Child Abuse Trauma: Theory and Treatment

Everyone, whether young or old, is subjected to stressful events that may affect their physical as well as emotional, and social well-being. Undeniably, most of us go through a week of our lives without experiencing fear and anxiety, especially during childhood. Typically, children’s problems are just brief and highly solvable (Regan, J., Johnson, C., & Alderson, A., 2002). However, there are also instances when children undergo intense catastrophes that may alter the rest of their lives. One example of these life-altering catastrophes is child sexual abuse.

Child sexual abuse refers to a wide array of sexual behaviors that are imposed by an older person on a child. According to Julia Whelan (n.d.), these sexual behaviors are done to erotically satisfy the arousal of the older person, disregarding the reactions and feelings of the child or the effects of the act upon the child. Oftentimes, these acts include bodily contact such as touching, kissing, fondling of genitals, and, worst, sexual intercourse. Nevertheless, non-contact sexual abuse is also possible such as genital flashing, verbal pressure for sex, and sexual exploitation like prostitution and pornography.

Most of the time, men are found to be the perpetrators of sexual abuse. When also reported that usually, these perpetrators know the child they abuse; 60% of which are non-relatives such as a babysitter, neighbor, family friend, etc.; 30% are relatives such as the father, uncle, cousin, etc.; and 10% are strangers.

Indeed, sexual abuse is a very traumatic event, especially when the act involves severe injury and even life threats. Thus, such experience may possibly trigger psychological disorders in an abused child, particularly PTSD or Post-Traumatic Stress Disorder (Clark, 1997). In this paper, we will look at the effects of PTSD in an abused child and how gender concepts and social support groups like the family and social institutions interfere with this psychological imbalance.

Post-Traumatic Stress Disorder or PTSD normally results from the aftermath of a traumatic experience wherein the person experiences increased arousal as he or she re-experiences the trauma of the event; hence, the person avoids stimuli associated with the traumatic experience (Kring, Davison, Neale, & Johnson, 2007). There are three major symptoms of PTSD (Kring et al., 2007). First, re-experiencing the traumatic event occurs when the person recalls the traumatic event frequently, as well as when one experiences nightmares manifesting the event. Second, the person is trying to avoid the stimuli that may remind him or her of the event, which in turn may intensely upset him or her. Third, a person with PTSD experiences symptoms of increased arousal such as difficulty in sleeping and concentrating, hyper-vigilance, and exaggerated startle reaction. Moreover, PTSD patients also have suicidal tendencies.

Although PTSD is not a direct product of sexual abuse, it is a frequent condition that results from traumatic sexual abuse as when the child has been raped, abducted, threatened, or coerced. Within the general population, the experience of sexual trauma or abuse is associated with psychological disturbance (Briere, 1992; Kendall-Tackett, Williams, Finkelhor, 1993; Friedrich, 1998). Symptoms may vary among children; these may be severe, evolving into a chronic traumatic disorder (Wiener, 2000). Some may be quiet and immobile, avoiding expressing their angst and agitation. Some may even repress the traumatic memories of the experience.

Let’s take the case of a woman who was sexually abused in childhood, and let’s investigate how PTSD has affected her life (Kleiner-Fisman, Salloway, Fisman, 1998).

Children’s Hospital of Western Ontario, Canada, reported a case of a 42-year-old woman who was admitted to the institution with a 2-day history of weakness, choking on food, hoarse voice, and the perception of throat closure. Her medical records showed a recent diagnosis of myasthenia gravis, confirmed by nerve conduction studies and electromyography, for which she was taking low-dose pyridostigmine. The patient was intubated for airway protection and ventilatory support after a rapid decline of forced expiratory volumes. However, the patient had eventually extubated herself. She confided that she could never bear intubation again because it made her feel like being choked and suffocated. Apparently, this reaction was rooted in her childhood experience when she was sexually abused from the ages of five to eight. In being intubated, she had experienced similar feelings when coerced to perform a fellatio on her father. Surprisingly, the woman had no awareness of the traumatic childhood experience until she began engaging in sexual relations. She reported that she experienced nausea and vomiting during her first sexual experience; hence, she subsequently avoided sexual encounters. She was then bombarded with intermittent, intrusive recollections of the abuse. The patient only became conscious of her repressed early-life sexual trauma as she discussed the issue of reintubation with the medical team.

Based on this case, the woman is badly affected by recurrent and intrusive memories of childhood sexual abuse. Though initially repressed, the remnants of the sexual experience had caused her great psychological distress. She also exhibits consistent avoidance of stimuli related to the traumatic experience. Drawing from these symptoms, the woman meets the established diagnostic criteria for PTSD.

In her condition, she seemed functional in her daily undertakings. But in a deeper sense, her history of chronic anxiety and avoidance of experiences reveal more acute symptoms. According to Terr (1991), this pattern of behavior is evident among people with prolonged or repeated traumatic exposures.

Indeed, traumatic exposure can affect many aspects of a person’s well-being and functioning. Not only their mental state or the psycho-social situation is greatly disturbed, but also their physical well-being. Now, let’s look at the health hazards caused by PTSD.

Evidently, there are a number of possible ways that PTSD can affect one’s health (Schnurr, n.d.). Physiologically, increased cardiovascular reactivity, autonomic hyperarousal, disturbed sleep, adrenergic dysregulation, enhanced thyroid function, and altered HPA activity are direct implications of PTSD. Behaviourally, on the other hand, depression, hostility, and coping with smoking, eating disorders, lack of exercise, substance abuse, and others are closely linked to traumatic experiences.

In order to understand the biological implications of PTSD, the body systems’ regulation must be considered, how each system interacts with one another to keep the body in homeostasis. However, Schnurr (n.d.) emphasized the role of allostasis than homeostasis in explaining the bodily systems’ response to PTSD.

According to McEwen and Stellar (as cited in Schnurr, n.d.), allostasis, specifically allostatic load, provides a clear understanding of how PTSD could promote poor health. The basic principle of the allostatic load is that the physiological burden of high levels of stress may lead to increased susceptibility to disease due to altered immune system functioning (Kring et al., 2007). This goes to show that the strain of the load is cumulative and repetitive, thus producing damage to organs and organ systems.

Consequently, studies show that allostatic load directly predicts disease, particularly cardiovascular disease (McEwen & Seeman, 1999). Dutch researchers support this consequence; they found out that the survivors of a 2000 explosion at a fireworks depot who developed PTSD were more likely to develop vascular problems such as atherosclerosis, varicose veins, and swelling (“Physical Health Problems Often Accompany PTSD,” 2007). This proves that the amount of allostatic load is positively correlated with the incidence of disease.

In relation to this, behavioral disorders may also occur. As stated earlier, depression, hostility and coping, smoking, poor diet, lack of exercise have all been linked to worse health outcomes (Schnurr, n.d.). Smoking and drinking, for instance, have been used as defense mechanisms by people with PTSD in order to compensate with sympathetic arousal. Clearly, the outcomes of these acts could upset the body system’s balance. It has been a known fact that these produce health complications such as drastic weight loss, alcoholism, cirrhosis of the liver, hypertension, stroke, lung cancer, and a lot more (Kring et al., 2007). Worse, such behaviors may affect even the social functioning of a person.

The most conspicuous implication of PTSD in one’s social sphere is self-isolation. In this sense, the patient with PTSD perceives the social environment as an actual threat (Kring et al., 2007). Thus, one may just stay away from others for the fear that the traumatic stimulus will be triggered by other people. Likewise, he or she may pay more attention to negative cues in the surroundings. Ohman and Soares (1994) noted that this attentive reaction towards threatening situations happens automatically and rapidly beyond the person’s control and awareness.

In a nutshell, the social implications of PTSD are equally treacherous with physiological implications in one’s health. Health, as defined by the World Health Organization (1958), is a “complete state of physical, mental and social well-being, not merely the absence of disease or infirmity.” Thus, aside from treating illnesses, there is a great need to address the social inhibitions caused by PTSD. How, then, can we compensate with this shortcoming? Developing one’s role in the society is a noble key.

Establishing a role or identity is a necessity. This entitles a person to have a sense of belongingness and acceptance in the society. For people who have undergone traumatic experiences such as childhood sexual abuse, there is a need for them to feel that they belong, that they are accepted and welcomed by the society despite their dark past. They have to reconstruct their damaged sense of self. As Carl Jung emphasized, the innate disposition of the self is the desire to move toward growth, perfection, and completion (as cited in Feist, J. & Feist, G., 2003). This may be possible if a person who suffered from a traumatic event like sexual abuse rebuilds his or her self-concept.

Self-concept was defined by Carl Rogers as all encompassing of all the aspects of one’s being and one’s experiences consciously perceived by an individual (as cited in Feist, J. & Feist, G., 2003). It answers the question, “Who am I?” This is crucial especially to the victims of traumatic experiences; they must recover from their haunted past in order to establish a positive self-concept. Otherwise, they may possibly remain in their pathetic and hopeless world. Establishing self-concept entails one to move from a negative to positive state. A positive self-concept helps a person to be optimistic about life in general. Thus, an established self-concept does not make change impossible; perhaps, merely difficult. However, such change only occurs in an atmosphere of acceptance by others. This allows a person to reduce anxiety and threat and to take ownership of previously traumatic experiences.

By having an established self-concept, one adheres to a sense of belongingness and consequently, a person may boost his or her self-esteem or sense of self-worth. Maslow (1970) stressed that people may only pursue their esteem needs such as reputation and self-esteem as long as they have satisfied their belongingness needs. In general, self-esteem does not only pertain to reputation or prestige; it is a desire for strength, achievement, adequacy, competence, and confidence in the face of others.

When one has already attained the assurance of acceptance and belongingness from other people, subsequently, one can have the power to establish his or her social role.

It is important to note that all individuals, whether male or female, have a special role to play in the society. In this regard, gender also plays a vital part in one’s role development.

Sad to say, though males and females have equal privileges in having a distinguished social role, reality shows an unequal access to such privileges. In this generally male-dominated society, for instance, gender inequality may clearly interfere with one’s role development. This is true as in the case of sexual abuse where males are oftentimes found to be the perpetrators. In a nutshell, why do men abuse women?

Basically, there is no such generalization about a sexual abuse perpetrator. Nevertheless, Better Health Channel from Australia reported a number of reasons for this phenomenon. Accordingly, men use abuse, either physical or emotional, to impose control over women. This is supported by the notion that a “real man” is someone who is tough and powerful. Specifically, they uphold the belief that they are entitled to sex from women. Worse, they offer a lot of excuses for their socially undesirable acts; they try to minimize these by justifying or denying their use of abuse and even by blaming others as if they are only provoked to do such acts.

These power inequities have an intense impact on every aspect of the victim’s life particularly on her health. As reported by Queensland Health (2007), this impact may be severe and long lasting. The case of the 42 year-old woman presented earlier is a clear proof of the prolonged implication of abuse especially on women.

Though not all victims are women, statistics show that most of them are. Queensland Police Annual Statistical Review 1998-1999 showed a higher incidence of men’s sexual abuse against women than women’s sexual assaults over men; 1665 cases against 463 cases, respectively. This implies that women, whether young or old, indeed are at higher risk for violence, particularly sexual violence.

Overall, this gender inequality imposes a disturbance in women’s social well-being. Such experiences of abuse cause a great trauma to women thus resulting to lack of self-confidence, devastated self-concept, deflated self-esteem, and above all, damaged social role as one cannot perform her function well. Hence, the most feasible way of compensating with this dilemma is women empowerment.

According to World Economic Forum (2005), there is a great call to empower women. This may be done by measures proposed by United Nations Development Fund for Women (UNIFEM) which include the need to increase women’s access to social, economic, political, educational, and health and well-being aspects. Generally, women empowerment calls not for women domination but for gender equality. This equality refers to a stage at which the rights, privileges, opportunities and responsibilities of a person are not determined by being born male or female. If only men recognizes women with equal potentials as they have, perhaps, abuse such as sexual abuse would cease to exist.

Taking the case of people with PTSD as a result of childhood sexual abuse, we may ask, “Why do these people have prolonged suffering of the event?” One definite answer to this is the lack of social support. Studies show that sexually abused children who have intensified PTSD generally have sparse social networks and these limited networks only provide minimal support (Keltner & Kring, 1998). Logically, this lack of social support makes a person vulnerable, thus lowering one’s ability to handle stressful events in life. In relation to this, Brown and Andrews (1986) found out that women experiencing a severely traumatic experience without a confidant had a 40% risk of developing depression while those with support from a confidant only have 4% risk. Depression yields to heightening PTSD effects on one person; thus, social support serves as a minimizer of the major stressors in one’s life.

Social support can be in different forms. Typically, these are classified into two: structural and functional social support (Kring et al, 2007). Structural support group, as the name suggests, refers to one’s basic network of social relationships. On the other hand, functional support group refers more to the quality of one’s relationships.

The most important social support group helping develop the social roles of the abused victims is the family. Family, as the basic unit of society, plays a very substantial role in helping these victims cope with their lives.

Sexual abuse, being a sensitive experience, must be first addressed by the family members of a victim. They must show empathy and acceptance so as to make the person feel secured and accepted. The family must also give unconditional positive regard by showing a warm, positive, and accepting attitude toward the affected family member; without judgment, without blame, without shame. Sexual abuse is not a thing to be ashamed of by the family. After all, no one, especially the victim, wished for the event to happen. Being ashamed of the event or blaming the victim does no help; it only makes the situation worse. Thus, of all people, the family is expected to provide the deepest understanding and the warmest support for the victims in cases like this.

As a matter of fact, the family is now being used as a therapeutic technique. Thus is called family therapy (Kring et al, 2007). As such, family therapy has long been used to address specific concerns of a family member, specifically for the treatment of childhood disorders such as PTSD (Liddle, 1999).

Such family approaches for childhood disorders focus on improving parental intervention and discipline. The basic goal of family therapy is to improve communication, to change roles, or to address family concerns. For sexually abused victims with PTSD, family therapy is an effective tool in reducing their agitation and negative feelings. Moreover, the family members are also taught by family therapy to minimize expressed emotion of hostility and criticism, improve understanding of the disorder, and learn skills for managing the symptoms of the disorder (Kring et al, 2007).

Lebow and Gurman (1995) found out that family therapy is an effective tool in reducing the symptoms of a broad range of disorders including PTSD.

However, the family is not always of great help; in fact, there is also some evidence that interpersonal problems within the family are particularly likely to trigger psychological disorders such as PTSD. Much of the evidence is drawn from expressed emotions which involve critical and hostile comments or emotional under/over-involvement with a person suffering from a traumatic disturbance. In the study of Butzlaff and Hooley (1998), for instance, 69.5% of patients in families with high levels of expressed emotion relapsed after one year; a relatively high ratio compared to 30.5% of patients living in families with low level of expressed emotion.

Hence, if you are parent or sibling of a sexually abused child, show all the need, support, and reassurance for the child. Show them that you believe what they have told you. Emphasize that the event is not their fault. More importantly, show them that you truly care about what has happened and assure them of the protection from further abuse.

In the same manner, there are also some institutions that are willing to extend help to victims of traumatic experiences such as sexual abuse. There are a number of psychological treatments and interventions for such cases. Counselling, for instance, is an effective tool. Counseling is defined as “an interpersonal helping relationship which begins with the client exploring the way they think, how they feel and what they do, for the purpose of enhancing their life” (“Definition of Counseling”). It deals mainly with simple problems of daily life and even to the more complex ones like chronic illness or disability, domestic violence, substance-related disorders, sexual abuse, trauma, and a lot more. The main goal of counseling is to provide extra help and support for patients undergoing extreme difficulties in dealing with the catastrophes bombarding them. In doing so, the suffering person may have an increased sense of hope and acceptance which are relevant in one’s formation and reconstruction of self-concept, self-esteem, and social role.

By and large, being sexually abused is undeniably one of the many disheartening and devastating experiences that a person may encounter during childhood. As stated, PTSD frequently follows such event. Consequently, a number of physiological and behavioral complications then arise.

As in many cases of sexual abuse just like that of the 42 year-old woman, the common victims are not just victims physically. The more hurtful truth holds that they are also victims of society particularly of gender inequality. As reported earlier, women have higher risk of being abused. Furthermore, the effects of childhood sexual abuse are strengthened by imposing guilt, powerlessness, and blame to these women victims. Society has already stigmatized these victims as damaged and incapable of living a normal life.

However, this statement has been falsified. There are many survivors who are able to manage their lives and succeed in various professions and strata of society. They made this possible by exemplifying great strength and courage. Despite their haunted past, these survivors resist and fight the abuse in a number of ways and they try to find effective techniques in healing.

These successful reports are proofs that it is very possible to obtain recovery from extreme traumatic instances such as sexual abuse. It is important to emphasize that being sexually abused is not the victim’s fault. Sexual abuse especially violates a woman’s personal integrity, and her sense of safety and control over her life. Hence, social support groups such as the family, friends, and institutions are of great considerations in combating with the effects of traumatic experiences including PTSD.

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