Child sexual abuse: A critical review of intervention and treatment modalities Rachel Lev-Wiesel ⁎ School of Social Work, University of Haifa, Har Hacarmel, Haifa, 31905 Israel Available online 1 February 2008 Abstract Recent years have ushered a growing understanding and a broadening knowledge base of the complexities of child sexual abuse. These complexities are acerbated by the need to account for the specific problem of child sexual abuse (CSA) in the larger context of multi-problem intervention, requiring coordinated multi-disciplinary team efforts as well as sensitive and focused attention to CSA itself. The aim of this paper is to critically examine the literature on several treatment modalities that are utilized by professionals from a range of disciplines treating victims of childhood sexual abuse. Acknowledging recent findings that dissociative disorders among CSA survivors are high compared to survivors of other forms of trauma and that about 80% of adult CSA survivors who were diagnosed with posttraumatic stress disorder actually suffer from dissociative disorders, the author discusses the phenomena of dissociative identity disorder among survivors who were sexually abused. The implications for the development of a therapeutic model are described, including a delineation of the model components. © 2008 Published by Elsevier Ltd. Keywords: Childhood sexual abuse; Treatment modalities; Dissociation; Trauma 1. Introduction The World Report on Violence and Health (Krug, 2002) defines sexual abuse as “any sexual act, attempt to obtain a sexual act, unwanted sexual comments or advances, or acts to traffic a person's sexuality, using coercion, threats of harm or physical force, by any person regardless of relationship to the victim, in any setting, including but not limited to home and work” (p. 149). Childhood sexual abuse (CSA) is defined as a sexual act between an adult and a child, in which the child is utilized for the sexual satisfaction of the perpetrator (Briere, 1992). Although the accuracy of statistics citing childhood sexual abuse are questionable due to the inability to assume complete disclosure from children, there is an underlying assumption that quoted prevalence figures of a childhood sexual abuse experience is one out of three or four children (e.g., Briere & Elliot, 2003). Childhood sexual abuse is considered to be a unique severe traumatic event since it includes violation of the child's body. Unlike other forms of abuse such as physical abuse in which the violation is on the body surface (whether or not internal injuries are caused), sexual abuse denotes oral, anal or genital penetration (e.g., DiLillo et al., 2006). The body, therefore, can no longer be perceived as a “safe home.” Escaping the abusive situation can often be possible only virtually in the victim's mind, whereas the body continues to endure suffering (Silberg, 1998). Available online at www.sciencedirect.com Children and Youth Services Review 30 (2008) 665 – 673 www.elsevier.com/locate/childyouth ⁎ Tel.: +972 4 8248045; fax: +972 4 6734627. E-mail address: rlev@univ.haifa.ac.il. 0190-7409/$ - see front matter © 2008 Published by Elsevier Ltd. doi:10.1016/j.childyouth.2008.01.008