A nurse in a family practice clinic is collecting data from a school-age child. Which of the following behavioral findings should the nurse identify as a possible indication of sexual abuse?

A. Destructive behavior can be associated with various psychological issues, including conduct disorders or exposure to domestic violence, but it is not a primary indicator of sexual abuse. B. Withdrawn behavior is a common indicator of sexual abuse. Children who have experienced sexual abuse may exhibit social withdrawal, anxiety, depression, or reluctance to engage in normal activities due to fear or shame. C. Manipulative behavior may be a learned response to stress or trauma, but it is not a direct indicator of sexual abuse. Other underlying issues, such as difficulty with attachment, may contribute to manipulative tendencies. D. Perfectionistic behavior is often linked to high expectations from caregivers or anxiety disorders rather than sexual abuse. While trauma can contribute to perfectionism, it is not a key behavioral indicator.