Childhood Sibling and Peer Relationships of ...

Archives of Psychiatric Nursing 27 (2013) 293–298

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Childhood Sibling and Peer Relationships of Perpetrators of Child Sexual Abuse Sandra P. Thomas ⁎, Kenneth Phillips, Mary Gunther University of Tennessee, Knoxville, TN

a b s t r a c t Maltreatment by parents inhibits a child's ability to form relationships with other children. Given that many sex offenders experienced parental abuse, investigation of their relationships with siblings and peers could provide new directions for early childhood interventions. Interview transcripts of 23 community-dwelling perpetrators of sexual abuse against children were examined in this secondary data analysis. Ages of participants ranged from 20s to 70s, and education ranged from GED to PhD. Phenomenological analysis revealed that neither sibling nor peer relationships adequately promoted participants' capacity for developing and maintaining healthy relationships in adulthood. Until societal preventive actions and early clinical interventions are more successful, the crime of child sexual abuse will continue to be far too common. © 2013 Elsevier Inc. All rights reserved.

The developmental precursors of sexual offending are poorly understood. A widely promulgated hypothesis is that adults who perpetrate sex crimes against children have themselves been abused in childhood and thus replicate these acts to reverse the role of powerless victim (Araji & Finkelhor, 1985). Support for this hypothesis has been found by several researchers (Cohen et al., 2002; Hulme & Middleton, 2013; Simons, Wurtele, & Heil, 2002). In contrast, other research shows that many perpetrators have not been abused, and Vizard (2013) concluded that there is no direct causal link between being sexually abused as a child and subsequently abusing others later. Vizard's conclusion raises questions about other possible etiological factors during the childhood years of sex offenders. Despite researchers' calls (e.g., Dhawan & Marshall, 1996) for additional investigation of the early lives of perpetrators of child sexual abuse, very little research has been conducted. Extant literature is largely quantitative, focused on risk factors for offending selected by the researchers (e.g., social isolation) (see Thomas et al., 2013, for a critique of this literature). Even when researchers have explored early experiences of sex offenders through interviews, questions were mainly directed toward abuse that was inflicted by parents or other adults. Therefore, unanswered questions remain about other childhood relationships, such as problematic relationships with siblings and peers, which could contribute to the propensity to commit sexual crimes against children later in life. This gap in the literature prompted the present investigation of childhood sibling and peer relationships of convicted sex offenders. Before turning to the report of our data, existing literature will be reviewed.

⁎ Corresponding Author: Sandra P. Thomas, PhD, RN, FAAN, University of Tennessee, Knoxville 1200 Volunteer Blvd. Knoxville, TN 37996–4180. E-mail addresses: [email protected] (S.P. Thomas), [email protected] (K. Phillips), [email protected] (M. Gunther). 0883-9417/1801-0005$34.00/0 – see front matter © 2013 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.apnu.2013.09.002

REVIEW OF LITERATURE Childhood Sibling Relationships Although the majority of children have siblings, and children spend a vast amount of time with siblings, relationships among siblings have been much less studied than other family relationships (Sanders, 2004). Noted Kim, McHale, Crouter, and Osgood (2007, p. 960): “Sisters and brothers can promote positive adjustment when they model and reinforce positive social behaviors and serve as sources of social support, but conflict and negativity can give rise to adjustment problems through observational learning and reinforcement of deviant behavior.” Drawing from folklore, myths, and literature, Sanders (2004) extracted 4 themes of sibling relationships: (1) siblings as allies (Maya Angelou and her brother Bailey); (2) siblings as rivals (Cain and Abel); (3) differentness of siblings (Cinderella and her sisters); and (4) sibling relationships in families of all brothers or all sisters (Brothers Karamazov, Little Women). He also pointed out flaws in well-known theories about sibling relationships, such as Levy's sibling rivalry theory and Toman's work on birth order, which have not been well supported by empirical research (Levy, 1934, cited in Sanders; Toman, 1961, cited in Sanders). Sibling abuse is seldom studied. Wiehe's (1997) investigation remains a major source of information on physical, emotional, and sexual trauma perpetrated by siblings. His research on 150 adult survivors documented a “shroud of secrecy” surrounding the childhood abuse, which often lasted for years. Most victims reported that they did not fight back and were disbelieved or blamed if they told parents. Some abuse was dismissed as mere sibling rivalry, although it strains credulity that slapping, beating, choking, and rape could be construed as anything other than egregious abuse. Victims of sibling maltreatment were left with feelings of worthlessness, selfblame, and profound difficulties in relating to other people.

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Two new studies, based on data from the National Survey of Children's Exposure to Violence, examined victimization of children by their siblings (Tucker, Finkelhor, Shattuck, & Turner, 2013; Tucker, Finkelhor, Turner, & Shattuck, 2013). The research team assessed physical, property, and psychological victimization. These studies attracted extensive media attention because of the high frequency of sibling abuse discovered by the researchers. In the first study (N = 1705), sibling victimization within the past year was reported by 37.6% of the sample; preschool and school-aged children reported the highest frequency of abuse. Sexual victimization was not examined (Tucker, Finkelhor, Shattuck, et al, 2013). In the second study (N = 3599) the researchers examined the association of sibling bullying (verbal or physical) with mental health effects of the abuse, including anger, anxiety, and depression. Whether mild or severe, sibling aggression was associated with significantly higher psychological distress symptom scores during childhood and adolescence (Tucker, Finkelhor, Turner, et al., 2013). As shown by these studies of a national probability sample, sibling abuse is quite common, even in households where parental abuse is not known to be taking place. If children are growing up in households of neglect and abuse, sibling relationships could assume even greater importance, possibly compensating for the parental neglect/abuse in some cases, but perpetrating additional abuse in other cases (Jenkins, 1992; Wiehe, 1997). Siblings may model their parents' abusive behavior. Bank (1992, p. 145) captured the crux of the matter: “When parents are frightening, abandoning, or invisible, siblings are not minor players in the family drama; they are the stars: the villains and the heroes who play a significant role in the child's life-and-death struggles for attachment, separateness, and identity.” The quality of sibling relationships is important, not only because of its aforementioned effects on psychological well-being but also because it is linked to social competence with peers outside the family, as noted by theorists (e.g., Minuchin, 1974) and researchers (e.g., Kim et al., 2007; Yeh & Lempers, 2004). In a longitudinal study tracking 197 families over 6 years or more, Kim et al. assessed sibling intimacy and sibling conflict as well as perceived peer social competence. Changes in sibling intimacy and conflict were linked to changes in peer social competence; greater intimacy led to increased competence, while conflict with siblings led to depressive symptoms. The potential effects of sibling relationships on adolescent development were investigated in 374 families across 3 waves of data collection (Yeh & Lempers, 2004). Adolescents who had positive perceptions of their relationships with siblings at Time 1 reported better peer friendships and higher self-esteem at Time 2, which were then linked to less loneliness, depression, substance use, and delinquency at Time 3.

adverse early experiences with significant others, a child could doubt that anyone could like him or her. Anticipating rejection, the child may tend to avoid interactions on the playground. Furthermore, the child may display submissive/nonassertive behaviors with playmates, signaling that he is an easy target for peer victimization (Fox & Boulton, 2006). PURPOSE OF THE STUDY Investigation of sex offenders' childhood relationships with siblings and peers could provide new directions for early childhood interventions and/or offender rehabilitation. However, research on this topic is virtually nonexistent. This gap in the literature prompted the present investigation, a secondary analysis of a unique data set. METHOD The purpose of our original study (Thomas et al., 2013) was to explore the childhood experiences of a community-dwelling sample of adult sex offenders who had victimized children. Potential participants were identified through an online sex offender registry or through therapists who told them about the study. All had been convicted of sexual offenses against children and had served time in prison and/or probation. Data were collected from 2010 to 2011. Participants were informed of our aim of exploring their childhood experiences, not crimes they had committed in adulthood. We used a blended research methodology derived from the phenomenological philosophy of Merleau-Ponty (1962) and from narrative inquiry (Riessman, 2008). Members of the research team included two doctorally prepared nursing professors, one PhD student with extensive psychiatric clinical experience, two MSN students, and one BSN student. A psychiatric nurse practitioner, whose private practice included sex offenders, joined the project during the final stages of the data interpretation and manuscript preparation. Bracketing, interview training of team members, and other details of the original study may be found in Thomas et al. (2013). After IRB approval and obtaining informed consent, the original research team had conducted private, in-depth, non-directive, face-to-face, audiotaped interviews, each lasting approximately 60–90 minutes, with 23 convicted sex offenders. Each interview began with a request for the participant to reflect on what stood out to him/her about childhood. Adhering to the tenets of phenomenological interviewing, thereafter the researchers posed questions only if necessary to obtain clarification or elaboration. Descriptions of sibling and peer relationships were prominent in the resultant narratives, facilitating this secondary analysis of the data.

Childhood Peer Relationships Secondary Data Analysis A child's experience with peers provides a context for development of many essential capabilities, including emotional regulation and conflict resolution skills. Conversations with peers help children and adolescents develop understanding of others and themselves. Peer relations go very badly for some children, however, and peer rejection contributes to risk for emotional disorders (Hays, Payne, & Chadwick, 2004). Furthermore, overt peer victimization (i.e., being tricked or coerced to do things, nasty remarks, theft of possessions, and physical bullying) has long-lasting effects. In a large prospective study in the UK, peer victimization was measured in childhood (ages 7–10); by early adolescence (ages 11–14), depression symptoms were higher in victims than in non-victims. The longitudinal study also showed that depression symptoms were persistent over time (Zwierzynska, Wolke, & Lereya, 2013). Maltreatment by either the parents, or siblings, or both, could have a deleterious effect on a child's ability to form healthy relationships with peers (Bolger, Patterson, & Kupersmidt, 1998). Based on such

As noted by Szabo and Strang (1997), secondary analysis is a costeffective mode of inquiry that makes maximum use of existing data, allowing researchers to ask a new question of the data. Members of the secondary analysis team followed the procedures of Thomas and Pollio (2002) to identify meaning units in the transcripts, to cluster meaning units into themes, and to select verbatim quotes to support each theme. Throughout the analysis, researchers continuously related the figural (predominant) themes to the contextual grounds of time, body, world, and others, as elucidated in the existential philosophy of Merleau-Ponty (1962). Figure and ground co-constitute one another to form a complete gestalt, a whole picture of the phenomenon of interest. To the extent possible, participants' own words were used to name the themes. Rigor of the analysis was enhanced by (a) prolonged immersion in the data, (b) reading transcripts aloud and developing preliminary themes in an interdisciplinary interpretive group, and (c) enlisting two MSN students in


psychiatric nursing to conduct independent transcript analyses and present their findings for critique and discussion in the interpretive group. Confidentiality of participants was protected by redacting all identifying information from transcripts prior to analysis by team members and the interpretive group. Demographic Characteristics of the Participants Participants were (1) adult male or female (Nage 18); (2) selfidentified as having sexually abused a child; (3) not currently incarcerated or facing criminal charges; and (4) willing to participate in a private interview about their childhood experiences. Education ranged from GED (high school equivalency) to PhD. Interviewees' ages ranged from 20s to 70s, with the oldest participant being 79 years of age. Most were Caucasian, consistent with the population of the southeastern United States; two were Asian and one was African American. Occupations ranged from manual labor/technical (house remodeling, automotive technician) to professional (dentistry, accounting, and engineering). There were 21 males and 2 females. The majority had been involved in 1 or more heterosexual marriages and had children and/or stepchildren of their own. Some of the older participants had grandchildren. Two men identified themselves as homosexual, but one of these men had always concealed his sexual orientation from his wife. Almost all participants were currently participating (or had participated) in cognitive–behavioral therapy, provided either within prison or community settings. FINDINGS There was considerable heterogeneity among participants and their reports of childhood experiences. The majority (2/3) of the sample of sex offenders had experienced one or more forms of childhood abuse, including abandonment, neglect, emotional, and/or physical abuse. Half reported sexual abuse; half did not. One third of the sample claimed a “pretty good childhood,” denying childhood trauma. In our report of the original study, we discussed the narrative analysis, which produced four types of narrative motifs (Thomas et al., 2013). This paper focuses exclusively on the findings of the secondary analysis, which sought to ascertain the meaning of offenders' sibling and peer relationships. Contextual Grounds of the Childhood Experience: World, Body, Others, Time “No safe place” describes the childhood lifeworld perceived by the interviewees; they were not safe at home, school, church, or neighborhood. Others failed to protect them and/or hurt them. Their bodies were perceived as unattractive and unskillful; boundaries were unclear and often violated. Time was a fragmented and confusing mélange of painful events and solitary ruminations. Against these contextual grounds, figural themes of sibling relationships and peer relationships were identified. Themes will be illustrated by quotes from the participants. All words in quotation marks were taken verbatim from the interview transcripts. Sibling Relationships Three themes were found in the transcripts of the 20 participants who had siblings (3 were only children): 1. “We really just didn't have a relationship.” This theme depicted lack of connection to brothers and sisters, often because the participant felt different from them (smaller, dumber, wide age difference), for example, “Even with 3 brothers I felt lonely.” One participant, now in his 40s, still sounded perplexed about his oldest sister's lack of affection for him: “She was very distant. I never got close to her. I wanted to

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get to know her more, but she died before I ever got the chance.” Some interviewees had been forcibly separated from their siblings because one parent would abandon the marriage, taking one or more children with him/her, weakening or permanently severing the ties between siblings. Other disruptions, such as an interviewee repeatedly running away or being sent away from the family home to live elsewhere, mitigated against the formation and maintenance of bonds with siblings. This theme also included failure to make meaningful connections with stepsiblings who were brought into the home when parents remarried after divorces. Beyond lack of relationship, some interviewees also spoke of outright abuse (“being treated like garbage” by siblings and/or stepsiblings), adversarial competition with siblings for attention of neglectful parents, and being scapegoated (i.e., labeled “the naughty one” or “the black sheep”). Scapegoated children often were beaten for misconduct by their brothers and sisters or for their failure to “police” the behavior of siblings, as their parents had ordered. Some participants reported collusion among their siblings to devise frightening experiences: “My brothers and sister would bury me in the sand up to my head and wouldn't let me out, or tie me to a tree and leave me there for hours.” 2. “We kind of learned to protect each other.” This pattern was most evident in households of physical abuse, for example, “We piled in and jumped on dad to get him off one of my sisters;” “I would fight for my sisters.” One participant, the only boy among 5 sisters, voluntarily took parental beatings with a belt for misbehavior of his sisters, and during adolescence he would fight boys who cast aspersions on his sisters (“Your sister's a bitch. We went out on a date and she wouldn't put out”). 3. “We were real close.” This theme included descriptions of healthy sibling closeness as well as inappropriate physical closeness. Healthy bonding was mainly evident in the narratives of participants who had claimed “a pretty good childhood;” these were the only participants who actually described having fun with their siblings. Some participants who experienced egregious abuse by parents did identify one sibling who was a companion and confidant (“I could trust her; I didn't trust my parents or my relatives”). Also within this theme, however, there were examples of incestuous sexual activity: “We did things to each other that I guess normal brothers and sisters don't do;” “The kissing by my stepsister felt really good; I never thought of it as being molested.” One participant spoke nostalgically about his sister's cuddling him in bed, a warm refuge from his physically abusive stepfather. Narratives of these participants depicted lack of awareness that the sexual behavior was wrong; its warmth and intimacy were welcomed, in fact, in households of neglect and abuse.

Peer Relationships Five themes were found in the transcripts of the 19 participants who talked about peers. Despite the heterogeneity among participants, not fitting in at school was a pervasive theme. Participants reported that they never fit in at school, which they attributed to their perceived unattractiveness (big-eared, buck-toothed, too skinny or too fat); differentness in learning abilities (too dumb or too smart); or other personal qualities, such as social or athletic ineptness. Study participants used pejorative self-descriptors such as “nerdy, wimpy, frail, clumsy, dorky, odd, ugly.” Attempting to gain peer acceptance, one smart student allowed classmates to copy his work and cheat on tests. Other participants tried to get attention by acting out in the classroom, which sometimes yielded a few laughs, or classmates' gratitude that teachers became flustered—but also resulted in punishment by teachers.

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Picked on and bullied was a second prominent theme. Participants reported verbal abuse, such as being called names, serving as “the butt of a lot of jokes,” and “made fun of.” Narratives also included physical abuse, such as being shoved and beaten by schoolmates, neighbor children, and cousins. In one extreme incident, the participant was forced into a freezing pool in the middle of winter. Bullying was especially severe among participants who were non-Caucasian and/or poor. These quotes were illustrative: “I was the only non-white person in the school, you can imagine what life was like, a nightmare;” “We would have to go to the dollar store and I would get picked on because of my clothes and my shoes.” A vivid recollection of one participant was his threadbare pants: “I'll never forget, I had a pair of dress pants and a pair of school pants, and I had those dress pants for so long that in the back they had worn so much you could see through'em.” Another participant lived in fear of “thugs” who harassed him as he walked to school each day, which eventually caused him to align himself with a drug dealer who would protect him. The theme of unable/afraid to get close portrayed withdrawal from peers and conveyed a posture of defeat. This theme is exemplified in quotes such as “I just didn't let anybody get close to me. It was just like a defense. I thought they would hurt me like my mom did;” “I was always by myself and kept things to myself;” “Every time I had a friend or two, it seems like they had better friends than me and better things to do with other friends than me;” “I had a friend once and my younger brother took him away from me.” The interviewee who made the last remark said that he stopped trying to make friends after this loss, for fear he would lose them also. The theme of sex as cost of friendship/substitute for friendship depicted powerlessness when peers began to take advantage of the participants sexually. One man, who referred to himself as “the weak one,” saw no way to resist his bigger, older peer: “I just had to let him do it whenever he required and forced me to. I had nowhere to go and nobody to go to.” Despite this painful introduction to sex, eventually it became a substitute for friendship, since he was unable to make friends. Sex became his “only fun, it was the only way I knew.” Other quotes illustrate children and adolescents acquiescing to sexual acts, such as oral sex, as the cost of friendship: “They wanted to have sex with me, that's what it cost to have a friend;” “I didn't want it, but I felt that's what I had to do;” “Everybody was just using me.” The final theme, peers as substitutes for intimacy in the family, showed the benefits of good peer relationships for those few who were fortunate enough to forge them: “He was kind of the brother I never had;” “What I found myself doing when life turned to hell at home, I would spend time over at my friends' houses because their families weren't as dysfunctional as mine.” Thematic Structure One way to articulate the thematic structure of a phenomenon is to draw the themes together in a researcher-created first person account of the meaning of the experience, as if the participant were speaking. Adopting this practice, a study participant's experience of his/her relationships with siblings and peers during childhood can be summarized as follows: When I reflect on my childhood, it was a real hard time for me. My siblings and classmates often hurt me. I really didn't understand why. Others in my world often invaded my space and used my body. There was no safe place for me. So I stayed by myself a lot. I feel sad when I remember how it was.

DISCUSSION To our knowledge, this study is the first to examine the childhood sibling and peer relationships of convicted perpetrators of sexual

crimes against children. We discovered childhood issues that deserve more extensive investigation. With few exceptions, neither sibling nor peer relationships adequately promoted participants' capacity for developing and maintaining healthy relationships in adulthood. In general, participants felt unlovable as children and described themselves as lacking in self-worth. They did not develop the core attributes of self-control, resilience, and confidence that should be developed in the formative stages of life (WHO, 2012). The majority of the sample had experienced multiple forms of childhood abuse from their parents (Thomas et al., 2013). This secondary analysis showed that parental abuse was compounded by sibling abuse in some (but not all) cases. Sibling abuse has been shrouded in secrecy except for a few classic studies such as Wiehe's (1997). Our findings support recent pleas for further research on this neglected phenomenon (Tucker, Finkelhor, Shattuck, et al, 2013; Tucker, Finkelhor, Turner, et al., 2013). Sibling bullying and sexual abuse are underreported and therefore untreated (Finkelhor, 1984; Wiehe, 1997). Kilgore (2013), who recently shared her own chilling memoir of abuse by her older sister (Girl in the Water: A True Story of Sibling Abuse), asserts that there are 40 million adult sibling abuse survivors in the United States. Perhaps her book, along with the heavily publicized 2013 studies by Tucker and colleagues will help to advance research and public awareness in this area. Bullying by peers was thematic in this study of sex offenders, including verbal abuse and coerced sex. School could have been an escape from homes of abuse and neglect, but instead it was another site of abuse. The word “outcast,” used by a study participant, speaks volumes about his perception of peer relationships. “Being different in any way” was a core theme in a study of bullied students conducted by Horowitz et al. (2004). Similarly, interviewees in our sample emphasized their differentness from peers, which prevented them from fitting in at school and gaining acceptance. The world of peers epitomized the “challenging and sometimes unforgiving environment” alluded to by Hays et al. (2004, p. 100). Peer sexual aggressors included neighborhood playmates, schoolmates, and cousins. “Traumatic sexualization,” as described by Finkelhor (1984), can include (a) being forced to engage in inappropriate sexual activity and/or (b) engaging in sex to garner rewards. Both were described by our study participants. For some, peers provided their first introduction to sex; for others, a Sunday school teacher, babysitter, scoutmaster, or family member had already violated them (Thomas et al., 2013). Recommendations for Intervention Early intervention with children who are victimized is imperative because early intervention increases the likelihood of recovery (Vizard, 2013). According to Finkelhor (1986), if childhood abuse victims are supported and comforted, they will have no need to abuse others. Support for this assertion can be found in a study comparing a group of male survivors of sexual abuse who became perpetrators to a group who were similarly abused in childhood but are “resilient” (Lambie, Seymour, Lee, & Adams, 2002). There were no significant differences between groups in the frequency or duration of childhood abuse. Highly relevant to the present study is the researchers' finding that the resilient non-offending group reported more emotional support from parents and other adults, as well as significantly more peer friendships during childhood. The researchers concluded that breaking the “victim–offender cycle” must begin with providing supportive responses to abused children, enhancing their self-esteem, and decreasing their social isolation. Social skills training (SST) has been recommended for childhood abuse victims who have difficulty making friends (Ryan & Lane, 1991), although it is doubtful that SST alone would be sufficient to alter long-ingrained wariness about interpersonal relationships. None of our victimized study participants received any support at the time of their childhood victimization, nor was any mental health


treatment provided until they were convicted of crimes as adults. They told no one about the inappropriate or coerced sexual activity initiated by adults, siblings or peers, consistent with findings by Craissati, McClurg, & Browne, (2002). Yet they did display childhood cries for help, such as running away, setting fires, stealing, or suicide attempts. Adults, including police, did not recognize these cries. Many participants were abused in places where adults should have been vigilant to ensure child safety, such as a scout troop, school, or church. The development of valid screening tools for child abuse and neglect would be useful to preschool caregivers, primary health care providers, school counselors, and psychiatric clinicians. Vizard (2013, pp. 507–508) warns, however, that standardized instruments with “a ‘tick box’ approach to assessment of these children is not sufficient to identify all their needs, no matter how well validated the psychometric measure or risk assessment instrument, so a clinical assessment by a trained mental health professional and a diagnostic formulation will also be needed.” Clinicians should be aware that the best predictors of sexual abuse are inappropriate sexual knowledge, sexual interest, and sexual acting out (American Psychological Association, 2013). Specific treatment recommendations are beyond the scope of this paper, but interested readers may consult Deblinger, Mannarino, Cohen, and Steer (2006); Sanders (2004); and Wiehe (1997). Teachers and school-based nurses must be more vigilant in identifying lonely children who do not fit in at school and lack social skills. As long ago as 1988, Crockett urged nurses to devote more attention to children exhibiting difficulties with peer relationships, by incorporating questions about peer relationships into clinical assessments. Such questions could reveal situations of cruel verbal abuse, such as that reported by our sample, and/or situations in which children feel compelled to provide sex to peers as the cost of friendship. Students who exhibit symptoms of depression should be referred to services provided by school psychologists or community counseling agencies. School connectedness has proved to be an important variable in contemporary mental health research on youth (Bonny, Britto, Klostermann, Hornung, & Slap, 2000; Resnick et al., 1997; Thomas & Smith, 2004). Students who feel connected to their schools describe a sense of closeness to the school personnel and environment, whereas those who are alienated are more likely to score lower on mental health indicators and/or become involved in truancy and delinquent behaviors (e.g., Bonny et al., 2000). Teachers could intensify efforts to encourage disliked and isolated students to discover their strengths and find ways to become involved in prosocial school-related activities (e.g., music, chess, and computer club). One participant in our study spoke with nostalgia about a school radio club that was hugely important to him, because it provided one place where he fit in. We agree with Zwierzynska et al. (2013) that peer victimization should be considered an important public health risk. The phenomenon of peer bullying is known to contribute to youth anger, anxiety, depression, and suicide (Tucker, Finkelhor, Turner, et al., 2013; Zwierzynska et al., 2013) and must be combated more vigorously by parents and schools. Psychiatric nurses are well suited for conducting anti-bullying interventions, and there are many excellent models, such as the Olweus Bullying Prevention Program (Olweus, Limber, & Mihalic, 1999). Inaction by school officials about bullying is still prevalent, however, as indicated by the frequency of reports in national media of suicides and retaliatory violence by victims of bullies. Harassed and bullied students need to feel that administrators are going to take definitive actions on their behalf against the bullies (Thomas & Smith, 2004). No such protective actions were ever described by any of our bullied study participants. Strengths of the study include (a) accessing a non-incarcerated sample of child sex offenders who were diverse with regard to age, education, and occupation, and (b) employing a research methodol-

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ogy that allowed offenders an opportunity to reflect on their childhood experiences and talk freely without constraints of structured questionnaires. Because the researchers had no affiliation with the justice system or treatment facilities, the participants had less motivation to lie or manipulate. They spoke candidly about shameful events, in hopes that their research participation would “help people learn and not go the route I had to” and “help people to not prejudge offenders” (Thomas et al. 2013). Limitations of the study include (a) the inability to review correctional case files or therapist records; (b) the nonlinear fashion in which childhood stories were told, preventing development of a precise chronology of childhood events; (c) the presence of memory gaps that are typical of trauma narratives; and (d) the standard caveat regarding studies employing secondary analysis (i.e., the interviews were not focused specifically on sibling and peer relationships and therefore some accounts were not as detailed as would be desirable). The last limitation is countered somewhat, however, by our conviction that participants in a nondirective phenomenological interview will always talk about what is figural (predominant) in their perceptions, a key tenet of Merleau-Ponty's (1962) philosophy. Generalizability/transferability of these qualitative findings cannot be claimed, although readers may find that the themes resonate with other clients who were victimized in childhood. We acknowledge that our participants, having received psychotherapy, were undoubtedly different from untreated (and undetected) child sex offenders. Many participants were still in ongoing therapy and therefore in various stages of working through painful memories and gaining insight into their early lives and behaviors. It is unclear whether the cognitive– behavioral therapy being provided to them will be adequate to address the severity of the early trauma they described to us. CONCLUSION The participants in this study were exposed to a plethora of detrimental influences in childhood. It is unknown which of these influences may have been more salient in the pathway toward becoming a perpetrator of sexual crimes against children. Given the current state of the science, we do not know which clinical interventions with abused/sexualized children will prevent them from becoming perpetrators of sex offenses. There is abundant potential for psychiatric–mental health nurse clinicians and researchers to contribute to the small body of literature on the early lives of perpetrators. Even as empirical knowledge remains incomplete, it is a societal mandate to take action to protect all children who are being abused by parents, siblings, and/or peers. Until societal preventive actions and early clinical interventions are more successful, the crime of child sexual abuse will continue to be far too common. Acknowledgment This research was funded by the Center for Health Science Research at the University of Tennessee, Knoxville. The contributions to the data analytic process by Chenoa Shenandoah, Joan Goodpasture, and members of the University of Tennessee Phenomenology Research Group are gratefully acknowledged. Additionally, we acknowledge Catie Chomicki and Sladana Lugonjic for their assistance with literature review and synthesis. References American Psychological Association. (2013). Understanding child sexual abuse: Education, prevention, and recovery. Retrieved from www.apa.org/pubs/info/ brochures/sex-abuse.aspx. Araji, S., & Finkelhor, D. (1985). Explanations of pedophilia: Review of empirical research. Bulletin of the American Academy of Psychiatry and Law, 13, 17–37. Bank, S. (1992). Remembering and reinterpreting sibling bonds. In F. Boer, & J. Dunn (Eds.), Children's sibling relationships: Developmental and clinical issues (pp. 139–151). Hillsdale, NJ: Lawrence Erlbaum.

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