Sexual Abuse: Surviving the Pain
Barabara E. Bogorad, Psy.D., A.B.P.P.
Founder and Former Director, Sexual Abuse Recovery Program Unit
South Oaks Hospital, New York
Specialists in the addiction field (alcohol, drugs and eating disorders) estimate that up to 90 percent of their patients have a known history of some form of abuse. Recent studies (Calam, 19892; Blume, 19893) point out that substance abuse, including "food abuse," is a frequent aftermath of early sexual abuse. Current studies (Koopmans, 19904) demonstrate that the vast majority of children and adolescents who attempt suicide have a history of sexual abuse as well. However, many individuals are resistant to seeking treatment for sexual abuse. This is especially true for males and adolescents. Men are often extremely reluctant to admit to any history of abuse and often fail to identify it as such. Many survivors are in denial of the effects of early abuse and may fail to see any connection with later tendencies toward ongoing abusive relationships, feelings of self-loathing, inability to trust, or problems with intimacy. Some patients denigrate themselves further, claiming that their abuse could not have been "as bad" as that of other victims. All abuse is bad.
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 areas: 7
1. Damaged goods: Low self-esteem, depression, self-destructiveness (suicide and self-mutilation), guilt, shame, self-blame, constant search for approval and nurturance.
2. Betrayal: Impaired ability to trust, blurred boundaries and role confusion, rage and grief, difficulty forming relationships.
3. Helplessness: Anxiety, fear, tendency towards re-victimization, panic attacks.
4. Isolation: Sense of being different, stigmatized, lack of supports, poor peer relations.
Adult incest survivors may demonstrate some 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
- Wearing excessive clothing
- Addictions, compulsive behaviors, obsessions
- Self-abuse, skin-carving (also addictive),
- Suicidality
- Phobias, panic attacks, anxiety disorders, startle response
- Difficulties with anger/rage
- Splitting/ de-personalization, shutdown under 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
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 rage8
If the rape or molestation was committed by an individual of the same sex (i.e., a man abusing a boy), questions regarding sexual orientation tend to arise in the patient ("I must be gay; after all, a man raped me!"). Female victims will frequently develop sexually promiscuous lifestyles in an effort to "conquer" the situation and bring it under their control. In other instances individuals will largely withdraw from any social or sexual interactions in order to avoid the feared stimuli, and turn toward extremely isolated lives.
The connection that is made for victims between sex and pain (love and humiliation, closeness and betrayal) is a particularly disastrous one. Frequently patients will express and/or demonstrate the belief that the only way to be loved or cared for is if they are also being abused ("I knew if I didn't let him keep beating me, I'd always be alone"). Often, in the extreme, physical and sexual abuse are even viewed as a normal part of everyday life. Healthy boundaries do not exist for these individuals, and therefore, healthy relationships are impossible. Victims will actually respond to feelings of loneliness or sadness by abusing themselves (e.g., self-mutilation) if the "significant other" is not available to do so.
One of the more difficult issues that arise is the recollection, by some individuals, of experiencing a certain amount of physical pleasure during a molestation or incest. This adds enormously to the sense of being at fault and "dirty." Thus, one of the aims of treatment is to educate survivors as to normal physiological responsiveness. The realization that their feelings are/were normal helps tremendously toward alleviating the sense of shame.
Even when individuals have spoken of their abuse prior to group treatment, any pleasurable aspects have typically been denied. The opportunity to relate to others who have shared these feelings, as well as the experience, is part of the healing power of this form of therapy. The sense of isolation, of being "different from the whole world," quickly begins to subside. It is only in revealing the secrets and dealing with the pain that survivors of sexual abuse can and do go on with their lives.
