Good mental wellbeing — some people call it happiness — is about more than avoiding mental health problems. It means feeling good and functioning well. It can be helpful to maintain an awareness of your overall wellbeing. It can help you to identify the things that have an impact on how well you’re doing and give you more power in improving your functioning. The below wellbeing assessment is a tool to help you with this.
This wellbeing assessment uses the Warwick-Edinburgh Mental Well-being Scale (WEMWBS) to measure wellbeing. More about the WEMWBS is below.
To get a wellbeing score, read through the statements and click on the box that best describes your thoughts and feelings over the last two weeks, then click next to continue on through the 14 questions. You will receive information at the end that will provide an assessment of your current wellbeing.
The WEMWBS is an internationally validated assessment of well-being that utilises strength based language less likely to be triggering or distressing for those who have been traumatised.
By integrating and promoting use of the WEMWBS on the Living Well site, we are very much aware that childhood sexual abuse and sexual assault can profoundly impact on an individuals mental and physical well-being. We have included information on our website on some of the particular difficulties people who have been abused can face, as well as some ways of addressing these.
Our decision to foreground the well-being assessment is based on a knowledge that living a fulfilling, healthy, connected, active life is possible after sexual abuse and we do not wish to accept a lesser goal for all those whom we live and work with.
About the wellbeing scale
The WEMWBS questionnaire for measuring mental well-being was developed by researchers at Warwick and Edinburgh Universities (see Tennant R, Hiller L, Fishwick R, Platt P, Joseph S, Weich S, Parkinson J, Secker J, Stewart-Brown S (2007) The Warwick-Edinburgh Mental Well-being Scale (WEMWBS): development and UK validation, Health and Quality of Life Outcome; 5:63 doi:101186/1477-7252-5-63).
The Warwick-Edinburgh Mental Well-being Scale was funded by the Scottish Executive National Programme for improving mental health and well-being, commissioned by NHS Health Scotland, developed by the University of Warwick and the University of Edinburgh, and is jointly owned by NHS Health Scotland, the University of Warwick and the University of Edinburgh.
The WEMWBS is subject to copyright. We are grateful that we have received permission to use and make available the WEMWBS. Click here for more information about the WEMWBS.
Get the mobile version
The well-being assessment is one of the features available in the free Living Well Appfor iPhone and Android. Keep track of your well-being on the go.
There is an undeniable link between dissociative identity disorder (DID) and child abuse. Child abuse can lead to mental health problems that occur in childhood and can continue into adulthood. People often relate childhood abuse to depressive disorders, anxiety disorders, and posttraumatic stress disorder (PTSD), but dissociative identity disorder has the most significant connection to childhood abuse and neglect, so much so that the connection between DID and child abuse cannot be ignored.
What Is Child Abuse and Neglect, and Who Is at Risk?
Child abuse includes physical abuse, sexual abuse, emotional abuse, and/or neglect that results in the harm of a child. In a large majority of child abuse cases, a parent is the abuser. It is also important to note that women perpetrate child abuse more frequently than men, a reality that goes against common societal belief.
Child abuse knows no boundaries. It occurs in rich families and in poor, in families of all religious backgrounds, and in all different races. There is no “type” of child that will be abused, just as there is no one “type” of abuser.
The Relationship between Child Abuse, Neglect and Dissociative Identity Disorder
DID develops in response to severe, recurring trauma in childhood. Children are not fully equipped to cope with continued, severe instances of abuse, so they may develop dissociation as a survival skill, which can then develop into DID. It makes sense, then, that the rate of childhood abuse and neglect in people with DID is so high.
Preventing Child Abuse Can Prevent Dissociative Identity Disorder
There’s no telling how much of those 90% of DID cases could have been prevented had those children been protected from abuse. If we prevent child abuse, we can greatly reduce the number of cases of DID, and cases of other disorders with roots in childhood trauma.
Awareness and prevention is a universal effort. Mental health workers, teachers, and other professionals working with children need to be aware of the signs of abuse and neglect. We, as a society, need to educate our children about abuse and body safety and eliminate the shame abuse causes.
Most importantly, never deny a child or adult who says they have been abused. Most of the time, abusers are also very good actors, playing the part society wants to see on the outside, and changing their roles into abusers behind closed doors. During one of my psychiatric hospitalizations, I overheard a mental health aide say, “She said her mom abused her, but I don’t know; her mom seemed really nice and caring on the phone.”
That feeling of being invalidated hurts in a way that cannot be erased.
So many times in my life, people turned a blind eye to the abuse. As a child, I showed many of the classic signs of abuse, but those signs were ignored or rationalized by people on the outside. Here was a family that went to church every Sunday, sent their children to private school, and seemed put-together in public. Abuse doesn’t happen in families like that. Except it does. It happened to me; and it happens to countless others.
I’m managing my DID, but I wouldn’t wish it on anyone. I don’t want future generations to have to go through the same turmoil that I went through. Child abuse is preventable. DID can be, too.
Crystalie is the founder of PAFPAC, is a published author and the writer of Life Without Hurt. She has a BA in psychology and will soon have an MS in Experimental Psychology, with a focus on trauma. Crystalie manages life with PTSD, DID, major depression, and an eating disorder. You can find Crystalie on Facebook, Google+, and Twitter.
If you are at greater risk, such as you are over 65 or have pre-existing conditions like heart disease, it’s reasonable to take extra precautions.
For most of us, our emotional response will largely come down to how risk-averse we are, explains David Savage, associate professor of behavioural economics at the University of Newcastle.
“On one end you have the people who are absolutely risk-averse; will go out of their way to avoid risk. These people will always have insurance even for the most bizarre things,” he says.
“They are the people panic-buying.
“At the other end you have what I would classify as risk-seeking people, otherwise known as teenage boys.”
What Dr Savage suggests we should all be aiming for is to be risk-neutral. Good at weighing up odds and responding accordingly.
But he acknowledges that can be difficult given how hard-wired risk aversion is for many of us.
“This aversion is not something we switch on and off, it’s part of our innate nature.”
He says telling people to be less risk-averse is like telling someone to stop being anxious.
Avoidance versus chaos
Your personality type will dictate what level of response you have to something like the spread of coronavirus, explains Dr Annie Cantwell-Bart, a psychologist specialising in grief and trauma.
“If, for example, you come from a family where avoidance style is what you’ve been taught, that’s what you will repeat,” she says.
“Or if you come from a fairly chaotic background where your dad has been in jail and mum is an alcoholic, you will hold a high level of anxiety in living anyway.”
She gives the example of her local barista, who is casually employed.
“When I asked how he was feeling, he said he doesn’t think about it, he just gets on with life.”
She says that avoidance style has its advantages and disadvantages.
“They risk not being prepared or cautious enough. He might feel some trauma if the boss of the cafe says we’re closing down for a fortnight, because he hasn’t prepared.”
On the other end of the scale, people might respond chaotically.
“Like the punch-up in the supermarket. Some people will … get agitated and it’s probably a fear the world will somehow not support them in any way,” Dr Cantwell-Bart says.
We should be more sensitive towards people with this level of anxiety, she says.
“It’s really important not to judge people … they are in a highly aroused anxious state.”
What we’ve been through shapes our response
Upbringing, cultural background and previous experiences all shape how we respond to difficult situations.
But it doesn’t always play out in ways you’d expect. For example, someone who has survived a similar incident previously may feel a false sense of security, rather than the need to be cautious or prepared.
Your beliefs may also cause you to underprepare.
“If you believe that everything is pre-ordained, and a higher power is directing your life, you may not bother with certain precautions,” Dr Savage says.
Having compassion and understanding
Dr Savage says Australians are living in a society that is becoming more individualist than collectivist.
“Half of us are going ‘that is very anti-social’, while the other half is saying ‘good on you’,” he says in regards to people stocking up on supplies.
Dr Cantwell-Bart says in a time of crisis, it’s important to be respectful and tolerant.
“It’s about being more compassionate. Understanding that people who might be behaving in ways we might not, are doing it for good reason.”
Dr Savage recommends taking a step back to remember we’re all different, and there isn’t always right and wrong.
“Take a little bit more time to say ‘I don’t understand what that person is doing, but is that a problem?'”
This video started with a conversation. In fact, it started with many private and professional conversations with Aboriginal and Torres Strait Islander men who have been sexually abused about how difficult it was to speak about what happened to them as a child, about how their lives and relationships had been negatively impacted and about how isolated and alone they felt. The Royal Commission into Institutional Responses to Child Sexual Abuse has highlighted this over representation and sexual abuse of Aboriginal and Torres Strait Islander children within government, community and church run institutions and the difficulties they face in being heard and accessing support.
Anthony Newcastle, Gordon Glenbar and I were discussing how to reach out and offer further support and encouragement to Aboriginal and Torres Strait Islander men who have been sexually abused in childhood. Many of these men have said they will never speak publicly about what was done to them, they have said how difficult it is to access support, how they do not know who to trust and how they are unsure if healing is even possible. These men have also said how important the connection to community and country is for them and how the encouragement and support of fellow community members is particularly meaningful and important for them. —Gary Foster, Living Well.
A starting conversation with Aboriginal & Torres Strait Islander men
by Anthony Newcastle, Natjul.com. In late 2015, I met with Gordon Glenbar, an Aboriginal man working as a special projects officer for Link Up, supporting community members to engage with the Royal Commission into Institutional Responses to Child Sexual Abuse, and Gary Foster from Anglicare: Living Well Service who works with men who had been sexually abused in childhood. Gordon and I have known each other a long time. We’ve always talked about our community, about Aboriginal and Torres Strait Islander families and about the ongoing challenges our communities face confronting the negative impacts of colonisation and resulting inter-generational traumas.
Gordon, Gary and I spoke together of how to raise awareness and offer support to Aboriginal and Torres Strait men who have been sexually abused in childhood. We spoke of how individuals, families and communities are so often struggling to cope and live life in the present that the subject of helping men sexually abused as children is not talked about. We discussed how difficult it was to raise this subject, how the men themselves struggled to talk about it. We acknowledged the importance of qualified and connected individuals and organisations to lead discussions and negotiate community workshops and the extensive work done by many Aboriginal and Torres Strait Islander women in addressing sexual violence. We also discussed how important it was for local Aboriginal men to take responsibility to start supportive conversations with Aboriginal men and their communities about this issue.
The didgeridoo group
Every second Sunday I run ‘Didgeri’ at an inner city park in Brisbane. Didgeri is an Aboriginal men’s didgeridoo group. Didgeri has between 9 and 15 men. Didgeri is a place or gathering where we as Aboriginal men can come along and learn the didgeridoo as a way to connect or re-connect with culture and heritage. It is also a place where we talk about community, identity, culture, about raising kids, dealing with anger, about family and about being a good dad or husband.
All the men who come along know they are welcome to bring a son or nephew, grand-son or friend. Didgeri is a place where Aboriginal men can build and enrich connection. No alcohol or drugs, no carry on or yukai. The boys and young men are encouraged to show respect to older men, to each other and to the purpose of the gathering. At times wives, mothers or grand-mothers do come along. They generally come to drop off family and say hello, but they don’t stay as part of Didgeri.
It was at Didgeri that I raised the idea of the men putting their voices to supporting men who had been sexually abused as children and now living with the consequences. We discussed the idea of us, as every day community members acting to help raise awareness and offer support.
The discussions at Didgeri
On a couple of occasions I found myself standing with three or four other men, all leaning on our didgeridoos talking about what to do about this, and how to support the men and families who suffer as a result of this issue. We talked about community and organisational responses to women who have been sexually abused, and of the advocacy groups, which so rightly wrap around these. None of us could think of a group or advocacy organisation established for Aboriginal and Torres Strait Islander men who were sexually abused as boys.
We talked about taboos and silences within the community. The idea of creating a video that makes a public statement addressing this issue started to sound important. It would be an expression of solidarity and support, by community members, for community members. It would be a way to start a conversation.
There was some talk about approaching well known footballers to see if they would like to participate. I’m happy now that talk lasted about 10 minutes before we moved on. Real happy. We had some quiet respectful discussion about who would be involved, we did not want the message being misunderstood, or not responded to, because we included men facing domestic violence charges or public nuisance charges. What was significant here was that ‘we as men’ from the community were talking about supporting men who had suffered sexual abuse as boys and young men – something we had not discussed before.
We talked about how men struggled, how many had attempted suicide, some dying. We talked about the guilt and pain many men carry about not being able to protect their friends, brothers and sisters from the abuser when they were children.
What became part of our discussions, is that by putting our voices and our images to this, we are giving voice to something that is almost silent, something almost invisible. We are saying silence is no longer OK. We want to lend our voices to acknowledge this as a challenge in the lives of men in our community. We very much wanted to offer support to families that are falling apart, where wives and children are seeing their husband and fathers become changed men because the demons from the past visit them late at night and torment them during their day.
We talked about how men found it difficult to talk with their families about why they are coming apart at the seams. Even though these men love their families dearly and would die without them, the taboo around this issue means it is difficult to speak about. Men do what men too often do. Push it down, ignore it, drink your way through it, yell at it, yell at others, feel ashamed, feel responsible, feel judged, feel alone, blame yourself, but don’t talk about it. As one man said:
“How the bloody hell do you talk about it anyway, and to whom?”
We want to find ways to talk about sexual abuse of males that invite participation. We want to communicate this in a way that invites empathy, understanding and respect, and says no more. Over the weeks we discussed how, if people aren’t talking about it, then nothing is being done. Some of our discussions had long pauses, or some changing of subject, before resuming. Some men stood in silence. We concluded that if nothing is being done about it and our brothers and our sisters lives are falling apart because of it, let’s do something.
We wanted to address the isolation and silence. We wanted to say,
“We know this happened to you and we are sorry it did. We want you to know that you are still our brother.”
We want to help address the fear of being judged and the feelings of shame. The shame is not yours to carry.
We talked about the importance of speaking, not just to men who have been sexually victimised, but to men and women across our communities.
Over the following weeks I rang, met with, and talked to about 20 people. All of the Didgeri group wanted to participate in some way. There were men who said straight away, “Yes, I want to support that and I will say it to camera.” Some said that they really wanted to offer support in some way, but because of family, work or how their involvement might be seen, they couldn’t be part of the video at present. There were men who said that although they felt for the fellas, they didn’t know if they could do it, as any talk of sexual abuse of children was hard for them to be around. Those who did not appear on camera, shook our hands and said, “Good on you for doing this.”
Making the video
Eleven of us gathered in a studio at the 4BE Multi-cultural radio station at Kangaroo Point to record our bits. We decided that in the room we would have only the person speaking to camera, the camera operator and myself, in order to help people relax and feel comfortable. We wanted to remove any shame-job. But with eleven Aboriginal people together in the waiting room, among the chats and yarns, people talking about who their mob were, and where their people are from, as always, family reconnections were found. “Hey, your mob from Roma? Your uncle is George from that cattle station? That’s my uncle too, that’s my tribe, we cousins.”
As people felt more comfortable with each other, as personal connections were made and a feeling of being in this together came over the group, then people started pairing up, saying, “Do you mind if I do it with Wayne, because he my cousin and we never met before.”
Others would say things like, “Brother, I never done anything like this before, can you sit with me and do one together?”
Before we knew it everyone was in the room supporting each other with comments like, “Oh that sounded deadly (really good) what you said then sis.” Or, “You two fellas look and sound good there when you said that.”
Ownership had shifted. Now the participants were making suggestions and talking about how good a project this was to be involved with.
It was on this day in the studio that some of participants spoke of how personal this was for them, their families and community. This issue impacted on members of the Didgeri and had not been discussed before that day. The gathering became an opportunity to talk and make a difference. The mood in the room changed, embracing connection, listening, caring, sharing and laughing together, offering support and genuine regard.
Talk turned to, “When this being released, we going to get to see it before?” and, “Do you think we can do another one?”
Six weeks later
It is now NAIDOC week and this Sunday afternoon we will have a first public showing of the video on a big screen at the Musgrave Park Cultural Centre in South Brisbane, where the guests of honour are the eleven people who participated, their families and friends. Over the weeks I have been constantly asked by those involved about when everyone gets to see the video.
This Sunday many of our Didgeri group will bring their didgeridoos and we will have our didgeridoo lesson aside before the video showing. My wife is making sandwiches, a curry and rice and some finger food. Gordon has been a constant source of encouragement and Gary has had almost boundless energy to keep pace, to bring this project together.
Now only days from the launch of our video I think about our first meetings (Gary, Gordon and I). I think of how appreciative I am of those individuals and organisations who work to address sexual violence and its impacts on our communities. I am however, particularly pleased that this project and these discussions happened in and amongst a group many would call grass roots. I am pleased that Aboriginal men and women stepped forward and put their face and voice to raising awareness and generating discussion that offers support to men who have been sexually abused in childhood, as well as their families. Community taking action and responsibility for community.
I was reminded of a discussion about suicide prevention and response I had with a 72 year old Aboriginal man on a remote Cape York community some years ago. When I asked him, “What can we do about this lack of counsellors and social workers and psychologists who can support people in remote places like this?” The old man said:
“When someone is finding it hard to live, we all know they might be finding it hard to live because we are a small town. Sometimes the best thing you can do for somebody else is go and see them, and sit on their porch and sit down and have a cup of tea with them. Even if you don’t know what to say about that thing that is a problem for them, you can still have a cup of tea with them. And they will know.”
We wish to express our appreciation to the men and women who have supported the development of the No More Silence: It’s Never Too Late to Start Healing video. This video reflects the power of everyday community members to make a difference.
We are only too aware of the profound impacts child sexual abuse can have on Aboriginal and Torres Strait Islander boys and men, girls and women and their communities:
Isolation, feeling alone and different.
Guilt, shame, self blame, distrust.
Feeling overwhelmed, hurt, angry, not good enough.
Disconnection from family, community and country.
Mental health problem, depression, anxiety.
Flashbacks, nightmares, sleep problems.
Suicide, self harm.
Relationship and sexual difficulties.
Drink and drug abuse.
Involvement with police and criminal justice system, prison.
Physical health problems.
Barriers to speaking
Men sexually abused in childhood report multiple barriers to speaking about what happened and accessing support:
Fear he won’t be believed or will be judged.
Sense of shame.
Concern his sexuality or manhood will be questioned.
Worry he will be seen as less of a man or people might think he will go on to abuse.
Distrust of authority, police, of anyone.
Fear of being blamed or that he will face payback for speaking up.
Worry that he will fall apart if he starts talking.
Being told to keep quiet that the community is not ready to talk about this.
Wanting to protect family members and others who were abused.
Having no-one to talk with.
Pressure from the abuser and others to keep the silence.
As well as hearing how difficult it is for Aboriginal and Torres Strait Islander men to speak about childhood sexual abuse, we hear that the pressure not to talk increases the sense of isolation, and makes it difficult to get the help they deserve.
A conversation starter
The video is designed as a conversation starter. Sharing the video is one way for community members to raise awareness and offer support, encouragement and hope to those who have been sexually abused in childhood. It sends a message to all those who have been sexually abused or sexually assaulted across Queensland and throughout Australia to say:
You’re not responsible for what happened to you as a child. You are not alone. We care. The blame is not yours to carry. The shame is not yours to carry. Keep talking until you get the help you deserve. Take care of yourself, you’re worth it. It’s never too late to start healing.
1800 Respect Website: 1800respect.org.au 24/7 telephone and online crisis counselling, information and referral for anyone in Australia who has experienced or been impacted by sexual assault, domestic or family violence. Staffed by trauma specialist counsellors. Phone: 1800 737 732 Online Counselling: 1800respect.org.au/telephone-and-online-counselling
Lifeline Website: lifeline.org.au 24 hour crisis support and suicide prevention. Phone: 131 114
Link Up (QLD) Aboriginal Corporation Website: link-upqld.org.au Provides counselling, healing and culturally appropriate support for indigenous Australians. Phone: 1800 200 855
Healing Foundation Website: healingfoundation.org.au The Healing Foundation is a national Aboriginal and Torres Strait Islander organisation with a focus on building culturally strong, community led healing solutions. Phone: 02 6272 7500
Micah Projects Inc / Lotus Place (Find and Connect QLD) Website: lotusplace.org.au Support and resource service for Forgotten Australians and former child migrants. Phone: 1800 161 109 Email: email@example.com
Relationships Australia QLD Website: raq.org.au Family, children and relationship counselling. Relationship Australia are committed to offering the best possible counselling, mediation, education and support services in a professional, relaxed and confidential environment. Phone: 07 3423 6890 Phone: 1800 552 127 Government Funded
Bravehearts Website: bravehearts.org.au Specialist case management, counselling and telephone counselling for child and adult survivors, non-offending family members and friends. Services include counselling, support engaging with the Royal Commission, preparation of written statements, attending private sessions and public hearings. Phone: 1800 272 831 (8am – 8pm AEST/AEDT, weekdays) Email: firstname.lastname@example.org
Blue Knot Foundation Website: blueknot.org.au (Formerly Adults Surviving Child Abuse – ASCA). National professional phone counselling, information and support for adult survivors of child abuse with referral database of experienced professionals and agencies. Provides workshops for survivors, family members, partners and friends. Professional development for health professionals is also available. Phone: 1300 657 380 (9am-5pm AEST/AEDT 7 days) Email: email@example.com
Murrigunyah Website: murrigunyah.org.au Murrigunyah Family & Cultural Healing Centre is a community based sexual assault support service run by Aboriginal & Torres Strait Islander women of Logan City. Phone: (07) 3290 4254 Email: firstname.lastname@example.org
BeyondBlue has programs for Aboriginal and Torres Strait Islander peoples and general information on mental health, including how to recognise depression and where to get help. Phone 1300 22 4636
Aboriginal and Torres Strait Islander Community Health Service (ATSICHS) Call the ATSICHS Healing Centre on (07) 3240 8907 to access culturally appropriate counselling services for Aboriginal and Torres Strait Islander people in Brisbane affected by mental illness.
Townsville Aboriginal and Torres Strait Islander Health Services (TAIHS) The TAIHS Social and Mental Health Unit offers mental health counsellors and run regular men’s and women’s groups to help cope with:
Prison and court matters.
Phone TAIHS on (07) 4759 4022 to book a counselling session or join a group.
The ideal response to child sexual abuse would be primary prevention strategies aimed at eliminating, or at least reducing, the sexual abuse of children (Tomison, 1995). This review has, however, focused on issues related to the deleterious outcomes linked to child sexual abuse rather than on the characteristics of abusers and the contexts in which abuse is more likely to occur, which are relevant to primary prevention. From the information presented here, the implications are for secondary and tertiary preventive strategies aimed at ameliorating the damage inflicted by abuse, and reducing the subsequent reverberations of that damage.
Child sexual abuse may be a necessary, but rarely (if ever) a sufficient, cause of adult problems. Child sexual abuse acts in concert with other developmental experiences to leave the growing child with areas of vulnerability. This is a dynamic process at every level, and one in which there are few irremediable absolutes. Abuse is not destiny. It is damaging, and that damage, if not always reparable, is open to amelioration and limitation.
Those who have been abused who subsequently have positive school experiences where they feel themselves to have succeeded academically, socially or at sport, have significantly lower rates of adult difficulties (Romans et al. 1995). Those whose relationship with their parents subsequent to abuse was positive and supportive fared better, and a good relationship with the father appeared to have a strong protective influence regarding subsequent psychopathology (Romans et al. 1995). Even aspects of the parental figures’ relationship to each other seem to have an influence. Expressions of physical affection between parents was associated with better outcomes, and marked domestic disharmony, particularly if associated with violence, added to the damage (Romans et al. 1995; Spaccarelli and Kim 1995). Finally, those who can establish stable and satisfactory intimate relationships as adults have significantly better outcomes.
There is no reason why a well-organised and funded school system should not provide all children with a positive experience academically, socially or in sport. There is no need to identify and target abuse victims, but simply to make every effort to ensure adolescents have the opportunity to share in the enhanced social opportunities, the increased mastery, and the pleasure of achievement that school should provide at some level to all.
The encouragement of sport may seem trivial, but it has a protective influence on psychiatric disorders in all adolescents, not just those with histories of child abuse (Romans et al. 1996; Thorlindsson et al. 1990; Simonsick 1991). Similarly in adult life, success in tertiary education and in the workforce is associated with reduced vulnerability to psychiatric problems for the abused and the non-abused alike, but particularly for the abused (Romans et al. 1996).
The secondary preventive strategies of relevance in reducing the impact of child sexual abuse are equally relevant to reducing a wide range of adolescent and adult problems unrelated to abuse. These include improved parental relationships, reduced domestic violence and disharmony, improved school opportunities, work opportunities, better social networks, and better intimate relationships as adults. The list is so familiar as to be platitudinous, but is nonetheless of central importance.
The model advanced in this paper is of child sexual abuse contributing to developmental disruptions that lay the basis for interpersonal and social problems in adult life. These, in turn, increase the risks of adult psychiatric problems and disorders. If this is correct, then focusing on improving the social and interpersonal difficulties of those with histories of child sexual abuse may be the most effective manner of reducing subsequent psychiatric disorder.
This argues for tertiary prevention strategies aimed at improving self-esteem, encouraging more effective action in work and recreational pursuits, attempting to overcome sexual difficulties, and working specifically on improving the victim’s social networks and capacities to trust in, and accept, intimacy. This does not imply that established affective disorders or eating disorders should not be treated in their own right, but suggests that focusing on current vulnerabilities and deficits may be more productive than extended archeologies of past abuse in the search of an elusive retrospective mastery.
The hypothesis advanced in this paper is that, in most cases, the fundamental damage inflicted by child sexual abuse is to the child’s developing capacities for trust, intimacy, agency and sexuality, and that many of the mental health problems of adult life associated with histories of child sexual abuse are second-order effects. This hypothesis runs counter to the post-traumatic stress disorder model, and suggests different therapeutic strategies and strategies of secondary prevention.
In practice, both models may be of value. The post-traumatic stress disorder like mechanisms may predominate in the short term, and in those who have been exposed to the grossest form of child sexual abuse. The developmental and social model may carry the weight of causality in the far commoner, but less utterly overwhelming, forms of child sexual abuse.
References (see Library)
Long-term Effects of Child Sexual Abuse by Paul E. Mullen and Jillian Fleming wwww.aaets.org/article176.htm