Sexual abuse and mental disorders: The dark side of violence

Rape and sexual violence occur in all social classes and societies. In most cases, the sexual offenders are known to the victim and the majority of rapes happen in intimate relationships. Children are particularly vulnerable to sexual abuse, in particular, the female sex. The sexual abuse of minors is defined as 'any sexual activities that an adult carries on or with a person under the age of consent.' Literature evidence that the prevalence of any type of violence among women with disabilities varies between 26.0% and 90.0%, compared to nondisabled women, showing that people with disabilities have an increased risk of suffering physical and sexual violence. Children with intellectual disabilities (ID) show a high risk of sexual victimization. The World Health Organization presently defines mental retardation as 'a significantly reduced ability to understand new or complex information and to learn and apply new skills (impaired intelligence). This results in a reduced ability to cope independently (impaired social functioning), and begins before adulthood, with a lasting effect on development.' The aim of this study is to investigate the correct identification of sexual abuse and severe mental retardation through the collaboration of a team of experts (forensic pathologist, psychiatrist, psychologist, gynecologist, pediatrician, and social worker). We present a case of a 12-year-old female child, who suffers from severe mental retardation and was the victim of rape by a 79-year-old man. The study shows the difficulties in discovering episodes of sexual abuse among children affected by ID by evidencing the importance of adequate analysis through a multidisciplinary approach. The work focuses on the need to improve knowledge about medical and forensic investigations through proper protocols, for early recognition and appropriate management of these complicated cases.