Tag Archives: Mental health

Violating children’s rights: The psychological impact of sexual abuse in childhood

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Professor Jill Astbury MAPS, College of Arts, Victoria University

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All forms of child sexual abuse (CSA) are a profound violation of the human rights of children. CSA is a crime under Australian law and an extreme transgression of trust, duty of care and power by perpetrators. The rights violations that define CSA are critically connected to the deleterious behavioural and psychological health consequences that ensue. This article examines the long-term effects of CSA on mental health and the determinants of these outcomes, in order to identify opportunities to ameliorate the profound psychological impacts of CSA on the lives of many victims/survivors. The article is based on a literature review commissioned to inform the APS response to the Royal Commission into Institutional Responses to Child Sexual Abuse, which was established in 2013 by the Gillard Government.

Prevalence of child sexual abuse

Rates of CSA are difficult to gauge accurately given the clandestine, sensitive and criminal nature of the sexual abuse to which children are exposed. Perpetrators of CSA are often close to the victim, such as fathers, uncles, teachers, caregivers and other trusted members of the community (Finkelhor, Hammer & Sedlak, 2008). CSA often goes undisclosed and unreported to professionals or adults for many complex reasons, including fear of punishment and retaliation by the perpetrator, as well as the stigma and shame associated with this type of abuse (Priebe & Svedin, 2008).

A global meta-analysis of child sexual abuse prevalence figures found self-reported CSA ranged from 164-197 in every 1,000 girls and 66-88 per 1,000 boys (Stoltenborgh, van Ijzendoorn, Euser, & Bakermans-Kranenburg, 2011). In Australia, Fleming (1997) used a community sample of 710 women randomly selected from the Australian electoral roll and found that 20 per cent of the sample reported experiencing CSA involving contact. Another national survey involving both men and women (Najman, Dunne, Purdie, Boyle, & Coxeter, 2005) reported a higher prevalence of CSA, with more than one third of women and approximately one sixth of men reporting a history of CSA. A more recent study in Victoria (Moore et al., 2010) reported a prevalence rate of 17 per cent for any type of CSA for girls and seven per cent for boys when they took part in the study during adolescence. Both Australian studies involving community samples of women or girls and men or boys indicate that girls are two or more times more likely to experience CSA than boys.

Long-term mental health consequences

A significant body of research has demonstrated that the experience of CSA can exert long-lasting effects on brain development, psychological and social functioning, self-esteem, mental health, personality, sleep, health risk behaviours including substance use, self-harm and life expectancy. CSA often co-occurs with physical and emotional abuse and other negative and stressful childhood experiences that independently predict poor mental and physical health outcomes in adult life.

Nevertheless, the research literature indicates that when other predictors of poor adult mental health are statistically controlled, CSA remains a powerful determinant of psychological disorder in adult life (Kendler et al., 2000). Strong evidence from twin studies indicates that a causal relationship exists between CSA and subsequent mental disorders. Twin studies necessarily control for genetic and family environment factors and a number since 2000 have documented significant associations between CSA, depression, panic disorder, alcohol abuse/dependence, drug abuse/dependence, suicide attempts and completed suicides.

A systematic review and meta-analysis of studies published between 1980 and 2008 (Chen et al., 2010) found that a history of sexual abuse including child sexual abuse was related to significantly increased odds of a lifetime diagnosis of several different psychiatric disorders, including anxiety disorders, depression, eating disorders, posttraumatic stress disorder (PTSD), sleep disorders and suicide. A particularly strong link between CSA and subsequent PTSD has been found.

Although the diagnosis of PTSD may be appropriate for those who have been exposed to relatively circumscribed CSA, Herman (1992) argued more than two decades ago that this diagnosis does not adequately capture the psychological responses of people who are repeatedly traumatised over a long period of time, experience subsequent re-victimisation in adolescence or adult life and typically display multiple symptoms of psychological distress and high levels of psychiatric co-morbidity. For survivors of this kind of CSA, Herman (1992) proposed the expanded diagnostic concept of complex PTSD on the grounds that it was better able to accurately capture the complex psychological sequelae of prolonged, repeated trauma.

Risk of suicide: Australian research

Survivors of CSA face a significantly increased risk of suicide and a higher prevalence of suicide attempts and ideation. An Australian follow-up study (Plunkett et al., 2001) of young people who had experienced CSA compared with those who had not, reported that those with a CSA history had a suicide rate 10.7-13.0 times the national rate. Furthermore, 32 per cent of those sexually abused as children had attempted suicide and 43 per cent had thought about suicide. None of the non-abused participants had completed suicide.

A more recent Australian study confirms and extends this finding. Cutajar and colleagues (2010) conducted a cohort study of 2,759 victims of CSA by linking forensic records from the Victorian Institute of Forensic Medicine between 1964 and 1995 to coronial records up to 44 years later. They found that female sexual abuse victims had 40 times higher risk of suicide and 88 times higher risk of fatal overdose than the rates in the general population. Interestingly these rates were even higher than those for males, in contrast to the usual gender pattern for suicide. The respective rates for males were 14 times and 38 times higher than those in the general population.

Determinants of long-term mental health outcomes

While victims/survivors of CSA face greatly increased risks of poor mental health in adult life, a significant minority do not go on to develop psychological disorders (Saunders, Kilpatrick, Hanson, Resnick, & Walker, 1999). Broadly, two approaches to explaining this finding have informed research: differences in the nature of the abuse that has taken place; and post-abuse factors that positively mediate or intervene in the development of negative long-term mental health outcomes.

Nature of the sexual abuse

The likelihood of experiencing severe, negative mental health outcomes in adult life as the result of CSA is increased by several abuse-specific characteristics. Large scale epidemiological studies have consistently documented that forced penetrative sex, multiple perpetrators, abuse by a relative, and a long duration of CSA (e.g., more than a year) predict more severe psychiatric disturbance and a higher likelihood of being an in-patient in a psychiatric facility in adult life.

More than 20 years ago, Pribor and Dinwiddie (1992) investigated different types of CSA of increasing severity and found that incest victims had a significantly increased lifetime prevalence rate for seven psychological disorders including agoraphobia, alcohol abuse or dependence, depression, panic disorder, PTSD, simple phobia and social phobia. Bulik, Prescott and Kendler (2001) also confirmed that a higher risk for the development of psychiatric and substance use disorders was associated with certain characteristics of the abuse, including attempted or completed intercourse, the use of force or threats and abuse by a relative. More severe and chronic abuse which starts at an early age has also been reported to increase the risk of developing symptoms of dissociation.

Post-abuse mediating factors

Certain factors, both negative and positive, are likely to intervene after CSA has taken place and to mediate adult mental health outcomes.

  • Coping strategies
    Specific coping strategies used by survivors can positively or negatively predict long-term psychological outcomes. Overall, positive, constructive coping strategies such as expressing feelings and making efforts to improve the situation are associated with better adjustment (Runtz & Schallow, 1997; Tremblay, Hebert, & Piche, 1999), and negative coping strategies, including engaging in self-destructive or avoidant behaviours, with worse adjustment (Merrill, Thomsen, Sinclair, Gold, & Miller, 2001). However, the coping strategies used by survivors are contingent to some degree on the availability of social or material resources over which children have little or no control.

    In addition, the number of negative or maladaptive coping strategies used is predictive of the likelihood of sexual re-victimisation in adulthood (Filipas & Ullman, 2006). This strongly indicates that the link between CSA, negative coping strategies and adverse adult psychological outcomes is strengthened by sexual re-victimisation. Several studies have confirmed this relationship.
  • Re-victimisation
    CSA is associated with an increased risk of subsequent violent victimisation including intimate partner violence and sexual violence in adolescence and adulthood (see, for example, Classen, Palesh, & Aggarwal, 2005). Sexual re-victimisation involving rape or other types of sexual abuse/assault poses a potent risk for worse psychological health in adult life. A number of studies have confirmed that women who are sexually re-victimised compared with their non-revictimised counterparts have more severe symptoms of psychological distress in adulthood.
  • Social support and reaction to disclosure
    Historically, the role of social support and other societal and cultural factors in determining survivors’ responses to CSA has been under-explored in comparison with the heavy focus on the survivor’s role in responding to sexual trauma. Increased interest in the contribution of social support and other sociocultural factors has prompted increased investigation into the social contextual factors that can mediate adult outcomes following childhood violence, many of which are associated with the reactions to disclosure.

Delay in the disclosure of CSA is linked inevitably with other delays, all of which are harmful to the child. These include delay in putting in place adequate means to protect the child from further victimisation, delay in the child receiving meaningful assistance including necessary psychological and physical health care, and delay in redress and justice for the victim. Without disclosure, negative health outcomes are more likely to proliferate and compound. Conversely, disclosure within one month of sexual assault occurring is associated with a significantly lower risk of subsequent psychosocial difficulties in adult life including lower rates of PTSD and major depressive episodes (Ruggiero et al., 2004).

Yet experiences of disclosure are not uniform and whether they are positive or negative depends on the reactions of the person to whom the CSA is disclosed. Unfortunately, negative reactions to disclosure are common, constitute secondary traumatisation and are associated with poorer adult psychological outcomes (Ullman, 2007). Such reactions include not being believed, being blamed and judged, or punished and not supported, all of which can compound the impact of the original abuse and further increase the risk of psychological distress including increased symptoms of PTSD, particularly when the perpetrator is a relative.

Specific characteristics of disclosure appear to be protective against the development of psychiatric disorders. This finding highlights the importance of social support in concert with effective action by the person in whom the child confides. The degree to which someone is affected is likely to reflect various indicators of the severity of the abuse as well as countervailing protective factors such as the strength of family relationships and the survivor’s self-esteem. One such factor is a warm and supportive relationship with a non-offending parent, which is strongly associated with resilience following CSA and lower levels of abuse-related stress.

Implications for psychological training and practice

The research outlined above shows conclusively that CSA is associated with multiple adverse psychological outcomes, although such outcomes are not inevitable. The identified mediating or intervening factors that increase or decrease the risk of developing psychological disorders as a result of CSA have important implications for psychological training and for the practising psychologists who work with survivors of CSA.

Training on CSA

It is a matter of grave concern that the issue of CSA has been neglected in psychology training. When psychologists lack appropriate knowledge and skills to work with survivors they put both their clients and themselves at risk and can cause unintended harm. Training on CSA is urgently needed in psychology programs to disseminate evidence to students on the protean psychological consequences of CSA as well as the skills necessary to carry out the demanding mental and emotional work of treating survivors. Survivors can have chronic, complex problems in many areas of functioning and psychological disorders can overlap with physical health problems, including pain syndromes and high risk health behaviours such as alcohol, tobacco and drug use. Careful long-term psychological care is often necessary. As survivors may seek help from a range of psychologists, it is important that all psychologists are educated about the magnitude and psychological consequences of CSA.

Apart from acquiring more in-depth knowledge of the emotional effects of CSA and experience in trauma-related interventions, postgraduate courses should prepare practitioners for how exposure to their clients’ traumatic material can traumatise them as well. To remain psychologically healthy while working with survivors of CSA, psychologists need to be able to recognise symptoms of secondary traumatic stress and develop self-care strategies and support systems that will help them to manage the stress related to working with CSA survivors.

Most practising psychologists today who work with survivors have acquired their knowledge and skills ‘on the job’ post-graduation or as a result of their own initiative by attending workshops delivered by specialists in the field. An unknown number of registered psychologists may have no training on CSA and a more systematic continuing education program should be available and accessible so that all psychologists are equipped, at the very least, to ‘do no harm’ to the clients who have experienced CSA.

Implications for psychological practice

Knowing how to facilitate disclosure and take a comprehensive trauma history is an essential first step in developing a treatment plan for survivors of CSA. How a psychologist responds to a client’s disclosure will have an enormous impact on whether a survivor continues or abruptly terminates treatment. Any hint of disbelief, blame or judgment is likely to fracture the client’s fragile hope that she or he will be believed and that it is safe to undertake the painful task of working through the original abuse and its aftermath. If the response to a disclosure is negative it may be years before a survivor is willing to try again, and in the meantime the psychological burden of the abuse and its effects can proliferate. The effort to remain silent and keep the abuse hidden is extremely isolating and cuts off access to potential avenues of psychosocial support.

It would be a mistake for psychologists to assume, for example, that knowing about prolonged exposure therapy for the treatment of PTSD, would, by itself, be sufficient to offer effective treatment to survivors. Beyond the symptoms of traumatic stress associated with CSA, survivors often struggle with many other pressing concerns. These often relate to the deep betrayal of trust by the adult/s with a duty of care towards them as children. This betrayal can prompt persistent negative self-perceptions, difficulties in trusting others and their own judgement, and abiding feelings of shame and intrinsic ‘unloveability’ that contribute to insecure, unsatisfying relationships in adult life. These same issues can impinge on the client-psychologist interaction, making it challenging to establish a robust therapeutic alliance or maintain appropriate boundaries.

CSA does not result in a single disorder such as depression, treatable within the 10 sessions supported under the Better Access to Mental Health Care initiative. The chronicity and complexity of the disorders stemming from CSA require much longer term mental health care. The current system under Medicare is very poorly suited to meeting the mental health care needs of perhaps the most numerous and psychologically vulnerable group in society – CSA survivors.

Conclusion

The Royal Commission has provided a timely opportunity to closely examine the enduring, deleterious and multi-faceted impacts of CSA on survivors, how institutions in which abuse took place failed to intervene and the kind of assistance survivors believe will be most helpful in healing from their traumatic experiences. Psychology has much to contribute to this process and to ensure that the best available psychological evidence is put forward to address the profoundly disturbing phenomenon of child sexual abuse.

Clergy-perpetrated child sexual abuseIn contrast with the large evidence base amassed since the 1980s on the prevalence and health consequences of CSA occurring in the general community, minimal research was published before 2000 on CSA perpetrated by clergy or others working for institutions or organisations, and evidence remains limited in scope.There is an additional theological and spiritual dimension to clergy-perpetrated abuse that sets it apart other forms of CSA, including a spiritual and religious crisis during and after the abuse (Farrell & Taylor, 2000). CSA perpetrated by priests and other members of the clergy has been described as “a unique betrayal” (Guido, 2008) and the “ultimate deception” (Cook, 2005), and the implications of such abuse for victims are eloquently described by McMackin, Keane and Kline (2008):The sexual exploitation of a child by one who has been privileged, even anointed, as a representative of God is a sinister assault on that person’s psychosocial and spiritual well-being. The impact of such a violent betrayal is amplified when the perpetrator is sheltered and supported by a larger religious community. (p.198)Psychological consequences of clergy-perpetrated child sexual abuseClergy-perpetrated sexual abuse of children can catastrophically alter the trajectory of victims’ psychosocial, sexual and spiritual development (Fogler et al., 2008). In the US, investigation into the Catholic Church by the John Jay Research Team repeatedly identified certain psychological effects of clergy CSA in the personal testimony of survivors and family members. These included major symptoms of PTSD with co-occurring substance abuse, affective lability, relational conflicts, and a profound alteration in individual spirituality and religious practices associated with a deep sense of betrayal by the individual perpetrator and the church more broadly (John Jay College, 2004, 2006; McMackin et al., 2008).Some of these negative psychological outcomes are shared with survivors of CSA in the general population but those related to spirituality, religious practices and a sense of betrayal by the church alter the nature of the harm caused by clergy-perpetrated CSA. While a diagnosis of PTSD may be useful as a starting point in understanding and treating survivors of clergy CSA, Farrell and Taylor (2000) contend that “there are qualitative differences in [clergy-perpetrated CSA] symptomatology, which the PTSD diagnosis cannot explain” (p. 28). Such symptoms include self-blame, guilt, psychosexual disturbances, self-destructive behaviours, substance abuse, and re-victimisation. These symptoms are argued to emanate from the theological, spiritual and existential features of clergy CSA. For these reasons, Farrell and Taylor (2000) suggest that a diagnosis of complex PTSD (Herman, 1992) offers a better fit for the symptoms reported by survivors of clergy-perpetrated CSA.Preventing clergy-perpetrated child sexual abuseThe history of denial, cover up and delays in response to disclosures of clergy CSA by churches has been well documented, with their responses to perpetrators evidencing a failure to implement any effective preventative measures. To stop institutional CSA from occurring, it is critical to understand the situational indicators of such abuse so that the opportunities they afford to perpetrators to commit the crime of CSA can be identified.Parkinson and colleagues (2009) identified that having immediate and convenient access to minors were the defining characteristics that facilitated abuse. The evidence also suggests the need for parents and their children to be made much more aware of the grooming tactics used by clergy who perpetrate CSA. The John Jay College study (2006) identified the strategies that allowed the perpetrators to become close to the child they subsequently abused including being friendly with the victims’ families, giving gifts or other enticements such as taking them to sporting events or letting them drive cars, and spending a lot of time with victims.A recurrent theme in Australian victims’ accounts is how their parents’ religious beliefs and trust and reverence for members of the clergy meant that they could not conceive of the possibility that priests could sexually abuse their children and betray their own vows. Yet there is ample evidence that this trust was sadly misplaced and the same caution that would be applied to other members of society needs to be applied to the clergy.Finally, in tandem with a message from churches that there is zero tolerance for CSA, there needs to be a clear and trustworthy process in place, independent of the churches, that encourages children to disclose CSA safely and confidentially. Educational programs in all schools beginning in primary school might be one way of achieving this.Victims of clergy-perpetrated CSA need to be heard with respect and compassion, given meaningful assistance to meet their psychosocial needs, and provided with justice through those who perpetrated the abuse and those who covered it up being held fully accountable. Only then will it be possible for recovery from the immense trauma of clergy CSA and the rebuilding of shattered lives to truly begin.

The author can be contacted at Jill.Astbury@vu.edu.au

References

  • Parkinson, P., Oates, K. & Jayakody, A. (2009). Study of reported child sexual abuse in the Anglican Church. Submission to the Victorian Inquiry into the handling of child abuse by religious and other organisations.
  • Plunkett, A., O’Toole B., Swanston, H., Oates, R. K., Shrimpton, S. & Parkinson, P. (2001). Suicide risk following child sexual abuse. Ambulatory Paediatrics, 1 (5), 262-266.
  • Pribor, E. F. & Dinwiddie, S. H. (1992). Psychiatric correlates of incest in childhood. American Journal of Psychiatry, 149, 52-56.
  • Priebe, G. & Svedin, C. G. (2008). Child sexual abuse is largely hidden from the adult society: An epidemiological study of adolescents’ disclosures. Child Abuse and Neglect, 32(12), 1095-108.
  • Ruggiero, K. J., Smith, D. W., Hanson, A., Resnick, H. S., Saunders, B. E., Kilpatrick, D. G., Best, C. L. (2004). Is disclosure of childhood rape associated with mental health outcome? Results from the National Women’s Study. Child Maltreatment, 9, 62-77.
  • Runtz, M. G. & Schallow, J. R. (1997). Social support and coping strategies as mediators of adult adjustment following childhood maltreatment. Child Abuse and Neglect, 21(2), 211-226.
  • Saunders, B. E., Kilpatrick, D. G., Hanson, R. F., Resnick, H. S., & Walker, M. E. (1999). Prevalence, case characteristics, and long-term psychological correlates of child rape among women: A national survey. Child Maltreatment, 4,187-200.
  • Stoltenborgh, M., van Ijzendoorn, M.H., Euser, E. M. & Bakermans-Kranenburg, M. J. (2011). A Global Perspective on child sexual abuse: Meta-Analysis of prevalence around the world. Child Maltreatment, 16(2), 79-101.
  • Tremblay, C., Hebert, M. & Piche, C. (1999). Coping strategies and social support as mediators of consequences in child sexual abuse victims. Child Abuse and Neglect, 23, 929–945.
  • Ullman, S. E. (2007). Relationship to perpetrator, disclosure, social reactions, and PTSD symptoms in child sexual abuse survivors. Journal of Child Sexual Abuse, 16(1), 19-36.
  • Bulik, C. M., Prescott, C. A., & Kendler, K. S. (2001). Features of childhood sexual abuse and the development of psychiatric and substance use disorders. British Journal of Psychiatry, 179, 444-449.
  • Chen, L. P., Murad, M. H., Paras, M. L., Colberson, K. M., Sattler, A. L., et al. (2010). Sexual abuse and lifetime diagnosis of psychiatric disorders: systematic review and meta-analysis. Mayo Clinic Proceedings, 85(7), 618-629.
  • Classen, C. C., Palesh, O. G. & Aggarwal, R. (2005). Sexual revictimization: A review of the empirical literature. Trauma, Violence & Abuse, 6(2), 102–129.
  • Cook, L. J. (2005). The ultimate deception: Childhood sexual abuse in the church. Journal of Psychosocial Nursing and Mental Health Services. 43(10), 18-24.
  • Cutajar, M. C., Mullen, P. E., Ogloff, J. R. P., Thomas, S. D., Wells, D. L. & Spataro, J. (2010b). Suicide and fatal drug overdose in child sexual abuse victims: A historical cohort study. Medical Journal of Australia, 192(4), 184–187.
  • Farrell, D. P. & Taylor, M. (2000). Silenced by God: An examination of unique characteristics within sexual abuse by the clergy. Counselling Psychology Review, 15, 22-31.
  • Filipas, H. H. & Ullman, S. E. (2006). Child sexual abuse, coping responses, self-blame, PTSD, and adult sexual revictimization. Journal of Interpersonal Violence, 21, 652-672.
  • Finkelhor, D., Hammer, H. & Sedlak, A. J. (2008). Sexually Assaulted Children: National Estimates and Characteristics. National Incidence Studies of Missing, Abducted, Runaway, and Thrownaway Children (NISMART–2) Bulletin. US: Department of Justice.
  • Fleming, J. (1997). Prevalence of childhood sexual abuse in a community sample of Australian women. Medical Journal of Australia, 166, 65-68.
  • Fogler, J. M., Shipherd, J.C., Clarke, S., Jensen, J. & Rowe, E. (2008). The impact of clergy-perpetrated sexual abuse: the role of gender, development and posttraumatic stress. Journal of Child Sexual Abuse, 17(3-4), 329-358.
  • Guido, J. (2008). A unique betrayal: Clergy sexual abuse in the context of the Catholic religious tradition. Journal of Child Sexual abuse, 17(3-4), 255-269.
  • Herman, J. L. (1992). Complex PTSD: A syndrome in survivors of prolonged and repeated trauma. Journal of Traumatic Stress, 5 (3), 377-391.
  • John Jay College. (2004). The nature and scope of sexual abuse of minors by Catholic priests and deacons in the United States, 1950-2000. Washington, DC: United States Conference of Catholic Bishops.
  • John Jay College. (2006). The nature and scope of sexual abuse of minors by Catholic priests and deacons in the United States- supplementary data analysis. Washington, DC: United States Conference of Catholic Bishops.
  • Kendler, K. S., Bulik, C. M., Silberg, J., Hettema, J. M., Myers, J. & Prescott, C.A. (2000) Childhood sexual abuse and adult psychiatric and substance use disorders: An epidemiological and co twin control analysis. Archives of General Psychiatry, 57, 953 -959.
  • McMackin, R.A., Keane, T. M. & Kline, P.M. (2008). Introduction to special issue on betrayal and recovery: Understanding the trauma of child sexual abuse. Journal of Child Sexual Abuse, 17(3-4), 197-200.
  • Merrill, L. L., Thomsen, C. J., Sinclair, B. B., Gold, S. R. & Milner, J. S. (2001). Predicting the impact of child sexual abuse on women: The role of abuse severity, parental support and coping strategies. Journal of Consulting Clinical Psychology, 69(6), 992-1006.
  • Moore, E. E., Romaniuk, H., Olsson, C. A., Jayasinghe, Y., Carlin, J. B. & Patton, G. C. (2010). The prevalence of childhood sexual abuse and adolescent unwanted sexual contact among boys and girls living in Victoria, Australia. Child Abuse and Neglect, 34 (5), 379-385.
  • Najman, J. M., Dunne, M. P., Purdie, D. M., Boyle, F. M. & Coxeter, P. D. (2005). Sexual abuse in childhood and sexual dysfunction in adulthood: An Australian population based study. Archives of Sexual Behaviour, 34, 517-526.

Disclaimer: Published in InPsych on October 2013. The APS aims to ensure that information published in InPsych is current and accurate at the time of publication. Changes after publication may affect the accuracy of this information. Readers are responsible for ascertaining the currency and completeness of information they rely on, which is particularly important for government initiatives, legislation or best-practice principles which are open to amendment. The information provided in InPsych does not replace obtaining appropriate professional and/or legal advice.OCTOBER 2013 | ISSUE INDEXThe sexual abuse of children


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Stop Telling Child Abuse Survivors to Forgive their Abusers

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Laura FoxAug 14, 2020¡4 min read

You cannot police someone’s healing process.

Photo by Bahaa A. Shawqi from Pexels

There’s a bunch of things you shouldn’t say to an abuse survivor, but the biggest no-no is insisting they need to forgive their abuser in order to move forward.

Forgiveness is healthy. It doesn’t necessarily mean reconciliation or condoning what happened. PsychologyToday.com defines forgiveness as the release of resentment or anger and describes it as â€œvitally important for the mental health of those who have been victimized.”

However, forgiveness is a process. And how someone navigates this journey is deeply personal to them. They have to do it in their way and their time. And sometimes, forgiveness is not what someone needs to do in order to heal. Insisting that forgiveness is the only way they can move on it extremely damaging.

I have tried to forgive my parents. But I can’t. It’s very hard to forgive people who show no remorse. If I am ever going to forgive them, I need time. And when people tell me to let go of my anger, it negatively impacts my mental health. You can’t just let go of emotions if you don’t experience them first. It’s unreasonable to ask someone to detach from something you never gave them the space to attach to in the first place.

When I am told to let go of my anger, I bottle it up to please people. The anger gets worse and I engage in unhealthy coping mechanisms. These behaviours are what people think I will engage in if I allow myself to be angry. But in reality, bottling up negative emotions is what leads to acting out and self-sabotage.

Anger is not a bad emotion. It is something everyone experiences. It can be expressed in unhealthy ways, and that is often what happens when survivors are told to â€œforgive” and â€œlet go of their anger”. The anger isn’t being allowed to be expressed, so it has to go somewhere. Unfortunately, it is often directed towards the survivor themselves.

There are links between being a survivor of child abuse and developing addictions. In a report by the National Institute of Health, it was found that more than a third of teenagers who have experienced abuse will have a substance misuse disorder before their eighteenth birthday.

Child abuse survivors are also more likely to experience suicidal ideation in later life. Unfortunately, the likelihood of this ideation escalating in risk is very high, with survivors being two to three times more likely to attempt suicide.

This anger is also directed at other people, with survivors being more at risk of committing crimes.

“…participants with histories of childhood physical and emotional abuse further showed that female participants were more likely to exhibit internalizing problems such as depression, social withdrawal, and anxiety during middle childhood, which in turn increased the risk of adult crime. In contrast, male participants were more likely to exhibit externalizing behavioral problems, such as aggression, hostility, and delinquency during middle childhood, which subsequently led to adult criminal behavior.”

–Pathways Between Child Maltreatment and Adult Criminal Involvement

These behaviour appear to be what people fear the survivor will display if they express their anger. And I believe the advice to forgive and let go of anger is usually well-meaning. However, survivors like me have been given that advice since forever. And since forever, survivors like me have not been given the space to address and understand this anger, which leads to unhealthy coping mechanisms.

The only way we can truly let go and be free is by having the support to experience our anger. And that’s okay because anger can be experienced in a constructive way. Matthew Tull PhD of VeryWellMind describes anger as a valid emotion that pushes us to express what we need. He gives tips on how to channel this anger constructively, so others hear what you need rather than just hearing that you are angry.

I believe a survivor’s reaction shouldn’t be policed. It’s hard to express anger constructively when you are experiencing pain you have been keeping a secret for so long. Sometimes, a survivor will need to explode and express anger in ways that make you uncomfortable before they can learn to channel it in healthy ways.

Cutting short this healing process with assertions that the survivor needs to let go of this anger is retraumatising. For so long they will have been punished for expressing negative emotions in response to what has happened to them. If I cried or showed I was struggling to cope with how my parents were treating me, they would punish me more. So when I say I am angry with them, it hurts me deeply when someone tells me I shouldn’t be.

If we really care about survivors, we need to support them even if we don’t understand their journey. They have made it this far, so we need to trust they will continue to heal. But they need to do this in their way. And if they cannot forgive their abusers and let go of their anger, that needs to be accepted.

I would argue that my anger and inability to forgive are what helps me to move forward. If I didn’t have these feelings, I would most likely reconcile with my parents and get trapped in the cycle of abuse again. This anger is because I care about myself now. I understand I deserve better. I understand it wasn’t my fault now.

A survivor has most likely been controlled for the entirety of their childhood by people who were supposed to care about them. As people who are supposed to care about them too, please don’t control how they heal from their abuse. Be part of them achieving the freedom they have always been deprived of.

RETRIEVED https://medium.com/@ashyfox/stop-telling-child-abuse-survivors-to-forgive-their-abusers-be8226ee2426

Misconceptions becoming weaponised

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For many of the CSA Victim-Survivours and their families, the misconception of ‘justified manipulation’ is making a major part of the bigger picture. In experiences of multiple forms of “only our student/family has to deal with this”, the similar deny-deny-deny veil has been used repeatedly throughout the different institutions (i.e. churches, schools, clubs & teams) to use fake-news to hide the truths.

Ron Miller. (2016).

Catholic, other denominations (e.g. Anglican, Baptist, Presbetarian, Methodist), Private Schools (e.g. GPS: ACGS, BBC, BGS, GT, NC, TGS, TSS; ), lawyers, justice dept., police (state + federal), schools (Private – notably same-gender), journalism (online, paid and social) and other interested bodies have each increased their POV.

PRAYBOY satire of iconic Playboy media

While broad scale requests were sent to noted Private Schools (SEQ-GPS & NSW), Legal Bodies and Institutions already mentioned – there has (expectedly) been minimal feedback. Although there have been relevant leaps in Blog statistics, countries and articles – relevant ABC and SBS News contact has been included:

  • Perhaps they are too busy adjusting for these earlier exploits;
  • the hand of god has sent a messenger;
  • they each promise their sorrow, never to repeat it again (again);
Tassos Kouris (2008)

These ‘different pieces’ are being combined in RCbbc’s posts, to explain to readers that their repeated use + reuse is all too common. While reuse of positives may be understood for ‘competitive gain’, ‘academic prowess’ and ‘scientific understanding’, the often (silent 🤐 ) ‘negative gains’ are also swept-under-the-carpet:

  • As harmful as this may be to our individual children,
  • it’s also gravely hurtful – when taking a step back,
  • realise one action leads to another (influence),
  • tweeks-adaptions made to allow greater deception +
  • seeing at the big patterns forming.

BLUE KNOT FOUNDATION
FACT SHEET: Understanding Trauma

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Fact Sheet

• The word ‘trauma’ describes events and experiences which are so stressful that they are overwhelming.
• The word ‘trauma’ also describes the impacts of the experience/s. The impacts depend on a number of factors.
• People can experience trauma at any age. Many people experience trauma across different ages.
• Trauma can happen once, or it can be repeated. Experiences of trauma are common and can have many sources.
• Trauma can affect us at the time it occurs as well as later. If we don’t receive the right support, trauma can affect us right through our life.
• We all know someone who has experienced trauma. It can be a friend, a family member, a colleague, or a client… or it can be us.
• It can be hard to recognise that a person has experienced trauma and that it is still affecting them.
• Trauma is often experienced as emotional and physical harm. It can cause fear, hopelessness and helplessness.
• Trauma interrupts the connections (‘integration’) between different aspects of the way we function.
• Trauma can stop our body systems from working together. This can affect our mental and physical health and wellbeing.

• While people who experience trauma often have similar reactions, each person and their experience is unique.
• Trauma can affect whole communities. It can also occur between and across generations, e.g. the trauma of our First Nations people.
• For our First Nations people, colonisation and policies such as the forced removal of children shattered important bonds between families and kin and damaged people’s connection to land and place.
• Many different groups of people experience high levels of trauma. This includes refugees and asylum seekers, as well as women and children. This is not to deny that many men and boys also experienced trauma.
• Certain life situations and difference can make trauma more common. People with disability of all ages experience and witness trauma more often than people without disability. LGBTQI people also experience high levels of trauma which is often due to discrimination.

Blue Knot Helpline 1300 657 380 | blueknot.org.au | 02 8920 3611 | admin@blueknot.org.au

Being a Survivor of Child Abuse
Inside the mind of a victim

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Inside the mind of a victim

I was abused for sixteen years by my mother.

From an outside perspective, I belonged to a middle-class family and lived a happy and fulfilled life. I excelled at school and partook in many extra-curricular activities, such as swimming, piano lessons and ballet. I was the textbook definition of a ‘good child’.

My first recollection of abuse was when I was perhaps five or six years old. My parents were arguing and when I tried to intervene, my mother lashed out and struck me across the face.

The stone of her engagement ring cut my face drawing blood. I vaguely remember being upset, however, what sticks with me is the next day. I was at school and met with questions as to what happened to my face. Instinctively I constructed a lie and told everyone that I had walked into the sharp edge of a door.

What amazes me, is that I was able to lie so quickly and convincingly at such a young age. I do not even remember my mother telling me to lie, I just know that felt as if I should.

As I grew older and my mother’s ability to control me diminished, her abuse developed.

There was one time where I truly feared for my life. I do not remember the cause for her distress, however, she became so enraged that she reached for a wooden statue of a seahorse that was in our hallway, and lifted her arm high up to strike me with it. At that moment, I saw her pupils shrink and her face was screwed up in extreme torment. I thought that if she hit me with that statue, I would probably die.

I froze in panic and said nothing. I think my passive reaction caused her to snap out of what I assume was a dissociative state. She changed her mind and she dropped the statue.

Another time, she had kicked my legs so I was sat on the floor and she was slamming my head into the wall. I kicked my legs out towards her and struck her in the chest, hoping to get her away from me. She cried out in pain and began crying, berating me for being abusive and hurting her. The problem with her was that she never thought logically and that situation then became one where I hurt her, regardless of the fact that she had just been assaulting me previously.

Many people have often questioned why myself or my father never spoke out and told anyone about the abuse that we faced. The answer is a complex one, yet it can be simplified to the fact that when you are subjected to abuse for the majority of your life, it can become normalised.

I understood what my mother did was wrong, however, I never believed that it was bad enough to speak out. The other reason is due to embarrassment. The trouble with abuse is the victim often feels ashamed, even though the shame should be entirely on the abuser.

I could not let my friends or teachers know what was happening, yet at the same time, I dreamed that they would somehow know and save me from the horrors that I faced.

When I recall the years of abuse that I faced, I think the emotional abuse affected me much greater than the physical. I did not like to be hit, however, I would’ve chosen that over the alternative, which was the punishment of humiliation.

She achieved this in various ways, such as locking me outside of the front of the house, forcing me to sit outside knowing the neighbours could see me. Another method would be to text my friends shameful and embarrassing messages from my phone, knowing that I would have to pretend it was me, as I could not explain that my mother would do such a thing.

Towards the end, as I neared adolescence, I became really upset with my situation. My mother and father had separated, due to her forcing him to leave, and her distress caused by the dissolution of marriage was taken out on me.

As her mental health spiralled, the emotional abuse and screaming became more frequent. I was nearing the age of taking exams as a sixteen-year-old girl, and I was tired of juggling my school work, with having to look after my mother who was out of control.

I would often have sleepless nights due to her making me sleep on the floor in a cold room as a punishment, or keeping me up by shouting at me for some trivial mistake that I had made. I then became desperate for my situation to change.

At this point, it was still never a viable option in my mind to tell an outsider and get help. Not because I was scared, or because I didn’t think that anyone would believe me. I just simply did not consider doing it. I then started hoping that someone else would save me from my situation. I often opened windows when my mother was in a fit of rage, hoping a neighbour or passerby would hear her and report it.

I shamefully remember hoping that she would do something really drastic- inflict so much damage to me that I would end up in the hospital or that someone would call the police to take her away. Like many others, I ask my younger self: ‘why did you not just simply tell someone?’

Then came the day that completely changed my life. I had recently been in contact with my father and had told him that I could not take the situation anymore and that he must do something. He had a wide range of evidence of her abuse, from text messages to videos. I was at school one day when I was asked to leave my classroom to speak to someone.

The police sat in a room and explained that my father had reported my mother for abuse and that she was in custody.

I was taken to a police safe house in the forest to complete a vulnerable witness video statement, as I was under the age of eighteen and the victim of traumatic crime.

I was asked to outline as much as I could of the abuse that I faced throughout the years. I listed multiple instances in a rather matter of fact way, to which the policeman was shocked. He told me how he was stunned that I could talk of such experiences so calmly and without getting upset.

He also told me how horrified he was, as a father of a young girl, that someone could face what I had. It was at this point, that I truly understood the reality of my experience, causing my resolute appearance to shatter. I broke down in tears, realising that for the first time in my life, somebody else knew what I had faced.

As an adult leading a happy and successful life, I can still see the remnants of my trauma. One of my biggest flaws is that I overthink how others perceive me. I spend hours worrying if I have said something wrong, or embarrassing, which I believe stems from punishments of humiliation, which were designed to render me as vulnerable.

RETRIEVED https://medium.com/@nepiggott/being-a-survivor-of-child-abuse-c19d08cdaae8

Natasha Piggott

‘We have to speak out … and be heard’: Life after sexual abuse

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Survivors of sexual abuse have spoken of their feelings of isolation and fear. Photograph: Getty Images

Yvonne Roberts Published onSun 9 Jun 2019 18.00 AEST

Observer special report Rape and sexual assault

After decades of denial and cover-up, adult survivors are coming forward, helped by radical new initiatives.

On 2 June, Noa Pothoven, 17, died at home in the Dutch city of Arnhem having refused all fluids and food. She had been sexually assaulted at the age of 11 and raped at 14, and suffered from anorexia and depression. She spoke of her “unbearable suffering” in the aftermath of the attacks – “I have not been alive for so long,” she wrote.

For survivors of childhood abuse, the potential long-term impact of their experiences is only beginning to be exposed; taboo, secrecy and shame still prevail. Yet, slowly, as inquiries are held and more cases come to court, greater numbers of adult survivors of childhood abuse are beginning to come forward. While some can cope well, for others lives and families are torn apart as the root causes remain hidden. Is society doing enough for adult survivors, who, too often, are overlooked, pathologised and criminalised?

Jimmy Savile, “eccentric and flamboyant”, garlanded with honours and awards, died in 2011 aged 84, never having paid for his crimes. A year after his death, he was revealed as a prolific and ruthless sexual predator throughout five decades. Concerns had been raised since the 1960s and suppressed. He had fame and power, so was free to abuse in plain sight.

Since then, a number of prolific offenders have appeared in court including Peter Ball, a bishop who was protected by the establishment, Barry Bennell, a football coach, and the pop singer Gary Glitter. In addition, groups of mainly Asian men, in cities including Rotherham, Nottingham and Oxford, have been given lengthy jail sentences for violently sexually exploiting vulnerable young girls, the victims treated by police and social workers as “child prostitutes”, their plight ignored.

In 2014 the government established the Independent Inquiry into Child Sexual Abuse (IICSA) to examine how institutions, including hospitals, care homes and boarding schools, have handled their duty of care to protect children. The inquiry has launched 14 investigations and has set up the Truth Project, “I Will Be Heard”. So far, more than 3,000 survivors of abuse have related their experiences at the hands of trusted adults, family members and in institutions.

Tessa Denham, the founder of Visible, says abuse still affects her life. Photograph: Gary Calton/The Observer

Four years ago in Leeds, Savile’s birthplace, Tessa Denham, 58, a counsellor, coach and chief executive of the Women’s Counselling and Therapy Service, organised a workshop. Sixty colleagues from healthcare, the police, GPs, voluntary organisations and the city council attended. “The decades of denial and cover-up were beginning to crack,” Denham says. “That made me think, as a city, ‘What should we do? What do we need to do?’

“Abuse has shaped me. It still affects my daily life,” she says. “I was abused by my grandfather and my stepfather. Yet for years I’d tell everyone that I hadn’t been affected. It was only when I went for counselling in my 30s that I began to join up the dots of my own behaviour.

“I’m middle class, mouthy and I don’t lack confidence. Imagine what it must be like for someone who has none of those resources. Some survivors cope, others experience addiction, unemployment, prison, chaotic, shattered families, and still the secret is kept. That’s why we passionately believe it’s time to make a difference.”

The difference is a potentially groundbreaking holistic city-wide project called Visible, launched in Leeds on 10 June after two years of plannning. The aim is to proactively support adult survivors and open up a national conversation about the extent of need and why long-term government funding is essential.

The ambition is that projects like Visible are replicated across the country.

“It was as if we all gave a collective sigh of relief,” says Sinéad Cregan, Leeds adult services commissioner and chair of Visible. “Phew! At last we’re going to try and do something. More and more people at inquiries are talking for the first time. Yet, across the country, the response has not been good enough.”

Sinéad Cregan says the country’s response has not been good enough. Photograph: Gary Calton/The Observer

What will Visible do in practice? Survivors say that many professionals don’t recognise trauma, and they don’t ask the right questions because they don’t know how to handle the response. Visible hopes to conduct research into what works best, increase public understanding, and train a range of professionals including police, magistrates, employers, commissioners, GPs, teachers and social workers to ask the right questions so that a range of appropriate help is offered. “We want to act as a catalyst.” Denham says. “When money is tight, there are no quick fixes but the door has begun to open.”

“Phil”, 52, is on Visible’s steering group. He waited 40 years before disclosing that as a boy he was abused by two men who threatened to harm his family if he told anyone. “It was when my son was the same age that I told my wife. I had a breakdown. I was worried the same thing would happen to him. I’d text him all the time.

“I waited 12 months before I got into the mental health system. I’ve self-harmed, I’ve tried to take my own life. I was interviewed by the police about Jimmy Savile because I worked with him as a hospital porter – and that’s when it got worse. I see the devil with the abusers’ face. I hear voices. In an ideal world, I’d like for people to speak out and be heard.”

In May, the all-party parliamentary group (APPG) on adult survivors of childhood sexual abuse published a report that drew on a survey of 365 survivors. Long-term consequences of abuse may include physical ailments, changes in brain function and development, post-traumatic stress disorder, obsessive compulsive disorder and dissociative disorder, an involuntary flight from reality that may include significant memory loss, depression and suicidal thoughts.

In the survey, 90% said their intimate relationships were negatively affected, 89% said their mental health was negatively affected, 72% said that it had damaged their career, and 46% said it had a detrimental effect on their financial situation (because they often had to pay for therapeutic help they couldn’t access otherwise). Only 16% said the NHS mental health services met their need. “I am a survivor of childhood sexual abuse and the mental health system,” was one response.

“The spectre hanging over them infiltrates every aspect of life,” Sarah Champion, Labour MP and chair of the APPG said in the Commons. “A trigger can be anything – the same aftershave that their abuser was wearing or a feeling of being in an enclosed space. Unless we recognise that these people are victims of crime, they will not be able to lead their full lives and reach the potential that we all deserve to achieve.”

“Deflection, denial and disbelief” has too often greeted those who speak out about abuse. Yet its scale is clear. The number of recorded sexual offences against children under 16 in England and Wales more than doubled in the four years to 2017 from 24,085 to 53,496.

Shaneen Mooney says victims don’t have to carry shame – healing is possible. Photograph: Gary Calton/The Observer

A 2015 survey of 400 adult survivors indicated that the abuse had begun, on average, at the age of seven and continued for long periods; 90% hadn’t seen their abuser brought to justice. The average wait before survivors tried to access services had been 20 years, and not even then had individuals disclosed abuse. For one in five who disclosed at the time, the abuse continued on average for a further six years.

Last year NHS England announced improved provision for victims of sexual abuse. The five-year strategy has an investment of ÂŁ4m a year until 2020-21. “It’s welcome but it’s a drop in the ocean,” says Fay Maxted, chief executive of the Survivors Trust, which represents 130 organisations. “In real terms, funding has dropped significantly in the last 10 years.”

She is also concerned that the specialist trauma-trained organisations in the voluntary sector, which survivors frequently say they prefer to statutory services, won’t benefit from the funding controlled by GPs’ clinical commissioning groups. “The CCGs often have a lack of understanding of what survivors need.”

“Adult survivors don’t always present as the perfect victim,” explains Gabrielle Shaw, chief executive of the National Association for People Abused in Childhood (Napac). “We all need to understand better that the question isn’t, ‘what’s wrong with you?’ but ‘what happened to you?’”

Shaneen Mooney, 34, a housing officer, who runs her own essential oils company, Essential Flow, waited 16 years before disclosing. At the age of 14 she was groomed by a man in his 30s. “I thought it was romantic love. He ended the affair when I was 16. For years I didn’t value myself. I drank, I took drugs, I was unfaithful. I had a breakdown and dropped out of university and gradually began to realise that what had happened to me wasn’t right. It was rape.

“In 2014 I was given free counselling by a rape support charity. That’s no longer available. Then I waited a year for NHS counselling, which was hard. Gradually, I realised that the silence, keeping all the stuff inside me, was more damaging.”

Now happily married, Mooney says counselling has been invaluable. “I’m in a much better place. Victims don’t have to carry shame and believe there’s something wrong with them. Healing and wellbeing are possible. That’s why I share my truth in the hope that it will encourage others to break the taboo, speak out and get help. Life can change.”

In 2018, Napac, received 6,458 calls on its helpline but there were another 87,619 calls that couldn’t be taken because of lack of resources.

In Leeds, will Visible unleash a demand that similarly can’t be met? According to the IICSA, some 2 million people, are adult survivors of childhood sexual abuse, and 15% of girls and 5% of boys are predicted to experience sexual abuse before the age of 16. In Leeds those figures would translate to 50,000 adult survivors and more than 15,000 children and young people.

Visible was launched with a grant of ÂŁ100,000 from Lloyds Bank Foundation. It has applied for further grants. Leeds city council faces a ÂŁ100m funding gap by 2022. Will hopes be raised but not met?

“Health commissioners and government have to stump up the money,” Richard Barber of Leeds Survivor-Led Crisis Service says unequivocally. “Society has got its head stuck in the sand about the scale of child sexual abuse. As a result, survivors get demonised and traumatised over and over again.”

Sharon Prince says everyone knows somebody who is directly or indirectly affected. Photograph: Gary Calton/The Observer

“Everybody knows somebody who is directly or indirectly affected,” points out Sharon Prince, consultant psychologist with Leeds and York Partnership NHS Foundation Trust, a part of Visible. “We have to change the response. That can range from family and friends listening and validating to more formal interventions. The first steps are for people to trust enough so they can disclose and be believed.”

Visible promotes “trauma-informed” support for survivors. It is based on building trust, collaboration and a survivor exercising choice. “It’s all about the quality of the relationship,” Prince says.

While funds for survivors are woefully inadequate, the Independent Inquiry into Child Sexual Abuse has spent an extraordinary £96m since 2014. It has recommended that support for adult survivors requires “urgent” attention. Money is promised in the forthcoming spending review. In addition, the parliamentary group wants the Home Office to commission research into the hidden economic and social cost of child sexual abuse, collect data on what is spent on therapeutic care, and research what support works best.

Dr Carol-Ann Hooper, Visible’s evaluator, says: “In the US, the term ‘parallel justice’ has been coined to argue for reparation for victims to take its place alongside the prosecution of offenders to enable survivors to heal and rebuild their lives. There is also a significant income-based justice gap. Those who can afford to pay for therapeutic help have options, those who can’t, may have none.”

“Helena”, 60, a former teacher, pays for trauma therapy. “Otherwise I’d have to wait several months and I can’t.” As a child, she and her friend, Janet, played in the street. A teenage girl invited them into her home. “We’d dress up in her clothes and stilettos,” Helena says. Play turned to abuse and both children had a bottle inserted in their vaginas. “I felt I’d done wrong. I did tell my parents three years later. They said, ‘We can’t do owt. It’s water under the bridge. The abuse made me wary of young women, mistrust everybody. I still find it very difficult to hug people. I became anorexic. I wanted to be unseen. Occasionally I’d mention what happened and people would say, ‘women don’t do that’.”

A few years ago, Helena went to an exhibition. “I’ve been lucky. There was an image called Release. I thought yes, you need to unburden, take away those heavy things on your shoulders. For years, I didn’t like clothes or dressing up, I didn’t like high heels. I never had friendships. But suddenly, I thought, yes, I can have friends. And I do. Abuse results in so many ripples over a lifetime. People don’t think to ask, ‘what are those ripples really about?’”

Visible already has plans to expand its work to include sporting bodies, churches, mosques, major corporations, magistrates and prisons. Leeds city council will also look at its own large workforce to assess the needs of potentially several hundred survivors. “We are also keen to collaborate with anyone in the UK,” Denham says. “We cannot afford to slip back.”

I was isolated and petrified

“I was abused until I was 11 by someone outside the family. When it was happening, it was horrible but I didn’t want to make a fuss” says Debbie, 43.

“By the time it stopped, I was isolated and petrified of everything. I’d hide in the cupboard if the phone rang. People would think I was rude. I just wanted to be invisible.

“I worked hard at university because I thought I was thick and horrible. I had a breakdown. I tried to commit suicide. I was in psychiatric hospital for four months. I became anorexic. At no point did anybody ask me why I hated myself. Why I was anorexic.”

At one point, Debbie weighed four stone and suffered multiple organ failure. “It took 10 years before I began psychotherapy and somebody finally asked me the right questions; otherwise my earlier medical records all say things like, ‘Deborah’s had a lot of input with little progress’.

“I’ve been diagnosed with OCD, personality disorder, complex PTSD.”

Unusually, Debbie received 12 years of support on the NHS, but then it stopped. Now she pays privately for psychotherapy. “I know things cognitively but I have no feeling. I’m not in touch with things emotionally. I’ve no attachment to anyone or anything.

“Six years ago, my mum asked if anyone had done anything to me. I don’t want my mum to know. I don’t want her to work out who it is. I don’t want him to say it didn’t happen. I want to feel safe and not want to be dead. I want to feel.”Topics

RETRIEVED https://www.theguardian.com/society/2019/jun/09/adult-survivors-childhood-sex-abuse-come-forward