CHILDHOOD TRAUMA - CHILD SEXUAL ABUSE
Complex trauma is still a relatively new field of psychology. Complex Post Traumatic Stress Disorder, results from enduring complex trauma.
Complex trauma is ongoing or repeated interpersonal trauma, where the victim is traumatised in captivity, and where there is no perceived way to escape. Ongoing child abuse, is captivity abuse, because the child cannot escape. Domestic violence, is another example. Enforced prostitution/sex trafficking is another.
Complex PTSD is a proposed disorder, which is different to Post Traumatic Stress Disorder. Many of the issues and symptoms endured by complex trauma survivors, are outside of the list of symptoms within the (Uncomplicated) PTSD diagnostic criterion. Complex PTSD does acknowledge and validate these added symptoms. Read more here.
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 - CPTSD, 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.
Some 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, and 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.
By far 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 Symptoms can extend far into adulthood and can include withdrawn behavior, reenactment of the traumatic event, avoidance of circumstances that remind one of the event, and physiological hyper-reactivity.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.”
Withdrawal and mistrust of adults
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
Extreme fear of being touched
Unwillingness to submit to physical examination
For me, the hardest things I have to control are the triggers. After years of therapy and research, being in and out of hospital, there was and still is not a great deal of understanding of C-PTSD and PTSD. As the years have gone on, I have more understanding on why I do the things I do, behave in the different ways I do – always on alert. From the age of 13 I have been dealing with this and only now finding some answers as why I am the way I am. I am different and with the length of the court case (10 years) reliving and reliving and reliving it over and over again, it got to the point that no one was left that could do much for me, I was trapped in the nightmare groundhog day so the best they could do is to sort out the medication I needed for me to survive. With a lot of experiments with different drugs and combinations they got something worked out the best they could. That’s just the way it is now.
I was lucky when I went to find help many years later. A lady through another lady that she knew this lady that she heard was good with trauma. So, off I go deciding that I needed help. I was raising 2 children as a single parent and didn’t want them to have to deal with the crap I was going through. Well, what a ride that was. She is a clinical psychologist specialising in trauma and had the understanding of what I was dealing with not just the shell on the outside but she understood feelings and emotions and I got answers for the first time on why I do/did the things and acted the way I do. Still to this day I have seen other psychologist and obviously psychiatrists too (to work out medication). No one has told me or gone through things with me that she has not predicted would happen to my body or mind that has either not already happened or are about to. The body can’t survive running the way my body does, it’s that simple. I am not the only one but I can only say how it is for me.
Triggers can be anything from sight, smell, sound, environment, to even a song. The smell in the wind as it changes. I went most of my life not understanding this and what it meant; I thought it was just pure rage, a raging bull going flat out. It is hell, un-controllable, un-stoppable in many ways and care factor is zero. I had no idea what was going on with the emotions and the anger. I have many social, anxiety based conditions I can’t leave the safety of home for weeks on end. My mood can change with wind e.g. triggers. I still have many problems dealing with this and I have now just come to accept that after all the years of therapy and the same things being said from different professionals, this is the best that I will be, and that’s ok. I have learnt to deal with it the best way I can, though not perfect, but sometimes you can damage something that bad that no matter how hard you try you can never get it back the way it was. But, who was I? I don’t know. I never had the chance to grow and develop as a ‘normal, un-traumatised’ child into adolescent adulthood. It was fight or flight, there was no other option. From the moment of the sexual abuse and exorcism my life was no longer my life, something had changed inside me, the anger and hatred grew over the years, though I was in such a conflict because I knew I was smart and artistic but I was so torn inside in many ways I just want to put my hands into the centre of my chest and tear it open and scream to let all the hurt, anger, emotion over the years and years come out in a massive roar and let it all out.
I still deal with it the same now. It just works for me. I’m a recluse basically. Friends and family walked away when they found out what the extent of what happened. They just can’t deal with it I expect, like most people, they don’t want to know about it but they know it happens. I don’t get it, but that’s the attitude. I’m just a damaged person, with lots of problems. I never asked or wanted to be abused but I have to deal with it. It makes it so much harder when friends and family just ignore you, they don’t know what to say I guess, I don’t know but that is just the way it is. The research and treatment of CPTSD is young. The physical strain it takes on your body to be constantly running on adrenaline is so immense that it is causing my body to shut down. Slowly, but surely, my body is beginning to deteriorate because of such a constant heightened state of emotion. Internally, my body has been destroyed from the amounts of stress.
I tired and have nothing left inside, there is no spark left. Still trying to find and ask questions why me? I know they will never be answered, but you still ask and the what if questions constantly replay over and over in your mind. I feel like I just want to have a breakdown, time out, but wherever I go it follows. I can spend days awake. I see so much hurt and pain out there from what these people have done.
The abuse of alcohol and drugs seem to go hand in hand with child sex abuse, anything to deal with the pain of the reality. Again, over the years, diet and exercise help, though those that know the depression know how hard it is to get moving, let alone exercise and not forgetting to take your medication.
The frustration of not finding help is extremely hard. The right help with the knowledge of childhood trauma is a must, but there is no one that I can find; even after years of searching. I have phoned all the institutions and they have not been able to help, and in some cases have made it worse.
The most respect I got was recently when my GP asked the mental health to check on me as I hadn’t been well for some time. They came into the house and sat down on the couch and asked some basic background questions. I stopped them there and went and got the medical reports and gave it to them to read. There were three of them; a supervisor, a psychologist and a trainee and she read it as tears rolled down her cheek and the supervisor got up and just said ‘this is out of our league, what we can do is make sure you have enough medication’, then handed me back the paper work, within the conversation they organised medication and that was the best thing they could of done for me. I felt that they showed me the greatest amount of respect that I have seen in a long time. They didn’t make excuses or try to fix something they couldn’t, it was just what can we do for you for right now.
I am writing a book, If I ever finish it. What happens when you find yourself in a deeper depression in a darker place than what anyone has experienced? This is what I found with the institution’s dealing with depression, anxiety etc
How it has best been explained to me is if you can imagine cptsd is the mother of them all, sits on top then you have everything else that branches off under that, just like a pyramid scheme diagram.
Intense Rage Outbursts
Complex post-traumatic stress disorder (C-PTSD; also known as complex trauma) is a psychological disorder similar to post traumatic stress disorder (PTSD) which results from repetitive, prolonged trauma involving harm or abandonment by a caregiver or other interpersonal relationships with an uneven power dynamic. C-PTSD is associated with child abuse or neglect, intimate partner violence, kidnap victims, hostages, indentured servants, slaves, sweatshop workers, prisoners of war, concentration camp survivors, and defectors of cults or cult-like organizations.
Situations involving captivity/entrapment (a situation lacking a viable escape route for the victim or a perception of such) can lead to C-PTSD-like symptoms, which include prolonged feelings of terror, worthlessness, helplessness, and deformation of one's identity and sense of self.
Impact on the cortex and limbic system
Research shows that children and adults with histories of child abuse often respond excessively to minor triggers. Traumatised children (and adult survivors) become increasingly responsive to relatively minor stimuli as a result of decreased frontal lobe functioning (learning and problem solving) and increased limbic system (amygdala) sensitivity (impulsiveness).
Decreased cortex activity
The cortex or the more rational, outer-layer of the brain is the seat of our thinking capacity. The cool, rational cortex is in constant communication with the amygdala and the hippocampus (the limbic system). The frontal lobes are situated in the cortex and are responsible for learning and problem solving. The capacity to learn from experience requires events to be registered in the prefrontal cortex, compared with other experiences and evaluated for an appropriate response.
Increased limbic system sensitivity
The limbic system is sometimes called 'the emotional brain'. It controls many of the most fundamental emotions and drives for survival (McLean Hospital, 2000). The limbic system initiates the fight, flight or freeze responses to threat. The amygdala and the hippocampus are part of the limbic system. A study by Teicher et al. (1993) found a 38% increased rate of limbic abnormalities ('emotional brain') following physical abuse, 49% after sexual abuse, and 113% following abuse of more than one type combined.
Decreased hippocampal volume
The hippocampus helps to process information and lends time and spatial context to memories and events. The hippocampus assists the transfer of initial information to the cortex which works to make sense of the information. However the hippocampus is vulnerable to stress hormones, in particular the hormones released by the amygdala's alarm. When those hormones reach a high level, they suppress the activity of the hippocampus and it loses its ability to function. Information that would make it possible to differentiate between a real and imagined threat never reaches the cortex and a rational evaluation of the information isn't possible (Rothschild, 2004).
If a particular stimulus is misinterpreted as a threat, this leads to immediate fight/flight/freeze responses (to non-threatening stimuli). This causes this system to respond to minor irritations in a totalistic manner.
Impact on the left and right hemisphere - Underdevelopment of left brain
A study by McLean Hospital (2000) found that children with histories of abuse were twice as likely as non-abused children to have abnormal electroencephalograms (EEGs). EEG is a medical test used to measure the electrical activity of the brain, via electrodes applied to your scalp. Research shows evidence of deficient development of the left brain hemisphere in abused patients (which controls language), suggesting that the right hemisphere may be more active than in healthy individuals.
A smaller corpus callosum
The corpus callosum is a major information pathway connecting the two hemispheres of the brain. McLean Hospital (2000) found that abused patients shifted the degree of activity between the two hemispheres to a much greater extent than normal. They theorised that a smaller corpus callosum leads to less integration of the hemispheres. This can lead to dramatic shifts in mood or personality.
Brain development is affected by stress early in development. Extensive research has been carried about the neuro-biology of stress. The link between a history of childhood abuse and neglect and neuro-endocrine impacts is well established. Research tells us that the bodies of children who are being abused react and adapt to the unpredictable dangerous environments to which they are exposed. Stress can set off a ripple of hormonal changes that permanently wire a child's brain to cope with a malevolent world (Teicher, 2002). Through this chain of events, violence and abuse pass from generation to generation (Teicher, 2002).
The neuro-endocrine system refers to the system of interaction between our brain/ nervous system and the hormones in our bodies. This system helps regulate our moods, our stress response, our immune system, and our digestion, amongst other things. Any disruption to the neuro-endocrine system affects a range of basic psychological and physiological functions.
Impact on stress hormones (including impact on cortisol production)
The nervous systems of children who are abused run on a constant high because they are constantly anticipating further danger. Their bodies are flooded with fight-or-flight hormones (Cozolino, 2002). A study by Linares et al. (2008) shows alterations in cortisol production in children with histories of abuse and neglect. This state of chronic 'hyper-arousal' persists for many survivors throughout their adult years as well.
Even when the abuse and violence has ceased and the environment is 'safe', many adult trauma survivors still perceive the threat to be present; their fear is maintained and becomes pathological (Giarratano, 2004b). A study by Joyce et al. (2007) found that experiences of childhood abuse were associated with high cortisol levels in depressed adult survivors.
Impact on Thyroid production
Trauma is biologically encoded in the brain in a variety of ways. Changes in structures like the hippocampus, and the coordination and integration of neural network functioning have been identified. These changes are reflected in the victim's physiological, psychological and interpersonal experiences (Cozolino, 2002). Deficit in psychological and interpersonal functioning then create additional stress which further compromises neurobiological structures
In this way, adaptation to trauma, especially early in life, becomes a "state of mind, brain, and body" around which subsequent experience organises (Cozolino, 2002).
Impact on gene expression
A research study, led by Michael Meaney from Douglas Mental Health University Institute in Montreal examined samples from the hippocampus region of the brain, which is associated with memory function, and is known to develop differently in abused children. (Meaney, 2009) They found a gene - NR3CI, which influences the brain's susceptibility to stress hormones - was less likely to be activated in people who have been abused. This study as the first to demonstrate that a genetic process appears to underlie such changes. Those who have been abused had lower levels of expression of the gene for the glucocorticoid (cortisol) receptor, which is critical for the stress response pathway.
We easily understand how beating a child may damage the developing brain, but what about the all-too-common psychological abuse of children? Because the abuse was not physical, these children may be told, as adults, that they should just “get over it.”
But as developmental neuropsychiatrist Martin H. Teicher reveals, scientists are discovering some startling connections between abuse of all kinds and both permanent debilitating changes in the brain and psychiatric problems ranging from panic attacks to posttraumatic stress disorder. In these surprising physical consequences of psychological trauma, Teicher sees not only a wake-up call for our society but hope for new treatments.
There are few published studies examining the developmental and the psychobiological consequences of sexual abuse. There are multiple mechanisms through which sexual abuse can cause PTSD, activate biological stress response systems, and contribute to adverse brain development. This article will critically review the psychiatric problems associated with maltreatment and the emerging biologic stress system research with a special emphasis on what is known about victimization by sexual abuse.
Children need stable, sensitive, loving, stimulating relationships and environments in order to reach their potential. They are particularly vulnerable to witnessing and experiencing violence, abuse and neglectful circumstances. Abuse and neglect at the
hands of those who are meant to care is particularly distressing and harmful for infants, children and adolescents.
Trauma in childhood: the neurobiological impact
Children all over the world are exposed to traumatic events such as natural disasters, abuse, domestic violence, community violence and war. In Australia, common adverse childhood experiences include abuse (emotional, physical, sexual) and neglect (emotional, physical), exposure to domestic violence or relational stress (e.g. separation, depression), alcohol or other substance abuse, mental illness or criminal behaviour in the household.
Some child sexual abuse survivors may show symptoms of C-PTSD - PTSD, including agitated behavior, frightening dreams, and repetitive play in which aspects of the abuse are expressed. They might exhibit other fears and anxieties or lose developmental skills and begin bed-wetting or thumb-sucking. They may show inappropriate sexual behavior or seductiveness or have difficulty maintaining appropriate boundaries with others. As a result of abuse, children, especially boys, might "act out" with behavior problems, such as cruelty to others and running away. Other children "act in" by becoming depressed or by withdrawing from friends or family. Older children or adolescents might try to injure themselves or attempt suicide.
Sexual abuse can be very confusing for children. A child who is used or manipulated by a trusted adult might learn that the only way for them to be attended to or loved is for them to give something of themselves or give up their dignity. Some children believe the abuse is their fault or that the perpetrator chose them because they must have wanted it or because there is something wrong with them. If the abuser was of the same-sex, children (and parents) might question their sexual orientation and wonder if they are "gay."
Almost every child sexual abuse victim describes the abuse as negative. Most children know it is wrong and experience fear, shock, anger, and disgust. However, a small portion of children might not realize it is wrong, especially if they are very young or have cognitive delays. In addition, some victims might enjoy the attention, closeness, and physical contact, especially if these needs are not met by a primary caregiver. Together, these reactions make the events very difficult and confusing for children.
Julia Whealin, PhD and Erin Barnett, PhD
The long term effects of child sexual abuse - Written by Melissa Hall Joshua Hall