ABSTRACT
Objective:
The aim of this study was to evaluate and discuss the sociodemographic characteristics and possible risk factors of incest cases which are discussed in a broad scope regardless of blood relatives, referred to the forensic medicine outpatient clinic with a multidisciplinary approach.
Methods:
Between 01.01.2010 and 31.12.2020, data obtained from genital examination reports, consultations and test results of 288 incest cases who applied to Mersin University Department of Forensic Medicine were retrospectively analyzed.
Results:
It has been found that, 86.5% of the cases were children with a mean age of 11.6 years (±3.936), 47.2% (n=136) of the perpetrators were first and second degree relatives, and the most common ones were, father, brother and stepfather. The mean age of the perpetrators was 29.8 years (±13.32) and they were married males with low educational and socioeconomic status. Incest was not reported for a long time, was usually accompanied by violence and occurred indoors, often in the home of the victim and the perpetrator. Vaginal and anal penetration were the most frequently alleged types of abuse and 73.5% (n=155) of the cases had a psychopathology, most commonly post-traumatic stress disorder and major depressive disorder.
Conclusion:
It has been reported in the literature that the, perpetrators are mostly family members or people with similar authority over the victims. In addition, the fact that most of the cases are children makes it easier for incest to become a taboo and remain hidden for many years. In order to reveal incest, awareness should be raised through trainings in fields such as education, health and social services and the public should be informed about incest. The importance of multidisciplinary approach in revealing incest should be emphasized.
Keywords: Sexual assault, sexual abuse, incest, medicolegal evaluation, multidisciplinary approach
References
1
Etimoloji Türkçe. Erişim: https://www.etimolojiturkce.com/2012-2020 Erişim Tarihi: 01.08.2021
2
Dokgöz H, Kar H. Çocukta cinsel istismar. Turkiye Klinikleri J Child Psychiatry-Special Topics 2017;3(3):169-174.
3
Burt MR, Estep RE. Who is A Victim? Definitional Problems in Sexual Victimization. Victimology. 1983:6(1-4):15-28.
4
World Health Organization, Report of the Consultation on Child Abuse Prevention. 1999.
5
Çavlin A, Kardam F, Aliefendioğlu H. Ailenin Karanlık Yüzü Ensest. İstanbul: Metis Yayınları, 2018.
6
Crowly, SR. Sexual Assault: The Medical Legal Examination. New York: McGraw-Hill, 1999.
7
Polat O. Aile İçi Cinsel Tecavüz Ensest. İstanbul: Nota Kitap, 2006.
8
Batten DA. Incest a review of the literature. Med Sci Law. 1983;23(4):245-253. https://doi.org/10.1177/002580248302300404
9
Peeters S. Betrayal of Innocence: Incest and its devastation By Susan Forward and Craig Buck. Pelican Books. 1982:6(4):26-27. https://doi.org/10.1017/S0312897000015484
10
Lester D. Incest. JSR. 1972;8(4):268-285. https://doi.org/10.1080/00224497209 550762
11
Koçtürk N, Yüksel F. Characteristics of victims and perpetrators of intrafamilial sexual abuse. Child Abuse Negl. 2019;96:104122. https://doi.org/10.1016/j.chiabu.2019.104122
12
Magalhães T, Carneiro de Sousa MJ, Gomes da Silva A, Pinto da Costa D, Grams AC, Ribeiro C, et al. Child sexual abuse: a preliminary study. J Clin Forensic Med. 1998;5(4):176-182. https://doi.org/10.1016/S1353-1131(98)90130-4
13
Finkelhor D. Current information on the scope and nature of child sexual abuse. Future Child. 1994;4(2):31-53. https://doi.org/10.2307/1602522
14
Fischer DG, McDonald WL. Characteristics of intrafamilial and extrafamilial child sexual abuse. Child Abuse Negl. 1998;22(9):915-929. https://doi.org/10.1016/S0145-2134(98)00063-5
15
Dirlik M, Özkök MS, Katkıcı U, Erel Ö. Aydın’da cinsel suç ve suçluların profili. Adli Tıp Bülteni. 2002;7(3):97-104. https://doi.org/10.17986/blm.200273483
16
Black DA, Heyman RE, Slep AMS. Risk factors for child sexual abuse. Aggression and Violent Behavior. 2001;6(2-3):203-229. https://doi.org/10.1016/S1359-1789(00)00023-9
17
Bozbeyoğlu AÇ, Koyuncu E, Sezgin AU, Kardam F, Sungur A. Türkiye’de ensest sorununu anlamak. Nüfusbilim Derneği ve Birleşmiş Milletler Nüfus Fonu. Ankara: Damla Matbaacılık, 2009.
18
Bahali K, Akçan R, Tahiroglu AY, Avci A. Child sexual abuse: seven years in practice. J Forensic Sci. 2010;55(3):633-636. https://doi.org/10.1111/j.1556-4029.2010.01357.x
19
Yiğit R. Cocuklarin Cinsel Istismari ve Ensest. Anadolu Hemşirelik ve Sağlık Bilimleri Dergisi. 2005;8(3):90-100.
20
Öztürk AB. Çocuğun Cinsel İstismarı ve Aileyle Çalışma. Toplum ve Sosyal Hizmet. 2009;20(2):89-98.
21
İbiloğlu AO, Atlı A, Oto R, Özkan M. Ensest ve Çocukluk Çağı Cinsel İstismarı. In: Şiddet ve Travmaya Psikiyatrik Bakış, Akademisyen Kitabevi, 2020.
22
Aktepe E. Çocukluk çağı cinsel istismarı. Psikiyatride Güncel Yaklaşımlar. 2009;1(2):95-119.
23
Alpaslan AH. Çocukluk döneminde cinsel istismar. Kocatepe Tıp Dergisi. 2014;15(2):194-201.
24
Finkelhor D. The international epidemiology of child sexual abuse. Child Abuse Negl. 1994;18(5):409-417. https://doi.org/10.1016/0145-2134(94)90026-4
25
World Health Organization, Regional Committee for Africa. Child sexual abuse: a silent health emergency: report of the Regional Director, 2011.
26
Polat O. Tüm Boyutlarıyla Çocuk İstismarı-1. Ankara: Seçkin Yayıncılık, 2019.
27
Dokgöz H. Adli Tıp ve Adli Bilimler. 1. Baskı. Istanbul: Akademizyen Yayınevi, 2019:379-415. https://doi.org/10.37609/akya.1
28
T.C. Cumhurbaşkanlığı Mevzuat Bilgi Sistemi. Erişim: https://www.mevzuat.gov.tr Erişim Tarihi: 26.08.2021.
29
Ezzati M, Lopez AD, Rodgers AA, Murray CJ. Comparative quantification of health risks: global and regional burden of disease attributable to selected major risk factors. Geneva, World Health Organization, 2004.
30
Yildirim A, Ozer E, Bozkurt H, Ozsoy S, Enginyurt O, Evcuman D, et al. Evaluation of social and demographic characteristics of incest cases in a university hospital in Turkey. Med Sci Monit. 2014;20:693-697. https://doi.org/10.12659/MSM.890361
31
İpek S. 1995 yılları arasında İstanbul adliyelerine yansıyan ensest olgularının psiko-sosyal açıdan incelenmesi. Adli Tıp Enstitüsü, Sosyal Bilimler Anabilim Dalı, Yüksek Lisans Tezi, İstanbul, 1996.
32
Karameşe O. Kocaeli Üniversitesi Tıp Fakültesi Adli Tıp Anabilim Dalı’na Gönderilen Ensest Olgularının Değerlendirilmesi. Kocaeli Üniversitesi Tıp Fakültesi, Uzmanlık tezi, Kocaeli, 2018.
33
Korkut S, Tüzün B. Ensest olgularının çocuğun konumu ve yasal hakları açısından değerlendirilmesi. Adli Tıp Dergisi. 2001;15(1):30-36.
34
Sezgin AU. Ensestin Ruhsal Değerlendirilmesi Uzman Tanıklık, Doktora Tezi, İstanbul Üniversitesi, Adli Tıp Enstitüsü, Sosyal Bilimler Anabilim Dalı, 1998.
35
Magalhães T, Taveira F, Jardim P, Santos L, Matos E, Santos A. Sexual abuse of children. A comparative study of intra and extra-familial cases. J Forensic Leg Med 2009;16(8):455-459. https://doi.org/10.1016/j.jflm.2009.05.007
36
Loinaz Calvo I, Bigas Formatjé N, Sousa AMD. Comparing intra and extra-familial child sexual abuse in a forensic context. Psicothema, 2019.
37
Gencer Ö, Özbek A, Özyurt G, Kavurma C. Çocuk ve ergenlerde aile dışı ve aile içi cinsel istismar olgularının karşılaştırılması. Anadolu Psikiyatri Dergisi. 2016;17(1):56-64. https://doi.org/10.5455/apd.1419190512
38
Bergh C. Intra-familial and extra-familial child sexual abuse: Differences in Swedish court cases. 2017.
39
Bertele N, Talmon A. Sibling Sexual Abuse: A Review of Empirical Studies in the Field. Trauma Violence Abuse. 2023;24(2):420-428. https://doi.org/10.1177/15248380211030244
40
Bowers Andrews A, Veronen LJ. Sexual assault and people with disabilities. Social Work & Human Sexuality. 1993;8(2):137-159. https://doi.org/10.1300/J291v08n02_08
41
Taner Y, Gökler B. Çocuk istismarı ve ihmali: Psikiyatrik yönleri. Acta Medica. 2004;35(2):82-86.
42
Koçak U, Alpaslan AH. Cinsel istismara uğrayan çocuk ve ergenlerin sosyodemografik özellikleri ve ruhsal değerlendirmesi. Adli Tıp Bülteni. 2015;20(1):27-33. https://doi.org/10.17986/blm.2015110915
43
Bilginer Ç, Hesapçıoğlu ST, Kandil S. Çocukluk çağı cinsel istismarı: Mağdur ve sanık açısından çok yönlü bakış. Düşünen Adam The Journal of Psychiatry and Neurological Sciences. 2013;26:55-64. https://doi.org/10.5350/DAJPN2013260106
44
Dube R, Hébert M. Sexual abuse of children under 12 years of age: A review of 511 cases. Child Abuse Negl 1988;12(3):321-330. https://doi.org/10.1016/0145-2134(88)90045-2
45
Baía PAD, Veloso MMX, Habigzang LF, Dell’Aglio DD, Magalhães CMC. Padrões de revelação e descoberta do abuso sexual de crianças e adolescentes. Revista de Psicología 2015;24(1). https://doi.org/10.5354/0719-0581.2015.37007
46
Cyr M, Wright J, McDuff P, Perron A. Intrafamilial sexual abuse: Brother-sister incest does not differ from father-daughter and stepfather-stepdaughter incest. Child Abuse Negl 2002;26(9):957-973. https://doi.org/10.1016/S0145-2134(02)00365-4
47
Ray SL. Male Survivors’ Perspectives of Incest/Sexual Abuse. Perspectives in Psychiatric Care 2001;37(2):49-59. https://doi.org/10.1111/j.1744-6163.2001.tb00618.x
48
Edwards PW, Donaldson MA. Assessment of symptoms in adult survivors of incest: A factor analytic study of the responses to childhood incest questionnaire. Child Abuse Negl 1989;13(1):101-110. https://doi.org/10.1016/0145-2134(89)90033-1
49
Akbaş S, Aydin B, Dündar C, Turla A. Ensest kurbanı kız çocuklarındaki depresyon ve TSSB ile algılanan sosyal destek ilişkisi. Anadolu Psikiyatri Dergisi. 2016;17(4):300-308.
50
De Jong AR, Hervada AR, Emmett GA. Epidemiologic variations in childhood sexual abuse. Child Abuse Negl. 1983;7(2):155-162. https://doi.org/10.1016/0145-2134(83)90067-4
51
Stermac L, Hall K, Henskens M. Violence among child molesters. Journal of Sex Research. 1989;26(4):450-459. https://doi.org/10.1080/00224498909551527
52
Wolfe DA, Sas L, Wekerle C. Factors associated with the development of posttraumatic stress disorder among child victims of sexual abuse. Child Abuse Negl. 1994;18(1):37-50. https://doi.org/10.1016/0145-2134(94)90094-9
53
World Health Organization. Guidelines for medico-legal care of victims of sexual violence: WHO clinical guidelines. World Health Organization. Geneva, 2003.
54
Aydin B, Akbas S, Turla A, Dundar C, Yuce M, Karabekiroglu K. Child sexual abuse in Turkey: an analysis of 1002 cases. J Forensic Sci. 2015;60(1):61-65. https://doi.org/10.1111/1556-4029.12566
55
Domaç E. Zonguldak Bülent Ecevit Üniversitesi Tıp Fakültesi Hastanesine gönderilen aile içi cinsel istismar (ensest) olgularının mağdur ve saldırgan açısından değerlendirilmesi. Zonguldak Bülent Ecevit Üniversitesi, Tıp Fakültesi Adli Tıp Anabilim Dalı, Tıpta Uzmanlık Tezi, 2019.
56
Barutçu N, Yavuz MF, Çetin G. Cinsel saldırı sonrası mağdurun karşılaştığı sorunlar. Adli Tıp Bülteni. 1999;4(2):41-53. https://doi.org/10.17986/blm.199942353
57
Glover DA, Loeb TB, Carmona JV, Sciolla A, Zhang M, Myers HF, et al. Childhood sexual abuse severity and disclosure predict posttraumatic stress symptoms and biomarkers in ethnic minority women. J Trauma Dissociation. 2010;11(2):152-173. https://doi.org/10.1080/15299730903502920
58
Sciolla A, Glover DA, Loeb TB, Zhang M, Myers HF, Wyatt GE. Childhood sexual abuse severity and disclosure as predictors of depression among adult African-American and Latina women. J Nerv Ment Dis. 2011;199(7):471-477. https://doi.org/10.1097/NMD.0b013e31822142ac
59
Beitchman JH, Zucker KJ, Hood JE, Akman D. A review of the short-term effects of child sexual abuse. Child Abuse Neglect. 1991;15(4):537-556. https://doi.org/10.1016/0145-2134(91)90038-F
60
Stechna SB. Childhood Pregnancy as a Result of Incest: A Case Report and Literature Review with Suggested Management Strategies. J Pediatr Adolesc Gynecol. 2011;24(3):e83-e86. https://doi.org/10.1016/j.jpag.2010.11.010
61
Özcebe H, Biçer BK. Önemli bir kız çocuk ve kadın sorunu: Çocuk evlilikler. Turkish Archives of Pediatrics. 2013;48(2). https://doi.org/10.4274/tpa.1907
62
Cutajar MC, Mullen PE, Ogloff JR, Thomas SD, Wells DL, Spataro J. Psychopathology in a large cohort of sexually abused children followed up to 43 years. Child Abuse Negl. 2010;4(11):813-822. https://doi.org/10.1016/j.chiabu.2010.04.004
63
Testa M, VanZile-Tamsen C, Livingston JA. Childhood sexual abuse, relationship satisfaction, and sexual risk taking in a community sample of women. J Consult Clin Psychol. 2005;73(6):1116. https://doi.org/10.1037/0022-006X.73.6.1116
64
Russell DE. The secret trauma: Incest in the lives of girls and women. Basic Books,1986.
65
Bal S, De Bourdeaudhuij I, Crombez G, Van Oost P. Differences in trauma symptoms and family functioning in intra-and extrafamilial sexually abused adolescents. J Interpers Violence. 2004;19(1):108-123. https://doi.org/10.1177/0886260503259053
66
Nasıroğlu S. Çocuk istismarında rehabilitasyon ve tedavi merkezleri. Psikiyatride Güncel Yaklaşımlar. 2014;6(1):67-78.
67
Boney-McCoy S, Finkelhor D. Prior victimization: A risk factor for child sexual abuse and for PTSD-related symptomatology among sexually abused youth. Child Abuse Negl. 1995;19(12):1401-1421. https://doi.org/10.1016/0145-2134(95)00104-9
68
Costa LPD, Rocha CJBD, Cavalcante LIC. Biopsychosocial characteristics of accused child sex offenders in the intrafamilial and extrafamilial contexts. Trends in Psychology. 2018;26:283-295. https://doi.org/10.9788/TP2018.1-11En
