CHILD SEXUAL ABUSE:THE INVISIBLE WOUND @ Lana Levin

CHILD SEXUAL ABUSE: THE INVISIBLE WOUND

?

?WRITTEN BY LANA LEVIN?

?

This article aims to provide the reader with an overview of the lasting effects of child sexual abuse. The article is broken down into several key areas: an overview of trauma including current statistics on what has been reported; signs and symptoms of child sexual abuse in both children and adults; the survivor?s coping skills and goals of therapy or treatment. For ease of reference, I have taken the position of referring to the perpetrator as a male and the victim as a female. This is in part because this form of abuse is the most prevalent. However, please use the information provided to reflect all forms of abuse survivors and abusers, as research has shown many similarities between male and female victims and symptomotology of child sexual abuse as perpetrated by either females and/or males.?

Overview of trauma: sexuality and identity?

Everyone experiences life crises, big or small. However, when theses crises challenge our very being and threaten our lives, they are called traumas. Trauma challenges a person?s fundamental beliefs about oneself, the world and other people. A primary trauma is one in which directly experienced by one?s self/physical body.[1] Sexual trauma is seen as a wound of the psyche, in other words, it is a wounding of one?s emotions, spirit, will to live, beliefs, dignity and one?s sense of security. Trauma is reserved to mean one of two types of experiences: natural catastrophes (such as hurricanes, earthquakes or fires), or man-made catastrophes (such as war, concentration camp experiences or abuse).[2] Herman (1992) notes tthat even a single traumatic event can have lasting-lasting effects.[3]

Sexuality is an intrinsic element of one?s being. At the moment of conception, a person?s sexual identity is defined. Becoming a man or a woman is part of life?s journey. Sexual abuse disrupts this and creates uncertainty of who one is as a sexual being. People generally avoid discussing sex. It is after all private, intimate and in some cases taboo. So what then is meant by ?sex??

Sex may be defined under three primary interpretations:

• Sex as the assignment of gender
• Sex as the biological act of procreation
• Sex as an expression of intimacy and love

Most people can relate to the gender and procreation aspects of sex and for adults who have not been abused, ?making love? and sharing the most intimate parts of one?s emotional and physical self are part of a healthy relationship. However, it is also this last definition that makes sexual abuse such a violation, particularly as the majority of perpetrators are not strangers to the survivor ? a national study in the United States indicated that 90% of child sexual abuse victims know the perpetrator in some way and 68% of victims are abused by family members.[4] These statistics are more than likely representative of the general world population. For adult survivors, the intimate side of sexuality is deeply challenged as the abuse roots sexuality in shame and guilt.

There are many ways that sexual abuse occurs. Currently, according to South Africa?s statutory definition, sexual abuse is much more inclusive of sexually abusive acts as it was in times gone by. Child (statutory) rape is regarded as any form of penetration of any area of the body with any object (digital, penile, oral or anal), and the general definition of sexual abuse is the touching of a child in inappropriate ways, exposing a child to inappropriate sexual material, child-pornography and suggestive remarks or innuendo. South Africa has one of the highest incidences of rape of children under the age of seven. These statistics only reflect the cases of reported rapes and it is estimated that the rates could be ten times higher than this.[5] It must borne in mind that child sexual abuse is perpetrated through the abuse of power and not for the sexual gratification of the abuser. Hence, perpetrators could be anybody who not only has access to a child but is also in a position of dominance.

Both international and South African studies estimate that one in three girls and one in five boys will be molested before the age of 18. [6]^;[7] In 149 studies of boys who were sexually abused, 90% of the perpetrators were men.[8] Although at least 5% of abusers are known to be women, the majority of abusers consist of male perpetrators. A myth surrounding child sexual abuse is that it is perpetrated by a stranger under threatening circumstances. This is simply not so. The majority of perpetrators are known to the child, that is, family members (fathers, brothers, cousins, uncles) or others close to the child (friends? parents, persons in a position of spiritual guidance, other children, medical professionals). Even if the perpetrator is a stranger, he tends to befriend the child and once some information is shared between the child and the abuser, the child no longer feels the perpetrator to be a stranger. Hence, it is rarely the case that a complete stranger sexually abuses a child. Paedophiles will find victims, however, in areas where children are not closely supervised, such as a public swimming pool. This article discusses the adult survivor of child sexual abuse as perpetrated by a male known to the female child.

There are two ways that abuse can occur. The first is that as a result of a pre-existing relationship, the perpetrator has access to a child and will immediately begin abusing the child. There may be little or no initiation process as the relationship is already established and the child may be abused in graphic ways from the start. The second form is where the perpetrator uses the child-adult relationship to prepare the child for ongoing abuse. Assuming that the perpetrator is known to the child, the perpetrator needs to win the child?s trust. This ensures accessibility, keeping a shared secret and the ?normalisation of the process?. This is known as the ?grooming process?. This is an important aspect for adult survivors, because it feeds into the notion that somehow they were responsible for the sexual abuse. However it is perpetrated the relationship is the root of guilt and shame.

Children speak the unspoken: signs and symptoms?

Children subjected to sexual over-stimulation, with or without threats, will develop problems. Those older than five years of age become caught between loyal to or dependant on the perpetrator as well as an awareness that what is occurring is wrong. However, the child does not blame the abuser and rather internalises the guilt and shame because she feels that she is doing something ?wrong.? Over time, the child develops low self-esteem, feelings of worthlessness or a sense of being damaged. Abnormal views relating to sexuality also develop.

Children may not approach an adult to express that she is being abused. This is as a result of fear and possible threats from the abuser. How then does one recognize such children? People often do not identify these signs as they may not see a sudden shift in the child or would put such a shift down to a ?phase?. Indeed, mothers are often unaware that their children are being abused. There is no definitive picture of an abused child as personality, support systems, isolation and social circumstances will mediate the child?s response. However, there are many signs, which cumulatively indicate the occurrence of child sexual abuse. These symptoms include inter alia the following:

• Withdrawal and mistrust of adults
• Suicidality
• Difficulty relating to others except in sexual or seductive ways
• Unusual interest in or avoidance of all things sexual or physical
• Sleep problems, nightmares, fears of going to bed
• Frequent accidents or self-injurious behaviours
• Refusal to go to school, or to the doctor, or home
• Secretiveness or unusual aggressiveness
• Sexual components to drawings and games
• Neurotic reactions (obsessions, compulsiveness, phobias)
• Habit disorders (biting, rocking)
• Covering up the body (such as wearing long sleeves in hot weather)
• Unusual and advanced sexual knowledge or behaviour, according to age
• Prostitution
• Forcing sexual acts on other children
• Extreme fear of being touched
• Unwillingness to submit to physical examination
• Specific physical indicators of recent sexual abuse include:
• Difficulty in walking or sitting
• Torn, stained or bloody clothing
• Pain or itching in genital area
• Bruises or bleeding in genital area or mouth
• Pregnancy or sexually transmitted diseases, especially in preteens
• Repeated urinary infections or genital blockages

Identifying adults abused as children

The effects of early sexual abuse last well into adulthood, affecting relationships, work, family, and life in general. Individual symptomatology tends to fall into four dominant areas:[9] identity, interpersonal relationships, emotional and/or psychiatric difficulties and sexuality.

In terms of identity, the woman may experience herself as ?damaged goods?. There is little or no sense of self. Her locus of control is usually external and self-trust very challenging. Many women describe themselves as feeling broken. In interpersonal relationships,. Child sexual abuse is such a violation of the child?s natural needs to be close with someone that the abuse?s impact can be severe. The adult survivor may thus constantly search for approval and nurturance .This is exacerbated by a sense of feeling different and stigmatised. The survivor may test relationships constantly in her attempts to gain reassurance that she is loved. Trusting others is often very difficult. The fear of betrayal is a constant companion. There may be blurred boundaries and role confusion. Emotionally there are intense feelings which may be difficult to manage. These include guilt, shame, self-blame, helplessness and grief. Psychiatrically the survivor may present with depression and anxiety, self-destructiveness (suicidal behaviours and self-mutilation). Addictions are also common with approximately 60% of people in drug rehabilitation having a history of child sexual abuse and 80% of people abused meet the criteria for at least one diagnosis of a psychiatric disorder[10]. On a sexual level, the survivor may fear her sexuality as well as experience guilt over having sexual needs or desires. There can be a variety of problems ranging from lack of libido to anorgasmia. Some women feel that if they are a willing party to the adult sexual experience then they were ?asking for it? as a child. Indeed, some survivors have dissociated so much that sexuality may not even feature in her sense of self. It may even be difficult for the survivor to taken care of even her most basic needs. Certain issues appear repeatedly. For example, victims typically blame themselves for the abuse, even if they were two or three years old at the time of the event. Guilt and shame are expressed, along with intense feelings of rage.[11] These feelings are cyclical and tend to re-emerge with triggers throughout the course of life. Living life on life?s terms is painful and scary.

Adult child sexual abuse survivors may demonstrate some, many or all of the following symptoms:

• Fear of the dark, fear of sleeping alone, nightmares, night terrors
• Difficulty with swallowing, gagging
• Poor body image, poor self-image in general (including eating disorders)
• Wearing excessive clothing
• Addictions, compulsive behaviours, obsessions
• Self-abuse, skin-carving/self-mutilation (also addictive),
• Suicidality
• Phobias, panic attacks, anxiety disorders, an exaggerated startle response
• Difficulties with expressing anger or rage
• Dissociation, de-personalization, inability to cope with stress
• Issues with trust, intimacy, relationships
• Issues with boundaries, control, abandonment
• Pattern of re-victimization, not able to say ?no?
• Blocking of memories, especially between age one and 12
• Feeling crazy, different, marked
• Denial, flashbacks
• Sexual issues and extremes
• Multiple personalities
• Signs of posttraumatic stress disorder

Beginning to heal: understanding the survivor?s fragility

An essential part of healing from child sexual abuse is disclosing the abuse to someone. The sexual molestation and the shame surrounding it thrive in an atmosphere of silence. Telling someone is possibly one of the hardest things to do, as no longer does the survivor protect the secret but also risks possible denial from others. Many survivors report difficulty simply owning the experience, that is, naming the abuse and taking on the title of survivor. The children and adult survivors may not tell of their experiences directly but will present with a variety of symptoms.

Trust is a key issue in sharing one?s story. However, forming relationships that are close and safe? especially with someone who bears witness to the process of healing- are essential to recovering a broken sense of self. It takes a long time to win this trust, however, as the survivor feels a constant sense of betrayal. She often feels guilty because she did not protect herself. Indeed she actually did. Keeping her secret was a method of survival. Sometimes this is because the abuser threatened her or in other ways created a feeling of a ?special secret?. As adults, the woman does not relate as a woman but rather as that of a scared child. In essence, her identity and emotions have been arrested at the point of abuse. She cannot grow because doing so would mean taking cognizance of the full extent of what has happened to her. So she battles through as a ?child-adult?.

Typically an adult survivor will try to compensate for her feelings of inadequacy through being an extremely hard worker, an over-protective mother and a ?perfect? wife. Often times, however, she feels that she is unreal or ?going through the motions?. This is because as a child, one of her primary survival strategies was to dissociate. This means that she would disconnect her mind from her physical body and in this way could both deny what was happening to her as well as avoid any sensations of pain. Once the abuse is over, the person goes into shock in and the adult-child struggles to trust her perception of reality. It is this confusion which leads to the hallmark double-guessing process so inherent in trying to recover. Furthermore, it is also why survivors struggle to remember a sequential pattern of events and experience flashbulb memories. Many survivors do not have memories of the abuse until they are older and have more resilience to cope with recall. However, this becomes a mind-field with many health care providers perpetuating survivor?s pain by denying the survivors? reality ? specifically as a result of false memory syndrome. People may not believe the survivor?s story as memories are neither sequential nor clear.

There has been a lot of controversy over the idea of manufactured memories ? memories ?implanted? by well-meaning therapists who want to identify for the person a reason for their bad feelings. False memory syndrome as defined by Peter J. Freyd describes a condition in which people recall events that are factually incorrect but believed to be true^[12]. This element of false memory syndrome has kept many survivors unable to move forward as they question the very validity of their memories and reality testing is in doubt. A therapist?s role is neither to push for memory recall nor invalidate memories when they are presented. Rather, ethical therapists will enquire purely around what is presented. It is the client?s truth and this is the reality that must be worked on.

Coping skills of survivors vary and are also determined by the severity of the abuse. This is expressed with caution because one incident of child sexual abuse can be as traumatic to one person, as several years of abuse to another. All experiences of child sexual abuse are traumatic to some degree, but its impact may not always affect the individual?s capacity for living a healthy and fulfilled life.

Coping skills: doing what it takes to survive

In coping with child sexual abuse, adult survivors develop many skills and defences. These must be respected as they serve to protect the survivor from constantly reliving and re-experiencing the trauma. In learning to adjust to the reality of one?s abuse, one needs to break down these defences slowly and with great sensitivity. Feeling safe is an internal process, not only one in which the survivor puts her trust in another.

There are emotional effects, varying from feelings of pain, betrayal, depression, confusion, powerlessness, to feelings of terror and an abhoration. As noted above, child sexual abuse also affects one?s beliefs about oneself. Such beliefs include ?I am bad?, ?I am dirty?, ?I am to blame? and ?if I had been smart enough I would have told someone?. In order to cope with the intensity of the emotional pain, survivors tend to minimise the effects of the abuse. This would be expressed as self-talk in varying guises: ?it wasn?t really that bad. Others have it worse?. This is a form of self protection and as a coping mechanism needs to be untangled slowly. To realise the severity of the child sexual abuse?s impact on one?s being can be traumatic in itself. Thus there is a fine line between respecting the need to take things slowly and the use of minimisation as a way of coping that reinforces negative beliefs such as self-blame and self-hatred. Rationalisation, that is, explaining the abusive behaviour away, is also common. This means that survivors continue to protect the perpetrator with reinforcing such internal messages as ?he didn?t know what he was doing. Anyway, he did it because he wanted to show me he loved me?. Denial reflects a survivor?s horror at what has happened, namely ?it didn?t really happen and I must be making this up. He?s such a good person, it can?t possibly be true?. Freyd?s interpretation of False Memory Syndrome perpetuates this denial and complicates the survivor?s capacity to heal. However, some form of denial can be healthy as emotional overload can occur if the full severity of the abuse is relived on a regular basis.[13] Dissociation is the experience of not being ?present? at the time of the abuse. Many survivors continue to dissociate, that is, create a split between the physical experiences of abuse and the way the mind interprets those experiences. Dissociation occurs on a continuum. On one end it means that the person feels ?spacey? and not present while the events are occurring (including recalling the events), while on the other end the personality fragments to such a degree that there are multiple personalities dealing with different parts of the survivor?s life. This extreme form of dissociation is referred to as multiplicity of in the DSM-IV as Dissociative Identity Disorder[14].

The healing process: finding safety?

Once a person has identified that sexual abuse has been part of her story, there are many goals in that need to be met in order for her to recover. The first step has already been monumental: she has broken the silence, by telling her secret, and thus begun to reprocess life. The core experience of psychological trauma are the feelings of disempowerment and disconnection from others.[15]

In the long run, goals of therapy include reclaiming identity, grieving and coming to some point of reconciliation.[16] A primary goal is also to empower the survivor and develop ego strength so that she no longer needs the defences of dissociation and victimisation. Essentially, this means that a good therapist will enable the survivor to control her own process of recovery, through the medium of validation and enable the survivor to control her own behaviour, rather than taking a prescriptive role. [17]This may or may not include forgiving the perpetrator. It is not necessary to forgive in order to recover. Sometimes the damage to self is so great and what has been stolen through the abuse is too much for forgiveness to take place. However, what is essential is that the survivor forgives herself. She needs to let go of the sense of self-blame and responsibility. A shame-based identity will not go away unless the survivor can learn that the abuse was not in her control. If she had been described as ?pretty? or ?seductive? this was not an invitation for anyone to abuse her trust. Children are entertainers by nature simply because they are inherently manipulative through their cuteness and charming manners. This does not mean that they are inviting sexual advances. Indeed, children do not even have the knowledge of how powerful their attractiveness can be. Therefore, the responsibility always lies solely with the perpetrator and never with the victim. Perpetrators will find every excuse to disown responsibility for their behaviours, to the extent that they will say to the child ?you are so pretty, you make me do this? or ?I can?t help myself because you are so cute? or even ?I?m getting you ready for adulthood because this is what people who love each other do, and you love me don?t you??.

The key issue is that when both children and adults present with stories that seem unreal, they need to be taken seriously. In some cases, justice is sought through legal prosecution. But in most cases adult survivors just want to survive and begin to thrive.

Adult survivors may also struggle with a tremendous amount of guilt as there may have been aspects of the abuse that they enjoyed. This could evolve from the way the body is built physiologically. It is designed to respond to sexual stimulation and hence the child may have become aroused or even climaxed. This in no way indicates that the child was a willing participant ? only that her body works normally. It is also true that children want to feel special and sexual abusers certainly have a manner of making the child feel this way. The child may even long for the validation she feels through the abuse. Since her identity is so shaken already, she becomes dependent on the perpetrator to make her feel loved and unique. There is a similar description of what is called the Stockholm Syndrome^[18] in which the survivor of a crime of captivity becomes attached to her persecutor. The Syndrome was first identified with a 1973 hostage incident in Stockholm, Sweden, where at the end of six days in captivity in a hostage situation at a bank, the survivors resisted rescue attempts. Stockholm Syndrome comes into play when a captive cannot escape and is isolated and threatened (often with death), but is also shown small acts of kindness by the captor. It typically occurs when there is a psychological shift of the abused becoming dependant on and even emotionally connected to the abuser. In terms of child sexual abuse the child is unable to escape from the perpetrator and as such experiences many of the same feelings as those held in captivity. This includes the child relying on the small incidences of positive experiences that the abuser and the abused may share together. It has been documented as a response to child sexual abuse.

Undoing this damage can be a life-long experience but survivors can and do get to a place where they can feel whole. Essentially, the adult has to ?grow the damaged child up?. This requires much nurturing and re-learning to exist in a world that is not an unsafe place. The survivor has to redefine her experiences with herself, her world and other people so that each is not seen as damaged, damaging or evil. With successful intervention, the survivor can heal. Essentially, healing occurs when the survivor can recall her experiences and not feel emotionally overwhelmed. They are part of her life story and not her definition of herself. Therapists co-create this through empowering the survivor to own her experiences and trust her truth.

As child sexual abuse has fed off the years of childhood and adolescence, recovery takes time. The defences built up did not happen over-night and neither shall the relief come over-night. However, being able to stay in a stable and long-term relationship (both with professional and inter-personal relationships) greatly improves the chances of a successful outcome.

As a final thought, watching someone become a person of truth and self-value is a gift. As therapists, what bigger inspiration is there than to journey with the child-adult until she flowers into an adult?

---

[1] Figley, C. (1992). Compassion fatigue as a secondary traumatic disorder: an overview. In C. Figley (Ed) Compassion fatigue: coping with secondary stress disorder in those who treat the traumatised. New York: Plenum Press

[2]???? Matsakis, A. (1992). I can?t get over it: a handbook for trauma survivors. New Harbinger Publications, Inc. CA.

[3] ??? Herman, J.L. (1992). Trauma and recovery. London: Pandora

[6]???? Childline, South Africa (1998)

[9]???? Heiman, M. (1988). Untangling incestuous bonds: The treatment of sibling incest. In M. Kahn & K. Lewis (Eds.), Siblings in Therapy, Norton & Co., N.Y.

[11]??? Hartman, M., Finn, S.E., & Leon, G.R. (1987). Sexual abuse experiences in a clinical population: Comparisons of familial and non-familial abuse. Psychotherapy, 24, 154-159

[12]??? McHugh, PR (2008). Try to remember: Psychiatry?s clash over meaning, memory and mind. Dana Press

[13]? Scurfield, R.M. (1985). Post traumatic stress assessment and treatment: overview and formulations. In C. Figley (Ed). Trauma and its wake (Vol. One). New York: Brunner/Mazal Publishers, Inc.

[14]??? American Psychiatric Association. (1994). Diagnostic and Statistical Manual of Mental Disorders, (fourth edition). Washington DC: Author

[15] Herman, J.L. (1992). Trauma and recovery. London: Pandora

[16] Classen, C. (1995). Introduction. In Yalom, I., Classen, C (Eds). Treating women molested in childhood. San Fransisco: Jossey-Bass Publishers.

[17] Herman, J.L. (1992). Trauma and recovery. Londond: Pandora

Source: http://lanalevin.co.za/child-sexual-abusethe-invisible-wound/

girl scouts printable bracket army wives game change own stacy francis tournament brackets