ARCHIVED: Appendix C: Handbook on Sensitive Practice for Health Care Practitioners: Lessons from Adult Survivors of Childhood Sexual Abuse – Traumagenic dynamics

 

Appendix C: Traumagenic Dynamics of Childhood Sexual Abuse

Some of the common problems experienced by childhood sexual abuse survivors are summarized in Table 6 using David Finkelhor and Angela Browne's conceptualization of the traumagenic dynamics of childhood sexual abuse.64 These dynamics describe the impact that abuse-related behaviours, events, and experiences can have on their victims.

TABLE 6 - Traumagenic dynamics of childhood sexual abuse
Characteristic Dynamics Possible Manifestations

Adapted from Finklehor and Browne64 with permission of D. Finkelhor.

Traumatic Sexualization
  • Rewarding a child for sexual behaviour may heighten the salience of sexual issues for him or her
  • Receiving attention and affection for sex can affect a survivor's ability to achieve a healthy sense of love and belonging
  • Sexual parts of the child may be fetishized
  • Abuse may impart misconceptions about sexuality (e.g., sexual identity, sexual orientation, sexual behaviour, and sexual morality)
  • Sexual activities may become conditioned to negative emotions and memories, creating an aversion to sex or intimacy
  • Avoidance of all things sexual
  • Preoccupation with sexual matters or compulsive sexual behaviours
  • Precocious sexual activity
  • Aggressive sexual behaviours
  • Promiscuity
  • Prostitution (making use of or working in the sex trade)
  • Sexual dysfunctions (e.g., lack of desire, difficulty with sexual arousal, inability to experience orgasm, and avoidance of sexual intimacy)
Betrayal
  • Childhood sexual abuse manipulates a child's vulnerability, violates the expectation that others will provide care and protection, and may interfere with the ability to trust
  • The child's autonomy and wellbeing are disregarded, which may affect the sense of self
  • Deep-seated guilt and shame develop because children believe something bad about them caused the abuse
  • Profound sense of grief over lost innocence or the "perfect" or "normal" family; depression
  • Extreme anxiety or fear, which engenders a sense of dependency
  • Overdependence or clinginess
  • Vulnerability to subsequent abuse and exploitation
  • Failure to accurately judge the trustworthiness or motives of others, leading to subsequent abuse and exploitation and/or inability to protect one's own children from abuse
  • Social withdrawal, isolation, and/or avoidance of intimate relationships
  • Chronic relationship difficulties
  • "Acting out" behaviours (e.g., aggression, delinquency, risk-taking, etc.)
Stigmatization
  • Abuser(s) and others blame or denigrate the victim engendering a sense of shame or guilt
  • The abuser and others pressure child for secrecy
  • The victim feels "damaged," "abnormal," "bad," which may contribute to a distorted sense of self and lowered self- esteem
  • Dysphoria or chronic depression
  • Stigmatization, isolation, and marginalization may contribute to substance abuse
  • Criminal behaviour
  • Failure to care for oneself (e.g., risk-taking behaviours, poor hygiene, poor health practices)
  • Self-harm or self-mutilation
Powerlessness
  • Unwanted invasion of one's body or personal space can interfere with the establishment and maintenance of healthy boundaries and increase risk of repeated victimization
  • Abuser(s) may use violence, threats, trickery, or bribery to involve their victim
  • If others do not believe and respond appropriately to disclosure of abuse, an individual may develop a lowered sense of efficacy
  • Some victims develop a high need for personal control and may even identify with the abuser
  • Hyper-arousal (i.e., chronic anxiety, phobias, tendency to startle easily, irritability, poor sleep)
  • Intrusion (e.g., flashbacks during waking states, traumatic nightmares during sleep)
  • Constriction (dissociation to endure danger that one is unable to fight off or escape) -alters perception, sensation, and time sense and may result in avoidance of reminders of the trauma, emotional numbing/blunting, detachment, and an inability to experience joy
  • Stress-related disease and illness; chronic and/or vague somatic problems
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