Information on risk factors such as prematurity, parental age, and history of abuse was also collected.     

Delayed Prosecutions of Historic Child Sexual Abuse: Analyses of 2064 Canadian Criminal Complaints

Recently, in many English-speaking countries, legal principles that had the effect of barring delayed criminal prosecutions have been abrogated. In these jurisdictions, criminal prosecutions of child sexual abuse that is alleged to have occurred in the distant past (historic child sexual abuse or HCSA) are a growing legal challenge. These cases raise myriad issues relevant to research and the development of public policy that would benefit from a considered exchange of ideas that is informed by a clear understanding of the phenomenon. Based on 2064 judicial decisions of Canadian criminal complaints of HCSA we describe the trial, the complainant, the accused, and the offence. In the context of these legal cases, we raise some of the germane issues as well as suggestions for future research and discussion that we believe are particularly current and pressing.