Indicators of Ritual Abuse

Category 1. Problems associated with sexual behavior and beliefs:
A. Child talks excessively about sex; shows age-inappropriate sexual knowledge; uses words for sex and body parts which are not used in the family.
B. Child is fearful of being touched or of having genital area washed; resists removing clothes for baths, bed, etc.
C. Child masturbates compulsively or publicly, tries to insert finger or object into vagina or rectum.
D. Child pulls down pants, pulls up dress inappropriately.
E. Child touches others sexually, asks for sex, interacts in an inappropriately sexualized fashion. Child is sexually provocative or seductive. Initiates sexual contact, has a preoccupation with sex. 

F. Child complains of vaginal or anal pain or burning in the genital area when washed, pain when urinating or defecating. 
G. Semen or blood stains are evident on child's underwear.
H. Child "hints" about sexual activity, complains someone is "bothering" him/her.
I. Child refers to sexual activity between other children or between him/herself and another child, in the abusive setting.
I. Child states someone removed his/her clothes.
K. Child states someone else exposed self to him/her.
L. Child states someone touched or penetrated his/her bottom, vagina, penis, rectum, mouth, etc. 

M. Child states (s)he was made to touch or penetrate someone's bottom, vagina, penis, rectum, mouth, etc.
N. Child states that sharp objects were inserted in his/her private areas.
0. Child states (s)he witnessed sex acts between adults, adults and children, adults or children and animals, etc

P. On examination by a pediatrician specially trained to diagnose sexual abuse in children, child relaxes rather than tenses rectum when touched; relaxed anal sphincter, anal or rectal laceration or scarring.
Q. On exam, blood or trauma around genital area; enlargement of vaginal opening, vaginal laceration or scarring in girls; sore penis in boys.
R. On exam, venereal disease.
S. Female child refers to being married, states that she is married, is going to have a baby; or, child states she will never be able to have a baby. 

T. Alludes to having nude pictures taken of them, strikes provocative poses etc

Category 2. Problems associated with toileting and the bathroom:
A. Child avoids bathroom; seems fearful of bathrooms, becomes agitated when has to enter a bathroom.
B. Child avoids or is fearful of using toilet; has toileting accidents because (s)he puts off going; develops chronic constipation. 

C. Child of toilet-training age is fearful and resistant to being toilet trained. 

D. Child avoids wiping self because it is "too dirty"; child's underwear is soiled because (s)he will not wipe, or due to relaxed anal sphincter. 

E. Child avoids bathtub; fears bathing; resists being washed in genital area. Child has an abnormal fear of water. 

F. Child is preoccupied with cleanliness, baths; changes underwear excessively. 

G. Child is preoccupied with urine and feces; discusses it compulsively or at meal times; becomes agitated while discussing it. Child uses words for bodily wastes that are not used at home, especially "baby" words. Child compulsively discusses or imitates passing gas. 

H. Child acts out in toileting behavior, eliminating inappropriate places, handling urine or feces, dirtying an area or sibling with bodily wastes, tasting or ingesting wastes. 

I. Child draws nude pictures of self or family members urinating or defecating. 

J. Child talks about ingesting urine or feces, having it put on his/her body or in his/her mouth, being urinated or defecated upon, or having any of these things happen to someone else.
K. Child has a fascination with excrement and puts it on self, a sibling parent or pet
Category 3. Problems associated with the supernatural, rituals, occult symbols, religion:
A. Child fears ghosts, monsters, witches, devils, dracula, vampires, evil spirits, etc.
B. Child believes such evil spirits inhabit his/her closet, enter the house, peer at the child through windows, accompany the child, torment or abuse him/her or watch to make sure (s)he keeps secrets, inhabit the child's body, and/or direct the child's thoughts and behavior.
C. Child is preoccupied with wands, sticks, swords, spirits, magic potions, curses, supernatural powers, crucifixions, and asks many or unusual questions about them. Child makes potions, attempts magic, throws curses, calls on spirits, prays to the devil.
D. Child sings odd, ritualistic songs or chants, sometimes in a language incomprehensible to the parent; sings songs with a sexual, bizarre, or "you better not tell" theme.

E. Child does odd, ritualistic dances which may involve a circle or other symbols. Child may costume him/herself in red or black, take off his/her clothes, or wear a mask for such dances. 

G. Child fears or has a fascination or preoccupation with occult symbols, satanism, religion and rituals and/or becomes agitated or upset in their presence. 

H. Child fears attending church, becomes agitated or upset in church, fears religious objects or people, refuses to worship God. Contempt for and rage at God, Jesus and Christianity

I. Child states that (s)he or someone else prayed to the devil, threw curses, made potions, performed ritualized songs or dances, called upon spirits, did magic. Child states that (s)he or someone else wore ghost, devil, dracula, witch etc. costumes, used ceremonial wands or swords, had their body painted (usually black).
J. Child writes the number 666, drawing pentagrams, inverted crosses and other occult symbols.
K. Fear of or fascination with ghosts, devils or believing that they have demons
L. Later in life, having tattoos with specific symbols

M. Cutting symbols into skin
Category 4. Problems associated with small spaces or being tied up:
A. Child fears closets or being locked in small spaces like a closet, attic. 

B. Child fears other small spaces e.g., elevators, becomes agitated if forced to enter one. 

C. Child closes pets or other children in closets, or otherwise attempts to entrap or confine them. 

D. Child states that (s)he or someone else was confined in a closet. 

E. Child expresses fears of being tied up, states that (s)he or someone else was tied up. 

F. Child expresses fears of being tied (usually by one leg) and hung upside down, states that j(s)he or someone else was hung upside down.

G. Rope burns are evident on the child. 

H. Child attempts to tie up other children, pets, parents, etc. 

Category 5. Problems associated with death: 

A. Child is afraid of dying; states (s)he is dying, or fears (s)he will die on his/her sixth birthday. 

B. Child states that (s)he is "practicing" to be dead, or is dead.

C. Child is afraid parents, sibling, other family members, or friends will die. D. Child talks frequently of death, asks many questions about illness, accidents, and other means by which people die. Questions may have an overly anxious, compulsive or even bizarre quality.
Category 6. Problems associated with the doctor's office: 

A. Child fears, avoids visits to the doctor; becomes highly agitated in or on the way to the doctor's office; refers to "bad doctors," or otherwise expresses mistrust of the doctor's motives. 

B. Child is excessively fearful of shots; may ask if (s)he will die from the shot. 

C. Child is excessively fearful of blood tests; asks if (s)he will die from blood tests or whether someone will drink the blood. 

D. Child fears taking clothes off in the doctor's office; asks whether (s)he will have to walk around naked in front of others. 

E. Child behaves in a sexually seductive way on the examining table, appears to expect or "invite" sexual contact.

F. Child states (s)he or someone else received "bad shots," had to take clothes off or have sexual contact with others, drank blood, or was hurt by a "bad doctor". 

Category 7. Problems associated with certain colors:
A. Child fears or strongly dislikes red or black (sometimes orange, brown, purple); refuses to wear clothes or eat foods of these colors,becomes agitated in the presence of them. 

B. Child states that black is a favorite color, for peculiar reasons. 

C. Child refers to ritualistic uses of red or black that are inconsistent with what (s)he has experienced in church.
Category 8. Problems associated with eating: 

A. Child refuses to ingest foods or drinks because they are red or brown (e.g. red drinks, meat); becomes agitated at meal times. Child refuses to eat foods or drink fluids associated with those colors (meat, spaghetti, tomatoes, grape or tomato juice)

B. Child expresses fears that his or her food is poisoned; refuses to eat home cooked food because (s)he fears the parents are trying to poison him/her, refers to poisons of various types. 

C. Child binges, gorges, vomits, or refuses to eat. 

D. Child states that (s)he or someone else was forced to ingest blood, urine, feces, human or animal body parts.
E. Sudden eating disorder, refusing to eat or wanting to eat excessively
F. Having problems with certain textures while eating
G. Child becomes agitated or fearful at meal times
H. Exaggerated gag reflex

Category 9. Emotional problems (including speech, sleep, learning problem s): 

A. Child has rapid mood swings, is easily angered or upset, tantrums, acts out. 

B. Child resists authority. 

C. Child is agitated, hyperactive, wild. 

D. Child displays marked anxiety, e.g. rocking, nail biting, teeth grinding. E. Child feels (s)he is bad, ugly, stupid, deserving of punishment. 

F. Child hurts self frequently, is accident prone. 

G. Child is fearful, withdrawn, clingy, regressed, babyish. 

H. Child's speech is delayed or regressed, speech production drops,speech disorder develops. 

I. Child has "flat" affect, fails to respond in emotionally appropriate ways. J. Child has frequent or intense nightmares; fears going to bed, cannot sleep, has disturbed sleep. 

K. Child has poor attention span, learning problems.
L. “Ever present” panic states.
M. Child age regresses in noticeable ways.
N. Higher levels of hostility towards self and others (increased aggressiveness) hurting other children.  

O. Self harm cutting or burning self.
Category 10. Problems associated with family relationships: 

A. Child fears the parent(s), pets will die, be killed, or abandon him/her or be molested.  

B. Child fears (s)he will be kidnapped and forced to live with someone else. 

C. Child is afraid to separate from parents, cannot be alone at all, clings. 

D. Child fears the parent(s) no longer love him/her, are angry and wish to punish him/her, or want to kill him/her.

E. Child seems distant from parent(s), avoiding close physical contact. 

Child "screens out" what the parents say, failing to retain information they give. 

G. Child becomes excessively angry or upset when told what to do or "no" by the parent(s). 

H. Child talks about "my other mommy", "my other daddy", or "my other family" (in the cult). 

I. Child expresses fears that a sibling or pet will be killed, kidnapped, molested.

J. Child physically attacks, initiates sexual contact with, confines, puts excrement on or threatens a parent, sibling, or pet. 

K. Child states that someone said his/her parents would die, be killed, abandon or try to hurt the child. Child states someone said (s)he would be kidnapped.
Category 11. Problems associated with play and peer relations: 

A. Child destroys toys. 

B. Child acts out death, threats, torture, bondage, mutilation, cannibalism,  sexual perversion, cannibalism, burial themes by pretending to kill play figures, taking out eyes, pulling off heads or limbs, pretending to eat the figures or drink their blood, and burying them. 

C. Child’s play involves theme of drugging, threats, humiliation, torture, bondage, magic, weddings and other ceremonies. Discusses drugs, pills, and drug-like effects. 

D. Child is unable to engage in age-appropriate fantasy play, or can do so for only brief periods. 

E. Child hurts other children, sexually and/or physically. 

F. Child's drawings or other creative productions show bizarre, occult, sexual, excretory, death or mutilation themes. 

G. Child is extremely controlling with other children, constantly plays "chase" games. 

H. Child talks to an "imaginary friend" who (s)he will not discuss, or who (s)he states is a "spirit friend". 
Category 12. Other fear, references, disclosures and strange beliefs:
A. Child fears the police will come and put him/her in jail, or states a "bad policeman" hurt or threatened him/her. 

B. Child is excessively afraid of aggressive animals, e.g. crocodiles, sharks, large dogs, or poisonous insects; states (s)he was hurt or threatened such animals or insects.  (especially has a fear of spiders, snakes, rats, and bugs that crawl)

C. Child fears the house will be broken into, robbed, or burned own, or states someone threatened that this would happen; may wish to move somewhere else. 

D. Child fears "bad people", "robbers," "strangers," or states (s)he had contact with such people; watches out the window for "bad people". 

E. Child discusses unusual places such as cemeteries, mortuaries, church basements, etc., or states (s)he or others were taken to such places; displays seemingly irrational fears of certain places. 

F. Child alludes to pictures or films of nude people, sometimes with references to sexual acts, provocative poses; states (s)he was a victim of pornography. 

G. Child discusses drugs, pills, bad candy, alcohol, mushrooms, "bad medicine," or injections in an age-inappropriate manner; may refer to drug or laxative effects, or state he was given a substance. Upon returning from an abusive setting, child’s eyes may be glazed, pupils dilated or constricted; (s)he may be difficult to rouse and may sleep excessively. 

H. Child fears his/her own blood, becomes hysterical, thinks (s)he is dying. 

I. Child excessively fears violent movies. 

J. Child believes or fears there is something foreign inside her chest or stomach, e.g., Satan’s heart, a demon or monster, a bomb, spiders, snakes that are poisonous, etc. 

K. Child talks about animals, babies, human beings confined, hurt, killed, mutilated, eaten, etc. 

L. Child experiences constant illness, fatigue, allergies, and somatic complaints, e.g. stomach, abdominal pain, or leg pains. 

References
Gould 1988 abridged version of “Children who have been victims of ritual abuse may have problems associated with the following:” as published in the Psychologists Interested in religious issues Newsletter American Psychological Association Division 36, Volume 14, No 1, Winter/Spring 1989
C. Gould. 1988 Catherine Gould, Ph.D., 16661 Ventura Blvd., Suite 303, Encino, CA 91436 (213) 650-0807.
Hopponen (1987)