Sexually abused children: identifying masked presentations in a medical setting

Sexual abuse of children frequently lies hidden while the victims receive medical care for other complaints. To identify clinical signals of latent abuse, we studied 50 children whose initial presentations masked the presence of sexual abuse and compared them with 31 overt cases identified by chief complaint. A broad variety of symptoms masked the abuse. While some, such as early adolescent pregnancy and genital symptomatology, might have suggested the diagnosis, unusual physical symptoms, psychosomatic, and behavioral disorders were as frequent. The masked group differed significantly from the more frequently studied overt group in that chronic history of sexual abuse was twice as common; school problems and psychosomatic disorders were three times as frequent; the alleged abuser was more often an immediate family member, usually the father; male victims were more likely to present in this disguised manner. Familiarity with typical masked presentations should aid earlier identification of these troubled children.