Recent studies help victims of sexual abuse

by Dr. Kekuni Minton

Recently a woman entered my psychotherapy office and complained her relationship with her husband was being "disturbed" by events that happened to her years before: an episode of sexual abuse.

She felt her body was reacting as if her husband as the abuser, a reaction she felt was "crazy." She felt embarrassed and that her "problem wasn't getting any better." What she didn't realize was she was not crazy nor alone in suffering from such problems. These reactions are quite widespread in sexual abuse survivors, but are generally misunderstood.

This is because although sexual abuse is epidemic (one third of all women, 14 percent of all men), it is relatively invisible.

Ninety percent or more of all cases of sexual abuse remain unreported to authorities and little information about the effects of sexual abuse has been known or available until recently.

A recent Cincinnati Children's Hospital Medical Center long-term study sheds light on some of the effects of sexual abuse by compare development of sexual abuse survivors with non-abused girls.

The study reports, "There is disturbing evidence survivors of childhood sexual abuse continue to suffer throughout development.

"This suffering may manifest acutely, in childhood, immediately following disclosure of abuse, or may emerge or be revisited later in life as developmentally salient issues reminiscent of the abuse surface or resurface."

These "salient issues" include adult relationships where specific emotional content, relationship dynamics or sexuality may trigger emotional and body reactions reminiscent of the original sexual trauma.

For example, several women I have worked with felt quite "competent" relationally until the emotional attachment deepened. Then it was as if Pandora's box opened with irrational fears, defensiveness, loss of intimacy, anxiety and depression.

Sexually abused girls show a tendency toward revictimization. They report twice as many subsequent rapes or sexual assaults, incidents of domestic violence and four times the amount of self-harm events and incidents of suicide attempts as the normal population of girls.

Treatment

Psychological treatment is often quite successful, but because of the relative societal invisibility of the problem, it often takes some initiative by the sexually abused survivor to get treatment. Here are some of the basic effects of sexual abuse and how they may be treated:

• Low self-esteem and self-destructive behaviors - Survivors often see themselves as "dam- aged goods." In the course of the abuse, messages from the perpetrator ("it's your fault") or from the environment ("you deserved this") are often internalized into the psyche of the abused.

This is toxic to self-esteem. These belief systems must be recognized and confronted or they can tend to draw the sexually abused survivor into a cycle of abuse by self and others.

Also, it is important to understand the relationship between post-traumatic stress disorder and self-esteem.

Depression, social anxiety, phobias to traumatic stimuli and inability to cope are common psychological responses to traumatic experiences and tend to lower self-esteem. The post- traumatic stress disorder effects have been treated successfully by psychotherapy and in some cases, medication.

• Sexual disruptions - Sexual experiences after sexual abuse tend to trigger many of the body states that originally affected the survivor.

The symptoms tend toward re-experiencing the stress of the abuse (terror, overwhelm, pain, claustrophobia, fight or flight reactions) or pain-avoidant defenses (dissociation, loss of sensation, loss of pleasure, loss of erotic capacity).

Recognizing, talking about, and working with the specific relational triggers causing the body reactions often helps relieve the symptoms.

Also, recent advances in somatic (body) psychotherapy show great promise in treating the reactions.

• Relational disruptions - When a sexually abused survivor enters into a relationship, all the above symptoms may be triggered.

This may cause confusion and inability to cope with relational difficulties and sexuality. In this case, couples counseling is often helpful in educating both partners about sexual abuse and working with the relational dynamics that may trigger traumatized reactions in the survivor.

This Health Beat Article will be followed, in the future, by another article by Dr. Minton about the effects of traumatic experiences on the brain.