A COMMUNITY OF COMPASSION AND SAFETY

Abuse and Trauma Resources

What Is Post Traumatic Stress Disorder?

National Organization for Victim Assistance 1-800-TRY-NOVA

Crime Victims/Witness Hotline 1-800-242-0804

How to Protect Yourself from Wife Abuse

Rape: It Could Happen to You, and What You Can Do

National Domestic Violence/Abuse Hotline 1-800-799-SAFE 24-hour-a-day hotline.

The National Coalition Against Domestic Violence

The National Coalition Against Domestic Violence and the Academy of Facial Plastic and Reconstructive Surgery and will provide free reconstructive face and neck surgery to domestic violence victims. Call 1-800-842-2546, 24 hours a day for consultations and referrals.

National Resource Center on Domestic Violence 1-800-537-2238

National Victim Center 1-800-FYI-CALL

If you are a victim of physical violence you may eligible for a variety of victim assistance services (medical, legal, financial, counseling, etc.) in your state. Call between 8:30am-5:30pm EST.

Pregnancy Hotline 1-800-238-4269, 1-800-848-5683 24-hour-a-day hotline.

What Is Child Sexual Abuse?

Sexual Abuse of Boys

The Sin of Forgiveness

Sexual Abuse by Doctors, Clergy, Counselors and Professors

Rape, Abuse, and Incest National Network 1-800-256-HOPE 24-hour-a-day hotline.

National Council on Child Abuse and Family Violence 1-800-222-2000

National Child Abuse Hotline 1-800-422-4253 24-hour-a-day hotline.

Youth Crisis Hotline 1-800-448-4663 24-hour-a-day hotline.

Boy's Town National Hotline 1-800-448-3000 24-hour-a-day hotline.

KID SAVE 1-800-543-7283 24-hour-a-day hotline.

NineLine 1-800-999-9999 24-hour-a-day hotline.

(Messages, abuse, parents, runaways, Covenant House.)

Runaway Hotline 1-800-231-6946 Message relay, 24-hour-a-day hotline.

National Runaway Switchboard 1-800-621-4000 24-hour-a-day hotline.

Vanished Children Alliance 1-800-VANISHED 24-hour-a-day hotline.

Child Find Hotline 1-800-426-5678

Missing Children Help Center 1-800-872-5437

National Center for Missing and Exploited Children 1-800-843-5678

Kidsrights 1-800-892-5437

Parents Anonymous 1-800-421-0253 or 1-800-843-5437

Parent Help Line 1-800-325-2544

Operation Lookout 1-800-782-SEEK

Children's Defense Fund 1-800-233-1200

National Childwatch Campaign 1-800-222-1646

National Runaway Switchboard 1-800-621-4000

Runaway Hotline 1-800-448-4663

Child Abuse Hotline 1-800-422-4253

Adam Walsh Child Resource Center 1-714-558-7812

Abused Boys: The Neglected Victims of Sexual Abuse by Mic Hunter List Price: $11.00 Our Price: $8.80 You Save: $2.20 (20%) 24 hours Paperback (1991) Fawcett Books. Well-written guide that raises the consciousness of professionals and gives hope and self-insight to survivors.
Abused Women and Survivor Therapy: A Practical Guide for the Psychotherapist by Lenore Walker List Price: $39.95 Our Price: $27.97 You Save: $11.98 (30%) 2-3 days Hardcover (1994) American Psychological Association. A must-have by a leader in the field.
Are You Getting Enlightened or Losing Your Mind/: How to Master Everyday and Extraordinary Spirtual Experiences by Dennis Gersten, Larry Dossey List Price: $13.00 Our Price: $10.40 You Save: $2.60 (20%) 24 hours Paperback (1998) Three Rivers. Practical and reassuring, this book tells readers how to become comfortable with disturbing or disruptive states of minds--from depression to mystical visions--and how to learn from and find meaning in them all.
Abused Boys: The Neglected Victims of Sexual Abuse by Mic Hunter List Price: $11.00 Our Price: $8.80 You Save: $2.20 (20%) 24 hours Paperback (1991) Fawcett Books. Well-written guide that raises the consciousness of professionals and gives hope and self-insight to survivors.
The Battered Woman by Lenore Walker List Price: $14.00 Our Price: $11.20 You Save: $2.80 (20%) 24 hours Paperback (1980) HarperCollins. Insight into the horrifying conditions that battered women endure in abusive relationships. A classic in the field.
Betrayal Trauma: The Logic of Forgetting Childhood Abuse by Jennifer J. Freyd List Price: $14.95 Our Price: $11.96 You Save: $2.99 (20%) 2-3 days Paperback (1998) Harvard Univiversity. Professor Freyd's betrayal trauma theory shows forgetting is an adaptive behavior. By blocking out knowledge of the abuse the child aligns with the caregiver and thus ensures his or her own survival. Freyd cites numerous studies to back her assertion that the forgetting and later remembering of childhood sexual abuse is real and well documented with extensive excerpts of recovered abuse memories which were subsequently corroborated.
The Body in Pain : The Making and Unmaking of the World by Elaine Scarry List Price: $15.95 Our Price: $12.76 You Save: $3.19 (20%) 24 hours Paperback (1987) Oxford University Press. Scarry's book is original and a work of philosophy under-rated and mis-shelved. This study of the relationship between human pain and meaning-making and the vision of the suffering God and suffering person in this God's image takes the theological issues of the Holocaust, abuse and torture where they have never been before and reveals why theodicy is so mute in the face of the questions from these experiences.
Breaking Free : A Self-Help Guide for Adults Who Were Sexually Abused As Children by Carolyn Ainscough, Kay Toon List Price: $12.95 Our Price: $10.36 You Save: $2.59 (20%) 24 hours Paperback (1993) Fisher Books.
Broken Boys/Mending Men : Recovery from Childhood Sexual Abuse by Stephen D. Gruban-Black List Price: $5.99 Our Price: $4.79 You Save: $1.20 (20%) 24 hours Paperback (1997) Ivy Books. One out of six males was sexually abused as a child. A counselor and survivor of childhood abuse explores what happens to adult survivors when the trauma of sexual abuse haunts their lives. Supportive and caring, for male survivors, the people who love them, and their counselors.
The Child's Song: The Religious Abuse of Children by Donald Capps List Price: $17.00 Our Price: $13.60 You Save: $3.40 (20%) 2-3 days Paperback (1995) Westminster John Knox.
Children Surviving Persecution: An International Study of Trauma and Healing by Judith S. Kestenberg (Editor), Charlotte Kahn (Editor) $65.00 1-2 weeks Hardcover (1998) Praeger. Focus on long-term effects of trauma, coping mechanisms and reparative experiences.
Counseling for Family Violence and Abuse (Resources for Christian Counseling, Vol 6) by Grant L. Martin $22.99 Hardcover (1987) Word 3-5 weeks.
Counseling Survivors of Sexual Abuse (Aacc Counseling Library) by Diane M. Langberg List Price: $24.99 Our Price: $22.49 You Save: $2.50 (10%) 2-3 days Library Binding (1997) Tyndale. This contribution to the Counseling Library of the American Association of Christian Counselors focuses on counseling survivors of sexual abuse and features chapters on dissociative disorder, false memory, and how the congregation can help survivors.
Cutting a New Path: Helping Survivors of Childhood Domestic Trauma by Laura Delaplain List Price: $12.95 Our Price: $10.36 You Save: $2.59 (20%) 2-3 days Paperback (1997) United Church. Ways to identify the adult victim-survivor, understanding the spiritual challenges of this population, and the role of forgiveness in healing. Each chapter offers case illustrations and vignettes as well as exercises that can be used by the caregiver to promote healing.
Getting Through the Day: Stratagies for Adults Hurt As Children by Nancy J. Napier List Price: $14.00 Our Price: $11.20 You Save: $2.80 (20%) 24 hours Paperback (1994) W.W. Norton Explains what it means to be dissociative, and how to cope with it. How to find a therapist and what the therapist-client relationship should be.
God and Evil: A Unified Theodicy/Theology/Philosophy by David Birnbaum $25.00 24 hours Hardcover (1989) Ktav Publishing House. Consistent, organized and all encompassing theodicy/theology such that this might be last book you read on this subject. Doesn't ignore other theodicies, discusses all of them while his thesis is consistent with normative Jewish belief.
Handbook on Sexual Abuse of Children: Assessment and Treatment Issues by Lenore Walker (Editor) $53.95 4-6 weeks Hardcover (1988) Springer. Focuses mostly on girls abused by fathers or father- substitutes. Legal and psychological aspects.
Haunted Memories: Healing the Pain of Childhood Abuse by Perry L. Draper List Price: $11.99 Our Price: $9.59 You Save: $2.40 (20%) 2-3 days Paperback (April 1996) Fleming H Revell Helping victims of childhood sexual abuse rise above their traumatic pasts. For pastors and counselors.
Helping Victims of Sexual Abuse: A Sensitive, Biblical Guide for Counselors, Victims and Families by Lynn Heitritter, Jeanette Vought List Price: $9.99 Our Price: $7.99 You Save: $2.00 (20%) 2-3 days Paperback (1989) Bethany. Tool for pastoral counselors of sexual abuse.
Horrific Traumata: A Pastoral Response to the Post-Traumatic Stress Disorder by N. Duncan Sinclair, Joel O. Brende (Designer) $39.95 2-3 days Hardcover (1993) Haworth.
I Can't Get over It: A Handbook for Trauma Survivors by Aphrodite Matsakis List Price: $15.95 Our Price: $12.76 You Save: $3.19 (20%) 24 hours Paperback (1996) New Harbinger. Guides survivors of crime, acidents, rape, family violence, suicide, traumatic memories, depression, guilt, and sexual abuse through the process of recovering from Post-Traumatic Stress Disorder (PTSD). Includes the new EMDR (Eye Movement Desensitization and Reprocessing) technique. This grounbreaking work is the first book to guide readers through the healing process of recovering from PTSD one step at a time.
Memory and Abuse: Remembering and Healing the Wounds of Trauma by Charles L., MD Whitfield List Price: $12.95 Our Price: $10.36 You Save: $2.59 (20%) 24 hours Paperback (1995) Health Communications.
Memory of Childhood Trauma: A Clinician's Guide to the Literature by Susan L. Reviere Our Price: $16.95 2-3 days Paperback (1996) Guilford Press.
Memory, Trauma Treatment, and the Law by Daniel P. Brown, Alan W. Scheflin, D. Corydon Hammond $100.00 2-3 days Hardcover (1998) W W Norton. Best Publication of the Year from the American Psychiatric Association. Memory research, trauma treatment and legal cases pertaining to the false memory controversy and current memory science are all critically reviewed along with the recovered memory debate, emotion and memory, flashback memory, autobiographical memory, memory for trauma, memory recovery through hypnosis and the current practice of phase oriented trauma treatment.
A Moral Emergency: Breaking the Cycle of Child Sexual Abuse by Jade Christine Angelica List Price: $10.95 Our Price: $8.76 You Save: $2.19 (20%) 2-3 days Paperback - 169 pages (1993) Theological Book Service. Aimed toward pastors.
Pastoral Care for Survivors of Family Abuse by James Leehan List Price: $14.00 Our Price: $11.20 You Save: $2.80 (20%) 2-3 days Paperback (1989) John Knox.
Post-Traumatic Stress Disorder: A Complete Treatment Guide by Aphrodite Matsakis, Leslie Tilley (Editor) List Price: $39.95 Our Price: $27.97 You Save: $11.98 (30%) 24 hours (1994) New Harbinger.
Recovered Memories of Abuse: Assessment, Therapy, Forensics by Laura S. Brown List Price: $24.95 Our Price: $19.96 You Save: $4.99 (20%) 2-3 days Paperback (1996) American Psychological Association.
Sexual Abuse in Christian Homes and Churches by Carolyn Holderread Heggen List Price: $11.99 Our Price: $9.59 You Save: $2.40 (20%) Paperback (1993) Herald Pr. How a congregation can begin to work to heal the wounds of sexual abuse and prevent further abuses from happening.
Sexual Abuse of Children and Adolescents: A Preventive Guide for Parents, Teachers, and Counselors by William E. Prendergast List Price: $29.95 Our Price: $20.97 You Save: $8.98 (30%) 2-3 days Hardcover (1996) Continuum.
Sexual Abuse Recalled: Treating Trauma in the Era of the Recovered Memory Debate by Judith L. Alpert (Editor) List Price: $60.00 Our Price: $42.00 You Save: $18.00 (30%) 24 hours. Hardcover (1996) Jason Aronson.
Sexual Misconduct in Counseling and Ministry (Contemporary Christian Counseling) by Peter T. Mosgofian, George W. Ohlschlager List Price: $22.99 Our Price: $16.09 You Save: $6.90 (30%) Hardcover (1995) Word 3-5 weeks. Prevention and response are both covered.
Sexual Violence: The Unmentionable Sin by Marie Marshall Fortune List Price: $15.95 Our Price: $12.76 You Save: $3.19 (20%) 2-3 days Paperback (1983) Pilgrim.
Too Scared to Cry: Psychic Trauma in Childhood by Lenore Terr List Price: $16.50 Our Price: $13.20 You Save: $3.30 (20%) 2-3 days Paperback (1992) HarperCollins. Winner of the Blanche Ittleson Award for her research on childhood trauma, clinical professor of psychiatry Terr examines the many ways that trauma has changed the children she's treated. She demonstrates that traumatized children can be helped through observing the recurring themes of the children's play.
Unchained Memories: True Stories of Traumatic Memories, Lost and Found by Lenore Terr List Price: $15.00 Our Price: $12.00 You Save: $3.00 (20%) 24 hours Paperback (1995) Basic. A child psychiatrist well-versed in trauma and memory, Terr has studied victims' recollection of the Chowchilla schoolbus kidnapping (Too Scared to Cry, 1990). One account concerns Eileen Lipsker, who suddenly and vividly recalled seeing her father kill her childhood playmate 20 years earlier, another about a former Miss America overwhelmed by the return of memories of incest.
Victims No Longer : Men Recovering from Incest and Other Sexual Child Abuse by Mike Lew List Price: $20.00 Our Price: $16.00 You Save: $4.00 (20%) 24 hours Paperback (1990) HarperCollins. A resource manual for men who are survivors of childhood sexual abuse and for the people who want to offer them support and understanding. Includes many survivors telling their stories in their own words.
When the Bough Breaks by Aphrodite Matsakis List Price: $13.95 Our Price: $11.16 You Save: $2.79 (20%) 2-3 days Paperback (1991) New Harbinger.
When Child Abuse Comes to Church: Recognizing Its Occurrence and What to Do About It by B. Darrell Anderson List Price: $8.99 Our Price: $7.19 You Save: $1.80 (20%) 24 hours Paperback (1992) Bethany.
Woman-Battering (Creative Pastoral Care and Counseling Series) by Carol J. Adams List Price: $15.00 Our Price: $12.00 You Save: $3.00 (20%) 2-3 days Paperback (1997) Fortress.

Special Message for Medical Professionals


Why Medical Professionals Don't See Child Sexual Abuse


Fifty charts of adults from a hospital emergency room were reviewed for history of sexual abuse. The rate was 7%. After the staff were instructed to ask questions about sexual abuse when taking the medical history fifty more charts were surveyed. The rate was 20%. To treat trauma is to come face to face both with human vulnerability and with evil in human nature. Those who discover trauma are caught in the conflict between victim and perpetrator. It is very tempting to take the side of the perpetrator and do nothing. To take the side of the victim is to share in the pain. The perpetrator does everything to promote not seeing, or seeing then forgetting. Secrecy and silence are the perpetrator's first line of defense. If secrecy fails, the perpetrator attacks the credibility of the victim. If the perpetrator cannot silence the victim absolutely, he tries to make sure that no one listens. After every discovery of abuse one can expect to hear the same predictable apologies: it never happened; the victim lies; the victim exaggerates; the victim brought it on; and in any case it is time to forget the past and move on. The more powerful the perpetrator, the greater the prerogative to name and define reality. Victims often tell their stories in a highly emotional, contradictory, and fragmented manner that undermines their credibility and thereby serves the twin imperatives of truth-telling and secrecy. The psychological distress symptoms of traumatized victims simultaneously call attention to the existence of an unspeakable secret and deflect attention from it. This is most apparent in the way traumatized victims alternate between feeling numb and reliving the event. It results in dramatic and often bizarre symptoms of hysteria which Freud recognized a century ago as disguised communications about sexual abuse in childhood. (Herman, 1991)

Medical Diagnosis of Child Sexual Abuse

Child Sexual Abuse (CSA) is frequent and has a serious impact on abused children's mental and physical health and well-being. Because of the frequency of normal physical findings in victims of CSA (Adams, 1994: "It's normal to be normal") the medical diagnosis does not aim at "proving" the abuse. It must never be the exclusive diagnostic procedure. Instead it is integrated into a multiprofessional approach. The essential part of the diagnosis is the history of the child. If not performed in a qualified and sensitive manner, the medical examination has the potential to be a re-traumatizing event. But a qualified examination with good (preferably photographic) documentation can eliminate or reduce the need for further exams and prevent potential trauma. Never use force or coercion to perform the medical exam.

Prerequisites Of The Medical Examination

The preparation of the child emotionally takes much more time than the exam itself. Speculum and bimanual examination are not indicated. A pre-existing suspicion might be confirmed and add to the history of the child. But the absence of physical findings NEVER excludes the possibility of CSA! The continued possibility of CSA should be noted on every normal report. Abused children have a distorted body image. The medical exam has great potential for reassuring a child about physical intactness and normalcy. This can help restore positive self-esteem and initiate the process of recovery, an effect called the "primary therapeutic effect" of the intervention process (Furniss, 1986). Even in the case of positive findings the enormous capability of anogenital tissue to regenerate after trauma legitimates the prognosis of healing and intactness.

Why are normal physical findings so frequent ?

Anogenital trauma heals rapidly and often completely. An incomplete hymenal tear can heal as fast as 9 days, a complete tear in 24-30 days and minor trauma much faster. Acute findings are easier to evaluate than chronic findings, but abused children rarely present in the acute situation (except for stranger perpetrators). The elastic texture of the hymen can lead to enlargement without tearing even in case of penetration. The popular conception of a so called "intact hymen" does not exclude penetration! The penetration of the vulva is legally defined as rape, but produces no trauma to the hymen. Physical signs with forensic significance occur rarely in CSA and usually are only found up to 72 hours after an assault (presence of sperm).

Anogenital Findings

1. In the absence of complex congenital disorders all girls are born with a hymen. Masturbation is performed clitoraly and does not involve the hymen (which is very susceptible to pain in prepubertal girls). Tampons lead to enlargement of the introitus but not to hymenal tears. Most substantive findings are: concave hymenal variations (notches, grooves, indentations) or tears and an absent or rudimentary hymen in the posterior part. Acute lacerations, abrasions, tears or scars of anogenital tissues are suspicious and turn highly specific in the posterior fourchette region (especially when involving the hymen). The attenuation of the posterior rim of the hymen of less than 1 mm and an enhanced visibility of intravaginal structures are very suspicious.
2. The vaginal opening is significant if exceeding 8-10 mm transverse horizontal diameter as the upper range of normal in the prepubertal child. Post-traumatic scarring might even reduce the size of the introitus.
3. Findings related to CSA are mostly described in the posterior area of the genital area of the child examined in supine position (from 3 to 9 o'clock in the supine position).
4. Perianal findings of deep lacerations involving the spincter externus and a reflex dilatation of more than 20 mm (sooner than 30 seconds and without visibility of stool in the ampulla) seem to correlate with anal abuse. Male genital trauma are rarely encountered. Male victims show anal fndings, if any. Still the medical exam is important for reasons of reassurance concerning distorted body image.
5. Extragenital and often not clearly classified findings include: hematoma and bite marks in the perigenital area, buttocks, thighs and other erogenous areas, hematomas in the kidney area by gripping tightly during sodomy, petechia and tearing of the labial frenulum due to oral abuse.
6. The medical or forensic proof of CSA is the exception (1-3 %) not the rule: Gonorrhea and syphilis, pregnancy and the observance of sperm or a spermspecific glycoprotein (p30) on or in the body of a child.

Differential Diagnosis:

The primary differential diagnoses are accidental genital traumata. They are mostly located anterior and external, often unilateral and never involve deeper genital structures like the hymen or the posterior fourchette. Generally more exposed structures like the clitoris and labia are involved when crushed between underlying bone and an object. The accompanying history is acute and spontaneous, consistent with the injuries and does not vary if told several times. A physician is typically consulted immediately after the incident.

An excellent overview on medical aspects of CSA is found in:
Bays, J.-Chadwick, D. (1993) Medical diagnosis of the sexually abused child. Child Abuse Negl 17: 91-110.
An excellent overview by Associate Clinical Professor of Psychiatry at Harvard Medical School J. Herman,M.D. on psychiatric aspects of CSA is found in:
Herman, J. (1997) Trauma and Recovery. Basic Books.




L. A. Rynasko, Board Certified Chaplain
Association of Professional Chaplains



� 1999 Chaplain L. A. Rynasko. All Rights Reserved.