Post-traumatic stress model
The relationship between child sexual abuse and adult psychopathology tended initially to be conceptualised in terms of a chronic form of post traumatic stress disorder (Lindberg and Distad 1985; Bryer et al. 1987; Craine et al. 1988). This model focused on trauma-induced symptoms, most particularly dissociative disorders such as desensitisation, amnesias, fugues and even multiple personality. The idea was that the stress induced symptoms engendered in the process of the abuse and have reverberated down the years to produce a post-abuse syndrome in adult life.
In its more sophisticated formulation, this model attempts to integrate the damage inflicted at the time to the victims’ psychological integrity, by the child sexual abuse and the need to repress the trauma, with resultant psychological fragmentation. The latter manifests itself in adult life in mental health problems, and in problems of interpersonal and sexual adjustment (Rieker and Carmen 1986). The post-traumatic stress model found its strongest support in the observations of clinicians dealing with individuals with histories of severe and repeated abuse. It was also often linked to notions of a highly specific post-abuse syndrome in which dissociative disorders were prominent.
In the United States, a less medicalised model for the mediation of the long term effects of child sexual abuse was proposed by Finkelhor (1987) with his ‘traumatogenic model’. This suggested that child sexual abuse produced a range of psychological effects at the time and, secondarily, behavioral changes. This model predicts a disparate range of psychological impairments and behavioral disturbances in adult life which contrasts with the post traumatic syndrome model with its specific range of symptoms. Finkelhor’s model, though less medical and symptom-bound, pays only scant attention to the developmental perspective. It cedes primacy to the psychological ramifications of the abuse with little acknowledgment of the social dimensions. Only in recent years have attempts been made to articulate the long-term effects of child sexual abuse within a developmental perspective (Cole and Putnam 1992), and to attend to the interactions between child sexual abuse and the child victims’ overall psychological, social and interpersonal development.