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Child Sexual Abuse: Long Term Effects

Lic. Ignacio R. Medina Cisterna (Psychologist)
Buenos Aires, ARGENTINA

Introduction

In this very short article I want to share a few of my findings about the effects of child sexual abuse. The cases I will describe are clients who disclosed their sexual abuse for the first time in their life during psychotherapy sessions.

What was interesting about the young women in these cases was the psycho-pathological symptoms they had, which were acute and increasingly dangerous to their daily lives.

It must be stated that child abuse as a subject is relatively new in Argentina. Only since 1985 have some groups started working with it. Thus not many professionals have much awareness of it. I work in Intrafamilial Violence Services at a Hospital in Buenos Aires, Argentina. The cases I'm presenting did not come to that service, but to my office where I work as a private clinical psychologist.

The Cases

Each of these young women came to my office after being referred by their physicians. The symptoms they all showed were intense tachycardia, an increase of blood pressure, and an acute sense of tightness of the chest, very close to suffocation. Many times they had gone to emergency rooms for treatment, because the symptoms caused them to collapse and gave them an intense fear of dying. After many medical tests, including lab work and echographies, the physicians in each of these cases concluded there was no physical cause, and decided to contact a psychotherapist.

The Psychotherapy: A Needed Change

When they came to my office the women not only showed the physical symptoms described above, but were also phobic. Their phobias consisted of fear of open places, fear of travel in any vehicle, fear of being alone anywhere. And the most terrifying to them was their fear of dying by suffocation. One client said, "...I can be standing anywhere, and my heartbeats begin to increase, slowly I start suffocating, suddenly I'm scared, I feel I'm going to die in that place, I have to run out as soon as I can...."

I started psychotherapy with these women, beginning to work with their phobia symptoms and investigating their histories. Pretty soon I made the hypothesis that I was working with child sexual abuse survivors. I realized I had no materials to work with these cases (there is not much of a bibliography available here on the subject), but I did already know some things about child sexual abuse.

Therapy was conducted with the women in order to provide a framework of confidence and inner strength for the abuse to be disclosed, which after a few more interviews was accomplished. Thus, the therapy changed from its previous short-term objective about this particular but dangerous point in their lives to a process of self-discovery.

I will not go into the psychotherapy process itself. Instead I want to show some common difficulties in the lives of these child sexual abuse survivors, who disclosed their abuse and came to the critical point of having psycho-pathological symptoms.

Difficulties in Sexuality

One of the main characteristics of these clients was their difficulty around sexuality. Since the physical growth stage of adolescence they had begun to fear sex. The idea alone scared them.

This difficulty was shown in many problems they had to establish any kind of relationship with boys. The boys were thought of as rapists, or on the other hand as "saints", that is incapable of doing anything, thus they were "stupid". Given these two categories the girls didn't want any contact with them. The first category frightened the girls very much, the second was considered under the assumption that they, the girls, knew more about sex.

An interesting aspect of this subject is the cultural mandate for "virginity" amongst girls, which is still considered a valuable treasure in many places in Argentina, and I would extend it to Latin America. This expectation gave the most terrible fear to the girls - of being discovered to be not virgins; and was another element used by them in order to maintain distance from boys.

Marriage was very traumatic in the area of sexuality for these young women. There was a negation of the sexual relationship. Every time they had contact with their husbands the feeling was of pain or else of no feelings at all. Obviously as time went by and things continued in such a way, the relationship of the couple was damaged.

One client said: "...every time my husband comes to touch me I feel fear, anger, pleasure all together, and as soon as I can I leave him alone...I run...I can't stand it...." This was a sense of being again in the traumatic scene of the father approaching them, whether it be conscious or unconscious feeling.

Difficulties in Marriage When the Children were Born

Since their first children were born the marriage relationship had changed, with the sense of needing to provide protection of the child occupying most of the energy of the clients.

The possibility of their children being abused by the father, as they had been in their own childhoods, increased the distance between them and their husbands. Their behaviors sought both to make a close relationship between father-child and to keep the father as far as possible from the child. These behaviors put them in difficult situations because they couldn't manage both without feeling themselves bad, guilty and ashamed.

Difficulties in Raising Children

Too afraid to leave their children alone, each of these women sought to have their kids near her as much as possible. When school began for the kids, the fear increased in the mother who would stop her children from going out to any place where she couldn't go. Anything the children needed would be done by the mother. All of these behaviors put the children slowly against the mother because they wished to do things by themselves and have contact with their friends. They didn't understand their mother's behavior; thus they begin to "fight a war with the mother for their freedom". However, the mother couldn't understand her child's rebelliousness because "they are trying to protect them."

Related to the stages in the development of the children the symptoms of stress started developing in the mothers. It's notable that these clients remembered that their symptoms began when their child arrived at the same age in which they were abused.

One of them said:"...when my daughter turned eight I thought I was going to die...When I was eight years old my father came for the first time to my bed...I said I have to protect her more than before...Since then I can't sleep very well, I always wake up in the middle of the night. I first see if my husband is beside me, after that I go to see if my daughter is sleeping well...."

Difficulties in Establishing Relationships with Other Mothers

Difficulties in relationships with peers also began when they were abused. The same difficulty occurred with mothers of their children's friends. They had problems relating with other ladies in school meetings where they usually got together. They felt that other women didn't have the same problems as them. One said: "...they were not abused, they don't have to be afraid of anything, they don't' understand..."

They think they are the only ones to have problems and they are always afraid to be discovered as being abused.

Self-esteem

The self-esteem of child abuse survivors is very low. They think of themselves as merely nothing. This low self-esteem leads them to pay little attention to any problems they have. Although they know something is wrong with them, when the symptoms appear they think they deserve them. Thus they don't ask for help until the symptoms are very strong and established in their lives, making it difficult to live.

Guilt

Together with the low self-esteem, guilt ensures for the survivor that everything that happened to her was because she was responsible for it. She always thinks that she could have stopped the abuse but didn't. Even when they recognize that they had asked for help but were not heard, they will say they could have insisted but they didn't do so.

Conclusion

Undisclosed sexual abuse can have such strong effects on survivors that they have severe psycho-pathological consequences such as described, which will probably turn into severe personality disorders if not treated.

The work I did with these specific cases within a psychotherapy framework gave me the chance to study and research more about the subject. I would now like to transfer the knowledge I took about the feelings experienced by a sexually abused child in order to work with children who actually are abused.

Working with these clients made me think of the many other people who have been abused but have not disclosed it, so as part of my work I'm trying to form groups for them. Already two more persons have come to my office, fortunately without such severe symptomology. If I have the chance I'll make comments about this work on the future.

Lic. Ignacio R. Medina Cisterna
Mexico 2078 - 1 "A"
1222 - Buenos Aries, Argentina
Tel: (54-1) 942-3439