Common Presenting Symptoms
Survivors who
do not initially disclose a history of childhood sexual abuse will often present
with a variety of non-specific psychiatric symptoms or with various social or
personal issues. Typically, survivors hope counseling will provide relief from
these symptoms or difficulties. They may focus on one or two symptoms or may be
troubled by many. Some of the more common presenting issues of survivors include:
Depressive
symptoms including feelings of guilt and shame, low self-esteem, low self-efficacy,
and unresolved grief.
Anxiety symptoms including generalized
anxiety, phobias, panic attacks, trauma symptomatology (e.g. nightmares, flashbacks,
dissociative experiences), and fear of invasive medical procedures.
Sexual
problems including sexual dysfunction (e.g. impaired arousal, orgasmic difficulties,
vaginismus, painful intercourse, impotence), avoidance of sexual intimacy, sexually
aggressive and compulsive behaviors, sexual identity confusion, and general sexual
dissatisfaction.
Interpersonal problems including difficulty
forming and maintaining intimate relationships, a pattern of involvement in unsatisfactory
relationships (sometimes involving continued physical, emotional, or sexual abuse),
distrust of men or women, isolation, poor social skills, and parenting problems.
Self-destructive behaviors including substance abuse,
eating disorders, self-mutilation, suicide attempts, and self-defeating behaviors
(e.g. occupational underachievement, inability to provide enjoyable or relaxing
activities for self).
Perceptual disturbances including
visual (e.g. seeing 'shadowy' figures), auditory (e.g. hearing footsteps at night),
and tactile (e.g. being touched by another) sensations.
Somatic
complaints including pelvic pain, migraine headaches, and chronic sleep disturbances.
Aggressive
behaviors including sexual offending, physical abuse of others, and antisocial
conduct.
Models That Organize Presenting Symptoms
Although the presence of several of these commonly experienced symptoms might
suggest that the client has had some experience with childhood sexual abuse, these
symptoms are numerous, varied, and non-specific, having many possible etiologies.
Such lists can have only limited utility in detecting a history of undisclosed
childhood sexual abuse. However, some authors have organized these symptoms into
meaningful, conceptually-based frameworks to aid counselors in detecting an undisclosed
history of sexual abuse and in understanding how these multiple and varied symptoms
might be related to abusive experiences in childhood.
A predictive
syndrome Ellenson, noting the wide variety of symptoms experienced by incest survivors,
attempted to specify a 'syndrome that is exclusively related to a history of childhood
incest' (1985: 525). He called this a predictive syndrome because he believed
that the presence of certain characteristic symptoms could differentiate women
who had been incestuously abused from those who had not. The framework is divided
into symptoms reflecting thought content disturbances and perceptual disturbances.
Certain combinations of the symptoms (e.g. seven total symptoms, five symptoms
including at least one perceptual symptom) are thought to be highly predictive
of incest, as these symptoms differ from symptoms that constitute other related
syndromes (e.g. posttraumatic stress disorder (PTSD) resulting from a catastrophic
event experienced in adulthood).
The recurring thought disturbances
identified by Ellenson (1985) as characteristic of incest and the specific
content of these disturbances are as follows:
1. Nightmares
(a) catastrophes affecting oneself or one's family;
(b) harm or death of children;
(c)
oneself or one's family being chased;
(d) death or violent scenes.
2.
Intrusive Obsessions
(a) impulses to hurt one's child;
(b) feeling one's
child is endangered.
3. Dissociative Sensations
(a) one's child is a
stranger;
(b) one's past is that of a stranger.
4. Persistent Phobias
(a) being alone;
(b) being in physically compromising situations.
The
recurring characteristic perceptual disturbances identified by Ellenson (1985)
and the form these disturbances take are as follows:
1.
Hallucinations - sensory perceptions of non-existent phenomena
(a) an evil entity is in the home;
(b) an evil entity enters
the self.
2. Auditory Hallucinations
(a) a person calling to the self;
(b)
intruder sounds (e.g. footsteps, doors opening);
(c) 'booming' sounds.
3. Visual Hallucinations
(a) movement of objects or persons in one's peripheral
vision;
(b) shadowy figures;
(c) appearance of dark figures at the bedside.
4. Tactile Hallucinations
(a) one's body being touched;
(b) being pushed
or thrown down.
Disguised presentation of undisclosed incest
Gelinas has organized the varied and commonly reported symptoms of incest survivors
into a 'coherent, explanatory, and heuristic framework' (1983: 312). She identifies
three underlying negative effects: chronic, traumatic neurosis, continued relationship
imbalances, and increased intergenerational risk of incest.
The
intense affect and vivid memories experienced by survivors following disclosure
and discussion of the incest are referred to as chronic traumatic neurosis.
Phases of denial or repression alternate with intrusive experiences of trauma
repetition (e.g. nightmares, pseudo-hallucinations, obsessions, emotional repetitions,
behavioral re-enactments). Symptoms such as depression, anxiety, and substance
abuse are secondary elaborations related to the hidden and untreated traumatic
neurosis.
The relational imbalances exhibited by survivors
are considered to be a result of the family dynamics that produced and maintained
the secret of the incest. Gelinas (1983) discussed a scenario that typifies the
development of incestuous family dynamics.
Parentification
occurs when a child, often an eldest daughter, assumes responsibility for parental
functions. The child learns to protect and nurture her parents, thereby developing
a caretaking identity. She becomes skillful in meeting the needs of others but
denies her own needs.
She chooses as a partner a man who requires
caretaking, typically one who is needy, narcissistic, or insecure. As she might
still be meeting the needs of her family of origin as well, she soon becomes emotionally
depleted. When she and her husband have children, maternal caretaking is added
to her responsibilities. She is then less able to attend to her husband's needs
and might attempt to enlist his support. He feels both threatened and abandoned
and becomes increasingly unavailable to her. She might then attempt to get emotional
support from her child, often her eldest daughter, and this daughter then begins
to experience parentification. The husband, if unable to meet his needs outside
the family, may do so through his daughter. Sexual abuse is most likely to occur
if the father is narcissistic, exhibits poor impulse control, and uses alcohol.
The
daughter, now an incest survivor, becomes an adult who is also very skillful at
caretaking, but who has a poor self-concept and is lacking the social skills needed
to meet her own needs (e.g. assertiveness). She is unable to establish mutually
supportive relationships with others and becomes isolated or abused and exploited
in the relationships she does establish. As she also remains emotionally depleted,
she will experience parenting difficulties and another generation of parentification
may begin.
The intergenerational risk of incest is due
to the establishment of the relationship imbalances discussed above. The incest
survivor's daughter becomes at risk for incest as the processes of parentification
and marital estrangement are repeated. The survivor, experiencing an untreated
traumatic neurosis, will avoid stimuli that provoke memories of her own abuse
and is therefore less likely to detect or attend to the sexual abuse of her daughter.
Gelinas (1983) stressed that this does not suggest that the mother is to blame
for the incest. Although each parent is responsible for the incestuous family
dynamics, the offender alone is responsible for the sexual contact.
- Draucker, C. B. (2006). Disclosing childhood sexual abuse. In Counselling survivors of childhood sexual abuse (pp. 18-22). London: Sage Publications.
The box directly below contains references for the above article.
=================================
Personal
Reflection Exercise #4
The preceding section contained information
about detecting a history of undisclosed incest. Write three case study examples
regarding how you might use the content of this section in your practice.
Update
" A Daily Reminder of An Ugly Incident … ":
Analysis of Debate on Rape and Incest
Exceptions in Early Abortion Ban Legislation
in Six States in the Southern US
Evans, D. P., Schnabel, L., Wyckoff, K., & Narasimhan, S. (2023). "A daily reminder of an ugly incident … ": analysis of debate on rape and incest exceptions in early abortion ban legislation in six states in the southern US. Sexual and reproductive health matters, 31(1), 2198283.
Peer-Reviewed Journal Article References:
Ensink, K., Borelli, J. L., Normandin, L., Target, M., & Fonagy, P. (2020). Childhood sexual abuse and attachment insecurity: Associations with child psychological difficulties. American Journal of Orthopsychiatry, 90(1), 115–124.
Pulverman, C. S., & Meston, C. M. (2020). Sexual dysfunction in women with a history of childhood sexual abuse: The role of sexual shame. Psychological Trauma: Theory, Research, Practice, and Policy, 12(3), 291–299.
Pruiksma, K. E., Cranston, C. C., Rhudy, J. L., Micol, R. L., & Davis, J. L. (2018). Randomized controlled trial to dismantle exposure, relaxation, and rescripting therapy (ERRT) for trauma-related nightmares. Psychological Trauma: Theory, Research, Practice, and Policy, 10(1), 67–75.
QUESTION
14 What will the result be for a survivor, experiencing an untreated
traumatic neurosis, who avoids stimuli that provokes memories of her own abuse?
Record the letter of the correct answer the Test.
