Post-traumatic Stress Disorder in Adult Survivors of Child Sexual Abuse—Literature Review

Research Question

This thesis seeks to understand the correlation between childhood sexual abuse (CSA) and symptoms of post-traumatic stress disorder (PTSD) in adult survivors. The thesis also examines available treatment modalities for PTSD in adult survivors of CSA and assesses the most effective types of treatment for this population.

Literature Review

CSA and PTSD

McDonagh et al. (2005) define child sexual abuse as any sexual content including caressing, fondling, or stimulation of a child’s genitals; forcing a child to stimulate the perpetrator’s genitals; and/or oral, anal, or vaginal rape of a child. CSA is considered early onset if the abuse begins before the child is 12 years old and late-onset if the abuse begins at 12 years old or later (McLean & Gallop, 2003).

Studies show strong correlations between CSA and symptoms of PTSD in adult survivors. If the patient is unable to resolve the instances of abuse through therapy, the long-term effects of the trauma present in varying ways in the patient’s adult life. The main ways PTSD presents in victims of CSA are intrusive thoughts or memories and attempts to avoid these thoughts, memories, and feelings associated with the abuse (Hyman et al., 2003). Additional symptoms of PTSD include anxiety, sleep disturbances, substance use or abuse, hyper-arousal (easily startled or agitated), depression, and aggressive behavior (Anda et al., 2006). Cloitre et al. (2005) add that functional impairment such as social anxiety, problems with emotional regulation, and difficulty in interpersonal relationships.

Treatment Modalities for PTSD from CSA

The majority of treatments that exist for PTSD consist of helping the patient process the abuse, challenge belief systems around the abuse, and gain skills to cope with memories, thoughts, and feelings associated with the abuse. Treatment modalities for PTSD include Dialectical Behavioral Therapy integrated with Trauma-Based Cognitive Behavioral Therapy (DBT for PTSD) (Steil et al., 2011); Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) (Deblinger et al., 2006); Cognitive Processing Therapy (CPT) (Chard, 2005); and Skill Training in Affect and Personal Regulation (STAIR) (Cloitre et al., 2010).

DBT for PTSD is designed to treat emotional regulation issues related to PTSD. The techniques used include exposure-based exercises to help patients learn to control their escape strategies, questioning guilt and shame, and radically accepting the fact that the trauma happened (Steil et al, 2011). The DBT techniques of acceptance and mindfulness are employed to help patients remain calm during triggering events.

TF-CBT offers education about PTSD and reactions to sexual abuse in order to help normalize experiences for the patient. This treatment approach provides patients with coping tools designed to actively process traumatic experiences (Deblinger et al., 2006).

CPT uses the Clinician-Administered Post-traumatic Stress Disorder Scale and the Beck Depression Inventory to assess PTSD and depression in survivors of CSA. This modality has been proven effective in treating PTSD symptoms through education on PTSD thoughts and emotions, formal processing of the trauma, and teaching cognitive coping skills (Chard, 2005).

Cloitre et al. (2010) define the STAIR technique as a “phase-based skills-to-exposure treatment” which has proven effective in improving emotional regulation and lessening the occurrence of PTSD symptoms in adult survivors of CSA.

References

Anda, R. F., Felitti, V. J., Bremner, J. D., Walker, J. D., Whitfield, C. H., Perry, B. D., ... & Giles, W. H. (2006). The enduring effects of abuse and related adverse experiences in childhood. European archives of psychiatry and clinical neuroscience, 256(3), 174-186.

Chard, K. M. (2005). An evaluation of cognitive processing therapy for the treatment of posttraumatic stress disorder related to childhood sexual abuse. Journal of Consulting and Clinical Psychology, 73(5), 965-971.

Cloitre, M., Miranda, R., Stovall-McClough, K. C., & Han, H. (2005). Beyond PTSD: Emotion regulation and interpersonal problems as predictors of functional impairment in survivors of childhood abuse. Behavior Therapy, 36(2), 119-124.

Cloitre, M., Stovall-McClough, K. C., Nooner, K., Zorbas, P., Cherry, S., Jackson, C. L., ... & Petkova, E. (2010). Treatment for PTSD related to childhood abuse: A randomized controlled trial. American Journal of Psychiatry, 167(8), 915-924.

Deblinger, E., Mannarino, A. P., Cohen, J. A., & Steer, R. A. (2006). A follow-up study of a multisite, randomized, controlled trial for children with sexual abuse-related PTSD symptoms. Journal of the American Academy of Child & Adolescent Psychiatry, 45(12), 1474-1484.

Hyman, S. M., Gold, S. N., & Cott, M. A. (2003). Forms of social support that moderate PTSD in childhood sexual abuse survivors. Journal of Family Violence, 18(5), 295-300.

McDonagh, A., Friedman, M., McHugo, G., Ford, J., Sengupta, A., Mueser, K., ... & Descamps, M. (2005). Randomized trial of cognitive-behavioral therapy for chronic posttraumatic stress disorder in adult female survivors of childhood sexual abuse. Journal of consulting and clinical psychology, 73(3), 515.

McLean, L. M., & Gallop, R. (2003). Implications of childhood sexual abuse for adult borderline personality disorder and complex posttraumatic stress disorder. American Journal of Psychiatry, 160(2), 369-371.

Steil, R., Dyer, A., Priebe, K., Kleindienst, N., & Bohus, M. (2011). Dialectical behavior therapy for posttraumatic stress disorder related to childhood sexual abuse: a pilot study of an intensive residential treatment program. Journal of traumatic stress, 24(1), 102-106.