Hijacked :: Childhood Sexual Abuse

No two stories are the same. This statement is perhaps rather obvious, considering the factors that contribute to one’s story and the degree to which each of those factors may vary. The degree of trauma varies widely between individuals as well as the physiological and psychological responses that inevitably follow. The famous statistician George Box once said, “Essentially, all models are wrong, but some are useful.” Though Box was referring to the design of experiments, this same awareness should be remembered when modelling most, if not all, mechanisms and manifestations, especially when those mechanisms involve emotional and psychological responses. Each of us is a culmination of our traits, experiences, beliefs, and thoughts. We are a result of our nature as well as the way we’ve been nurtured. Some of these traits may be quite inherent while others may be a direct result of our upbringings. And while a patterned connection between our abuse experiences and our reactions may exist, variations in those reactions are certainly expected.

A dynamic model may be used to illustrate many of the potential outcomes and the pathways by which they come, namely the original concept model developed by the University of Southern California.[1] In their longitudinal research the authors identify what I like to call inputs—factors that influence the degree of trauma experienced. These inputs include the type(s) of abuse, duration, frequency, relationship to the abuser, the age and gender of the abuser, physical force or threats, and the age of onset. Additional factors may include telling or no telling, added effects of additional trauma(s), institutional response, and any other relationship(s) involved at the time of the abuse including parents’ reactions to the abuse.

The Child Welfare Information Gateway notes the importance of whether or not the child has a dependable and nurturing support figure in his or her life at the time. Most of the time, women aren’t abused by someone who “jumped out of the bushes, but by somebody they had a trusting, loving relationship (with),” Stephen Braveman, licensed marriage and family therapist of California, says. CSA experienced at the direction of a parent can lead to greater feelings of insecurity.

Psychological distress (suffering, including the effect to one’s memory) and physiological stress (strain and/or anxiety) are categorized as responses to the abuse factors. It’s no surprise that an abused child will focus her brain on responding to threats and mere survival. Such a focus can lead to a cascade of effects. Justin and Lindsay Holcomb sum up these effects in their book, Rid of My Disgrace:
Sexual assault causes harmful emotional, psychological, and/or physiological effects that are more severe than the effects of other crimes. These effects include: shame, self-blame, guilt, embarrassment, anxiety, stress, fear, anger, confusion, sexualized behaviors, loss of sex drive, interpersonal problems, denial, irritability, depression, despair, social withdrawal, numbing/apathy (detachment, loss of caring), chronic and acute somatizing (experiencing of physical symptoms in response to emotional distress), feelings of isolation and alienation, restricted affect (reduced ability to express emotions), nightmares, flashbacks, headaches, difficulty concentrating, diminished interest in regular activities, negative self-image, loss of self-esteem, emotional shock or numbness, erratic mood swings, feeling powerless, disorientation, OCD, panic attacks, body memories, loss of security, confusion with sex and love, extreme dependency, impaired ability to judge the trustworthiness of others, various phobias, hostility, aggression, change in appetite, suicidal ideation (thoughts of suicide and death), hyper vigilance (always being “on your guard”), insomnia or other sleep disturbance, decreased energy and motivation, exaggerated startle response (jumpiness), eating problems/disorders, self-mutilation (cutting, burning, or otherwise hurting oneself), sexual dysfunction (not being able to perform sexual acts), sexual effects (ranging from avoidance to compulsive promiscuity), hyper arousal (exaggerated feelings or responses to stimuli), inability to concentrate or focus, feeling uncomfortable being alone, gastrointestinal disturbance, substance use and abuse (alcohol and other drugs) and other compulsive behaviors, shock, impaired memory, and post-traumatic stress disorder (PTSD).[12]
These effects can be considered to be the consequences of CSA at a high level, but if we dig deeper, we’ll later find that the changes occur at the physiological and psychological levels.

Family and peer support in addition to pubertal stage are included as modifiers, and the potential outcomes include items that alter one’s social competence as well as one’s psychopathology. Specific outcomes may lie within the following areas: cognitive, social (difficulty trusting and saying no/maintaining boundaries in relationships), self-esteem, control, depression, anxiety (fear), dissociation (splitting the mind from the body), and hypersexuality. Effects not yet mentioned may include those that are a result of the items in the previously stated list, for example, sleep disturbances and self-harm.

Martin Teicher of Harvard Medical School, also confirms this list of effects. “We know that (lab) animals exposed to stress early in life develop a brain that is wired to experience fear, anxiety, and intense fight-or-flee reactions,” says Teicher. “We think the same is true of people.” Teicher’s research shows that growth in certain areas of the brain is stunted as a result of sexual abuse (possibly also as a result of verbal and other types of abuse). Other research has revealed that the brains of abuse survivors exhibit electrical irregularities similar to the brains of those with epilepsy, which is commonly characterized by seizures. Teicher says, “It’s puzzling. Childhood abuse can produce abnormal electrical brain activity that resembles a seizure state, but does not actually produce epilepsy.” Researchers have known that these abnormalities exist in incest victims for thirty-five years. What goes on inside of a survivor that could generate such a bizarre response within her brain?

It’s long been believed that children simply repeat and reenact what they see and hear. When parents are emotionally distant, it isn’t surprising that children tend to repeat the actions of the parents with their own children, yet some issues may be much more complex than a simple passing on of negative behaviors. Anatomical and functional changes occur in the brain when a child is exposed to adverse events.[2] Chemical and structural changes can be detected by relatively new technologies such as fMRI and PET among others.[3]

Often the abuser lives inside the home. If incest or neglect occurs, the child may suffer from a disrupted attachment process, which may lead to more susceptibility to stress, excessive dependency or isolation, and an inability to control emotions. If the child cannot obtain a feeling of safety and security with her caregiver(s), the attachment may be insecure or anxious.[4] Repeated negateve child-parent interactions effect the child’s perception, leading to unique emotions, perceptions, and behaviors. Another study suggests that duration of the abuse by a closely related individual matters more when it comes to memory impairment, whereas age of onset, number of abusers, or duration of abuse by another, less closely related individual were not more strongly linked to memory performance.[5]

Those with a history of sexual abuse are twice as likely as non-abused individuals to exhibit these abnormal electrical activities.[6] In other words, the biggest post-abuse issue is arguably the survivor’s mental health. According to Dr. Berman, the long-term tangible effects of childhood sexual abuse may include the following: Poor body image because the body was the instrument used during the sexual abuse; feelings of shame, guilt, isolation, depression and low self-esteem; sexual confusion or promiscuity as a result of not dealing with the emotions and feelings surrounding the abuse; confusing rape or sexual abuse fantasies; eating disorders, obesity and anorexia; drug abuse and alcoholism; poor decision-making in relationships; difficulty with intimacy; and self-destructive or even suicidal behavior. In fact, those with epileptic-type electrical irregularities appear to be more likely to be suicidal. A strong correlation exists between these irregularities and thoughts of suicide. Individuals whose brains display this kind of activity are four to five times more likely to consider suicide. And this correlation may be even stronger than the link between suicide and depression.[10]

The Merriam-Webster dictionary indicates that body image is a “subjective picture of one’s own physical appearance established both by self-observation and by noting the reactions of others.” Poor or negative body image is defined as an intellectual or idealized image of what one’s body is or should be. Body image is a mental idea, meaning it really is “all in our heads.” One’s perception of her own body is so intricate and bizarre in that no part of her perception may actually involve a single ounce of truth. Unfortunately, most women absorb the input from their mirrors, the world around them, and the media perhaps in addition to messages received due to past sexual abuse to determine just how well they measure up. Modern-day media and unrealistic cultural expectations have cultivated an environment in which body image distortion is nurtured. This distortion is a brain condition where the individual is unable to view her body accurately in the mirror. Features and size are distorted. What happens when sexual abuse is added to the list of inputs? When it’s mistreated me against the world and the media?

Eating Disorders Review concludes, “Those who have undergone sexual trauma have a more negative perception of their own body.”[7] Furthermore, an article in NCBI (National Center for Biotechnology Information) found that “Specific forms of childhood maltreatment (emotional abuse, sexual abuse) were significantly associated with body dissatisfaction. These results highlight self-criticism as a potential mechanism through which certain forms of childhood maltreatment may be associated with depressive symptoms and body dissatisfaction in patients with BED (Binge Eating Disorder).”[8]

It seems that the most tangible consequences of sexual abuse can be summed up (at a very high level) as distorted views of self, sex, and the world. Self-destructive behavior, confusion, shame, depression, anxiety, and difficulty with intimacy (potentially leading to dissociation) flow downstream from poor body image.

An abused child was presented with a logic game she seemingly could not win. The result? Sex becomes nothing or everything post-abuse. A survivor may shun sex in an attempt to protect herself from facing further damage to her worth, or sex and sex appeal may be pursued at all costs in attempt to gain or maintain worth. Braveman says, “They (abuse survivors) typically wind up with splitting behavior, where things become very black and white. Either they are very sexually active, or they shut down sexually.”[9] Those who become highly sexually active tend to dissociate (mentally and emotionally remove themselves) from the body during sex. The cables that connect the heart and the mind are severed during the act, meaning she goes through the motions absent of feeling.

In general, it appears that each survivor is presented with a fork in the road. In general, she either swears off all sexual activities, deeming them dirty and destructive in all contexts, or she vainly embarks on an endeavor to master the evil practice of it. Sex becomes only the means to an end, and sex appeal becomes a definitive quality. She may even believe that if she gives sex, no one can take it from her again. In this way, she may aim to attain “control.” Yet if we peel back the layers further, research may provide another explanation. Vasopressin has been found to enhance attention, learning, and memory, and research indicates that oxytocin may be a critical aspect of “love, maintenance of monogamous relationships, and normal non-sexual social interactions. In rats, Teicher says that early stress leads to a life-long increase in vasopressin levels and decrease in oxytocin levels in the thalamus. If this is true for humans, abused individuals therefore have a reduced ability to experience a reduction in stress due to non-sexual contact. They also may not be as likely to experience sexual fulfillment, and they may have difficulty committing to a single partner. In fact, developing stable relationships may be one of the most challenging aspects of recovery. “To the brain so tuned, Eden itself would seem to hold its share of dangers: building a secure, stable relationship may later require enormous personal growth and transformation.”[10]

One may also seek to have control over her performance in other areas of her life, which can very well lead to perfectionist tendencies. I find it quite interesting that someone who has a black and white sex view would also have a black and white world view. In Healing the Hurt Within, Jan Sutton says, “Perfectionists often think in black and white terms, either something is right or wrong, flawed or a failure—there’s no middle ground or room for shades of grey.” At the base of perfectionism lies the belief that one must or should be perfect. In turn, the low self-esteem cycle perpetuates. “The drive to succeed, to be the best and to avoid mistakes at all costs is limiting at best, crippling at worst…Perfectionism breeds low self-esteem, because the perfectionist rarely lives up to his or her standards of performance, leaving the perfectionist feeling like a failure.”[11]

What’s even worse, neglect and abandonment often go hand-in-hand with CSA. Neglect can be thought of as an overall lack of stimulation, i.e. a failure to meet a child’s physical, emotional, cognitive, or social needs. Researchers use the term global neglect to refer to the disregarding of needs in more than one area. Those areas may include language, touch, and interaction with others.

The difficulty that these effects present is that CSA prompts the child to anticipate only wickedness from the world. In other words, the child may actually have difficulty operating when the world instead presents her with kindness, nurturing, and all around goodness.

These effects are some of the most tangible ones—they can be seen in plain sight. But what’s really going on inside? If we’re considering the effects of abuse using a top-down approach, the previously listed effects are the fizz bubbles that rise to the top and are most easily seen. However, the real changes within an abused child lie within her neurochemical systems and brain structures. We'll examine these changes in the following chapter.

[1] Trickett PK, et al (2011): “The impact of sexual abuse on female development: Lessons from a multigenerational research study.” Development and Psychopathology, University of Southern California.
[2] De Bellis MD, Keshavan MS, Clark DB, et al (1999): A.E. Bennet Research Award. Developmental traumatology. Part II: Brain development. Biological Psychiatry. 45(10):1271-84.
[3] McCollum D (2006): Child Maltreatment and Brain Development. Clinical and Health Affairs.
[4] Understanding the Effects of Maltreatment on Brain Development (2009): Child Welfare Information Gateway.
[5] Navalta CP, Polcari A, Webster DM, Boghossian A, Teicher MH (2006): Effects of Childhood Sexual Abuse on Neuropsychological and Cognitive Function in College Women. Journal of Neuropsychiatry and Clinical Neurosciences, 18(1):45-53.
[6] Cromie WJ (2003): Child abuse hurts the brain. Harvard University Gazette.
[7] Trauma’s Effect on Body Image: Sexual trauma can lead to a more negative body image, especially among women (2010): Eating Disorder Review, Gürze Books, 21(4).
[8] Dunkley, DM, et al (2010): Childhood Maltreatment, Depressive Symptoms, and Body Dissatisfaction in Patients with Binge Eating Disorder: The Mediating Role of Self Criticism.” National Center for Biotechnology Information, The International Journal of Eating Disorders, 43(3).
[9] Thompson D (2013): The Aftermath of Childhood Sexual Abuse. Everyday Health Media, LLC.
[10] Teicher MH (2007): Child Abuse, Brain Development and Impulsivity. MASOC/MATSA Joint Conference. Marlboro, MA. 12 April 2007. Keynote Address.
[11] Pitts L (2013): Perfectionism Facts. LifeScript. <www.lifescript.com>.
[12] Holcomb J and Holcomb L (2011): Rid of My Disgrace. Crossway.

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