Post-traumatic Stress Disorder in Adult Survivors of Child Sexual Abuse—Research Paper Outline

Thesis

Adults who were sexually abused as children are likely to exhibit symptoms of post-traumatic stress disorder (PTSD) that impact functionality in various areas of life. In order to lessen or eliminate symptoms, patients must receive appropriate treatment.

1. Literature review on PTSD in adults with Childhood Sexual Abuse (CSA)

A. “Studies have established that childhood stressors such as abuse can lead to a variety of negative health outcomes and behaviors such as substance abuse, suicide attempts, and depression” (Anda et al., 175).

a. Emotional regulation and interpersonal problems should be addressed in treatment as these affect functional impairment (Cloitre et al., 2005).

b. Self-blame and shame are common in victims of CSA (Ullman, 2007).

B. In addition to traditional PTSD, complex PTSD, which is a combination of PTSD symptoms and Borderline Personality Disorder characteristics, has been defined and discovered in women who’s onset of sexual abuse began before the age of 12 (McLean & Gallop, 2003).

C. Victims who knew the perpetrator were more likely to blame themselves than victims who did not know the perpetrator (Ullman, 2007).

D. Treatment improves the existence of PTSD symptoms including severity of symptoms, anxiety, and trauma related cognitive schemas (McDonagh et al., 2005).

E. Social support lessens severity of PTSD symptoms (Hyman et al., 2003).

2. Childhood Sexual Abuse (CSA)

A. McDonagh et al. (2005) define CSA as any sexual content occurring between an adult and a child. This includes:

a. caressing, fondling, or stimulating the genitals of a child

b. having the child stimulate the perpetrator’s genitals, and/or

c. oral, anal, or vaginal rape) occurring between an adult and a child.

B. Victims of CSA often know the perpetrator, such as a family friend or family member, and it is common for victims to face disbelief or be shamed by others who know the perpetrator when they disclose the abuse (Ullman, 2007).

3. Post-traumatic stress disorder (PTSD)

A. The core symptoms of PTSD include intrusive thoughts or images and avoidance of emotions or thoughts that recall traumatic event (Hyman et al., 2003).

B. PTSD related to CSA presents with symptoms including affect regulations and disturbances that negatively impair functionality in the world (Cloitre et al., 2010).

a. Functional impairment can include: social anxiety, occurrence of flashbacks, emotional regulation, and interpersonal problems (Cloitre et al., 2005).

b. Disturbances in behavior can include anxiety and stress, sleep disturbances, substance abuse, sexuality issues, self-injury hyper-arousal, depression, aggression, difficulty controlling anger, and perpetuation of intimate partner violence (Anda et al., 2006).

C. Weierich and Nock (2008) explain that there are clusters of PTSD symptoms.

a. Re-experiencing symptoms include recurrent, distressing, intrusive thoughts or images.

b. Avoidant or numbing symptoms are the efforts to avoid thoughts, feelings, places, or people that the victim associates with the trauma.

c. Hyper-arousal symptoms include hyper-vigilance and an exaggerated startle response.

D. Traumatic amnesia, also known as repression or dissociation, is the “failure to recognize some significant and negative aspect of reality” (Freyd et al. 2007).

a. Traumatic amnesia is a symptom of PTSD

b. Unknown or unrecognized material from an adult’s past can display negatively in other areas of life such as emotional regulation.

4. Treatment modalities for PTSD

A. A variety of treatment modalities for PTSD have been researched.

a. Cognitive Processing Therapy (CPT) and Cognitive Behavioral Therapy (CBT) teach cognitive coping skills and help the victim to process the trauma (Chard, 2005).

b. Trauma-Focused CBT is a structured treatment providing coping skills designed to actively process traumatic events (Deblinger et al., 2006).

c. Skill Training in Affect and Personal Regulation (STAIR) in conjunction with Exposure Therapy improves emotional regulation (Cloitre et al., 2010).

d. Dialectical Behavioral Therapy for PTSD is a DBT approach tailored to adult victims of CSA (Steil et al., 2011).

e. Social support models suggest that group support and building self-esteem help the victim with emotional regulation and processing of the event (Hyman et al., 2003).

B. The most common scales used to assess PTSD are the Clinician-Administered PTSD scale and the Beck Depression Inventory (Chard, 2005).

Conclusion

PTSD symptoms are common in adults with a history of CSA. While these symptoms can be debilitating in areas including social functioning, education, ability to work, romantic and sexual relationships, and mood disorders, effective treatments exist to help patients control symptoms and live more peaceful and productive lives.

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.

Freyd, J. J., DePrince, A. P., & Gleaves, D. H. (2007). The state of betrayal trauma theory: Conceptual issues, and future directions. Memory, 15(3), 295-311.

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.

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.

Weierich, M. R., & Nock, M. K. (2008). Posttraumatic stress symptoms mediate the relation between childhood sexual abuse and nonsuicidal self-injury. Journal of consulting and clinical psychology, 76(1), 39.