Sexual abuse can involve any type of sexual contact between an adult and child or adolescent. The sexual contact could be utilised to pursue power over an adolescent or child and may often involve a betrayal of the adolescent's trust (Colman & Widom, 2004).
There are numerous types of sexual abuse that could include touching or physical contact offenses. On the other, non-touching type of sexual abuse can also involve indecent exposure, leering or exposing an adolescent or child to pornographic material or purposely putting an adolescent in the vulnerable position of having to witness an act of sexual intercourse (Colman & Widom, 2004). In the assignment, I will explore a selected case study, further analyse issues with the child victim and identify the most appropriate treatment therapy that could be utilised.
Trauma Case Study 1
The case study focuses on a 12-year-old female disclosing in school to her teacher that she had been abused in her homeland country, Ghana, when she was 6 years old. Due to the sexual abuse and psychological intimidation inflicted on the girl child, she has developed maladaptive behaviour that includes post-traumatic stress disorder, depression and attachment issues. The Child also showed attachment issues that could have emanated from the absence of her parents who were not present to protect her as they emigrated to the overseas and left her in the care of her grandmother. The teacher noted the girls psychological imbalance after her display of behaviours consistent with psychiatric disorders such as mood swings, depression and inappropriate sexual behaviours.
Stages of Grief
Santrock (2007) noted that the stages of grief are universal and were likely to be experienced by the young girl as a result of her traumatic experience of sexual abuse. The grief process could have further been enhanced by the emotional state of the girl. Elisabeth Kubler-Ross first proposed five stages of normal grief. Each adolescent suffering from sexual abuse may experience the stages in differing orders. However, as a therapist, it is an essential tool to understand these stages and utilise the knowledge as a guide in the mediation of a grieving process to assist in understanding the behaviour of the adolescents (Bonanno, 2004). However, people grieve differently. Some people will wear their emotions on their sleeve and be outwardly emotional while others will experience their grief more internally (Bonanno, 2004).
1. Denial and Isolation
The first reaction to learning of terminal illness or death of a cherished loved one is to deny the reality of the situation. It is a normal reaction to rationalize overwhelming emotions. It is a defense mechanism that buffers the immediate shock. We block out the words and hide from the facts. This is a temporary response that carries us through the first wave of pain (Berger, 2009).
As the masking effects of denial and isolation begin to wear, reality and its pain re-emerge. In most cases, the victims are not ready to manage the grief. The intense emotion is deflected from our vulnerable core, redirected and expressed instead as anger. The anger may be aimed at inanimate objects, complete strangers, friends or family. Anger may be directed at our dying or deceased loved one. Rationally, we know the person is not to be blamed. Emotionally, however, we may resent the person for causing us pain or for leaving us.
The normal reaction to feelings of helplessness and vulnerability is often a need to regain control. Victims are more likely to question themselves that:
If only we had sought medical attention sooner
If only we got a second opinion from another doctor
If only we had tried to be a better person toward them
Secretly, victims resolve to religion and spirituality in an attempt to postpone the inevitable. However, this is a weaker line of defense to protect the victims from the painful reality.
Two types of depression are associated with mourning. The first one is a reaction to practical implications relating to the loss. Sadness and regret predominate this type of depression. We worry about the costs and burial. We worry that, in our grief, we have spent less time with others that depend on us. This phase may be eased by simple clarification and reassurance. We may need helpful cooperation and encouragement. The second type of depression is more subtle and, in a sense, perhaps more private. It is our quiet preparation to separate and to bid our loved one farewell.
Reaching this stage of mourning is a gift not afforded to everyone. Death may be sudden and unexpected or we may never see beyond our anger or denial. It is not necessarily a mark of bravery to resist the inevitable and to deny ourselves the opportunity to make our peace. This phase is marked by withdrawal and calm. This is not a period of happiness and must be distinguished from depression.
Loved ones that are terminally ill or aging appear to go through a final period of withdrawal. This is by no means a suggestion that they are aware of their own impending death or such, only that physical decline may be sufficient to produce a similar response. Their behavior implies that it is natural to reach a stage at which social interaction is limited. The dignity and grace shown by our dying loved ones may well be their last gift to us.
Coping with loss is an ultimately personal and singular experience, nobody can help the victims go through it more easily or understand all the emotions that they are going through. However, family members and professionals can be there for the victim and comfort her/him through the grief process. The best thing victims can do is to allow themselves to feel the grief as it comes over. Resisting it only will prolong the natural process of healing.
Severe abuse early in life can lead to reactive attachment disorder. Children with this disorder are so disrupted that they have extreme difficulty establishing normal relationships and attaining normal developmental milestones, therefore needing special treatment and support.
Children with pre-existing attachment problems are often more prone to be victimized and abused. This is due to their propensity to keep secrets, lack of boundaries with strangers, and often seeking attention from adults (Macdonald et al., 1996).
All types of child abuse and neglect leave lasting scars. Some of these scars might be physical, but emotional scaring has long-lasting effects throughout life, damaging a child's sense of self, ability to have healthy relationships and ability to function at home, at work and at school. Some effects include:
Lack of trust and relationship difficulties. Incidences of abuse by primary caregiver damage the most fundamental relationship of a child that you will safely, reliably get their physical and emotional needs met by the person who is responsible for their care (Patel, 1996). Without this base, it is very difficult to learn to trust people or know who is trustworthy. This can lead to difficulty maintaining relationships due to the fear of being controlled or abused. Abused children cannot express emotions safely. As a result, the emotions of the victims build-up leading to psychological imbalance. Adult survivors of child abuse can struggle with unexplained anxiety, depression, or anger. They may turn to alcohol or drugs to numb out the painful feelings.
The term complex trauma describes the dual problem of children's exposure to traumatic events and the impact of this exposure on immediate and long-term outcomes. Complex traumatic exposure refers to childrens experiences of multiple traumatic events that occur within the caregiving system the social environment that is supposed to be the source of safety and stability in a child's life (McLean & Gallop, 2003).
Typically, complex trauma exposure refers to the simultaneous or sequential occurrences of child maltreatment, including emotional abuse and neglect, sexual abuse, physical abuse, and witnessing domestic violence that could become chronic and begin in early childhood (Gillies et al., 2013). Moreover, the initial traumatic experiences (e.g., parental neglect and emotional abuse) and the resulting emotional deregulation, loss of a safe base, loss of direction and inability to detect or respond to danger cues, often lead to subsequent trauma exposure (e.g., physical and sexual abuse, or community violence). Complex trauma outcomes refer to the range of clinical symptomatology that appears after such exposures.
Whitfield and Davidson (2007) noted that exposure to traumatic stress in early life is associated with enduring sequelae that not only incorporate, but also extend beyond, Posttraumatic Stress Disorder (PTSD). These sequelae span multiple domains of impairment and include: (a) self-regulatory, attachment, anxiety, and affective disorders in infancy and childhood; (b) addictions, aggression, social helplessness and eating disorders; (c) dissociative, somatoform, cardiovascular, metabolic, and immunological disorders; (d) sexual disorders in adolescence and adulthood; and (e) revictimization.
Children and adolescent who have been exposed to sexual abuse are more likely to experience psychiatric disorders. Based on the studies by Lanius et al., (2010), sexually abused children and adolescent tend to exhibit the following psychiatric disorders, post-traumatic stress disorder, depression, suicidal ideas and substance abuse. Furthermore, the diagnosis of psychiatric disorder over the lifetime of the sexually abused victims was much higher for individuals who experienced childhood sexual abuse compared to adult sexual abuse (Macdonald et al., 1996). In addition to the identified psychiatric disorders, sexual abuse among children has also been associated with developmental processes such as relationships. Both adult and childhood sexual abuse victims have been noted to exhibit low sexual interest and difficulty in developing and maintaining sexual relationships. On the contrary, some victims tend to develop high risks sexual behaviours. The following section discusses key psychiatric disorders that have been clinically attributed to childhood and adolescent sexual abuse.
Post-traumatic Stress Disorder
Cohen et al., (2012) noted that sexual abuse results to the emergence of post-traumatic stress disorder (PTSD) among children and adult. Leahy et al. (2012) further added that PTSD is characterised with the repeated re-experience of the traumatizing events that could be inform of recurring recollection of the event through dreams, psychological distress, flashbacks and development of avoidance behaviour to stimuli associated with the sexual abuse event. According to a study by Coid (2003), women who reported childhood sexual abuse were five times more likely to experience PTSD compared to non-victims. It is paramount that family members identify with the unique manifestations of childhood PTSD. Fassler et al., (2005) noted that the development of PTSD in children majorly manifest through the following children loss of interests in undertakings which used to pleasure them, bed wetting and self wetting, inappropriate behaviours for their age and the onset of lack of concentration behaviours. However, these symptoms may not develop immediately after the incidence of sexual abuse but could manifest after years.
Similarly, sexually abused children and adolescent are also likely to be depressed. Studies by Basile and Saltzman (2002) indicated that children...
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