How many sufferers of abuse go on to abuse? Julia Hinde investigates.

Gitta Sereny's book on child killer Mary Bell suggests that the 11-year-old strangled two small boys partly because, from an early age, Bell was herself the victim of physical and sexual abuse at the hands of her mother.

What Sereny dismisses is the suggestion that Bell is innately evil. Many of the psychiatrists and social workers who treat children who abuse and, sometimes, kill other children would agree. Children are not born bad, they tell you, but are moulded by early life experiences. But what these professionals would question is the inevitability of Bell's reaction, and that of other abused children, to the events of their childhood. In Sereny's book and the debate that followed, there seems to be almost an assumption that it is unavoidable that a child who is sexually abused will go on to abuse others.

Rather, what the professionals stress is that whether a victim goes on to assault others is a complex issue. Given the risk factors in Bell's childhood, perhaps one should have expected her deviancy. But, just as the concept of innate evil deflects responsibility for a child's crime away from the child's original abuser, blaming the logic of childhood abuse takes responsibility away from the perpetrator. According to many psychiatrists, children who commit serious crimes are only too aware that they have done wrong.

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Much research has looked back to the childhoods of sexual offenders and collated figures for their early experiences of abuse. Such research shows that 30 to 90 per cent of offenders were abused as children. But what are more scarce are longitudinal studies, those which look forward and ask what proportion of victims will go on to abuse others.

According to Jonathon Hill, professor of child psychiatry at the Alder Hey Hospital in Liverpool, sexual abuse is very common. He suggests 20 per cent of women have experienced sexual abuse before the age of 16. The figure for men, he claims, is nearer 5 per cent. Catherine Spatz Widom, professor of American criminal justice, followed up the criminal histories of sexually abused children. She found that they were not more at risk of becoming adult abusers. But she did find a correlation between being physically abused (beaten or starved) as a child and later sexual offending.

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A similar study, funded by the Department of Health, is underway at London's Institute of Child Health. Dean McMillan, a psychologist involved in the project, says: "Not everyone who is abused goes on to abuse. No one really knows yet what the figures will look like, but the expectation is that the continuity will not be great." He adds: "Sexual abuse may be just one of many risk factors, such as emotional maltreatment, physical abuse and neglect, which mean children go on to sexually abuse others."

Mary Bell appears to have had all these risk factors in her childhood, but even then violence and sexual abuse of others is not inevitable, particularly for a girl. Sue Bailey, psychiatrist at Mental Health Services, Salford, says the timing of abuse is crucial in affecting a child's resilience. "Lots of kids say this horrible thing was going on, but another of their relationships was good. The other relationship is often with a teacher, who may not even recognise that they are giving these kids some small positive."

Surya Bhate, senior lecturer in psychiatry at Newcastle University, adds that compared to abused boys, abused girls very rarely turn on others. He suggests between 85 and 95 per cent of sexual abusers are boys, some as young as ten. "We don't understand why boys go on to abuse and girls don't," he says, pointing to a survey of offending boys in Newcastle which shows each abusive child had multiple difficulties. Many were from disadvantaged homes, they were often not doing well at school, and often lived in poverty. Only 41 per cent of these abusers were themselves sexually abused.

While boys tend to abuse others as a way of expressing trauma, girls turn on themselves, often becoming depressed. In extreme cases they self-mutilate. From Sereny's book we are left in little doubt that Mary Bell was sexually abused and that her strangling of two young boys in 1968 in Newcastle had a sexual dimension. So what was different in her case from that of the majority of the one in five girls who are sexually abused - but who, rather than inflicting their inner pain on others, instead turn it on themselves?

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