Somatic Complaints and Bodily Concerns
Therapists
generally agree that boys are more likely to experience somatic complaints following
sexual abuse. This may reflect social acceptability of bodily complaints versus
emotional and psychological ones. Headaches, stomach aches, sore throats, and
fatigue are the most frequently reported somatic complaints, sore throats and
stomach aches often being linked with the child having been forced to perform
oral sex.
Sexually abused children frequently have tremendous
concerns about their bodies which they may feel have been damaged; this can be
particularly true if the sexual abuse was painful and involved force. Older children
might worry about contracting sexually transmitted diseases and AIDS. Some children
are encopretic or enuretic. Some young children fear that people know about their
abuse just by looking at them. They may view their bodies as 'different' and permanently
'damaged'. They may feel increased shame and self-consciousness and project these
feelings onto others.
Treatment Implications
Ensure that the child has had a thorough medical examination to exclude, or get
treatment for, physical problems and infections. In order to come to terms with
what has happened to them, children need to express their feelings and concerns
about their bodies. They often respond to encouragement, as they may feel embarrassed
about how their bodies work. This is particularly relevant with younger children,
but older children frequently are confused and have misinformation about bodily
functions. Most children desire and need accurate information about how their
bodies work. Encourage children to ask questions about bodily functions, changes,
or possible ill effects of the abuse. The therapist can help children to express
their concerns by speaking about what some other children's worries might be.
If
appropriate, help the child to understand the correlation between the somatic
complaint and the abuse. Usually children are unaware of the link. Normalize the
child's symptoms, give reassurance, and let the child know that the complaints
will lessen and go away with time. AIDS, infection, or physical damage need assessment,
treatment and the prognosis verified. The child should have suitable factual information
and support, with encouragement to express feelings about the abuse, the abuser,
and future concerns.
Reassure the child who believes that
'everyone knows' about the abuse that this is not so. Inform the child that
it is impossible to tell if someone has been sexually abused simply by looking
at them. Groups can be effective in helping children to realize that victimization
is not physically visible.
At one level sexual abuse is experienced
as a physical trauma. Children up to the age of about four encode memories in
the basal brain and are likely to act out physically or emotionally; older children
may revert to bodily symptoms under stress, but have greater access to language
and emotion (van der Kolk, 1996). Children may experience disgust towards their
bodies and attempt to disown them. Many adult survivors dissociate from their
bodily experience as a result of sexual abuse as children. Focusing on taking
care of, and enjoying, the body can help prevent disowning and dissociative tendencies
from developing. Encourage children to participate in physical activity and to
have a positive awareness of their body. Warm, fragrant baths and attractive clean
clothes are part of the process of helping children feel better about themselves.
If
children experienced physiological pleasure as a result of the sexual activity,
they may feel that they were betrayed by their own body. Educating and normalizing
physiological and pleasurable response to the abuse will help the child accept
the physiological response as a normal and natural reaction.
Sleep
Disturbances
Sleep disturbances are common. Children may experience
a fear of sleep or an inability to fall asleep; this may be particularly true
if the abuse occurred at night. Children often complain of disturbed sleep; they
may wake up frequently throughout the night and be unable to fall back to sleep.
They may think about the abuse at this time, and experience painful emotions or
thoughts related to the abuse. Some children engage in excessive masturbation.
Children may have difficulty waking up in the morning due to the poor quality
of sleep, and may be fatigued throughout the day.
Children
frequently have frightening dreams and nightmares. Some dreams involve the actual
abuse experience or a variation on what happened. Other common themes reported
by children are monsters, wild animals, or situations in which the child, or those
close to the child, is/are in danger. The child may be reluctant to go to sleep
for fear of bad dreams.
Treatment Implications
Theoretical
analysis of dream content has focused on the adaptive work of the ego and on the
problem-solving nature of dreams. Dreams help to process internal and external
experience. For example, in a nightmare or dream children may achieve mastery
by taking control of a situation in which they were previously powerless. Dreams
can provide useful diagnostic information about the issues and conflicts the child
is currently facing, and can indicate the child's ego strength and functioning.
Dreams
or nightmares can be used as a tool to facilitate drawings, acting out, poetry,
or discussion. The therapist can help the child to understand the meaning and
importance of dreams. Dreams, like play and art therapy, can provide a safe distance
for exploration. The feelings and experiences of the child, related to dreams,
can be discussed, leading to greater understanding for the child.
Encourage
the child to bring dream material to sessions. Have the child work on the
dream and what it means. What feelings do the dream images bring up in the child?
Normalize the feelings and help the child to see the connection, if applicable,
to the abuse situation.
There are several ways of working on
the dreams. They can be talked about, or the child may wish to make a dream journal.
Writing dreams down as soon as they occurred 'seemed to get them out of Kenny's
head, to distance and diminish their power' (Carolin and Mimer, 1999: 27-8). They
can be acted out, made into pictures or paintings, written as stories, or tape
recorded. Children can be encouraged to change the dream or ending of the dream
in any way they desire. James suggests that children can be empowered to reduce
the frightening elements by making them smaller, twitching their noses at them,
picking them up or some such ploy (1989: 198). Using a gestalt technique, older
children can name the objects or feelings in the dream, the child talking as if
she were each of those things with the therapist reflecting inferences and making
links.
- Wickham, R. E., & West, J. (2002). Common Symptomology. In Therapeutic work with sexually abused children (pp. 91-93). London: SAGE.
The box directly below contains references for the above article.
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Personal
Reflection Exercise #10
The preceding section contained information
about somatic complaints and sleep disturbances in sexually abused children. Write
three case study examples regarding how you might use the content of this section
in your practice.
Update
Adverse Childhood Experiences
and Sleep Difficulties
among Young Adult College Students
Albers, L. D., Grigsby, T. J., Benjamin, S. M., Rogers, C. J., Unger, J. B., & Forster, M. (2022). Adverse childhood experiences and sleep difficulties among young adult college students. Journal of sleep research, 31(5), e13595.
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.
Rose, S., Berg-Cross, L., & Crowell, N. (2021). Investigating the relationship between sleep, psychological abuse, and partner dynamics. Couple and Family Psychology: Research and Practice, 10(1), 17–37.
QUESTION
20 Who is most likely to experience somatic complaints following sexual
abuse? Record the letter of the correct answer the Test.
