Dr Jane Barker
Aboriginal Health
Psychiatry
The Heart of Parenting (Book review)
Children Disclosing Sexual Abuse
Adult Sequelae of Child Sexual Abuse
Table of Contents |
Statistics suggest that one in four girls and one in eleven boys are sexually assaulted by the age of 18. Childhood sexual abuse may have a detrimental effect on the child's emotional development. Abuse by a family member is a betrayal of trust and a violation of boundaries, which compromises the child's safe environment.
Sexual abuse does not inevitably lead to psychological and emotional problems and people who have been abused can develop the resources and strength to overcome their difficulties. Many are able to lead happy and fulfilled lives. For others the abuse has a profound effect and may lead to problems for the rest of their lives.
Sexually abused children may experience:
- powerlessness/loss of control
- feelings of guilt, shame and isolation
- loss of trust and safety
- associated physical and emotional abuse
- emotional and psychological problems
- sexual maladjustment
- problems with interpersonal relationships
- social functioning
Emotional and Psychological Problems
- Depression - The most commonly reported symptom, it may present as sadness, inability to experience pleasure, sleep and appetite disturbances and it may persist for many years.
- Low self esteem - They may feel unworthy of love or happiness and feel they deserve abusive relationships and unhealthy lifestyles. They may present themselves with negativity and lack of self love.
- Dissociative symptoms - This is a psychological defence against overwhelming emotions, a child's defence system carried on into adulthood. This disorder is seen more commonly amongst survivors of childhood sexual abuse than other psychiatric patients. It may present as suppressed memory (psychogenic amnesia), denial of self, or a feeling of being outside self.
- Flashbacks and nightmares - Suppressed memories are experienced in sleep as nightmares (particularly of a sexual nature) or as flashbacks when awake causing fear and anxiety in response to trigger events.
- Physical symptoms - Somatisation may present as headaches, dermatological disorders or pelvic pain. Survivors have a higher incidence of gynaecological problems.
- Self destructive behaviour - This may present as substance abuse - a history of childhood abuse is more commonly reported amongst survivors than other groups, or suicide attempts.
- Eating disorders - Survivors are more likely to have body image problems leading to eating disorders, particularly bulimia.
Defects in Interpersonal Relationships
- Impaired ability to form intimate and trusting relationships with men or women. Since the mother figure may be seen by the child as collaborating or at least failing to protect, survivors may feel anger towards both parents and may have difficulty relating to other women.
- Women victimised as children are more likely to become victims as adults and are more likely to be physically or sexually abused.
- Men who have been abused as children are more likely to become the perpetrators of abuse and this may be so of a small number of women survivors.
Sexual Maladjustment
- Low levels of sexual esteem - This may lead to inappropriate sexual behaviour, promiscuity or prostitution.
- Retreat from all sexual activities, particularly fear of men.
- Physical sexual problems - vaginismus, failure to obtain pleasure from sex, dyspareunia.
- Flashbacks during sexual activity.
- Fear of medical examination of genitalia or breasts.
Social Function
- Children may leave home early to escape from abuse. This may lead to them using anti-social survival techniques such a criminality or prostitution, and expose them to exploitation by other adults. Use of alcohol and other drugs is common. Feelings of isolation prevent socialisation.
Dr Jane Barker
General Practioner
Bangalow, NSW Australia
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