|
|
Adult sequelae of child sexual abuse |
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
There is little information on the causal relationship between the type
of abuse, the perpetrator, the time the abuse continued and the long-term
sequelae. This discussion concerns women survivors as little work has been
reported on men. Studies suggest that the ongoing problem areas include:
- 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.
In summary, studies suggest that less than one in five adult survivors of
childhood sexual abuse show serious psychopathology. Some have difficulties
of a lesser degree but many are proud to be true "survivors" having
used their courage and resources to overcome their childhood history.
Dr Jane Barker is a general practioner in Bangalow, NSW, Australia
This page was last built on 21/01/03. It was originally posted on 12/4/98; 8:40:51 AM.
|
|
|
|
