Male survivors and their unspoken story

“I am glad to be speaking about this. I have never met someone who said out loud that they have been sexually abused as a child, so I never mentioned my story either”. 
The growing demand for men looking for therapy at my clinic gives me an optimistic view of men's mental health. However, I have noticed that the story behind their current psychological and behavioural struggles shares one theme in common: child sexual abuse.  

Looking for CPD courses to enhance my knowledge on child sexual trauma in men, I was surprised and saddened to discover that it’s quite a rare event to find. So, I decided to do my own research and put together some information and a real client case, while respecting confidentiality, highlighting how prevalent male survivors are in our society. How they are living in silence, suffering with the psychological aftermath, emotional and behavioural dysfunctional symptoms of their childhood sexual trauma. 

Several studies, such as (Shanta R. Dube et al. 2005) explain that a common outcome of child sexual abuse survivors is substance use disorder (SUD), depression, personality disorders, eating disorders, dysfunctional sexual behaviours, social and relationship dysfunction. 

Research papers also explore the severity of those lifelong struggles that are related to some aspects of the child abuse, such as the age of the child (the younger the more severe the outcome), the relationship with the perpetrator (family member or stranger) and the type of assault (penetration, exhibitionism, touch and so on). Furthermore, as the duration of the abuse (as shown in studies by Hodder and Gow 2012, long-term child sexual abuse can also result in substance abuse, long-term depression, negative attributions, and even eating disorders).   

All outcomes mentioned above are recurrent and painful to experience, particularly interpersonal dysfunction (difficulty in creating and maintaining intimate relationships), given our innate want and need to connect with others. Sexual male survivors find it difficult to trust and connect, they fear being seen for “what they really are” and being rejected. All of that results in a lifelong sense of otherness and profound loneliness. 

The statistics published in 2024 by the NSPCC on child sexual molestation say that one in every 20 children suffered sexual abuse. In my clinical practice, that number feels bigger, and I wonder how many people feel unable to disclose that they have experienced this life-changing trauma. Another report (UNICEF 2020a) revealed that more than 120 million individuals worldwide face forced sexual acts during their childhood. Most are females (89%), and 11% are males. 

Several studies have found that male child abuse is less reported than female sexual abuse (Vander-Mey, 1988). Some of the factors that can hold a male back from disclosing their story are the social stigma of being labelled “inadequate”, being ostracised or treated differently or being othered in many other ways. Also, research indicates that mental health professionals rarely ask adult males about childhood sexual abuse (Lab et al., 2000). 

It's a common experience for survivors to feel blocked from accessing, exploring and talking about their traumatic childhood. Some memories are compartmentalised somewhere in the unconscious, a dissociation from the body and the event, an instinctual survival adaptation. However, inherited memories can be manifested in various ways in a survivor's living experience, such as extreme emotional reactivity to others, difficulty in self-regulating, a sense of emptiness and gullibility (easily persuaded), to mention some.  

Working with survivor clients allowed me to witness a gradual access of past memories as well as inviting flashbacks from small and important details of the abuse. Needless to say, that working with such individuals, much attention is needed on grading the client's capacity to bear such memories and therefore the adequate therapeutic intervention can be applied in order to process the emotions trapped into the unconscious, as well as honouring the parts of self that have been in exile for safety.  

Case study 

(Client's details have been changed for confidentiality.) 

Steve, 42 years old, came to therapy two years ago to deal with his anxiety attacks. He has been 10 years in drug recovery but is still struggling with alcohol misuse.  

Besides portraying himself as a happy, playful and self-aware person, he experiences panic attacks, night terrors, insomnia and dissociative episodes (physically freezing). 

At the beginning of our work together, I felt that his overtly happy disposition gave me some sort of discomfort; it felt like he was trying to control where the session would go. Until one day, when he casually commented that he was 12 years old, he seduced his male neighbour. At least that is what he’s been telling himself for the past 30 years. 

Further down in our work, snips of his memory started to come to the surface in and out of session hours. We found out how he was abused physically and sexually by this man, who lived three doors away from him, who turned out to be on the paedophile police watchlist.  

As a child he kept it as a secret as per agreed with the aggressor and as adult apart from making his own story up, perhaps in order to have some sort of self-agency, he also never felt that this kind of subject could be discussed anywhere and with anyone.  

The work went on to be a difficult and sensitive one as more “forgotten” and “distorted realities” came to awareness. The more this client became aware of what really happened the more he could process all the repressed emotions about this including shame, guilt, fear and so on. 

John Briere (1989), refers to this as a Conditional Reality, that being where survivors of sexual abuse through the suffering of a loss of self-reference resulting from disconnection of the self and the moment, therefore impairing the sense of what is in the here and now.  

We need as a society to make more effort to encourage men to seek emotional and psychological help, and more training and awareness on how to interview and treat sexual abuse survivors.

Supporting male survivors: Tips for counsellors

The following are a few tips that seem to help my male survivor clients: 

• Make sure that a solid and lovely therapy alliance is built before bringing up questions of child sexual assault.
• If you grade to be safe enough, do ask! Be aware that the subject can bring a lot of shame to the field, so lots of caring support will be required.
• Allow the client time to respond, slow the pace right down. Be aware that some grounding tools might be required from minute to minute in the session.
• Make sure that the client is able to feel his presence in the here and now in the adult's body, safety in the room and control as to how far he wants to process.
• Last but not least, it's important to note that these people crave to have their pain heard, acknowledged, and understood (child sexual molestation carries complex feelings attached to it, such as guilt, self-hatred, deep shame...).

These men must have an opportunity to understand how premature sexual exposure informs their way of experiencing the world as an adult and hopefully have a chance to develop self-compassion, self-care care and skills to live a healthier life.  

They deserve to have their stories heard with dignity, support and empathy, understanding that they are not alone with those memories that have been haunting them, and also, they are not broken, they are wounded! The more we speak, the less hold trauma has on us. Furthermore, failure in identifying the symptoms resulting from child molestation can determine the efficacy of therapy outcomes, given that the root problems were not properly addressed. 

References

• Shanta R. Dube, Robert F. Anda, Charles L. Whitfield, David W. Brown, Vincent J. Felitti, Maxia Dong, Wayne H. Giles, Long-Term Consequences of Childhood Sexual Abuse by Gender of Victim, American Journal of Preventive Medicine, Volume 28, Issue 5, 2005.
• Ali, S., Pasha, S., Cox, A. et al. Examining the short and long-term impacts of child sexual abuse: a review study. SN Soc Sci 4, 56 (2024). 
• UNICEF (2020a) Sexual violence against children. UNICEF. 
• Vander Mey BJ. The sexual victimization of male children: a review of previous research. Child Abuse Negl. 1988;12(1):61-72. doi: 10.1016/0145-2134(88)90008-7. PMID: 3284613.
• Lab D, Feigenbaum J, De Silva P (2000), Mental health professionals’ attitudes and practices towards male childhood sexual abuse. Child Abuse Negl 24:391–409
• Briere J, Rickards S. Self-awareness, affect regulation, and relatedness: differential sequels of childhood versus adult victimization experiences. J Nerv Ment Dis. 2007 Jun;195(6):497-503. doi: 10.1097/NMD.0b013e31803044e2. PMID: 17568298