After-Effects of Childhood Sexual Abuse: Long Term Effects, PTSD and the Issue of Retrieved Memories

Since the advent of contemporary psychology the issue of childhood sexual abuse and its after-effects has been a part of the clinical experience. Freud himself encountered patients wrestling with a variety of symptoms (amongst which the famous hysteria of some of his female clients) that under hypnosis or via the talking cure, the name he first gave to psychoanalysis, would reveal what seemed like memories of molestation or sexual abuse incurred in childhood.


Freud, Psychoanalysis and Incest

It was not easy for Freud to accept that the very well to do Viennese society was hiding disturbing skeletons under its Victorian façade of respectability. And some of his theories in this area may reflect the uneasiness he was experiencing with regards to his very own findings.

The harsh reality of childhood sexual abuse was hard to accept and integrate even for Freud. Alice Miller, a modern Austrian Freudian psychoanalyst, which subsequently distanced herself from her ideological roots, believes that Freud’s theories of the “polymorphous perversus“, the sexual drives of the child, and the oedipal and Electra complexes, were nothing but a way for Freud to rationalize sexual abuse and incest into a more palatable theory, which shifted the sexual urge from parental dysfunction to that of a child’s imagination and desire. An interesting thought and one that may very well be true. It’s hard for many to accept the reality of abuses of a sexual nature perpetrated on children.

Since the 80s however, we have come a long way in recognizing the unfortunate truth that childhood sexual abuse is, sadly, a more frequent phenomenon than most people would like to imagine. And that the effects of such abuse can continue to impact, sometimes severely, the adult lives of those that survived it for years after the abuse occurred. Recent statistics estimate the incidence of sexual abuse to be 4-16% amongst boys and 20% amongst girls, crossing all racial, ethnic and economic boundaries. But what is considered to be childhood sexual abuse today?


The Definition of Childhood Sexual Abuse

Childhood sexual abuse is defined as "any action on the part of an adult or an older child toward a child that is intended to sexually stimulate either the older person or the child”. Based on this definition, it can be seen that sexual abuse encompasses a wide spectrum of behaviors. Some behaviors that many interpret as normal or acceptable are classified as sexual abuse solely on the basis of intent. Consequently a wide range of incidents and behaviors fall under the umbrella of childhood sexual abuse. Research seems to evidence that the more physically intrusive the abuse, the more it can create disturbances to the natural development of the child and the more likely to result in psychopathology in adult life.

The physical differences in the nature of the abuse are, however, only one of a variety of factors that determine the intensity of the abuse's lasting after-effects. A significant factor seems to be that of the closeness of the perpetrator to the child and the power-relationship that the perpetrator has over the child. This is particularly so when the perpetrator is a trusted member of the family or the person in soul charge of the child, such as a parent, step-parent or a foster parent. In these cases the child not only experiences the physical side of the abuse, but also experiences a betrayal of trust that, along with threatening the feelings of safety of the child within the family unit, can literally be shattering for the personality. The effects of such shattering of trust are seen to be so central to the issue of childhood sexual abuse that some authors are re-classifying the notion of sexual abuse under the label of "Betrayal Trauma".

If the abuse is experienced repeatedly, for example over a period of years, the impact and effects in the adult life are also more likely to be significant. However, it is important to note that even just one unrepeated incident of even a "mild" form of sexual abuse experienced in childhood can produce pathology inducing effects. There are no hard and fast rules as to what degree of trauma will produce what effects, although there is a general correlation between degree of trauma and effects. So what are the most likely lasting after-effects of childhood sexual abuse that might occur in adult survivors?


After Effects of Childhood Sexual Abuse 



Physical Symptoms

Physical symptoms are observed frequently in abuse survivors. A wide variety of somatic manifestations may occur: frequent sore throats; difficulty swallowing; migraines; unexplained vaginal/anal pain; frequent bladder/vaginal infections; skin disorders; numbness; and tingling in the arms/legs.

Emotional Symptoms

Emotional and psychological problems are even more frequent. Emotional and psychological effects include: anger/rage outbursts; mood swings; depression; anxiety; panic disorder; dissociation; dissociative identity disorder; memory loss; time blockages; extreme fears/phobias; addictions (food, drugs/alcohol); compulsive/obsessive behavior; flashbacks (triggered by sights, sounds, smells, touches); abusive behavior (pattern repetition); self-destructive behavior (suicide and self-mutilation); eating disorders; nightmares; bed wetting (past the age of eight), destruction of property and fire setting; general delinquency; overwhelming confusion; severe guilt and shame; helplessness.

Impaired Relationships

Negative effects are also observed in relationship with others. Survivors of childhood sexual abuse seem to have difficulty generally in sustaining successful intimate relationships. A history of child sexual abuse is reported to be associated in adult life with insecure and disorganized attachments as well as increasing the likelihood of experiencing divorce. Particularly in the case of the more physically intrusive types of abuse experiences, there seems to be an increased risk of social, interpersonal and sexual problems in adult life. Many survivors seem to have problems with trust and opening up to a partner, but some become extremely promiscuous and dangerously risk taking with their sexuality.



Childhood Sexual Abuse and Post Traumatic Stress Disorder

Many studies have drawn parallels between the symptoms of adult survivors of childhood sexual abuse and those of who suffer from Post Traumatic Stress Disorder, or PTSD, a psychological disorder first addressed in relationship to the symptoms displayed by traumatized veterans returning from the Vietnam war.


Definition of Post Traumatic Stress Disorder

PTSD is described as a disorder that can occur following the experience or witnessing of life-threatening events such as military combat, natural disasters, terrorist incidents, serious accidents, or violent personal assaults like rape. People who suffer from PTSD often re-live the traumatic experience through nightmares and flashbacks, have difficulty sleeping, and feel detached or estranged. These symptoms can be severe enough and last long enough to significantly impair the person’s daily life. PTSD is marked by clear biological changes as well as psychological symptoms and is complicated by the fact that it frequently occurs in conjunction with related disorders such as depression, substance abuse, problems of memory and cognition, and other problems of physical and mental health. The disorder is also associated with impairment of the person’s ability to function in social or family life, including occupational instability, marital problems and divorces, family discord, and difficulties in parenting.

It is easy to see the parallels between the symptoms ascribed to PTSD described above and to those experienced by childhood sexual abuse survivors. If the abuse is interpreted as a form of severe trauma, the adult psychopathology deriving from it can be interpreted as a chronic form of PTSD and even be treated accordingly. The wealth of counseling techniques employed to help Vietnam veterans recover from their traumas, is possibly transferable to childhood sexual abuse survivors. One of the most valuable aspects of conceptualizing the symptoms of survivors as a form of PTSD is that it is then possible to transfer the studies on the effects of trauma on memory and the dissociative effects of trauma to the dissociation and memory issues experienced by survivors of sexual abuse and incest.


Childhood Sexual Abuse and Memory

It is a very common phenomenon for people who have experienced sexual abuse in childhood to suddenly remember episodes of abuse in their adult years that they were not previously aware of. Especially in cases in which the perpetrator of the abuse is someone that the child depends on for its survival, conscious memory of the abuse can be so threatening to the child's psyche that in order to adapt, the child needs to dissociate and repress the conscious memory of the event. The memory disappears from conscious awareness, however, it is shown by general studies on memory and trauma (see for example Van der Kolk’s studies on memory and trauma), that the memories are often retained in the form of dissociated mental imprints of sensory elements of the traumatic event, such as visual, olfactory, affective, auditory and kinesthetic experiences.

It is therefore possible for an adult survivor to have no conscious memory of the abuse but to retain sensory elements of it on other levels of their being.

Sometimes survivors will encounter triggers in their environment that will remind them of the abuse at a subconscious level and the survivor will experience flashbacks. Flashbacks may take the form of pictures, sounds, smells, body sensations, feelings or numbness. Many times there is no actual visual or auditory memory. One may have a sense of panic, of being trapped, feeling powerless with no conscious visual memory attached to these sensations. These experiences can also happen in dreams.

The experience of flashbacks was encountered extensively by Vietnam veterans, whose reported experiences have contributed to normalizing this effect on memory as a natural response to an overwhelming traumatic event. Flashbacks are one of the most definite symptoms that suggest a link between survivors of childhood sexual abuse and PTSD.

Flashbacks sometimes occur as a survivor start to recover memories of their experience of sexual abuse. The survivors’ abuser might have died, their children might have reached the age they were when the abuse started or they might have reached a peaceful stage in their life, in which they feel safe from harm, such as having established a nurturing stable relationship. Memories may start flooding through, first as disjointed sensory experiences, and eventually piecing themselves together as "explicit memories".

Memory retrieval can be instrumental for the survivor’s process of healing and there seems to be evidence to support that it might be a commonly experienced byproduct of the healing process itself. However in recent years the validity of the accuracy of retrieved memories has been called into question by some who have been accused of childhood sexual abuse by their adult children and other organizations.


The False Memory Syndrome Foundation

These organizations sustain that "retrieved memories" are false and accuse the therapists that have been treating their adult children of planting the memories of abuse, in some cases engaging in law suits against the therapists involved.The first and most militant organization to support these views is the False Memory Syndrome Foundation, an organization whose mission statement is to research the reason for the spreading of false memories, to work ways to prevent alleged false memories as well as providing support to the families destroyed by false accusations.

The False Memory Syndrome Foundation believe that therapeutic methods such hypnosis, regression therapies, guided imagery, body memories, literal dream interpretation, and journaling, as well as any use of consciousness-altering techniques, such as drug-mediated interviews or hypnosis, can distort factual information about any past experiences, including sexual abuse. The term False Memory Syndrome, was actually created by the False Memory Syndrome Foundation. False Memory Syndrome, however, although a term that has become now frequently used in the mainstream media, does not constitute a scientifically approved definition of a psychiatric disorder. There is no mention of a False Memory Syndrome in the DSM IV, for example. Or in any other published journals. False Memory Syndrome is not a medical or psychiatric diagnosis.

The False Memory Syndrome Foundation, founded by the Rockefeller Foundation, however, have been very proactive in obtaining media coverage and publicity for their cause. And have generally succeeded in securing public opinion in their favor, by employing convincing experts and psychologists to back their claims. However, the public and the media are often unaware that FMSF's impressive array of scientific advisers represents just one part of the broad spectrum of psychological thought. Their board is dominated by research psychologists, biologically oriented therapists along with older, psychoanalytically oriented psychiatrists.

FMSF was founded in 1992 by Pamela and Peter Fryed as a reaction to the accusation of childhood sexual abuse brought towards them by their adult daughter Jennifer Fryed. It is interesting to notice that Jennifer Fryed is one of the references quoted in this paper: a respected multi-published psychologist and memory researcher from the University of Oregon, the creator of the very label of "betrayal trauma" we were talking about above, as a new description of the trauma suffered by incest survivors. The Freyds, at the time, blamed their daughter's therapist for her memories of abuse, but Jennifer Freyd denies that her memories surfaced through hypnosis or any of the other therapeutic practices that FMSF attacks. There is no mention of Jennifer Freyd and her published work on the trauma and memory in the False Memory Syndrome Foundations web site or literature.


The Importance of Memory

Media hype or scientific reality, the issue of false memories remains a hot topic for all who are involved in the healing of the after effects of childhood sexual abuse. Many survivors experienced not being believed in childhood for the disturbing stories they reported to disbelieving adults and/or parents in denial. Many were told to be quiet about their abuse and threatened by their abusers if they were to talk. Having their truth denied in childhood, often leads survivors to question their memories, regardless. When memories resurface they are often patchy and dreamlike and the process of dealing with memories of trauma is a therapeutic setting is a delicate one for both the adult survivor and the practitioners that support them. Believing one's own memories and being able to speak out about the abuse is considered, in survivor recovery groups, to be a large component of the recovery process. The current trend against the validity of retrieved memories, leading to the questioning of childhood sexual abuse survivor’s memories could prove to be quite destructive for survivors healing and recovery.


Conclusion

Concluding, it would seem that there is ample evidence to support that trauma has effects on memory and that childhood sexual abuse is a form of trauma. Some of the studies presented supporting the theory of false memory syndrome seem debatable when further investigated. Harvard psychologist and brain researcher Daniel L. Schachter believes that both true and false memories exist, but states that there is no conclusive scientific evidence that false memories can be created. The False Memory Syndrome Foundation, the main organization fueling the public debate with regards to memory retrieval, is not as scientifically authoritative as it may appear at a first glance. A possible follow up to this article could be to verify in more detail the claims and funding of organizations such as False Memory Syndrome Foundation and their supporters and to find if there is substantial scientific evidence to back their position.

Meanwhile, at a first glance, it would seem that truth lies, as usual, somewhere in the middle. Many retrieved memories appear to be consistent. The loss of specific memory and memory retrieval appear to be a frequent pattern in the recovery from trauma, but suggestions from therapists and false memory are also possible. However, it is important for workers in the field of psychology and counseling to acknowledge that the negative repercussions resulting from the general public espousing the false memory syndrome theory could be damaging to both survivors and therapists. Therapists might increasingly refrain from exploring alternative techniques or probing areas of obvious denial in survivors for fear of possible law suits and loss of licensing. Survivors could become reluctant to accept their memories as real, fearing disclosure and the disbelief of others, just as happened to them in childhood. It is vital to keep the debate on memory retrieval open, allowing for discernment, but being careful not to create a situation in which survivors of childhood sexual abuse and the therapists that support them in their healing are forced to operate underground.

Let the therapeutic community continue to support to survivors and their healing. Let there be room for their memories.

©2003-2011 Katie Gallanti. All rights reserved. http://katiespapers.blogspot.com. This article has been expanded from the original final paper for a class on Human Sexuality.



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