Each year, approximately 150,000-200,000 children are sexually abused, 70-80% of those cases involve a family member or a friend of the family that the child knows, including older children. It’s an appalling proposition to anyone who wants to work in the treatment of mental disorders. The people that we are supposed to trust, the “in group,” is more likely to do damage than any stranger. Even the most well-balanced counselors and therapists I know get floored by stories of child sexual abuse.
The Journal of Mental Health Counseling published an article by Frazier et al. covering some very good information regarding recovery from CSA. Here are some of the key facts regarding recovery:
- Primary symptoms of CSA include avoidance behaviors (including caregiver phobias), developmental delays, diminished responsiveness to the outside world, lack of interest in a previously-enjoyed activity, and feelings of detachment or estrangement.
- Survivors of CSA may lose developmental achievements. They may start bedwetting behavior, or they may become unable to feed themselves.
- When an abused child views their preabuse life as high-quality, they are more likely to have a positive self-view after the abuse.
- Survivors who believe that others do not view them as responsible for the abuse often feel empowered, leading to a more positive adjustment.
- Abused children who receive emotional support from a non-offending adult are less symptomatic.
Note that the emphasis of this article is on children. Adults who survived CSA are more likely to show symptoms of depression and anxiety, but children respond well to treatment. Frazier et al. recommends using an ecosystem approach in working with child survivors of CSA, and calls for counselors to be aware of transgenerational trauma, or situations in which a child keys into an adult’s behavior surrounding the adult’s experience with sexual abuse. Children are quick to pick up cues from parents. If we can assist these children as early as possible, we may be able to break that cycle.
Of course, CSA is not without its controversies. The biggest of which is probably the diagnosis of Dissociative Identity Disorder.
I’ve been reading bits and pieces of Science and Pseudoscience in Clinical Psychology, and last night I finished a chapter on DID (Lilienfeld & Lynn, 2003). It does a great job of highlighting the controversy surrounding DID.
Briefly, DID is a disorder in which a client presents with two or more distinct “personality states” that alternate in their control over the individual. It is one of the dissociative disorders, disorders which present with disturbances with memory, identity, or perception of the external world. The common belief regarding DID is that the development of separate personalities is caused by child sexual abuse. (note: this is a more recent development. The two famous early cases, those presented in The Three Faces of Eve and Sibyl contain no mention of CSA). The belief is that the child develops the second personality as a way of protecting the primary personality from facing the fact that they are being abused.
The other camp, the place where I hang my hat, claims that DID is the result of therapist cueing. Lilienfeld & Lynn point to a few facts: that a huge number of DID cases come from only a handful of therapists, the flexibility of memory as demonstrated by Elizabeth Loftus, the fact that a majority of the cases of DID begin treatment for other problems and do not report the expression of different personalities until later.
Lilienfeld and Lynn are quick to point out that they are not denying that DID patients experience these symptoms. The question is whether the symptoms are a natural reaction to trauma.
This leads me to a story. In an earlier job, I was treating a female with DID who claimed that her parents performed ritual sexual and satanic abuse. I was an undergraduate student at the time, and I happened to read one of Loftus’ memory studies around that time, and read the FBI statements that there had never been any documented cases of ritual satanic abuse in the US. I was confused, so I went to my boss. He was (and still is) a great counselor and he said “it probably isn’t true, but it is true to her.” This, or course, is a take on the old adage with schizophrenia, never challenge the delusion. Of course, it does beg the question, how do you treat someone who bases their life on events that did not occur?
(Original Photo by D Sharon Pruitt)
Frazier, K.N., West-Olatunji, C.A., St Juste, S., Goodman, R.D. (2009). Transgenerational Trauma and Child Sexual Abuse: Reconceptualizing Cases Involving Young Survivors of CSA Journal of Mental Health Counseling, 31 (1), 22-33