While much knowledge has come out of the official investigations conducted in different countries in the last decade, sexual abuse in institutions is still an understudied domain. Many studies on child sexual abuse have failed to include an appropriate number of victims of institutional abuse. For example, in a 2010 survey examining prevalence data on sexual abuse in Germany that contacted nearly 12,000 individuals, just 4 respondents – less than 0.001 percent of the total – were former residents of children’s homes
. The current study, based on data collected in 2010–2011 through the reporting system established by the Independent Commissioner, represents the largest sample of victims of child sexual abuse in institutions ever studied in Germany. It is also the first to specifically compare sexual abuse within the Roman Catholic, Protestant, and non–religiously affiliated settings, as most earlier reports focused on Roman Catholic institutions only e.g.
Sexual abuse was reported for each of these three settings. Based on the testimonials of victims of child sexual abuse in our sample it appears that factors common to all institutions such as group cohesion, hierarchical power structures and dependence
[17, 42], and credibility bias in favor of authority figures are conducive to the occurrence of repeated sexual abuse over long periods of time, regardless of religious affiliation. Many of the patterns of abuse in all three settings regardless of religious affiliation were similar: victims from all three settings described repeated assaults that were committed by males; one-third overall reported acts of penetration; and over 90% indicated that the abuse had been ongoing. Many victims stated that when they disclosed the abuse to authorities, they were ignored or even punished. Assaults by multiple offenders were reported more often for secular than for religiously affiliated institutions. In all three settings, offenders used the strategies of gaining the victims’ trust, creating situations where they were alone with the victim, and disguising sexual abuse as something educational; all of which have been reported by victims in other studies e.g.
[43, 44]. Offenders in the religiously affiliated settings additionally exploited situations of trust (e.g., confession), and the use of religious threats to frighten children into submission.
Although females are usually at greater risk for sexual abuse
, more victims in our sample were male. This can be explained by the fact that generally more boys than girls were sent to boarding schools or residential institutions. This is still true today; as of 2010, two-thirds of the children in youth welfare institutions were boys.
Several studies e.g.
[34, 45] have revealed a high life prevalence in survivors of institutional child abuse of psychiatric disorders such as depression, anxiety disorders, substance abuse, and PTSD. (In our sample, some victims reported still experiencing PTSD symptoms decades after the abuse had ended.) As not all victims seek treatment and receive diagnoses, the rate in our sample may in fact have underestimated the percentage of victims with such problems. Apart from psychiatric disorders, abuse by a trusted person can also result in psychosocial impairment, affecting a child’s ability to establish relationships and attachments later in life. While some victims show resilience to trauma or are able to overcome its effects
, others are caught in a complex vicious cycle in which a distorted view of attachment is retained throughout life and has a strong influence on adult relationships
[46, 47]. In our sample, more females than males described abuse that continued into adulthood. With respect to differences in outcome for victims of religious vs. secular institutions, we found similar rates of psychiatric disorders across all three settings but a higher rate of psychosocial impairment among victims who had been abused in Protestant-run institutions. In line with Max Weber’s sociological theories
, it is possible that the so-called “Protestant work ethic” played a role in that individuals with higher expectations of success in life might be more distressed by low achievement and hence more likely to report it as an impairment; however, this is only speculation.
The analysis of the qualitative data provided by respondents sheds light on the hardships sometimes faced by children in previous generations. Until relatively recently the problem of child abuse was not discussed openly, and the general public knew little about its prevalence, process, and consequences. Children did not have any special rights; corporal punishment was acceptable (in Germany, it was only legally abolished in 2001); and sex education before the 1970s was rare. Older victims in our sample described dependency, helplessness, and subjection to cruel punishment; and those in institutions with religious affiliations described the additional element of sexual abuse sometimes being disguised as religious ritual, or of the offender threatening the child with religious consequences such as hellfire if he or she resisted.
Most studies of child abuse in institutions or foster care settings have focused on events that took place before the 1980s. The data from the few studies that have looked at more recent situations indicate that the rate of sexual abuse in such settings has decreased in the last decades
[12, 19], but that children in these environments are still at higher risk of being sexually abused or otherwise maltreated than the population at large
[49–52]. There may also still be a lack of awareness and understanding of the problem by those in authority. The government-sponsored reappraisal program and the findings described in this report serve several important functions. First, the program gave victims of previous generations, many of whom had never before revealed the abuse to anyone, the opportunity to speak out about what had happened to them. Second, the political process that was initiated through the program has been designed to improve situation of victims of child sexual abuse (e.g. by assisting victims to get access to effective therapies). Third, the findings showed that past child sexual abuse in institutions was associated not with any particular religious affiliation but with institutions in general. Finally, while the rights of children and the quality of education provided in institutions have improved over the last few decades, advocates for children’s welfare can still learn from these experiences and can use them to strengthen the implementation of prevention and intervention strategies. Although the publicity around the program has led to greater public awareness of child sexual abuse in institutions, the problem may still sometimes be underestimated. In a German study
 that surveyed 1,128 principals, 702 counsellors, and 736 directors of institutions, merely 3.1% of respondents could cite even a suspected case of sexual abuse within the last three years, which is surprising. However, it is not clear whether this finding reflects true prevalence rates or is skewed by study limitations (e.g., there was no validation of information, and the individuals who agreed to participate were self-selected).
Several important limitations of this study must be acknowledged. First, as the individuals who provided data were self-selected, the sample may not have been representative of the overall population. Victims who made use of the reporting system may have been particularly motivated to do so, and it is possible that our data represent a sub-sample of severely traumatized individuals. Thus, we cannot definitively conclude from our data that the patterns of abuse we were told about did in fact commonly occur. However, the size of the sample and the fact that our results are consistent with those obtained by different international commissions
[7, 12] support the likelihood that they paint a realistic picture of the conditions in German institutions for the periods that most victims described. Second, apart from demographic data, information was not collected in any standardized way; rather, victims could simply share whatever was relevant to them. It is important to keep this aspect in mind when analyzing and interpreting the findings, because different amounts of information were obtained for different categories of data. Third, there was no independent validation of the information provided. However, as the liaison office had no authority to provide any form of compensation, callers had no financial incentive to invent or exaggerate any of the information that they provided. These limitations were imposed by the confidential nature of the issue under investigation, by the ethical requirement of maintaining victims’ privacy, and by the duty of the Independent Commissioner. Despite these limitations, the method of data collection used in this study has provided valuable exploratory data that can serve as a starting point for building hypotheses. Any hypothesis would need to be tested via representative sampling using standardized interviews or questionnaires, but it must be recognized that those approaches involve asking leading questions that may pressure some participants into making statements that do not fully represent their personal experience.
With respect to institutional affiliations, our results show that sexual abuse is not a problem specific to Roman Catholic settings or to religiously affiliated settings in general, but rather that the risk to children is increased in any institution, regardless of affiliation. Given the prevalence and serious consequence of child sexual abuse in all types of institutions, there is a critical need for effective prevention and intervention strategies, although there have been changes within the last decades concerning rights of children, accepted disciplinary methods, awareness of child sexual abuse. First, professionals who work with children and adolescents should be educated through workshops or e-learning platforms about risks, warning signals, and intervention strategies, as well the consequences of child sexual abuse. E-learning platforms are an effective way to educate a large group of people at the same time. The groups to be targeted include psychotherapists, social workers, teachers, priests/pastors, and educators, as well as physicians since sexual abuse victims may experience problems affecting their physical health
. Second, prevention strategies such as guiding principles, supervision, the handling of complaints, and standard processes when suspicion is raised should be implemented in institutions. Third, professionals such as psychiatrists and psychotherapists should be better trained in trauma therapy, and should be made more aware of the occurrence of PTSD symptoms in older patients. In a German survey of more than 2000 psychotherapists
, respondents said that on average, 22% of their patients had experienced sexual abuse, 38% had started therapy with the aim of overcoming this experience, and 43% had disclosed abuse during the course of the therapy; yet more than half of these therapists did not feel qualified to treat patients with a background of sexual abuse.