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They were also willing to work on their relationship openly and honestly. Experiencing betrayal is associated with externalization and internalization problems Finkelhor, Past research has shown that depression is among the most common of internalization problems that sexual abuse survivors confront. Feelings of betrayal can manifest themselves not only through behavioral problems, but also through insecure attachment styles. For example, if a child grows up in an environment where he or she cannot depend on the caregiver for love and protection, the child may turn inward and not express emotions for fear of increased pain or retaliation, thus developing a dismissive or avoidant attachment pattern.

Alternatively, in an inconsistent parenting environment where there is a lack of responsiveness to a child, this will influence the child's sense of self and make him or her feel unworthy of love. In this situation, children tend to develop extreme dependency and clinginess, characteristic of a preoccupied attachment pattern. Some survivors of CSA develop a fixation on safety in their adult relationships.

Fearfulness, jealousy, feelings of emptiness, abandonment fears, problems with identity, emotional outbursts, and lack of boundaries are all features of Borderline Personality Disorder BPD; American Psychiatric Association, In a sample of incest survivors, Alexander found that attachment predicted avoidance of memories of the abuse along with various personality disorders, including BPD. Rose is 61 years old. She had been adopted after her biological family died in a car crash.

She reported that her biological parents were Jewish Danish immigrants. When she was adopted, she was 6 years old. Her stepfather was the minister of a church who molested her in the basement where he worked. Rose reported having flashbacks of violence toward her. She said that her stepfather was an authoritarian who controlled everything.

What can I do to prevent this in the future?

Rose had many difficulties later in life as a result of her CSA and the lack of a secure base and loving caregivers. The blatant betrayal of her adoptive parents made it very difficult for her to form interpersonal relationships as an adult, and this fear of intimacy probably contributed to her status as the only support group member without a spouse.

She suffered from multiple health problems and did not have the social support that would have allowed her to cope adequately with all her economic, medical, and social struggles. Externalizing factors of betrayal include anger and hostility. Survivors often express anger towards the abuser, other family members, society, and themselves Finkelhor, Gender differences emerge regarding the direction of anger. Alternatively, girls show more aggressive behaviors toward themselves. Female survivors of CSA are more likely to have attempted suicide Dube et.

Steele found that girls who had experienced CSA had higher levels of suicidal thoughts and activities. Adolescents with histories of suicidal behavior and suicidal ideation are more likely to experience attachment-related trauma e. Another dynamic of CSA that has a harmful influence on survivors is the feeling of powerlessness.

A small child who is being sexually abused does not have the power to defend himself or herself from the predator in the home. Unlike other traumatic events that are rare or isolated, living with an abuser is unremitting stress for a dependent child. A chronic state of hyperarousal and vigilance can cause dysregulation of a child's developing brain and body, as the home, a supposed safe haven, is a place of danger and degradation where the abused child is powerless to escape. Continuous feelings of being trapped add to a sense of powerlessness.

According to the Learned Helplessness Hypothesis developed by Abramson, Seligman, and Teasdale , when a person considers outcomes in life to be uncontrollable—or if their attributions for failure are stable, global, and internal—he or she is more likely to develop depression.

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Much evidence has accumulated that overall, when a person lacks an internal sense of control over his or her life, that person is more prone to depression e. Another major effect of powerlessness is anxiety, which is expressed through increases in fearfulness, somatic complaints, changes in sleep, and nightmares American Psychiatric Association, These symptoms are frequently associated with post-traumatic effects of CSA, often resulting in the development of anxiety disorders, including PTSD e.

For example, Ashley reported her feelings of helplessness and powerlessness since her father was in charge of everything, and she could not disclose her abuse to anyone. For Ashley, her feelings of powerlessness as a child led her to become preoccupied with remaining in control of situations as an adult.

In order to command more power over her life, she was very committed to therapy and spent many years on developing a strong sense of self. Complex PTSD is more difficult to diagnosis and treat, leaving survivors with more severe health issues and somatic complaints, personality and identity changes, and with an increased vulnerability to future harm.

However, secure attachment can lead to a willingness to confront memories of trauma Alexander, A predisposition toward anxiety disorders and PTSD can be tied to the attachment perspective. It is the responsibility of an attentive, caring parent not only to protect a child, but also to teach the child self-protection strategies.

Attachment Theory

A parent who is abusive or neglectful does not serve as a secure base and may not teach a child the necessary coping strategies. A child who grows up in such a way will not have a functional working model of how to remain secure and sufficient, and this child may be predisposed to further victimization. Moreover, the lack of a supportive family system would make any victimization more likely to result in psychological damage.

Ashley, Rose, Roberta, and Sue, who were participating in the group therapy, all reported having continuous nightmares, intrusive thoughts, and flashbacks--traumatic reenactments--of their sexual abuse. Ashley reported that until her 40s, she had constant nightmares about the incidents of the abuse and rape. She reported that she started to change the events in her nightmares through talking to herself in her dreams and showing herself a way out of the abuse.


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Rose, on the other hand, reported that she had lots of nightmares until her stepfather died. Roberta's intrusive thoughts and flashbacks of her abuse consistently undermined her relationships with her children and ability to be present and engaged with them; she is still using anxiolytic medications, along with antidepressants, to feel like she is in control of her life.

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The last dynamic related to sexual abuse is stigmatization. Stigmatization can be described as abuse-specific shame and self-blame. Such negative connotations about abusive experiences are communicated to children Finkelhor, These negative meanings are transmitted to children in many ways. For example, the abuser may directly blame, insult, or humiliate the child for the abuse, or the abuser may command the child to keep this activity secret. Stigmatization also occurs when attitudes from others carry negative connotations, both in and out of the family Finkelhor, When a child experiences stigmatization following sexual victimization by an adult, it is an example of misdirected blame and the failure of the family system to put responsibility on the perpetrator.

Roberta is 37 years old. She is married with two sons. When she was growing up, starting at age 6, Roberta was sexually abused by her older brother. She reported that he was doing sexual things to her and threatened her not to tell their parents. At age 11, Roberta told her brother to stop, and he did. She reported that it was almost as difficult as the abuse to go through that disclosure process, and she still suffers from anxiety and depression.

She reports that she feels responsible for the abuse due to this. Additionally, through the exchange of affection, attention, privileges, and gifts for sexual behavior, a child might learn sexual behavior as a strategy to manipulate others to satisfy personal needs. Sue is a 49 year-old sexual abuse survivor who has never been married but has partner for 11 years.

She reported that when she was growing up, her father was her perpetrator. She reported that her parents spent little time together and had little communication. Sue reported that when she was growing up, she spent most of her time with her father, and he was trying to satisfy his sexual needs through her. He would buy expensive gifts for her while her mother became jealous. Sue reported that she has a hard time understanding why her mother was not monitoring them while they were spending enormous amounts of time alone with each other. Attachment history exerts a powerful and direct influence on relationships later in life.

Some maladaptive attachment patterns that may emerge from the loss of an attachment figure are compulsive self-reliance or compulsive care-giving; adults with anxious attachments are more likely to demand love and care or to be compulsively caring yet simultaneously resentful that the caring is not reciprocated Bowlby, Such interpersonal difficulties often make therapy or counseling with mental health professionals indispensable for the person with a history of CSA who is looking to improve his or her mental health.

However, there may be a drawback for the abuse survivor if he or she only participates in individual or group therapy to process CSA, while simultaneously neglecting the dynamics and needs of the current family system. Effective therapists must adequately address attachment relationships preceding and following the experience of abuse, up to and including the current romantic relationship, in order to beneficially transform the internal working model.

Therefore, therapists who are working with CSA survivors individually or within groups must serve as a secure base for the clients whose partners cannot serve as one Alexander, Utilization of attachment theory helps therapists to identify the fundamental presenting problem, such as attachment insecurity, in distressed couples and families. It also helps therapists identify the development of insecurity and its manifestation in the relationship, such as through maladaptive actions and emotions, including jealousy, anxiety, and avoidance of the relationship.

It also provides therapists with a framework to alleviate attachment insecurity by facilitating authentic dialogue about attachment needs among members of the system Johnson, This paper provides an overview of the effects of CSA on adult survivors with insight from attachment and family systems perspectives in order to help clinicians develop more comprehensive therapy models for working with sexually abused clients.


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Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH. National Center for Biotechnology Information , U. Am J Fam Ther. Author manuscript; available in PMC Jan 1.

Healing Journeys: Male Survivors of Sexual Abuse Panel

Gunnur Karakurt and Kristin E. Attachment Theory According to attachment theory, the early affectional bond between caregiver and infant is crucial for healthy development Bowlby, Family Systems Theory Systems theory is based on the assumption that all parts of the system are connected to each other, and a true understanding is not possible if considering the parts in isolation. Interpersonal and psychological sequelae resulting from childhood sexual abuse In order to help adult survivors, therapists must understand the lifelong effects of CSA, particularly by their family members.

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Theme of powerlessness Another dynamic of CSA that has a harmful influence on survivors is the feeling of powerlessness. The theme of stigmatization The last dynamic related to sexual abuse is stigmatization. The healing journey of adult sexual abuse survivors Attachment history exerts a powerful and direct influence on relationships later in life. Learned helplessness in humans: Journal of Abnormal Psychology. Attachment organization and history of suicidal behavior in clinical adolescents. Journal of Consulting and Clinical Psychology.

Application of attachment theory to the study of sexual abuse. The differential effects of abuse characteristics and attachment in the prediction of long-term effects of sexual abuse. Journal of Interpersonal Violence. Understanding the effects of child sexual abuse history on current couple relationships: A perspective for couple and family therapy.

American Psychiatric Association; Childhood sexual abuse, attachment, and trauma symptoms in college females: The moderating role of attachment. Additionally, when you come to therapy and start to deal with some of these memories you may gradually begin to remember more detail. This can feel quite disconcerting to experience but it is perfectly normal. Our unconscious mind stores memories away in different ways in order to try to protect us from the trauma we experienced.

Unlocking memory is a gradual process that can be dealt with in therapy, sometimes over a number of years. The issues of trust and of memory raise the question of being believed. This is the third aspect of counselling for survivors of sexual abuse that we want to talk about this week. Child abusers often plant ideas in the minds of their victims about what might happen if they ever tell. These might be threats against you or your family. Or it might be that they have suggested to you that the abuse was somehow your fault or that you colluded in it.

It takes an enormous leap of faith to tell about your abuse for the first time. You will be watching very carefully for any reaction or doubt on the part of your therapist. We understand the difficulty this creates especially in the light of what we have said about the effects of trauma on memory.

We will listen to what you have to say with openness and without making any judgement of you. There is a lot more that we could write about abuse and the legacy it can leave. It is a subject we will return to again in our journal. For this week we just wanted to discuss those three points. Firstly, building trust in your therapist and not rushing to disclose detail. Secondly, to understand how trauma affects memory and learning to trust your recall of what happened.

And thirdly is the experience of being believed in a safe and non-judgemental setting. Then we can continue with the therapy and work towards coming to terms with child sexual abuse. Counselling for Survivors of Child Sex Abuse.