title: Comparing child victims and adult survivors: clues to the pathogenesis of child sexual abuse.
abstract: Sexual abuse consists of two discrete traumatic elements; the repeated infliction of sexual assault that is superimposed on a chronic background of pathological family interaction, including betrayal, stigmatization, role reversal, and violation of personal boundaries. The acute episodes of sexual assault may be overwhelming to the child and result in anxiety-related symptoms, including PTSD. The long-standing family dysfunction leads to a pathological defensive organization that becomes woven into the victim's personality structure, resulting in long-term characterological changes. As the sexually abused child progresses through adolescence into adulthood, and the immediacy of his or her victimization recedes to the background, the acute posttraumatic anxiety symptoms are gradually replaced by more enduring symptoms and characterological defenses. Traumatic memories of the abuse become repressed or dissociated from consciousness. Identifications, attitudes, and affects derived from the abusive environment are usually organized around victimization experiences, leading to identifications with the aggressor or victim, which contribute to sadomasochistic object relationships and problems with the regulation of sexual behavior. The repressed or dissociated traumatic memories of sexual abuse carry the potential for producing future psychopathology through displacement in the form of conversion symptoms or somatization, and by generating delayed PTSD when these memories are elicited by current experiences. Anxiety and depression triggered by the emergence of these traumatic memories often lead to alcohol and drug abuse. These substances may be used for their anxiolytic and antidepressant effects.
authors.affiliation: Columbia University, College of Physicians and Surgeons, USA.
authors.forename: A H
authors.initials: AH
authors.lastname: Green
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D002648:Child; D002650:Child Abuse, Sexual / Q000523:psychology* / Q000628:therapy; D003674:Defense Mechanisms; D005190:Family / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D010553:Personality Development; D011574:Psychoanalytic Theory; D011575:Psychoanalytic Therapy; D012651:Self Medication / Q000523:psychology; D013313:Stress Disorders, Post-Traumatic / Q000523:psychology* / Q000628:therapy; D013534:Survival / Q000523:psychology*