"Victim, Perpetrator, or Just My Brother?" Sibling Sexual Abuse in Large Families: A Child Advocacy Center Study.

Sibling sexual abuse (SSA) is a continuum of childhood sexual behaviors that do not fit the category of age-appropriate curiosity. Although SSA may be the most prevalent and longest lasting form of intrafamilial sexual abuse-as well as the one with the worst repercussions-it is also the least reported, studied, and treated. Based on 100 mostly religious Jewish families referred to a child advocacy center (CAC) in Jerusalem from 2010 to 2015, this qualitative study examines SSA characteristics, dynamics, and perceptions of deviancy in multisibling subsystems. The findings are based on an analysis of case summaries, demographic charts, and documented conversations between social workers and siblings. Qualitative document analysis reveals two types of SSA dynamics: "identified perpetrator" and "routine relationship," the latter being a particularly understudied dynamic that challenges common stereotypes. We also found sibling perceptions of deviancy to vary along a continuum from deviant to completely normative. These perceptions are affected by the type of dynamics as well as by factors associated with disclosure. Our findings highlight the importance of studying the lived experiences of children involved in SSA as an input with critical policy, treatment, and research implications. Interventions must be adjusted to the family system and sibling subsystem's perceptions and needs to avoid treatment that exacerbates the crisis already experienced by the family. Common assumptions-there must be a "perpetrator"; abuse is necessarily traumatic; and treatment should focus on the trauma-are challenged by the routine type. We conclude that treatment should account for the complexity of SSA by shedding these assumptions and considering the sibling subsystem as an autonomous unit within the large family.