L’objectif de cette étude est d’explorer un lien entre un vécu d’abus sexuel et une situation d’inaptitude à l’éducation physique et sportive (eps), appelée communément « dispense de sport ».

Nous avons interviewé 361 adolescents de classe de seconde de deux lycées d’enseignement général ou des élèves de niveau équivalent (première année de bep) d’un lycée d’enseignement professionnel de Tours (France): soit 43% de garçons, n=151 et 57% de filles, n=204; âge moyen 16,58 ans, ET 0,87 an et étendue 4,67 ans.

Des questions exploraient un vécu antérieur d’abus sexuel (attouchements [1] ou sexualité forcée [2]) et le fait d’avoir déjà bénéficié au cours de sa scolarité d’un certificat d’inaptitude à l’eps: (a) à l’année, (b) de plus de trois mois, (c) pour des durées brèves, mais répétées et représentant au total plus de trois mois et (d) le fait d’être parfois absent du cours sans raison valable. Ces questions étaient complétées par des échelles sur la santé psychique (General Health Questionnaire, Goldberg 1972), l’estime de Soi (Rosenberg’s Self-Esteem Scale, Rosenberg 1965) et le niveau d’idéation suicidaire (Suicidal Ideation Questionnaire, Reynolds 1987).

En avril 2004 en classe (anonymat garanti et participation basée sur le volontariat).

La prévalence des abus sexuels parmi ceux qui ont bénéficié d’une inaptitude à l’eps est importante. Le vécu d’attouchements (1) parmi (a) les inaptitudes annuelles concerne 10,8% des filles (n=3); (b) 32,1% (n=9) pour les inaptitudes de plus de trois mois et (c) 50% (n=28) pour celles cumulées. Le seul garçon concerné n’a bénéficié d’aucun certificat d’inaptitude. Le vécu d’une sexualité forcée (2) concerne respectivement (a) 16,7% des filles (n=2), (b) 41,7% (n=5) et (c) 50% (n=6). Tandis qu’un des deux garçons concerné a bénéficié de toutes les formes de certificat d’inaptitude. Ces résultats sont confirmés par une analyse de variance. Pour les adolescentes, nous ne retrouvons un effet significatif que sur les inaptitudes de courte durée et cumulées (supérieures à trois mois d’arrêt) pour le vécu de violences sexuelles, ou de rapport sexuel forcé. Pour les garçons, il existe une influence de la sexualité contrainte sur les inaptitudes annuelles. Une recherche de corrélations complète cette approche. On retrouve un lien entre inaptitudes cumulées (supérieures trois mois) et un vécu d’attouchements, et de relations sexuelles contraintes. Il existe également une relation significative entre les inaptitudes supérieures à trois mois et les relations sexuelles forcées, et des liens entre l’absentéisme au cours d’eps et les deux situations d’abus. Ces résultats ont été complétés par l’étude des relations entre ce vécu d’abus sexuel et les variables psychologiques: les filles concernées présentent une plus grande morbidité psychique, une moins bonne estime d’elles-mêmes et davantage d’idéations suicidaires.

Cette étude montre l’existence d’un lien entre inaptitude à l’eps et vécu d’abus sexuel. L’expression de la souffrance psychique au travers d’une demande de certificat pour inaptitude à l’eps est moins repérable que des conduites à risque « bruyantes ». Par conséquent, toute demande d’inaptitude à l’eps de longue durée (annuelle ou de plus de trois mois) doit attirer l’attention des professionnels. Celles de courte durée et qui se répètent doivent faire l’objet d’une vigilance accrue, puisqu’elles ne sont pas contrôlées par le médecin scolaire. Ces situations d’inaptitudes ne peuvent être systématiquement rapprochées d’un vécu d’abus sexuel, mais elles sont une bonne occasion d’évaluer la santé psychique de l’adolescent, la qualité de son soutien social et du fonctionnement familial. Cette recherche apporte des premiers constats qu’il s’agira de compléter par des travaux ultérieurs.

In the course of a previous study on risky behaviors during adolescence, the first two authors uncovered a statistical link between a history of sexual abuse and medical exemptions from sports class. This association intrigued them, as it has not been described in the literature, although it is supported by the experience of several doctors employed by the National Education System, who are often confronted with revelations of sexual abuse during routine verifications of medical certificates for exemption from sports class. Cases of sexual abuse are frequently reported in the literature, with varying consequences, such as: feelings of degradation, difficulties inhabiting their bodies which they perceive to be dirty and/or damaged, associated with guilt that may incite the adolescent to injure his or her body or to put him/herself in danger. Frequently we see a drop in self-esteem and in feelings of well-being, a depressive symptomatology with more suicidal ideations and suicide attempts. During adolescence, the sexualization of the body obliges the adolescent to perform an intense narcissistic reshaping. Practicing a sport is one of the possible ways to appropriate this body in mutation. It appears to be a protective factor against anxious or depressive affects, encouraging identity building, high self-esteem, and a drop in suicidal ideations and contributes to better social integration. The emotional investment of hypermotricity may appear to oppose corporal inhibition, while they should both raise the issue of mastery over the sexual body. Exemptions from p.e. class thus take on a particular acuity given the stakes at his age. In France, the granting of an exemption from sports class is guided by legislation dating from 1988 and 1989, which was completed in 1994. For any medical exemption of three months or more (granted by the family doctor), the student (of primary school, junior high or high school) is re-examined by a school doctor who judges the legitimacy of the medical exemption certificate. In fact, a certain number of these situations can provide an opportunity to discover the mental suffering behind a physical complaint. The goal of this study is to confirm the link between a history of sexual abuse and a situation of exemption from sports class (long or partial exemption, single or repeated…) and the fact that this may be evidence of mental distress.

Population: we interviewed 361 adolescents in 10^th grade from 3 high schools in Tours (2 general high schools and a “professional” high school (high schools with a goal of preparing students for rapid insertion into the work force) in the “Centre” region of France): 43% boys, n=151 and 57% girls, n=204; with a median age of 16.58, SD=0.87 years and range=4.67 years. Students from the professional high school made up 18% of the total sample.

Questions exploring the relationship between students’ previous experiences of sexual abuse, with or without penetration (having been touched in a sexual way (1) or forced to participate in sexual intercourse(2)), and exemptions from physical education activities at some time during their school years: (a) for an entire year, (b) for more than 3 months, (c) for short but repeated periods which add up to more than 3 months altogether or (d) having been absent from class with no valid reason. These questions were completed with evaluations of mental health (General Health Questionnaire, Goldberg 1972), self-esteem (Rosenberg’s Self-Esteem Scale, Rosenberg 1965) and the level of suicidal ideation (Suicidal Ideation Questionnaire, Reynolds 1987).

In April 2004 in class (with guaranteed anonymity and volunteer participation (only 4 students refused to participate in the study).

Analysis of the reliability of the scale. The adaptation of the questionnaires to our population was measured by the Cronbach alpha coefficient and proved to be satisfactory: coefficients of 0.78, 0.83 and 0.96 for mental health (GHQ), self-esteem (RSS) and suicidal ideations (SIQ). Sexual abuse and exemption from sports. The prevalence of sexual abuse measured (1) sexual violence (fondling) is 0.6% of boys (n=1) and 13,9% of girls (n=28) and (2) forced sexual intercourse for 1.3% of boys (n=2) and 5.9% of girls (n=12). But many students did not answer these questions. Concerning exemptions from sports, we can emphasize the fact that 3/4 (n=260) of the high school students that we interviewed had at some time during their school attendance presented a certificate of medical exemption (of any length). Otherwise, we note that (a) 8% of boys (n=12) and 10% of girls (n=20) had presented a certificate for exemption of more than one year; (b) 18.7% of boys (n=28) and 21.4% of girls (n=43) for a period of more than three months; (c) 12.7% of boys (n=19) et 21% of girls (n=42) for short periods which add up to more than three months exemption from sports class and (d) finally that 16% of boys and 17% of girls had presented an unjustified absence. The prevalence of sexual abuse among those who had been exempted from p.e. activities is high: (1) 10.8% of girls excused from sports (a) (for the entire year) had experienced sexual abuse without penetration (n=3); as had 32.1% (n=9) of those exempted (b) for periods of more than 3 months and 50% (n=28) for those who had obtained (c) exemptions for all the different periods of time considered together. The only boy concerned had never been exempted from sports; (2) the experience of sexual abuse with penetration concerned, respectively, (a) 16.7% (n=2), (b) 41.7% (n=5) and (c) 50% (n=6) of the girls, while one of the concerned boys had been excused for all the different periods of time. A study into to the influence of a history of sexual abuse on the incidence of exemptions from sports is done by analysis of variance (anova). For adolescents, we do not find a significant effect on accumulated short-term exemptions (>3 months absence): F (1,198)=17.81; p<0.001 for a history of sexual violence (fondling) and F (1,198)=6.62; p<0.05 for an antecedent of forced sexual intercourse. For boys, there is an influence of a history of forced sexual intercourse and exemptions for the entire year: F (1,148)=4.95; p<0.05. The other tendencies observed are not significant. We find a link between exemptions adding up to more than three months and a history of sexual abuse: coefficient of correlation r=0.24, p<0.001 for sexual fondling and 0.16, p<0.05 for forced sexual intercourse. There is also a significant relationship between exemptions of more than three months and forced sexual intercourse (0.14, p<0.05). Finally, there are links between absenteeism from sports classes and two situations of abuse, (respectively 0.15, p<0.05 and 0.21, p<0.001). For the other relationships, the correlations are not significant. Sexual abuse, mental health, self-esteem and suicidal ideations. As very few of the boys stated that they had been exposed to one of the forms of sexual abuse (n=2) we only find insignificant tendencies concerning them (by correlation analysis). On the other hand, the girls presenting a history of sexual violence (fondling) have a diminished mental health (score above GHQ-12), lower self esteem and more suicidal ideations. Those who stated that they had been subject to forced sexual intercourse presented the same tendencies but only a rise in suicidal ideations is significant. Finally, the existence of meaningful links (>0.50, p<0.001) between a poor self-image, mental health (measured in the sense of psychic morbidity) and the rate of suicidal ideations shows that these 3 dimensions do indeed bear witness to suffering on the part of the subject.

The prevalence of sexual abuse in our population falls into the lower limits of those reported in the literature. The number of boys admitting to a history of abuse is too small to be exploited statistically. Their rate of non-response, higher than that of the girls, could lead us to believe that in reality their number is higher, especially as we know that boys express their suffering less directly than girls and have higher recourse to risky and antisocial behavior. This study allows us to confirm the relationship between exemption from sports class and a history of sexual abuse in the two forms we studied. (Fondling and forced sexual intercourse). A request for exemption from sports class may be the mark of an intense corporal malaise and represent indirect symptoms expressed by an adolescent who is the victim of sexual abuse. Reactional depression, defense mechanisms such as cleavage and dissociation may explain the increase in somatic complaints, which justify the request for exemption from sports. This flight from all physical activity or sports may also result more directly in an excessive pursuit of modesty, a denial or rejection of the body, feelings of shame or disgust towards the body. Physical activity and sports mobilize the adolescent in his physical, cognitive, emotional and social entirety. When a traumatism occurs, all of these aspects may be unsettled. The particularity of this work is its questioning of the relationship to sports and physical activity with a motricity of avoidance (socially adapted), which encourages putting separation of corporal trials and affects perceived as dangerous. These results complete the data described in the literature concerning the expression of suffering on the part of adolescents with a history of sexual abuse (suicide attempts, scarification, repeated accidents…) risky sexual behavior or the practice of intensive sports which tends to ensure mastery of the body. Any request for long-term exemption from sports class (for the entire year or more than three months) should attract. The attention of all professionals who may be concerned (school doctors, general practitioners, pediatricians, other specialists…, also indirectly sports teachers). Repeated short-term exemptions from sports (especially when they add up to significant periods of time) should be watched with increased attention, as they are not verified by school doctors. This also applies to absenteeism from sports class.

This study shows the existence of a link between exemption from sports class and a history of sexual abuse. The expression of mental suffering through the request for a medical exemption from sports class is more difficult to discern than “noisy” risky behaviors. Requests for medical exemption from sports class present a good opportunity to evaluate the mental health of adolescents, as well as the quality of social support system and family function. This research is a first look at these facts and should be completed by further research.