The traumatization process

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Frameworks for understanding victims responses to sexual abuse

If we consider the multi-layered impacts of sexual trauma, we can begin to conceptualise how and why victim/survivors respond in the many different ways that they do. Nevertheless, the fact that not all survivors present with the same nicely packaged and easy to conceptualise impacts has given rise to much debate on the traumagenic effects of sexual abuse.

There are a number of factors that influence survivors differential responses to abuse and perhaps the most obvious of these are the survivors own defence mechanisms, and it's worthwhile for us to briefly explain what these are and how they operate.

The traumatization process

If we conceptualise of the child pre-abuse in a state of normal childhood innocence and trust and introduce sexual trauma, what results is a shock state. While all human beings deal with trauma and crisis as part of life, because sexual abuse is outside the range of normal childhood experiencing, the trauma of sexual abuse is not resolvable by a child without the help of supportive and understanding adults. There are many reasons why children do not receive the support and help they need to recover from sexual abuse and it is highly likely that the abuse was kept a secret.

Frameworks for understanding victims responses to sexual abuse

Clinicians and researchers have attempted to formulate explanatory models which explain the full range of symptoms and observed effects in order to account for the adverse long term effects of child sexual abuse. One well established model for understanding trauma effects is Post Traumatic Stress Disorder (PTSD).

Subsuming childhood sexual abuse within the PTSD framework has been an important step forward in understanding its impact. In addition, PTSD enables these effects to be viewed as a syndrome with a core aetiology rather than just a list of symptoms. This places childhood sexual abuse into a broader context by highlighting similarities with other trauma experiences and dynamics.

On the negative side, although PTSD accounts for many of the observed impacts of childhood sexual abuse it doesn't account for the full range of survivors experience, such as depression, self-blame, guilt and sexual problems as well as self-destructive behaviours, suicide, and revictimisation. In focusing almost entirely on emotion as the location of trauma the PTSD model is in danger of minimising or ignoring other vital impacts, especially impacts on cognition. Distortions of cognitive processes are common in childhood sexual abuse survivors and it is these distortions that are related to mood disturbances and low self-esteem in adulthood.

Another problem with the PTSD framework is that many of the diagnostic criteria are not met in many survivors. Childhood sexual abuse is not always, necessarily accompanied by danger, threat or violence and much of childhood sexual abuse is a process rather than a discreet event. Children often only realise in retrospect that they have in fact been abused. This awareness develops in light of increasing awareness and cognitive understanding of appropriate and inappropriate touching and sexual behaviour. So the trauma of childhood sexual abuse stems not solely from potential physical danger or threat, or from an overwhelming event but may be lodged in the dynamics of a relationship involving the betrayal of trust, the meaning allocated to the behaviour and feelings of guilt.

The traumagenic dynamics model of child sexual abuse

A more comprehensive alternative to the PTSD model has been formulated by Finkelhor & Browne (1985). This model proposes four Traumagenic dynamics to explain the impacts of childhood sexual abuse. Finkelhor & Browne offer a much broader definition of Traumagenic dynamics:

An experience that alters a child's cognitive or emotional orientation to the world and cause trauma by distorting the child's self-concept, worldview, or affective capacities.

In turn, they view coping with these distortions as giving rise to the observed psychological and behavioural effects of childhood sexual abuse. The four dynamics are:

1: Traumatic sexualisation

The first dynamic explains how sexuality is shaped, often in an inappropriate and dysfunctional manner, by several processes. These dynamics are unique to childhood sexual abuse and would not occur in other childhood traumas. Included in this process are the use of secondary gains and rewards by the abuser for inappropriate sexual behaviour. As a result of the rewards the child may adopt sexual behaviour in order to manipulate others to gain gratification.

2. Stigmatisation

The second dynamic of stigmatisation focuses on the received negative messages operating in the abuse experience. Essentially these include badness, worthlessness, shamefulness and guilt.
These messages may be overtly communicated during the abuse by the abuser as a way of blaming (for example, you seduced me; look what you made me do) or labelling the child as 'bitch', or communicated covertly through the furtiveness and secrecy of the abuse. In some cases messages are received later, especially during disclosure, when moral judgments about the deviancy of their experiences may be communicated by others such as the mother, family members, relatives or professionals.

3. Betrayal

In the third dynamic, betrayal occurs when the victim discovers that someone they trust and depend upon, wishes or causes them harm. This may happen the first time abuse takes place, or may not occur until much later. Betrayal is also dependent on how much the victim feels s/he has been betrayed, not just as a result of the closeness of the relationship. Betrayal may be much worse in the case of an abusive relationship which started off in an affectionate and nurturing way than in one in which there was suspicious behaviour from the outset.

4: Powerlessness

The dynamic of powerlessness consists of two components:

i) repeated overruling and frustration of desires and wishes, along with a reduced sense of productivity; and

ii) the threat of injury and annihilation leading to disempowerment.
There are a number of aspects of childhood sexual abuse that play a central role in the dynamic of powerlessness, not least of which is the repeated and undesired invasion of the body through threat and deceit.

Major advantages

This model has four major advantages over other frameworks.

Firstly, it offers a much broader explanation of the range of reported impacts of childhood sexual abuse.

Secondly, the model proposes that the impact of trauma is related to the extent to which any of the four dynamics are present and how they might work in conjunction. This enables the explicitation of similar effects with different behavioural manifestations which has major implications for treatment. For example, symptoms of depression may be related to stigma or powerlessness.

Thirdly, this model conceptualises childhood sexual abuse as a process, not simply an event as in the PTSD formulation.

Finally, this model allows for variation and individual differences in the manifest effects of childhood sexual abuse and explains why some survivors manifest certain impacts while others do not. This has important implications for treatment in that it allows targeting of specific traumagenic dynamics rather than a general, rigid treatment plan for all childhood sexual abuse survivors.

References

Finkelhor, D. & Browne, A. (1985). The traumatic impact of child sexual abuse: A conceptualization. American Journal of Orthopsychiatry, 55 (4), 530-541.

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