title: Myasthenia gravis

text: In about two-thirds of individuals, the initial symptom of MG is related to the muscles around the eye. Eyelid drooping (ptosis may occur due to weakness of m. levator palpebrae superioris) and double vision (diplopia, due to weakness of the extraocular muscles). Eye symptoms tend to get worse when watching television, reading, or driving, particularly in bright conditions. Consequently, some affected individuals choose to wear sunglasses. The term "ocular myasthenia gravis" describes a subtype of MG where muscle weakness is confined to the eyes, i.e. extraocular muscles, m. levator palpebrae superioris, and m. orbicularis oculi. Typically, this subtype evolves into generalized MG, usually after a few years.


title: Myasthenia gravis

text: The weakness of the muscles involved in swallowing may lead to swallowing difficulty (dysphagia). Typically, this means that some food may be left in the mouth after an attempt to swallow, or food and liquids may regurgitate into the nose rather than go down the throat (velopharyngeal insufficiency). Weakness of the muscles that move the jaw (muscles of mastication) may cause difficulty chewing. In individuals with MG, chewing tends to become more tiring when chewing tough, fibrous foods. Difficulty in swallowing, chewing, and speaking is the first symptom in about one-sixth of individuals.


title: Myasthenia gravis

text: Weakness of the muscles involved in speaking may lead to dysarthria and hypophonia. Speech may be slow and slurred, or have a nasal quality. In some cases, a singing hobby or profession must be abandoned.


title: Myasthenia gravis

text: Due to weakness of the muscles of facial expression and muscles of mastication, facial weakness may manifest as the inability to hold the mouth closed (the "hanging jaw sign") and as a snarling expression when attempting to smile. With drooping eyelids, facial weakness may make the individual appear sleepy or sad. Difficulty in holding the head upright may occur.


title: Myasthenia gravis

text: The muscles that control breathing and limb movements can also be affected; rarely do these present as the first symptoms of MG, but develop over months to years. In a myasthenic crisis, a paralysis of the respiratory muscles occurs, necessitating assisted ventilation to sustain life. Crises may be triggered by various biological stressors such as infection, fever, an adverse reaction to medication, or emotional stress.


title: Myasthenia gravis

text: MG is an autoimmune synaptopathy. The disorder occurs when the immune system malfunctions and generates antibodies that attack the body's tissues. The antibodies in MG attack a normal human protein, the nicotinic acetylcholine receptor, or a related protein called MuSK, a muscle-specific kinase. Other, less frequent antibodies are found against LRP4, agrin, and titin proteins.


title: Myasthenia gravis

text: Human leukocyte antigen haplotypes are associated with increased susceptibility to myasthenia gravis and other autoimmune disorders. Relatives of people with myasthenia gravis have a higher percentage of other immune disorders.


title: Myasthenia gravis

text: The thymus gland cells form part of the body's immune system. In those with myasthenia gravis, the thymus gland is large and abnormal. It sometimes contains clusters of immune cells that indicate lymphoid hyperplasia, and the thymus gland may give wrong instructions to immune cells.


title: Myasthenia gravis

text: For women who are pregnant and already have MG, in a third of cases, they have been known to experience an exacerbation of their symptoms, and in those cases, it usually occurs in the first trimester of pregnancy. Signs and symptoms in pregnant mothers tend to improve during the second and third trimesters. Complete remission can occur in some mothers. Immunosuppressive therapy should be maintained throughout pregnancy, as this reduces the chance of neonatal muscle weakness, and controls the mother's myasthenia.


title: Myasthenia gravis

text: About 10–20% of infants with mothers affected by the condition are born with transient neonatal myasthenia (TNM), which generally produces feeding and respiratory difficulties that develop about 12 hours to several days after birth. A child with TNM typically responds very well to acetylcholinesterase inhibitors, and the condition generally resolves over a period of three weeks, as the antibodies diminish, and generally does not result in any complications. Very rarely, an infant can be born with arthrogryposis multiplex congenita, secondary to profound intrauterine weakness. This is due to maternal antibodies that target an infant's acetylcholine receptors. In some cases, the mother remains asymptomatic.


title: Myasthenia gravis

text: MG can be difficult to diagnose, as the symptoms can be subtle and hard to distinguish from both normal variants and other neurological disorders.


title: Myasthenia gravis

text: The signs of congenital myasthenia usually are present in the first years of childhood, although they may not be recognized until adulthood.


title: Myasthenia gravis

text: When diagnosed with MG, a person is assessed for his or her neurological status and the level of illness is established. This is usually done using the accepted Myasthenia Gravis Foundation of America Clinical Classification scale.


title: Myasthenia gravis

text: During a physical examination to check for MG, a doctor might ask the person to perform repetitive movements. For instance, the doctor may ask one to look at a fixed point for 30 seconds and to relax the muscles of the forehead, because a person with MG and ptosis of the eyes might be involuntarily using the forehead muscles to compensate for the weakness in the eyelids. The clinical examiner might also try to elicit the "curtain sign" in a person by holding one of the person's eyes open, which in the case of MG will lead the other eye to close.


title: Myasthenia gravis

text: Muscle fibers of people with MG are easily fatigued, which the repetitive nerve stimulation test can help diagnose. In single-fiber electromyography, which is considered to be the most sensitive (although not the most specific) test for MG, a thin needle electrode is inserted into different areas of a particular muscle to record the action potentials from several samplings of different individual muscle fibers. Two muscle fibers belonging to the same motor unit are identified, and the temporal variability in their firing patterns is measured. Frequency and proportion of particular abnormal action potential patterns, called "jitter" and "blocking", are diagnostic. Jitter refers to the abnormal variation in the time interval between action potentials of adjacent muscle fibers in the same motor unit. Blocking refers to the failure of nerve impulses to elicit action potentials in adjacent muscle fibers of the same motor unit.


title: Myasthenia gravis

text: Applying ice for 2–5 minutes to the muscles reportedly has a sensitivity and specificity of 76.9% and 98.3%, respectively, for the identification of MG. Acetylcholinesterase is thought to be inhibited at the lower temperature, which is the basis for this diagnostic test. This generally is performed on the eyelids when ptosis is present and is deemed positive if a ≥2-mm rise in the eyelid occurs after the ice is removed.


title: Myasthenia gravis

text: This test requires the intravenous administration of edrophonium chloride or neostigmine, drugs that block the breakdown of acetylcholine by cholinesterase (acetylcholinesterase inhibitors). This test is no longer typically performed, as its use can lead to life-threatening bradycardia (slow heart rate) which requires immediate emergency attention. Production of edrophonium was discontinued in 2008.


title: Myasthenia gravis

text: A chest X-ray may identify widening of the mediastinum suggestive of thymoma, but computed tomography or magnetic resonance imaging (MRI) are more sensitive ways to identify thymomas and are generally done for this reason. MRI of the cranium and orbits may also be performed to exclude compressive and inflammatory lesions of the cranial nerves and ocular muscles.


title: Myasthenia gravis

text: The forced vital capacity may be monitored at intervals to detect increasing muscular weakness. Acutely, negative inspiratory force may be used to determine adequacy of ventilation; it is performed on those individuals with MG.


title: Myasthenia gravis

text: Treatment is by medication and/or surgery. Medication consists mainly of acetylcholinesterase inhibitors to directly improve muscle function and immunosuppressant drugs to reduce the autoimmune process. Thymectomy is a surgical method to treat MG.


title: Myasthenia gravis

text: Worsening may occur with medication such as fluoroquinolones, aminoglycosides, and magnesium. About 10% of people with generalized MG are considered treatment-refractory. Autologous hematopoietic stem cell transplantation (HSCT) is sometimes used in severe, treatment-refractory MG. Available data provide preliminary evidence that HSCT can be an effective therapeutic option in carefully selected cases.


title: Myasthenia gravis

text: Acetylcholinesterase inhibitors can provide symptomatic benefit and may not fully remove a person's weakness from MG. While they might not fully remove all symptoms of MG, they still may allow a person the ability to perform normal daily activities. Usually, acetylcholinesterase inhibitors are started at a low dose and increased until the desired result is achieved. If taken 30 minutes before a meal, symptoms will be mild during eating, which is helpful for those who have difficulty swallowing due to their illness. Another medication used for MG, atropine, can reduce the muscarinic side effects of acetylcholinesterase inhibitors. Pyridostigmine is a relatively long-acting drug (when compared to other cholinergic agonists), with a half-life around four hours with relatively few side effects. Generally, it is discontinued in those who are being mechanically ventilated, as it is known to increase the amount of salivary secretions. A few high-quality studies have directly compared cholinesterase inhibitors with other treatments (or placebo); their practical benefit may be such that conducting studies in which they would be withheld from some people would be difficult.


title: Myasthenia gravis

text: The steroid prednisone might also be used to achieve a better result, but it can lead to the worsening of symptoms and takes weeks to achieve its maximal effectiveness. Due to the myriad symptoms that steroid treatments can cause, it is not the preferred method of treatment. Other immune suppressing medications may also be used including rituximab or azathioprine.


title: Myasthenia gravis

text: If the myasthenia is serious (myasthenic crisis), plasmapheresis can be used to remove the putative antibodies from the circulation. Also, intravenous immunoglobulins (IVIGs) can be used to bind the circulating antibodies. Both of these treatments have relatively short-lived benefits, typically measured in weeks, and often are associated with high costs, which make them prohibitive; they are generally reserved for when MG requires hospitalization.


title: Myasthenia gravis

text: As thymomas are seen in 10% of all people with the MG, they are often given a chest X-ray and CT scan to evaluate their need for surgical removal of their thymus glands and any cancerous tissue that may be present. Even if surgery is performed to remove a thymoma, it generally does not lead to the remission of MG. Surgery in the case of MG involves the removal of the thymus, although in 2013, no clear benefit was indicated except in the presence of a thymoma. A 2016 randomized, controlled trial, however, found some benefits.


title: Myasthenia gravis

text: People with MG should be educated regarding the fluctuating nature of their symptoms, including weakness and exercise-induced fatigue. Exercise participation should be encouraged with frequent rest. In people with generalized MG, some evidence indicates a partial home program including training in diaphragmatic breathing, pursed-lip breathing, and interval-based muscle therapy may improve respiratory muscle strength, chest wall mobility, respiratory pattern, and respiratory endurance.


title: Myasthenia gravis

text: In people with myasthenia gravis, older forms of iodinated contrast used for medical imaging have caused an increased risk of exacerbation of the disease, but modern forms have no immediate increased risk.


title: Myasthenia gravis

text: The prognosis of people with MG is generally good, as is quality of life, given very good treatment. Monitoring of a person with MG is very important, as at least 20% of people diagnosed with it will experience a myasthenic crisis within two years of their diagnosis, requiring rapid medical intervention. Generally, the most disabling period of MG might be years after the initial diagnosis. In the early 1900s, 70% of detected cases died from lung problems; now, that number is estimated to be around 3–5%, which is attributed to increased awareness and medications to manage symptoms.


title: Myasthenia gravis

text: MG occurs in all ethnic groups and both sexes. It most commonly affects women under 40 and people from 50 to 70 years old of either sex, but it has been known to occur at any age. Younger people rarely have thymoma. Prevalence in the United States is estimated at between 0.5 and 20.4 cases per 100,000, with an estimated 60,000 Americans affected. Within the United Kingdom, an estimated 15 cases of MG occur per 100,000 people.


title: Myasthenia gravis

text: The first to write about MG were Thomas Willis, Samuel Wilks, Erb, and Goldflam. The term "myasthenia gravis pseudo-paralytica" was proposed in 1895 by Jolly, a German physician. Mary Walker treated a person with MG with physostigmine in 1934. Simpson and Nastuck detailed the autoimmune nature of the condition. In 1973, Patrick and Lindstrom used rabbits to show that immunization with purified muscle-like acetylcholine receptors caused the development of MG-like symptoms.


title: Myasthenia gravis

text: Immunomodulating substances, such as drugs that prevent acetylcholine receptor modulation by the immune system, are currently being researched. Some research recently has been on anti-c5 inhibitors for treatment research as they are safe and used in the treatment of other diseases. Ephedrine seems to benefit some people more than other medications, but it has not been properly studied as of 2014.


title: Myasthenia gravis

text: In the laboratory, MG is mostly studied in model organisms, such as rodents. In addition, in 2015, scientists developed an "in vitro" functional, all-human, neuromuscular junction assay from human embryonic stem cells and somatic-muscle stem cells. After the addition of pathogenic antibodies against the acetylcholine receptor and activation of the complement system, the neuromuscular co-culture shows symptoms such as weaker muscle contractions.


title: Child sexual abuse

text: Child sexual abuse (CSA), also called child molestation, is a form of child abuse in which an adult or older adolescent uses a child for sexual stimulation. Forms of child sexual abuse include engaging in sexual activities with a child (whether by asking or pressuring, or by other means), indecent exposure (of the genitals, female nipples, etc.), child grooming, and child sexual exploitation, such as using a child to produce child pornography.


title: Child sexual abuse

text: Child sexual abuse can occur in a variety of settings, including home, school, or work (in places where child labor is common). Child marriage is one of the main forms of child sexual abuse; UNICEF has stated that child marriage "represents perhaps the most prevalent form of sexual abuse and exploitation of girls". The effects of child sexual abuse can include depression, post-traumatic stress disorder, anxiety, complex post-traumatic stress disorder, propensity to further victimization in adulthood, and physical injury to the child, among other problems. Sexual abuse by a family member is a form of incest and can result in more serious and long-term psychological trauma, especially in the case of parental incest.


title: Child sexual abuse

text: The global prevalence of child sexual abuse has been estimated at 19.7% for females and 7.9% for males. Most sexual abuse offenders are acquainted with their victims; approximately 30% are relatives of the child, most often brothers, fathers, uncles, or cousins; around 60% are other acquaintances, such as "friends" of the family, babysitters, or neighbors; strangers are the offenders in approximately 10% of child sexual abuse cases. Most child sexual abuse is committed by men; studies on female child molesters show that women commit 14% to 40% of offenses reported against boys and 6% of offenses reported against girls.


title: Child sexual abuse

text: The word "pedophile" is commonly applied indiscriminately to anyone who sexually abuses a child, but child sexual offenders are not pedophiles unless they have a strong sexual interest in prepubescent children. Under the law, "child sexual abuse" is often used as an umbrella term describing criminal and civil offenses in which an adult engages in sexual activity with a minor or exploits a minor for the purpose of sexual gratification. The American Psychological Association states that "children cannot consent to sexual activity with adults", and condemns any such action by an adult: "An adult who engages in sexual activity with a child is performing a criminal and immoral act which never can be considered normal or socially acceptable behavior."


title: Child sexual abuse

text: Child sexual abuse can result in both short-term and long-term harm, including psychopathology in later life. Indicators and effects include depression, anxiety, eating disorders, poor self-esteem, somatization, sleep disturbances, and dissociative and anxiety disorders including post-traumatic stress disorder. While children may exhibit regressive behaviours such as thumb sucking or bedwetting, the strongest indicator of sexual abuse is sexual acting out and inappropriate sexual knowledge and interest. Victims may withdraw from school and social activities and exhibit various learning and behavioural problems including cruelty to animals, attention deficit/hyperactivity disorder (ADHD), conduct disorder, and oppositional defiant disorder (ODD). Teenage pregnancy and risky sexual behaviors may appear in adolescence. Child sexual abuse victims report almost four times as many incidences of self-inflicted harm. Sexual assault among teenagers has been shown to lead to an increase in mental health problems, social exclusion and worse school performance.


title: Child sexual abuse

text: A well-documented, long-term negative effect is repeated or additional victimization in adolescence and adulthood. A causal relationship has been found between childhood sexual abuse and various adult psychopathologies, including crime and suicide, in addition to alcoholism and drug abuse. Males who were sexually abused as children more frequently appear in the criminal justice system than in a clinical mental health setting. A study comparing middle-aged women who were abused as children with non-abused counterparts found significantly higher health care costs for the former. Intergenerational effects have been noted, with the children of victims of child sexual abuse exhibiting more conduct problems, peer problems, and emotional problems than their peers.


title: Child sexual abuse

text: A specific characteristic pattern of symptoms has not been identified, and there are several hypotheses about the causality of these associations.


title: Child sexual abuse

text: Studies have found that 51% to 79% of sexually abused children exhibit psychological symptoms. The risk of harm is greater if the abuser is a relative, if the abuse involves intercourse or attempted intercourse, or if threats or force are used. The level of harm may also be affected by various factors such as penetration, duration and frequency of abuse, and use of force. The social stigma of child sexual abuse may compound the psychological harm to children, and adverse outcomes are less likely for abused children who have supportive family environments.


title: Child sexual abuse

text: Child abuse, including sexual abuse, especially chronic abuse starting at early ages, has been found to be related to the development of high levels of dissociative symptoms, which includes amnesia for abuse memories. When severe sexual abuse (penetration, several perpetrators, lasting more than one year) had occurred, dissociative symptoms were even more prominent. Recent research showed that females with high exposure to child sexual abuse (CSA) develop PTSD symptoms that are associated with poor social functioning, which is also supported by prior research studies. The feeling of being "cut-off" from peers and "emotional numbness" are both results of CSA and highly inhibit proper social functioning. Furthermore, PTSD is associated with higher risk of substance abuse as a result of the "self-medication hypothesis" and the "high-risk and susceptibility hypothesis." Prolonged exposure therapy (PE) was found to decrease PTSD and depressive symptoms in female methadone using CSA survivors.


title: Child sexual abuse

text: Besides dissociative identity disorder (DID), posttraumatic stress disorder (PTSD), and complex post-traumatic stress disorder (C-PTSD), child sexual abuse survivors may present borderline personality disorder (BPD) and eating disorders such as bulimia nervosa.


title: Child sexual abuse

text: Because child sexual abuse often occurs alongside other possibly confounding variables, such as poor family environment and physical abuse, some scholars argue it is important to control for those variables in studies which measure the effects of sexual abuse. In a 1998 review of related literature, Martin and Fleming state "The hypothesis advanced in this paper is that, in most cases, the fundamental damage inflicted by child sexual abuse is due to the child's developing capacities for trust, intimacy, agency and sexuality, and that many of the mental health problems of adult life associated with histories of child sexual abuse are second-order effects." Other studies have found an independent association of child sexual abuse with adverse psychological outcomes.


title: Child sexual abuse

text: Kendler et al. (2000) found that most of the relationship between severe forms of child sexual abuse and adult psychopathology in their sample could not be explained by family discord, because the effect size of this association decreased only slightly after they controlled for possible confounding variables. Their examination of a small sample of CSA-discordant twins also supported a causal link between child sexual abuse and adult psychopathology; the CSA-exposed subjects had a consistently higher risk for psychopathologic disorders than their CSA non-exposed twins.


title: Child sexual abuse

text: A 1998 meta-analysis by Bruce Rind et al. generated controversy by suggesting that child sexual abuse does not always cause pervasive harm, that girls were more likely to be psychologically harmed than boys, that some college students reported such encounters as positive experiences and that the extent of psychological damage depends on whether or not the child described the encounter as "consensual." The study was criticized for flawed methodology and conclusions. The US Congress condemned the study for its conclusions and for providing material used by pedophile organizations to justify their activities.


title: Child sexual abuse

text: Depending on the age and size of the child, and the degree of force used, child sexual abuse may cause internal lacerations and bleeding. In severe cases, damage to internal organs may occur, which, in some cases, may cause death.


title: Child sexual abuse

text: Child sexual abuse may cause infections and sexually transmitted diseases. Due to a lack of sufficient vaginal fluid, chances of infections can heighten depending on the age and size of the child. Vaginitis has also been reported.


title: Child sexual abuse

text: Research has shown that traumatic stress, including stress caused by sexual abuse, causes notable changes in brain functioning and development. Various studies have suggested that severe child sexual abuse may have a deleterious effect on brain development. Ito et al. (1998) found "reversed hemispheric asymmetry and greater left hemisphere coherence in abused subjects;" Teicher et al. (1993) found that an increased likelihood of "ictal temporal lobe epilepsy-like symptoms" in abused subjects; Anderson et al. (2002) recorded abnormal transverse relaxation time in the cerebellar vermis of adults sexually abused in childhood; Teicher et al. (1993) found that child sexual abuse was associated with a reduced corpus callosum area; various studies have found an association of reduced volume of the left hippocampus with child sexual abuse; and Ito et al. (1993) found increased electrophysiological abnormalities in sexually abused children.


title: Child sexual abuse

text: Some studies indicate that sexual or physical abuse in children can lead to the overexcitation of an undeveloped limbic system. Teicher et al. (1993) used the "Limbic System Checklist-33" to measure ictal temporal lobe epilepsy-like symptoms in 253 adults. Reports of child sexual abuse were associated with a 49% increase to LSCL-33 scores, 11% higher than the associated increase of self-reported physical abuse. Reports of both physical and sexual abuse were associated with a 113% increase. Male and female victims were similarly affected.


title: Child sexual abuse

text: Navalta et al. (2006) found that the self-reported math Scholastic Aptitude Test scores of their sample of women with a history of repeated child sexual abuse were significantly lower than the self-reported math SAT scores of their non-abused sample. Because the abused subjects' verbal SAT scores were high, they hypothesized that the low math SAT scores could "stem from a defect in hemispheric integration." They also found a strong association between short-term memory impairments for all categories tested (verbal, visual, and global) and the duration of the abuse.


title: Child sexual abuse

text: Incest between a child or adolescent and a related adult is known as child incestuous abuse, and has been identified as the most widespread form of child sexual abuse with a highly significant capacity to damage the young person. One researcher stated that more than 70% of abusers are immediate family members or someone very close to the family. Another researcher stated that about 30% of all perpetrators of sexual abuse are related to their victim, 60% of the perpetrators are family acquaintances, like a neighbor, babysitter or friend and 10% of the perpetrators in child sexual abuse cases are strangers. A child sexual abuse offense where the perpetrator is related to the child, either by blood or marriage, is a form of incest described as "intrafamilial child sexual abuse".


title: Child sexual abuse

text: The most-often reported form of incest is father–daughter and stepfather–stepdaughter incest, with most of the remaining reports consisting of mother/stepmother–daughter/son incest. Father–son incest is reported less often; however, it is not known if the actual prevalence is less or it is under-reported by a greater margin. Similarly, some argue that sibling incest may be as common, or more common, than other types of incest: Goldman and Goldman reported that 57% of incest involved siblings; Finkelhor reported that over 90% of nuclear family incest involved siblings; while Cawson et al. show that sibling incest was reported twice as often as incest perpetrated by fathers/stepfathers.


title: Child sexual abuse

text: Prevalence of parental child sexual abuse is difficult to assess due to secrecy and privacy; some estimates state that 20 million Americans have been victimized by parental incest as children.


title: Child sexual abuse

text: Commercial sexual exploitation of children (CSEC) is defined by the Declaration of the First World Congress against Commercial Sexual Exploitation of Children, held in Stockholm in 1996, as "sexual abuse by an adult accompanied by remuneration in cash or in kind to the child or third person(s)." CSEC usually takes the form of child prostitution or child pornography, and is often facilitated by child sex tourism. CSEC is particularly a problem in developing countries of Asia. In recent years, new innovations in technology have facilitated the trade of Internet child pornography.


title: Child sexual abuse

text: In the United Kingdom, the term "child sexual exploitation" covers any form of sexual abuse which includes an exchange of a resource for sexual activity with a child. Prior to 2009, the term commonly used to describe child sexual exploitation was "child prostitution". The term "child sexual exploitation" first appeared in government guidance in 2009 as part of an attempt to promote an understanding that children involved in exploitation were victims of abuse rather than criminals. Because early definitions of child sexual exploitation were created to foster a move away from use of the term "child prostitution", the concept of exchange, which made child sexual exploitation different from child sexual abuse, referred to financial gain only. However, in the years since the birth of the concept of child sexual exploitation, the notion of exchange has been widened to include other types of gain, including love, acquisition of status and protection from harm.


title: Child sexual abuse

text: Children who received supportive responses following disclosure had less traumatic symptoms and were abused for a shorter period of time than children who did not receive support. In general, studies have found that children need support and stress-reducing resources after disclosure of sexual abuse. Negative social reactions to disclosure have been found to be harmful to the survivor's well-being. One study reported that children who received a bad reaction from the first person they told, especially if the person was a close family member, had worse scores as adults on general trauma symptoms, post traumatic stress disorder symptoms, and dissociation. Another study found that in most cases when children did disclose abuse, the person they talked to did not respond effectively, blamed or rejected the child, and took little or no action to stop the abuse. Non-validating and otherwise non-supportive responses to disclosure by the child's primary attachment figure may indicate a relational disturbance predating the sexual abuse that may have been a risk factor for the abuse, and which can remain a risk factor for its psychological consequences.


title: Child sexual abuse

text: The American Academy of Child and Adolescent Psychiatry provides guidelines for what to say to the victim and what to do following the disclosure. Asa Don Brown has indicated: "A minimization of the trauma and its effects is commonly injected into the picture by parental caregivers to shelter and calm the child. It has been commonly assumed that focusing on children's issues too long will negatively impact their recovery. Therefore, the parental caregiver teaches the child to mask his or her issues."


title: Child sexual abuse

text: In many jurisdictions, abuse that is suspected, not necessarily proven, requires reporting to child protection agencies, such as the Child Protection Services in the United States. Recommendations for healthcare workers, such as primary care providers and nurses, who are often suited to encounter suspected abuse are advised to firstly determine the child's immediate need for safety. A private environment away from suspected abusers is desired for interviewing and examining. Leading statements that can distort the story are avoided. As disclosing abuse can be distressing and sometimes even shameful, reassuring the child that he or she has done the right thing by telling and that they are not bad and that the abuse was not their fault helps in disclosing more information. Anatomically correct dolls are sometimes used to help explain what happened, although some researchers consider the dolls too explicit and overstimulating, which might contribute to non-abused children behaving with the dolls in one or more ways that suggest they were sexually abused. For the suspected abusers, it is also recommended to use a nonjudgmental, nonthreatening attitude towards them and to withhold expressing shock, in order to help disclose information.


title: Child sexual abuse

text: The initial approach to treating a person who has been a victim of sexual abuse is dependent upon several important factors:


title: Child sexual abuse

text: The goal of treatment is not only to treat current mental health issues, and trauma related symptoms, but also to prevent future ones.


title: Child sexual abuse

text: Children often present for treatment in one of several circumstances, including criminal investigations, custody battles, problematic behaviors, and referrals from child welfare agencies.


title: Child sexual abuse

text: The three major modalities for therapy with children and adolescents are family therapy, group therapy, and individual therapy. Which course is used depends on a variety of factors that must be assessed on a case-by-case basis. For instance, treatment of young children generally requires strong parental involvement and can benefit from family therapy. Adolescents tend to be more independent; they can benefit from individual or group therapy. The modality also shifts during the course of treatment; for example, group therapy is rarely used in the initial stages, as the subject matter is very personal and/or embarrassing. In a 2012 systematic review, cognitive behavior therapy showed potential in treating the adverse consequences of child sexual abuse.


title: Child sexual abuse

text: Major factors that affect both the pathology and response to treatment include the type and severity of the sexual act, its frequency, the age at which it occurred, and the child's family of origin. Roland C. Summit, a medical doctor, defined the different stages the victims of child sexual abuse go through, called child sexual abuse accommodation syndrome. He suggested that children who are victims of sexual abuse display a range of symptoms that include secrecy, helplessness, entrapment, accommodation, delayed and conflicted disclosure and recantation.


title: Child sexual abuse

text: Adults who have been sexually abused as children often present for treatment with a secondary mental health issue, which can include substance abuse, eating disorders, personality disorders, depression, and conflict in romantic or interpersonal relationships.


title: Child sexual abuse

text: Generally, the approach is to focus on the present problem, rather than the abuse itself. Treatment is highly varied and depends on the person's specific issues. For instance, a person with a history of sexual abuse and severe depression would be treated for depression. However, there is often an emphasis on cognitive restructuring due to the deep-seated nature of the trauma. Some newer techniques such as eye movement desensitization and reprocessing (EMDR) have been shown to be effective.


title: Child sexual abuse

text: Although there is no known cure for pedophilia, there are a number of treatments for pedophiles and child sexual abusers. Some of the treatments focus on attempting to change the sexual preference of pedophiles, while others focus on keeping pedophiles from committing child sexual abuse, or on keeping child sexual abusers from committing child sexual abuse again. Cognitive behavioral therapy (CBT), for example, aims to reduce attitudes, beliefs, and behaviors that may increase the likelihood of sexual offenses against children. Its content varies widely between therapists, but a typical program might involve training in self-control, social competence and empathy, and use cognitive restructuring to change views on sex with children. The most common form of this therapy is relapse prevention, where the patient is taught to identify and respond to potentially risky situations based on principles used for treating addictions.


title: Child sexual abuse

text: The evidence for cognitive behavioral therapy is mixed. A 2012 Cochrane Review of randomized trials found that CBT had no effect on risk of reoffending for contact sex offenders. Meta-analyses in 2002 and 2005, which included both randomized and non-randomized studies, concluded that CBT reduced recidivism. There is debate over whether non-randomized studies should be considered informative. More research is needed.


title: Child sexual abuse

text: Sexual abuse is associated with many sub-clinical behavioral issues as well, including re-victimization in the teenage years, a bipolar-like switching between sexual compulsion and shut-down, and distorted thinking on the subject of sexual abuse (for instance, that it is common and happens to everyone). When first presenting for treatment, the patient can be fully aware of their abuse as an event, but their "appraisal" of it is often distorted, such as believing that the event was unremarkable (a form of isolation). Frequently, victims do not make the connection between their abuse and their present pathology.


title: Child sexual abuse

text: Child sexual abuse prevention programmes were developed in the United States of America during the 1970s. Some programme are delivered to children and can include one-to-one work and group work. Programmes delivered to parents were developed in the 1980s and took the form of one-off meetings, two to three hours long. In the last 15 years, web-based programmes have been developed. School-based education programs were evaluated in 2015 by Cochrane that demonstrated improvements in protective behaviors and knowledge among children.


title: Child sexual abuse

text: Offenders are more likely to be relatives or acquaintances of their victim than strangers. A 2006–07 Idaho study of 430 cases found that 82% of juvenile sex offenders were known to the victims (acquaintances 46% or relatives 36%).


title: Child sexual abuse

text: More offenders are male than female, though the percentage varies between studies. The percentage of incidents of sexual abuse by female perpetrators that come to the attention of the legal system is usually reported to be between 1% and 4%. Studies of sexual misconduct in US schools with female offenders have shown mixed results with rates between 4% to 43% of female offenders. Maletzky (1993) found that, of his sample of 4,402 convicted child sex offenders, 0.4% were female.


title: Child sexual abuse

text: According to research conducted in Australia by Kelly Richards on child sexual abuse, 35.1% of female victims were abused by another male relative and 16.4% of male victims were abused by another male relatives. Male relatives were found to be the most relevant predators in the case of both gender.


title: Child sexual abuse

text: In U.S. schools, educators who offend range in age from "21 to 75 years old, with an average age of 28".


title: Child sexual abuse

text: According to C.E. Dettmeijer-Vermeulen, Dutch national spokeswoman on human traffic and sexual violence against children, in the Netherlands, 3% of the convicted perpetrators are women, 14.58% of the victims are boys and "most victims were abused by a family member, friend or acquaintance." One in six perpetrators are underage.


title: Child sexual abuse

text: Early research in the 1970s and 1980s began to classify offenders based on their motivations and traits. Groth and Birnbaum (1978) categorized child sexual offenders into two groups, "fixated" and "regressed". Fixated were described as having a primary attraction to children, whereas regressed had largely maintained relationships with other adults, and were even married. This study also showed that adult sexual orientation was not related to the sex of the victim targeted, e.g. men who molested boys often had adult relationships with women.


title: Child sexual abuse

text: Later work (Holmes and Holmes, 2002) expanded on the types of offenders and their psychological profiles. They are divided as follows:


title: Child sexual abuse

text: Causal factors of child sex offenders are not known conclusively. The experience of sexual abuse as a child was previously thought to be a strong risk factor, but research does not show a causal relationship, as the vast majority of sexually abused children do not grow up to be adult offenders, nor do the majority of adult offenders report childhood sexual abuse. The US Government Accountability Office concluded, "the existence of a cycle of sexual abuse was not established." Before 1996, there was greater belief in the theory of a "cycle of violence", because most of the research done was retrospective—abusers were asked if they had experienced past abuse. Even the majority of studies found that most adult sex offenders said they had "not" been sexually abused during childhood, but studies varied in terms of their estimates of the percentage of such offenders who had been abused, from 0 to 79 percent. More recent prospective longitudinal research—studying children with documented cases of sexual abuse over time to determine what percentage become adult offenders—has demonstrated that the cycle of violence theory is not an adequate explanation for why people molest children.


title: Child sexual abuse

text: Offenders may use cognitive distortions to facilitate their offenses, such as minimization of the abuse, victim blaming, and excuses.


title: Child sexual abuse

text: Pedophilia is a condition in which an adult or older adolescent is primarily or exclusively attracted to prepubescent children, whether the attraction is acted upon or not. A person with this paraphilia is called a "pedophile".


title: Child sexual abuse

text: In law enforcement, the term "pedophile" is sometimes used to describe those accused or convicted of child sexual abuse under sociolegal definitions of "child" (including both prepubescent children and adolescents younger than the local age of consent); however, not all child sexual offenders are pedophiles and not all pedophiles engage in sexual abuse of children. For these reasons, researchers recommend against imprecisely describing all child molesters as "pedophiles".


title: Child sexual abuse

text: The term "pedocriminality" (De: "Pädokriminalität"; Fr: "pédocriminalité") is a controversial term which originated in the 1980s and has been used by organisations such as UNICEF, UNHRC, the World Health Organization and the Council of Europe to refer to child sexual abuse and sexual violence used against children, child prostitution, child trafficking and the use of child pornography. The term "cyber-pedocriminality" has been used to refer to the activities of viewers of child pornography online.


title: Child sexual abuse

text: Although reconviction data suggest that not many sex offenders reoffend, OJP reported that observed recidivism rates of sex offenders are underestimated of actual reoffending. Estimated rates among child sex offenders vary by surveys and it is difficult to estimate accurately. One study found that 42% of offenders re-offended (either a sex crime, violent crime, or both) after they were released. Risk for re-offense was highest in the first 6 years after release, but continued to be significant even 10–31 years later, with 23% offending during this time. A study done in California in 1965 found an 18.2% recidivism rate for offenders targeting the opposite sex and a 34.5% recidivism rate for same-sex offenders after 5 years.


title: Child sexual abuse

text: Because recidivism is defined and measured differently from study to study, one can arrive at inaccurate conclusions being made based on comparison of two or more studies that are not conducted with similar methodology.


title: Child sexual abuse

text: When a prepubescent child is sexually abused by one or more other children or adolescent youths, and no adult is directly involved, it is defined as child-on-child sexual abuse. The definition includes any sexual activity between children that occurs without consent, without equality, or due to coercion, whether the offender uses physical force, threats, trickery or emotional manipulation to compel cooperation. When sexual abuse is perpetrated by one sibling upon another, it is known as "intersibling abuse", a form of incest.


title: Child sexual abuse

text: Unlike research on adult offenders, a strong causal relationship has been established between child and adolescent offenders and these offenders' own prior victimization, by either adults or other children.


title: Child sexual abuse

text: According to a 2010 UNICEF report, 46% of Congolese schoolgirls confirmed that they had been victims of sexual harassment, abuse, and violence committed by their teachers or other school personnel. In Mozambique, a study by the Ministry of Education found that 70 percent of female respondents reported knowing teachers who use sexual intercourse as a necessary condition to advance students to the next grade. A survey by Promundo found that 16% of girls in North Kivu said they had been forced to have sex with their teachers. According to UNICEF, teachers in Mali are known to use "La menace du bic rouge" ("the threat of the red pen"), using the threat of bad grades to coerce girls into acquiescing to sexual advances. According to Plan International, 16% of children in Togo, for instance, named a teacher as responsible for the pregnancy of a classmate.


title: Child sexual abuse

text: Based on self-disclosure data, a 2011 meta-analysis of 217 studies estimated a global prevalence of 12.7%–18% for girls and 7.6% for boys. The rates of self-disclosed abuse for specific continents were as follows:


title: Child sexual abuse

text: A 2009 meta-analysis of 65 studies from 22 countries found a global prevalence of 19.7% for females and 7.9% for males. In that analysis, Africa had the highest prevalence rate of child sexual abuse (34.4%), primarily because of high rates in South Africa; Europe showed the lowest prevalence rate (9.2%); and America and Asia had prevalence rates between 10.1% and 23.9%.


title: Child sexual abuse

text: A ten-country school-based study in southern Africa in 2007 found 19.6% of female students and 21.1% of male students aged 11–16 years reported they had experienced forced or coerced sex. Rates among 16-year-olds were


title: Child sexual abuse

text: 28.8% in females and 25.4% in males. Comparing the same schools in eight countries between 2003 and 2007, age-standardised on the 2007 Botswana male sample, there was no significant decrease between 2003 and 2007 among females in any country and inconsistent changes among males.


title: Child sexual abuse

text: The prevalence of child sexual abuse in Africa is compounded by the virgin cleansing myth that sexual intercourse with a virgin will cure a man of HIV or AIDS. The myth is prevalent in South Africa, Zimbabwe, Zambia and Nigeria and is being blamed for the high rate of sexual abuse against young children.


title: Child sexual abuse

text: Child rape is on the rise in the war-ravaged eastern Democratic Republic of the Congo. Aid workers blame combatants on all sides, who operate with much impunity, for a culture of sexual violence. South Africa has some of the highest incidences of child rape (including the rape of babies) in the world (also see sexual violence in South Africa). A survey by CIET found around 11% of boys and 4% of girls admitted to forcing someone else to have sex with them. In a related survey conducted among 1,500 schoolchildren, a quarter of all the boys interviewed said that "jackrolling", a term for gang rape, was fun. More than 67,000 cases of rape and sexual assaults against children were reported in 2000 in South Africa, compared to 37,500 in 1998. Child welfare groups believe that the number of unreported incidents could be up to 10 times that number. The largest increase in attacks was against children under seven. The virgin cleansing myth is especially common in South Africa, which has the highest number of HIV-positive citizens in the world. Eastern Cape social worker Edith Kriel notes that "child abusers are often relatives of their victims – even their fathers and providers."


title: Child sexual abuse

text: A number of high-profile baby rapes appeared since 2001 (including the fact that they required extensive reconstructive surgery to rebuild urinary, genital, abdominal, or tracheal systems). In 2001, a 9-month-old was raped and likely lost consciousness as the pain was too much to bear. In February 2002, an 8-month-old infant was reportedly gang-raped by four men. One has been charged. The infant has required extensive reconstructive surgery. The 8-month-old infant's injuries were so extensive, increased attention on prosecution has occurred.


title: Child sexual abuse

text: In Afghanistan, some boys are forced to participate in sexual activities with men. They are also termed 'dancing boys'. The custom is connected to sexual slavery and child prostitution.


title: Child sexual abuse

text: In Bangladesh, child prostitutes are known to take the drug Oradexon, an over-the-counter steroid, usually used by farmers to fatten cattle, to make child prostitutes look larger and older. Charities say that 90% of prostitutes in the country's legalized brothels use the drug. According to social activists, the steroid can cause diabetes and high blood pressure and is highly addictive.


title: Child sexual abuse

text: In 2007, the Ministry of Women and Child Development published the "Study on Child Abuse: India 2007." It sampled 12447 children, 2324 young adults and 2449 stakeholders across 13 states. It looked at different forms of child abuse: physical abuse, sexual abuse and emotional abuse and girl child neglect in five evidence groups, namely, children in a family environment, children in school, children at work, children on the street and children in institutions. The study's main findings included: 53.22% of children reported having faced sexual abuse. Among them, 52.94% were boys and 47.06% girls. Andhra Pradesh, Assam, Bihar and Delhi reported the highest percentage of sexual abuse among both boys and girls, as well as the highest incidence of sexual assaults. 21.90% of child respondents faced severe forms of sexual abuse, 5.69% had been sexually assaulted and 50.76% reported other forms of sexual abuse. Children on the street, at work and in institutional care reported the highest incidence of sexual assault. The study also reported that 50% of abusers are known to the child or are in a position of trust and responsibility and most children had not reported the matter to anyone. Despite years of lack of any specific child sexual abuse laws in India, which treated them separately from adults in case of sexual offense, the 'Protection of Children Against Sexual Offences Bill, 2011' was passed the Indian parliament on May 22, 2012, which came into force from 14 November 2012.


title: Child sexual abuse

text: In Pakistan, sexual abuse of children is a problem in some madrassas. Child sexual abuse has also been reported in Madrassas across Bangladesh and India.


title: Child sexual abuse

text: The Kasur child sexual abuse scandal, which involved forced sex acts and an estimated 280 to 300 children, was termed the largest child abuse scandal in Pakistan's history.


title: Child sexual abuse

text: In 2019, Pakistan's Human Rights Minister, Shirin Mazari has said that Pakistan was ranked as the country with the largest numbers of child pornography viewers. Geo Pakistan, the Federal Investigation Agency, cyber-crime chief has said, "Child pornography is a business . . with those involved in the crime linked to international child pornography rings."


title: Child sexual abuse

text: In Uzbekistan, the UK Ambassador Craig Murray wrote that the government, under president Islam Karimov, used child rape to force false confessions from prisoners.


title: Child sexual abuse

text: According to UNICEF, nearly half of reported rape victims in Papua New Guinea are under 15 years of age and 13% are under 7 years of age while a report by ChildFund Australia citing former Parliamentarian Dame Carol Kidu stated 50% of those seeking medical help after rape are under 16, 25% are under 10 and 10% are under 8.


title: Child sexual abuse

text: Additionally, a study found that men with a history of victimization, especially having been raped or otherwise sexually coerced themselves, were more likely than otherwise to have participated in both single-perpetrator and multiple-perpetrator non-partner rape. 57·5% (587/1022) of men who raped a non-partner committed their first rape as teenagers.


title: Child sexual abuse

text: Child sexual abuse occurs frequently in Western society, although the rate of prevalence can be difficult to determine. Research in North America has concluded that approximately 15% to 25% of women and 5% to 15% of men were sexually abused when they were children. In the UK, a 2010 study estimated prevalence at about 5% for boys and 18% for girls (not dissimilar to a 1985 study that estimated about 8% for boys and 12% for girls). More than 23,000 incidents were recorded by the UK police between 2009 and 2010. Girls were six times more likely to be assaulted than boys with 86% of attacks taking place against them. Barnardo's charity estimates that two thirds of victims in the United Kingdom are girls and one third are boys. Barnardo's is concerned that boy victims may be overlooked. A firm of solicitors that acts in many cases of child abuse has published a list of over twenty Children's Homes and group actions that they have an interest in or for which they are lead solicitors.


title: Child sexual abuse

text: The estimates for the United States vary widely. A literature review of 23 studies found rates of 3% to 37% for males and 8% to 71% for females, which produced an average of 17% for boys and 28% for girls, while a statistical analysis based on 16 cross-sectional studies estimated the rate to be 7.2% for males and 14.5% for females. The US Department of Health and Human Services reported 83,600 substantiated reports of sexually abused children in 2005, while state-level child protective services reported 63,527 sexual abuse incidents in 2010. Including incidents which were not reported would make the total number even larger. According to Emily M. Douglas and David Finkelhor, "Several national studies have found that black and white children experienced near-equal levels of sexual abuse. Other studies, however, have found that both blacks and Latinos have an increased risk for sexual victimization".


title: Child sexual abuse

text: Surveys have shown that one fifth to one third of all women reported some sort of childhood sexual experience with a male adult.


title: Child sexual abuse

text: A 1992 survey studying father-daughter incest in Finland reported that of the 9,000 15-year-old high school girls who filled out the questionnaires, of the girls living with their biological fathers, 0.2% reported father-daughter incest experiences; of the girls living with a stepfather, 3.7% reported sexual experiences with him. The reported counts included only father-daughter incest and did not include prevalence of other forms of child sexual abuse. The survey summary stated, "the feelings of the girls about their incestual experiences are overwhelmingly negative." Others argue that prevalence rates are much higher, and that many cases of child abuse are never reported. One study found that professionals failed to report approximately 40% of the child sexual abuse cases they encountered. A study by Lawson & Chaffin indicated that many children who were sexually abused were "identified solely by a physical complaint that was later diagnosed as a venereal disease ... Only 43% of the children who were diagnosed with venereal disease made a verbal disclosure of sexual abuse during the initial interview." It has been found in the epidemiological literature on CSA that there is no identifiable demographic or family characteristic of a child that can be used to bar the prospect that a child has been sexually abused.


title: Child sexual abuse

text: Child marriage is often considered to be another form of child sexual abuse. Over 200,000 marriages involving minors were allowed between 2000 and 2015 in the US. These marriages were most often between an adult male and female minor. Child marriage in the United States is allowed in the majority of states as long as parental consent or judicial approval (typically for pregnancy) is given.


title: Child sexual abuse

text: In US schools, according to the United States Department of Education, "nearly 9.6% of students are targets of educator sexual misconduct sometime during their school career." In studies of student sex abuse by male and female educators, male students were reported as targets in ranges from 23% to 44%. In U.S. school settings same-sex (female and male) sexual misconduct against students by educators "ranges from 18 to 28% of reported cases, depending on the study"


title: Child sexual abuse

text: Significant underreporting of sexual abuse of boys by both women and men is believed to occur due to sex stereotyping, social denial, the minimization of male victimization, and the relative lack of research on sexual abuse of boys. Sexual victimization of boys by their mothers or other female relatives is especially rarely researched or reported. Sexual abuse of girls by their mothers, and other related and/or unrelated adult females is beginning to be researched and reported despite the highly taboo nature of female–female child sex abuse. In studies where students are asked about sex offenses, they report higher levels of female sex offenders than found in adult reports. This underreporting has been attributed to cultural denial of female-perpetrated child sex abuse, because "males have been socialized to believe they should be flattered or appreciative of sexual interest from a female." Journalist Cathy Young writes that under-reporting is contributed to by the difficulty of people, including jurors, in seeing a male as a "true victim".


title: Child sexual abuse

text: In the United Kingdom, reported child sex abuse has increased, but this may be due to greater willingness to report. Police need more resources to deal with it. Also parents and schools need to give children and adolescents regular advice about how to spot abuse and about the need to report abuse. Software providers are urged to do more to police their environment and make it safe for children.


title: Child sexual abuse

text: Child sexual abuse is outlawed nearly everywhere in the world, generally with severe criminal penalties, including in some jurisdictions, life imprisonment or capital punishment. An adult's sexual intercourse with someone below the legal age of consent is defined as statutory rape, based on the principle that a child is not capable of consent and that any apparent consent by a child is not considered to be legal consent.


title: Child sexual abuse

text: The United Nations Convention on the Rights of the Child (CRC) is an international treaty that legally obliges states to protect children's rights. Articles 34 and 35 of the CRC require states to protect children from all forms of sexual exploitation and sexual abuse. This includes outlawing the coercion of a child to perform sexual activity, the prostitution of children, and the exploitation of children in creating pornography. States are also required to prevent the abduction, sale, or trafficking of children. As of November 2008, 193 countries are bound by the CRC, including every member of the United Nations except the United States and South Sudan.


title: Child sexual abuse

text: The Council of Europe has adopted the Council of Europe Convention on the Protection of Children against Sexual Exploitation and Sexual Abuse in order to prohibit child sexual abuse that occurs within home or family.


title: Child sexual abuse

text: In the European Union, child sexual abuse is subject to a directive. This directive deals with several forms of sexual abuse of children, especially commercial sexual exploitation of children.


title: Child sexual abuse

text: Child sexual abuse has gained public attention since the 1970s and has become one of the most high-profile crimes. While sexual use of children by adults has been present throughout history, public interest in prevention has tended to fluctuate. Initially, concern centered around children under the age of ten, but over time, advocates have attracted attention toward the sexual abuse of children between the ages of 11 and 17. Up until the 1930s, the psychological impact of sexual abuse was not emphasized, instead emphasis was placed on the physical harm or the child's reputation. Widespread public awareness of children's sexual abuse did not occur until the 1970s in the West.


title: Child sexual abuse

text: The first published work dedicated specifically to child sexual abuse appeared in France in 1857: "Medical-Legal Studies of Sexual Assault" "(Etude Médico-Légale sur les Attentats aux Mœurs)", by Auguste Ambroise Tardieu, the noted French pathologist and pioneer of forensic medicine.


title: Child sexual abuse

text: Child sexual abuse became a public issue in the 1970s and 1980s. Prior to this point in time, sexual abuse remained rather secretive and socially unspeakable. Studies on child molestation were nonexistent until the 1920s and the first national estimate of the number of child sexual abuse cases was published in 1948. By 1968 44 out of 50 U.S. states had enacted mandatory laws that required physicians to report cases of suspicious child abuse. Legal action began to become more prevalent in the 1970s with the enactment of the Child Abuse Prevention and Treatment Act in 1974 in conjunction with the creation of the National Center for Child Abuse and Neglect. Since the creation of the Child Abuse and Treatment Act, reported child abuse cases have increased dramatically. Finally, the National Abuse Coalition was created in 1979 to create pressure in congress to create more sexual abuse laws.


title: Child sexual abuse

text: Second wave feminism brought greater awareness of child sexual abuse and violence against women, and made them public, political issues. Judith Lewis Herman, Harvard professor of psychiatry, wrote the first book ever on father-daughter incest when she discovered during her medical residency that a large number of the women she was seeing had been victims of father-daughter incest. Herman notes that her approach to her clinical experience grew out of her involvement in the civil rights movement. Her second book "Trauma and Recovery" coined the term complex post-traumatic stress disorder and included child sexual abuse as a cause.


title: Child sexual abuse

text: In 1986, Congress passed the Child Abuse Victims' Rights Act, giving children a civil claim in sexual abuse cases. The number of laws created in the 1980s and 1990s began to create greater prosecution and detection of child sexual abusers. During the 1970s a large transition began in the legislature related to child sexual abuse. Megan's Law which was enacted in 1996 gives the public access to knowledge of sex offenders nationwide.


title: Child sexual abuse

text: Anne Hastings described these changes in attitudes towards child sexual abuse as "the beginning of one of history's largest social revolutions."


title: Child sexual abuse

text: Media reporting plays a crucial role in tackling the word-wide problem of child sexual abuse because it puts the issue on the public and political agenda. Media reporting can even contribute to the exposure and criminal investigation of sexual abuse cases in institutions. One notorious example is the "Boston Globe" coverage of the sex abuse scandal in the Catholic Archdiocese of Boston for which the newspaper received a Pulitzer Prize for Public Service in 2003. Another award-winning example is the "Indianapolis Star" coverage of the USA Gymnastics sex abuse scandal in 2016. Media reporting can be very beneficial by giving survivors a voice and informing the public.


title: Child sexual abuse

text: Media reporting can also violate the rights of abuse survivors and disseminate misleading and harmful messages. Content analyses of news reporting have revealed several quality issues such as a focus on sensationalized individual cases (so-called episodic framing) and neglect of thematic framing in the sense of contextualizing individual cases and pointing to the systematic problems that enable child sexual abuse. When media reporting on child sexual abuse is investigated, usual methodological approaches are the media content analysis and the media quality analysis. Here it is important to not only analyze text but also documentary and stock photos commonly used in media that report about child sexual abuse. Research shows that myths and stereotypes about child sexual abuse are disseminated through text and images alike. Several checklists and guidelines for journalist have been published by violence prevention and journalism organizations to help improve the quality of news reporting on child sexual abuse. Future media content and media quality analyses will show if and how the quality of news reporting on child sexual abuse will be improving over time in different countries and across different media systems.


title: Child sexual abuse

text: In the United States growing awareness of child sexual abuse has sparked an increasing number of civil lawsuits for monetary damages stemming from such incidents. Increased awareness of child sexual abuse has encouraged more victims to come forward, whereas in the past victims often kept their abuse secret. Some states have enacted specific laws lengthening the applicable statutes of limitations so as to allow victims of child sexual abuse to file suit sometimes years after they have reached the age of majority. Such lawsuits can be brought where a person or entity, such as a school, church or youth organization, or daycare was charged with supervising the child but failed to do so with child sexual abuse resulting, making the individual or institution liable. In the Catholic sex abuse cases the various Roman Catholic Diocese in the United States have paid out approximately $1 billion settling hundreds of such lawsuits since the early 1990s. There have also been lawsuits involving the American religious right. Crimes have allegedly gone unreported and victims were pressured into silence.


title: Child sexual abuse

text: As lawsuits can involve demanding procedures there is a concern that children or adults who file suit will be re-victimized by defendants through the legal process, much as rape victims can be re-victimized by the accused in criminal rape trials. The child sexual abuse plaintiff's attorney Thomas A. Cifarelli has written that children involved in the legal system, particularly victims of sexual abuse and molestation, should be afforded certain procedural safeguards to protect them from harassment during the legal process.


title: Child sexual abuse

text: In June 2008 in Zambia the issue of teacher-student sexual abuse and sexual assault was brought to the attention of the High Court of Zambia where a landmark case decision, with presiding Judge Philip Musonda, awarded $45million Zambian kwacha (US$13,000) to the plaintiff, a 13-year-old girl for sexual abuse and rape by her school teacher. This claim was brought against her teacher as a "person of authority" who, as Judge Musonda stated, "had a moral superiority (responsibility) over his students" at the time.


title: Child sexual abuse

text: A 2000 World Health Organization – Geneva report, "World Report on Violence and Health (Chap 6 – Sexual Violence)" states, "Action in schools is vital for reducing sexual and other forms of violence. In many countries a sexual relation between a teacher and a pupil is not a serious disciplinary offence and policies on sexual harassment in schools either do not exist or are not implemented. In recent years, though, some countries have introduced laws prohibiting sexual relations between teachers and pupils. Such measures are important in helping eradicate sexual harassment in schools. At the same time, a wider range of actions is also needed, including changes to teacher training and recruitment and reforms of curricula, so as to transform gender relations in schools."


title: Brown recluse spider

text: The brown recluse (Loxosceles reclusa), Sicariidae (formerly placed in a family "Loxoscelidae") is a recluse spider with necrotic venom. Similar to those of other recluse spiders, their bites sometimes require medical attention. The brown recluse is one of three spiders in North America with medically significant venom, the others being the black widow and the Chilean recluse.


title: Brown recluse spider

text: Brown recluse spiders are usually between , but may grow larger. While typically light to medium brown, they range in color from whitish to dark brown or blackish gray. The cephalothorax and abdomen are not necessarily the same color. These spiders usually have markings on the dorsal side of their cephalothorax, with a black line coming from it that looks like a violin with the neck of the violin pointing to the rear of the spider, resulting in the nicknames fiddleback spider, brown fiddler, or violin spider.


title: Brown recluse spider

text: The violin pattern is not a definitive identifier, as other spiders can have similar markings (e.g. cellar spiders and pirate spiders). Instead, while most spiders have eight eyes, recluse spiders have six eyes arranged in pairs (dyads) with one median pair and two lateral pairs. Only a few other spiders have three pairs of eyes arranged in this way (e.g., scytodids). Recluses have no obvious coloration patterns on the abdomen or legs, and the legs lack spines. The violin marking can vary in intensity depending on the age of the brown recluse spider, with mature spiders typically having dark violin shapes.


title: Brown recluse spider

text: The documented range of this species lies roughly south of a line from southeastern Nebraska through southern Iowa, Illinois, and Indiana to southwestern Ohio. In the southern states, it is native from central Texas to western Georgia and north to Kentucky.


title: Brown recluse spider

text: Despite rumors to the contrary, the brown recluse spider has not established itself in California or anywhere outside its native range. There are other species of the genus "Loxosceles" native to the southwestern part of the United States, including California, which may resemble the brown recluse, but interactions between humans and the recluse species in California and the region are rare because those species native ranges lie outside of dense human populations. The number of "false positive" reports based on misidentifications is considerable; in a nationwide study where people submitted spiders that they thought were brown recluses, of 581 from California only 1 was a brown recluse—submitted by a family that moved from Missouri and brought it with them (compared to specimens submitted from Missouri, Kansas, and Oklahoma, where between 75% and 90% were recluses). From this study, the most common spider submitted from California as a brown recluse was in the genus "Titiotus", whose bite is deemed harmless. A similar study documented that various arachnids were routinely misidentified by physicians, pest control operators, and other non-expert authorities, who told their patients or clients that the spider they had was a brown recluse when in fact it was not. Despite the absence of brown recluses from the Western U.S., physicians in the region commonly diagnose "brown recluse bites", leading to the popular misconception that the spiders inhabit those areas.


title: Brown recluse spider

text: Over the last century, spiders have occasionally been intercepted in locations where they have no known established populations; these spiders may be transported fairly easily, though the lack of "established" populations well outside the natural range also indicates that such movement has not led to the colonization of new areas, after decades of opportunities. Note that the occurrence of brown recluses in a single building (such as a warehouse) outside of the native range is not considered as successful colonization; such single-building populations can occur (e.g., in several such cases in Florida), but do not spread, and can be easily eradicated. The spider has also received numerous sensationalized media reports of bites occurring where these spiders are absent (and no specimens were found), such as a 2014 report from Thailand, where a man was claimed to have died from a brown recluse bite. Many misidentifications and erroneous geographic records stem from the similarity between "L. reclusa" and a related introduced species, the Mediterranean recluse ("Loxosceles rufescens"), which is found worldwide, including numerous sightings throughout the United States; the two species are superficially almost indistinguishable, and misidentifications are common, making it difficult to distinguish which reports of recluses refer to which species.


title: Brown recluse spider

text: Adult brown recluse spiders often live about one to two years. Each female produces several egg sacs over a period of two to three months, from May to July, with approximately fifty eggs in each sac. The eggs hatch in about one month. The spiderlings take about one year to grow to adulthood. The brown recluse spider is resilient and can tolerate up to six months of extreme drought and scarcity or absence of food. On one occasion, a brown recluse survived in controlled captivity for over five seasons without any food at all.


title: Brown recluse spider

text: As part of the haplogynae, brown recluse do not balloon, which limits its ability to widely disperse geographically. The brown recluse will, though not habitually, cannibalize another if food becomes scarce; especially during its typical mating season from June to September or when an unreceptive female encounters an aggressive male.


title: Brown recluse spider

text: A brown recluse's stance on a flat surface is usually with all legs radially extended. When alarmed it may lower its body, withdraw the forward two legs straight rearward into a defensive position, withdraw the rearmost pair of legs into a position for lunging forward, and stand motionless with pedipalps raised. The pedipalps in mature specimens are dark and quite prominent and are normally held horizontally forward. When threatened it usually flees, seemingly to avoid a conflict, and if detained may further avoid contact with quick horizontal rotating movements or even resort to assuming a lifeless pose (playing dead). The spider does not usually jump unless touched brusquely, and even then its avoidance movement is more of a horizontal lunge rather than a vaulting of itself entirely off the surface. When running, the brown recluse does not leave a silk line behind, which would make it more easily tracked when it is being pursued. Movement at virtually any speed is an evenly paced gait with legs extended.


title: Brown recluse spider

text: The brown recluse spider displays autotomy as a defense mechanism against physical, predatory attack to a leg as well as to prevent predatory, venom injections from spreading to the rest of the body. "Once a leg is lost, a recluse spider does not regenerate a new one with subsequent molts", unlike the huntsman spider that does regenerate autotomized legs. With each time that a leg is autotomized, the recluse "changes its gait to compensate for the loss."


title: Brown recluse spider

text: Brown recluse spiders build asymmetrical (irregular) webs that frequently include a shelter consisting of disorderly threads. They frequently build their webs in woodpiles and sheds, closets, garages, plenum spaces, cellars, and other places that are dry and generally undisturbed. When dwelling in human residences they seem to favor cardboard, possibly because it mimics the rotting tree bark which they inhabit naturally. Human-recluse contact often occurs when such isolated spaces are disturbed and the spider feels threatened. Unlike most web weavers, they leave these lairs at night to hunt. Males move around more when hunting than the females, which tend to remain nearer to their webs.


title: Brown recluse spider

text: "Loxosceles reclusa" (as with all of the "Loxosceles" genus) can deliver, through envenomation via uncate chelicerae-type fangs, a potentially dermonecrotic loxoscelism due to the presence of sphingomyelinase D toxin in its venom. Most bites are minor with no dermonecrosis. However, a small number of brown recluse bites do produce dermonecrotic loxoscelism; an even smaller number produce severe cutaneous (skin) or viscerocutaneous (systemic) symptoms. In one study of clinically diagnosed brown recluse bites, skin necrosis occurred 37% of the time, while systemic illness occurred 14% of the time. In these cases, the bites produced a range of symptoms common to many members of the genus "Loxosceles" known as loxoscelism, which may be cutaneous and viscerocutaneous. In very rare cases, bites can even cause hemolysis—the bursting of red blood cells.


title: Brown recluse spider

text: As suggested by its specific name "reclusa" (recluse), the brown recluse spider is rarely aggressive, and bites from the species are uncommon. In 2001, more than 2,000 brown recluse spiders were removed from a heavily infested home in Kansas, yet the four residents who had lived there for years were never harmed by the spiders, despite many encounters with them. The spider usually bites only when pressed against the skin, such as when tangled within clothes, shoes, towels, bedding, inside work gloves, etc. Many human victims report having been bitten after putting on clothes or shoes that had not been worn recently or had been left for many days undisturbed on the floor. The fangs of the brown recluse are not large enough to penetrate most fabric.


title: Brown recluse spider

text: When both types of loxoscelism do result, systemic effects may occur before necrosis, as the venom spreads throughout the body in minutes. Children, the elderly, and the debilitatingly ill may be more susceptible to systemic loxoscelism. The systemic symptoms most commonly experienced include nausea, vomiting, fever, rashes, and muscle and joint pain. Rarely, such bites can result in hemolysis, low platelet levels, blood clots throughout the body, organ damage, and even death. Most fatalities are in children under the age of seven or those with a weak immune system.


title: Brown recluse spider

text: While the majority of brown recluse spider bites do not result in any symptoms, cutaneous symptoms occur more frequently than systemic symptoms. In such instances, the bite forms a necrotizing ulcer as the result of soft tissue destruction and may take months to heal, leaving deep scars. These bites usually become painful and itchy within 2 to 8 hours. Pain and other local effects worsen 12 to 36 hours after the bite, and the necrosis develops over the next few days. Over time, the wound may grow to as large as 25 cm (10 inches). The damaged tissue becomes gangrenous and eventually sloughs away. "L. reclusa" can produce slightly more than 0.1 microliters of venom, though the average yield is less.


title: Brown recluse spider

text: There is an ELISA-based test for brown recluse venom that can determine whether a wound is a brown recluse bite, although it is not commercially available and not in routine clinical use. Clinical diagnoses often use Occam's razor principle in diagnosing bites based on what spiders the patient likely encountered and previous similar diagnoses.


title: Brown recluse spider

text: A mnemonic device, "NOT RECLUSE", has been suggested as a tool to help laymen and medical professionals more objectively screen and diagnose potential cases of loxoscelism.


title: Brown recluse spider

text: There are numerous documented infectious and noninfectious conditions that produce wounds that have been initially misdiagnosed as recluse bites by medical professionals, including:


title: Brown recluse spider

text: Many of these conditions are far more common and more likely to be the source of necrotic wounds, even in areas where brown recluse spiders actually occur. The most important of these is methicillin-resistant "Staphylococcus aureus" (MRSA), a bacterium whose necrotic lesions are very similar to those induced by recluse bites, and which can be lethal if left untreated. Misdiagnosis of MRSA as spider bites is extremely common (nearly 30% of patients with MRSA reported that they initially suspected a spider bite), and can have fatal consequences.


title: Brown recluse spider

text: Reported cases of brown recluse bites occur primarily in Arkansas, Colorado, Kansas, Missouri, Nebraska, Oklahoma, and Texas. There have been many reports of brown recluse bites in California—though a few related species may be found there, none of these are known to bite humans. To date, the reports of bites from areas outside of the spider's native range have been either unverified or, if verified, the spiders have been moved to those locations by travelers or commerce. Many arachnologists believe that a large number of bites attributed to the brown recluse in the West Coast are either from other spider species or not spider bites at all. For example, the venom of the hobo spider, a common European species established in the northwestern United States and southern British Columbia, has been reported to produce similar symptoms as the brown recluse bite when injected into laboratory rabbits. However, the toxicity of hobo spider venom has been called into question as actual bites have not been shown to cause necrosis, and no such occurrences have ever been reported where the spider is native.


title: Brown recluse spider

text: Numerous other spiders have been associated with necrotic bites in the medical literature. Other recluse species, such as the desert recluse (found in the deserts of southwestern United States), are reported to have caused necrotic bite wounds, though only rarely. The hobo spider and the yellow sac spider have also been reported to cause necrotic bites. However, the bites from these spiders are not known to produce the severe symptoms that can follow from a recluse spider bite, and the level of danger posed by these has been called into question. So far, no known necrotoxins have been isolated from the venom of any of these spiders, and some arachnologists have disputed the accuracy of spider identifications carried out by bite victims, family members, medical responders, and other non-experts in arachnology. There have been several studies questioning the danger posed by some of these spiders. In these studies, scientists examined case studies of bites in which the spider in question was identified by an expert, and found that the incidence of necrotic injury diminished significantly when "questionable" identifications were excluded from the sample set. (For a comparison of the toxicity of several kinds of spider bites, see the list of spiders having medically significant venom.)


title: Brown recluse spider

text: First aid involves the application of an ice pack to control inflammation and prompt medical care. If it can be easily captured, the spider should be brought with the patient in a clear, tightly closed container so it may be identified.


title: Brown recluse spider

text: Routine treatment should include immobilization of the affected limb, application of ice, local wound care, and tetanus prophylaxis. Many other therapies have been used with varying degrees of success, including hyperbaric oxygen, dapsone, antihistamines (e.g., cyproheptadine), antibiotics, dextran, glucocorticoids, vasodilators, heparin, nitroglycerin, electric shock, curettage, surgical excision, and antivenom. In almost all cases, bites are self-limited and typically heal without any medical intervention.


title: Brown recluse spider

text: Outpatient palliative care following discharge often consists of a weak or moderate strength opioid (e.g. codeine or tramadol, respectively) depending on pain scores, an anti-inflammatory agent (e.g. naproxen, cortisone), and an antispasmodic (e.g. cyclobenzaprine, diazepam), for a few days to a week. If the pain or spasms have not resolved by this time, a second medical evaluation is generally advised, and differential diagnoses may be considered.


title: Brown recluse spider

text: In presumed cases of recluse bites, dapsone is often used for the treatment of necrosis, but controlled clinical trials have yet to demonstrate efficacy. However, dapsone may be effective in treating many "spider bites" because many such cases are actually misdiagnosed microbial infections. There have been conflicting reports about its efficacy in treating brown recluse bites, and some have suggested it should no longer be used routinely, if at all.


title: Brown recluse spider

text: Wound infection is rare. Antibiotics are not recommended unless there is a credible diagnosis of infection.


title: Brown recluse spider

text: Studies have shown that surgical intervention is ineffective and may worsen outcomes. Excision may delay wound healing, cause abscesses, and lead to scarring.


title: Brown recluse spider

text: Purportedly application of nitroglycerin stopped necrosis. However, one scientific animal study found no benefit in preventing necrosis, with the study's results showing it increased inflammation and caused symptoms of systemic envenoming. The authors concluded the results of the study did not support the use of topical nitroglycerin in brown recluse envenoming.


title: Brown recluse spider

text: Antivenom is available in South America for the venom of related species of recluse spiders. However, the bites, often being painless, usually do not present symptoms until 24 or more hours after the event, possibly limiting the effect of this intervention.


title: Brown recluse spider

text: Due to increased fear of these spiders prompted by greater public awareness of their presence in recent years, the extermination of domestic brown recluses is performed frequently in the lower midwestern United States. Brown recluse spiders possess a variety of adaptive abilities, including the ability to survive up to 10 months with no food or water. Additionally, these spiders survive significantly longer in a relatively cool, thermally stable environment.


title: Cleveland Browns

text: The Cleveland Browns are a professional American football team based in Cleveland. Named after original coach and co-founder Paul Brown, they compete in the National Football League (NFL) as a member club of the American Football Conference (AFC) North division. The Browns play their home games at FirstEnergy Stadium, which opened in 1999, with administrative offices and training facilities in Berea, Ohio. The Browns' official club colors are brown, orange, and white. They are unique among the 32 member franchises of the NFL in that they do not have a logo on their helmets.


title: Cleveland Browns

text: The franchise was founded in 1944 by Brown and businessman Arthur B. McBride as a charter member of the All-America Football Conference (AAFC), and began play in 1946. The Browns dominated the AAFC, compiling a 47–4–3 record in the league's four seasons and winning its championship in each. When the AAFC folded after the 1949 season, the Browns joined the NFL along with the San Francisco 49ers and the original Baltimore Colts. The Browns won a championship in their inaugural NFL season, as well as in the 1954, 1955, and 1964 seasons, and in a feat unequaled in any of the North American major professional sports, played in their league championship game in each of their first 10 years of existence, winning seven of those games. From 1965 to 1995, they qualified to play in the NFL playoffs 14 times, but did not win another championship or play in the Super Bowl during that period.


title: Cleveland Browns

text: In 1995, owner Art Modell, who had purchased the Browns in 1961, announced plans to move the team to Baltimore. After threats of legal action from the city of Cleveland and fans, a compromise was reached in early 1996 that allowed Modell to establish the Baltimore Ravens as a new franchise while retaining the contracts of all Browns personnel. The Browns' intellectual property, including team name, logos, training facility, and history, were kept in trust and the franchise was regarded by the NFL as suspended for three seasons. While several of the then-30 existing franchises considered re-locating to Cleveland, in 1998 it was confirmed that the NFL would field 31 teams when the Browns resumed play in 1999, thus while the 1999 Browns were not technically considered to be an expansion franchise, the club's roster was re-stocked via an expansion draft.


title: Cleveland Browns

text: Since resuming operations in 1999, the Browns have struggled to find success, especially during the 2010s when they did not post one winning season throughout that decade. They have had only three winning seasons (2002, 2007, and 2020), two playoff appearances (2002 and 2020), and one playoff win (2020), winning less than one third of their games in total, and in 2017 were only the second team in NFL history to have a 0-16 season after the 2008 Detroit Lions. The franchise has also been noted for a lack of stability with head coaches (10 full time - including two who were fired after only one season - and two interim since 1999) and quarterbacks (34 different starters since 1999). From 2003 to 2019, the Browns had a 17-season playoff drought, which ended during the 2020 season. They are one of four teams to have never appeared in a Super Bowl, along with the Detroit Lions, Houston Texans, and Jacksonville Jaguars.


title: Cleveland Browns

text: The history of the Cleveland Browns American football team began in 1944 when taxi-cab magnate Arthur B. "Mickey" McBride secured a Cleveland franchise in the newly formed All-America Football Conference (AAFC). Paul Brown was the team's namesake and first coach. The Browns began play in 1946 in the AAFC. The Browns won each of the league's four championship games before the league dissolved in 1949. The team then moved to the more established National Football League (NFL), where it continued to dominate. Between 1950 and 1955, Cleveland reached the NFL championship game every year, winning three times.


title: Cleveland Browns

text: McBride and his partners sold the team to a group of Cleveland businessmen in 1953 for a then-unheard-of $600,000. Eight years later, the team was sold again, this time to a group led by New York advertising executive Art Modell. Modell fired Brown before the 1963 season, but the team continued to win behind running back Jim Brown. The Browns won the championship in 1964 and reached the title game the following season, losing to the Green Bay Packers.


title: Cleveland Browns

text: When the AFL and NFL merged before the 1970 season, Cleveland became part of the new American Football Conference (AFC). While the Browns made it back to the playoffs in 1971 and 1972, they fell into mediocrity through the mid-1970s. A revival of sorts took place in 1979 and 1980, when quarterback Brian Sipe engineered a series of last-minute wins and the Browns came to be called the "Kardiac Kids". Under Sipe, however, the Browns did not make it past the first round of the playoffs. Quarterback Bernie Kosar, whom the Browns drafted in 1985, led the team to three AFC Championship games in the late 1980s but lost each time to the Denver Broncos.


title: Cleveland Browns

text: In 1995, Modell announced he was relocating the Browns to Baltimore, sowing a mix of outrage and bitterness among Cleveland's dedicated fan base. Negotiations and legal battles led to an agreement where Modell would be allowed to take his personnel to Baltimore as an expansion franchise, called the Baltimore Ravens, but would leave Cleveland the Browns' colors, logos and heritage for a reactivated Browns franchise that would take the field no later than 1999.


title: Cleveland Browns

text: After three years of inactivity while Cleveland Stadium was demolished and FirstEnergy Stadium was built on its site, the Browns were reactivated and started play again in 1999 under new owner Al Lerner. The Browns struggled throughout the 2000s and 2010s, posting a record of 101–234–1 () since their 1999 return. The Browns have only posted three winning seasons and two playoff appearances (2002, 2020) since returning to the NFL. The team's struggles have been magnified since 2012, when the Lerner family sold the team to businessman Jimmy Haslam. In six seasons under Haslam's ownership, the Browns went through four head coaches and four general managers, none of whom had found success. In 2016 and 2017 under head coach Hue Jackson, the Browns went 1–31 (, including a winless 0–16 season in 2017), the worst two-year stretch in NFL history, and received the number one overall draft pick in both of those years. In 2020, the Browns secured their first playoff berth since 2002 by defeating the Pittsburgh Steelers in week 17 and finishing the season 11–5.


title: Cleveland Browns

text: The Browns are the only National Football League team without a helmet logo. The logoless helmet serves as the Browns' official logo. The organization has used several promotional logos throughout the years; players' numbers were painted on the helmets from 1957 to 1960; and an unused "CB" logo was created in 1965. But for much of their history, the Browns' helmets have been an unadorned burnt orange color with a top stripe of dark brown (officially called "seal brown") divided by a white stripe.


title: Cleveland Browns

text: The team has had various promotional logos throughout the years, such as the "Brownie Elf" mascot or a Brown "B" in a white football. While Art Modell did away with the elf in the mid-1960s (believing it to be too childish), its use has been revived since the team's return in 1999. The popularity of the Dawg Pound section at First Energy Stadium has led to a brown and orange dog being used for various Browns functions. But overall, the orange, logo-less helmet continues as the primary trademark of the Cleveland Browns. The Browns have used special commemorative logos during individual seasons, such as the 1999 logo to celebrate the team's return to the NFL, a 60th-anniversary logo for the 2006 season, and a 75th-anniversary logo in 2021.


title: Cleveland Browns

text: The current logos and wordmarks were introduced on February 24, 2015, with the helmet design remaining largely as is, the only differences being minor color changes to the shade of orange used on the helmet and the facemask being changed from gray to brown.


title: Cleveland Browns

text: For the 2022 season - by virtue of a fan poll - the Brownie elf logo is featured at midfield at First Energy Stadium.


title: Cleveland Browns

text: The original designs of the jerseys, pants, and socks remained mostly the same, but the helmets went through many significant revisions throughout the years. The Browns uniforms saw their first massive change prior to the 2015 season.


title: Cleveland Browns

text: Helmet: Solid white (1946–1949); solid white for day games and solid orange for night games (1950–1951); orange with a single white stripe (1952–1956); orange with a single white stripe and brown numerals on the sides (1957–1959); orange with a brown-white-brown stripe sequence and brown numerals on the sides (1960); orange with a brown-white-brown stripe sequence (1961–1995 and 1999–present).


title: Cleveland Browns

text: Over the years, the Browns have had on-and-off periods of wearing white for their home games, particularly in the 1970s and 80s, as well as in the early 2000s after the team returned to the league. Until recently, when more NFL teams have started to wear white at home at least once a season, the Browns were the only non-subtropical team north of the Mason-Dixon line to wear white at home on a regular basis.


title: Cleveland Browns

text: Secondary numerals (called "TV numbers") first appeared on the jersey sleeves in 1961. Over the years, there have been minor revisions to the sleeve stripes, the first occurring in 1968 (brown jerseys worn in early season) and 1969 (white and brown jerseys) when stripes began to be silkscreened onto the sleeves and separated from each other to prevent color bleeding. However, the basic five-stripe sequence has remained intact (with the exception of the 1984 season). A recent revision was the addition of the initials "AL" to honor team owner Al Lerner who died in 2002; this was removed in 2013 upon Jimmy Haslam assuming ownership of the team.


title: Cleveland Browns

text: Orange pants with a brown-white-brown stripe sequence were worn from 1975 to 1983 and become symbolic of the "Kardiac Kids" era. The orange pants were worn again occasionally in 2003 and 2004.


title: Cleveland Browns

text: Other than the helmet, the uniform was completely redesigned for the 1984 season. New striping patterns appeared on the white jerseys, brown jerseys and pants. Solid brown socks were worn with brown jerseys and solid orange socks were worn with white jerseys. Brown numerals on the white jerseys were outlined in orange. White numerals on the brown jerseys were double outlined in brown and orange. (Orange numerals double outlined in brown and white appeared briefly on the brown jerseys in one pre-season game.) However, this particular uniform set was not popular with the fans, and in 1985 the uniform was returned to a look similar to the original design. It remained that way until 1995.


title: Cleveland Browns

text: In 1999, the expansion Browns adopted the traditional design with two exceptions: first, the TV numbers, previously on the sleeves, were moved to the shoulders; and second, the orange-brown-orange pants stripes were significantly widened.