Sexual abuse is a particularly sinister type of trauma because of the shame it instills in the victim. With childhood sexual abuse, victims are often too young to know how to express what is happening and seek out help. When not properly treated, this can result in a lifetime of PTSD, depression and anxiety.

The trauma that results from sexual abuse is a syndrome that affects not just the victim and their family, but all of our society. Because sexual abuse, molestation and rape are such shame-filled concepts, our culture tends to suppress information about them.

In the U.S (according to childtrauma.org), one out of three females and one out of five males have been victims of sexual abuse before the age of 18 years. And according to the American Academy of Experts in Traumatic Stress (AAETS), 30% of all male children are molested in some way, compared to 40% of females.

One of the most startling statistics unearthed during research into sexual abuse are that children are three times as likely to be victims of rape than adults. Stranger abuse constitutes by far the minority of cases. It is more likely for a child to experience sexual abuse at the hands of a family member or another supposedly trustworthy adult.

Sexual abuse is a truly democratic issue. It affects children and adults across ethnic, socioeconomic, educational, religious, and regional lines.

Exactly what constitutes “sexual abuse” when it comes to children?

The Incest Survivors Resource Network states that “the erotic use of a child, whether physically or emotionally, is sexual exploitation in the fullest meaning of the term, even if no bodily contact is ever made.” It’s important to notice this clause about “no sexual contact.” Often, victims of sexual abuse will try to downplay their experience by saying that it “wasn’t that bad.” It’s vital to recognize that abuse comes in many shapes, colors and sizes, and that all abuse is bad.

Outcomes of sexual abuse

The most common effect of sexual abuse is Post Traumatic Stress Disorder. Symptoms can extend far into adulthood and can include withdrawn behavior, reenactment of the traumatic event, avoidance of circumstances that remind one of the event, and physiological hyper-reactivity.

Another legacy of sexual abuse is that children abused at any early age often become hyper-sexualized or sexually reactive. Issues with promiscuity and poor self-esteem are unfortunately common reactions to early sexual abuse.

Substance abuse is a common outcome of sexual abuse. In fact, according to the AAETS, “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.”

Specific symptoms of sexual abuse:
(citation, the American Academy of Experts in Traumatic Stress)

• Withdrawal and mistrust of adults
• Suicidality
• Difficulty relating to others except in sexual or seductive ways
• Unusual interest in or avoidance of all things sexual or physical
• Sleep problems, nightmares, fears of going to bed
• Frequent accidents or self-injurious behaviors
• Refusal to go to school, or to the doctor, or home
• Secretiveness or unusual aggressiveness
• Sexual components to drawings and games
• Neurotic reactions (obsessions, compulsiveness, phobias)
• Habit disorders (biting, rocking)
• Unusual sexual knowledge or behavior
• Prostitution
• Forcing sexual acts on other children
• Extreme fear of being touched
• Unwillingness to submit to physical examination

Studies have shown that children who experience sexual abuse tend to recover quicker and with better results if they have a supportive, caring adult (ideally a parent) consistently in their life.

Because most child sexual abusers were once abused themselves, it’s crucial for victims of sexual abuse to seek counseling and care so that they don’t end up repeating the pattern themselves.

“The location of the dividing line between the concepts of shame, guilt, and embarrassment is not fully standardized.^[4]

According to cultural anthropologist Ruth Benedict, shame is a violation of cultural or social values while guilt feelings arise from violations of one’s internal values. Thus, it is possible to feel ashamed of thought or behavior that no one knows about and to feel guilty about actions that gain the approval of others.

Psychoanalyst Helen B. Lewis argued that “The experience of shame is directly about the self, which is the focus of evaluation. In guilt, the self is not the central object of negative evaluation, but rather the thing done is the focus.”^[5] Similarly, Fossum and Mason say in their book Facing Shame that “While guilt is a painful feeling of regret and responsibility for one’s actions, shame is a painful feeling about oneself as a person.”^[6] Following this line of reasoning, Psychiatrist Judith Lewis Herman concludes that “Shame is an acutely self-conscious state in which the self is ’split,’ imagining the self in the eyes of the other; by contrast, in guilt the self is unified.”^[7]

Clinical psychologist Gershen Kaufman’s view of shame is derived from that of Affect Theory, namely that shame is one of a set of instinctual, short-duration physiological reactions to stimulation.^[8][9] In this view, guilt is considered to be a learned behavior consisting essentially of self-directed blame or contempt, with shame occurring consequent to such behaviors making up a part of the overall experience of guilt. Here, self-blame and self-contempt mean the application, towards (a part of) one’s self, of exactly the same dynamic that blaming of, and contempt for, others represents when it is applied interpersonally. Kaufman saw that mechanisms such as blame or contempt may be used as a defending strategy against the experience of shame and that someone who has a pattern of applying them to himself may well attempt to defend against a shame experience by applying self-blame or self-contempt. This, however, can lead to an internalized, self-reinforcing sequence of shame events for which Kaufman coined the term “shame spiral.^[8]

One view of difference between shame and embarrassment is that shame does not necessarily involve public humiliation while embarrassment does, that is, one can feel shame for an act known only to oneself but in order to be embarrassed one’s actions must be revealed to others. In the field of ethics (moral psychology, in particular), however, there is debate as to whether or not shame is a heteronomous emotion, i.e. whether or not shame does involve recognition on the part of the ashamed that they have been judged negatively by others. Immanuel Kant and his followers held that shame is heteronomous; Bernard Williams and others have argued that shame can be autonomous.^[10][11] Shame may carry the connotation of a response to something that is morally wrong whereas embarrassment is the response to something that is morally neutral but socially unacceptable. Another view of shame and embarrassment, though, is that the two emotions lie on a continuum and only differ in intensity.”

More on http://en.wikipedia.org/wiki/Shame

Compulsive behavior is behavior which a person does compulsively—in other words, not because they want to behave that way, but because they feel they have to do so.

Mental health professionals have identified signs of compulsive behavior in various disorders such as:

1. Obsessive–compulsive disorder – obsessive, distressing, intrusive thoughts and related compulsions which attempt to neutralize the obsessions.
2. Drug addiction – a condition where a person takes a drug compulsively, despite potential harm to themselves, or their desire to stop. More at http://en.wikipedia.org/wiki/Compulsive_behavior

http://ptsd.about.com/od/glossary/g/hypervigilance.htm

Compassion Fatigue

Medical professionals such as physicians, nurses, psychotherapists, and emergency workers, who help traumatized patients may develop their own Post Traumatic Stress Disorder (PTSD) symptoms as an indirect response to their patient’s suffering. This phenomenon has been referred to as compassion fatigue, vicarious traumatization or secondary traumatic stress.

A survey showed that “86.9% of emergency response personnel reported symptoms after exposure to highly distressing events with traumatized people” . . . [and] . . . “90% of new physicians, between 30 to 39 years old, say that their family life has suffered as a result of their work”. When health care professionals struggle with their responses to the trauma suffered by their patients, their mental health, relationships, effectiveness at work, and their physical health can suffer.

Caregivers who reported experiencing compassion fatigue, expressed such feelings as, “I frequently dissociated and felt that I walked around in an altered state. I didn’t realize that I had been in a gray space all year. That had sort of creeped in” and “It got to the point where I would feel physically sick before the appointment and feeling nauseous.” Others described that they picked up their client’s symptoms and explained that they had “tightness in the exact same spot” as their clients and continued to carry the sensation sometimes for days. One psychotherapist expressed, “I am the empathy lady from the old Star Trek episode and get may be 45 % hit of what my patients might be feeling 100% of.”

The helpers symptoms, frequently unnoticed, may range from psychological issues such as dissociation, anger, anxiety, sleep disturbances, nightmares, to feeling powerless. However, professionals may also experience physical symptoms such as nausea, headaches, general constriction, bodily temperature changes, dizziness, fainting spells, and impaired hearing. All important warning signals for the caregiver that need to be addressed or otherwise might lead to health issues or burnout.

Researchers and authors such as Babette Rothschild, Charles Figley, Laurie Anne Pearlman and Karen Saakvitne, and B. Hudnall Stamm have recognized that medical personnel and psychologists may experience trauma symptoms similar to those of their clients. They speculate that the emotional impact of hearing traumatic stories could be transmitted through deep psychological processes within empathy. Further, Babette Rothschild hypothesizes that it is the unconscious empathy, the empathy outside awareness and control that might interfere with the well being of the caregiver.

Hearing and witnessing horrific stories of abuse and other traumas can be very stressful and trauma experts have found that self-care techniques, both psychological and somatic, can reduce susceptibility to the internalization of traumatic stress and compassion fatigue. Bernstein indicates that paying attention to and being aware of physiological signals and somatic counter transference such as “dizziness, emptiness, hunger, fullness, claustrophobia, sleepiness, pain, restlessness, sexual arousal, and so forth” can be an important method of preventing and managing compassion fatigue. Somatic countertransference entails the psychotherapist’s reaction to a client with bodily responses such as sensations, emotions, and images that can only be noticed through body awareness. Since somatic countertransference is often neglected in both the literature and in the caregiver’s training, many are not aware of the somatic countertransference elicited in the helper-patient relationship.

Reducing compassion fatigue means not fighting the symptoms but working with  feelings which occur during and after the interactions with the traumatized patient. One psychotherapist shared;  “If I start to not feel my body, I pause and just take a moment.” There is a lot to take in. Giving oneself permission to take a break for a short time and taking care of oneself, may not only help the caregiver but may also provide a role model of self-care for the patient. Taking a break might be just to stop and feel one’s body, asking the patient to slow down, taking a deep breath, or making a small movement, which are forms of regulating the nervous system and decreasing the stress of working with traumatized patients.

Since caregivers commonly dissociate, staying connected or reconnecting to one’s identity and physical presence has been rated as very important as well. Some professional helpers use visual or kinesthetic reminders of their lives outside of their work. Visual reminders might be placing pictures of family, certificates, and favorite artwork in the office. Whereas kinesthetic reminders bring awareness back to the body and might be accomplished by feeling one’s feed on the floor, intentionally fiddling with a wedding ring or holding the office chair. One caregiver expressed, every time she closes the office door she uses the door as a kinesthetic reminder and says, “This is my life outside and that’s where I’m entering.”

Studies have also shown that the attitude toward life such a sense of humor, self confidence, being curious, focusing on the positive, and feeling gratitude ranked high in being helpful in treating traumatized people. Additionally, support, supervision, balancing work and private life, relaxation techniques, and vacation time have been useful.

Research indicates that caregivers are not immune to trauma and might experience compassion fatigue. A better understanding and knowledge about this phenomenon as well as self care techniques that include both psychological and somatic tools can help caregivers to more effectively deal with patients’ sufferings.

Susanne Babbel, MFT, PhD is a licensed marriage and family therapist, somatic psychotherapist, and workshop leader in San Francisco. If you would like further information on this topic please visit her website: www.bodyconversations.com