CASTIMONIA

Sexual Purity Support & Recovery Group

Character Defects

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Feeling Trapped and Fearing Abandonment

Feeling Trapped and Fearing Abandonment
Posted by James Browning on October 23, 2012

If you think your wife is codependent, there’s a good chance you are, too. Often codependent men are attracted to women who are needy, demanding, jealous, or critical. Men become dependent on their wives’ approval, and then feel trapped by their manipulation, demands, or expectations. They’re unable to set boundaries and fear emotional retaliation and/or rejection, including withholding of sex. Their wives may be very emotional, providing a sense of aliveness to the relationship and compensating for the numbness many codependent men feel inside. In the beginning, a man can feel powerful, helping a needy girlfriend or wife and giving her attention or gifts. He conforms to her expectations, while being assured that she won’t abandon him, but eventually discovers that it’s never enough to satisfy her. . Fear of rejection and abandonment are powerful motivators for codependency, usually because of early emotional abandonment by a parent. Consequently, the men never leave – physically – but withdraw to the safety of a self-made emotional prison. After a while, they feel trapped, controlled, and resentful. They may use drugs or addictive behavior to manage anxiety and depression, while some look outside the marriage for validation. However, it’s not their wives that are the cause of their problem, it’s their codependency. Darlene Lancer, M.A., MFT, J.D.

“More people would learn from their mistakes if they weren’t so busy denying them.” –   Harold J. Smith

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Four Jobs of an Accountability Partner

Originally posted: http://porntopurity.com/blog/2013/05/13/the-four-jobs-of-an-accountability-partner/

Four Jobs of an Accountability Partner

by Jeff Fisher on May 13, 2013

We are working on a podcast and a series of blog on accountability. A major part of sexual recovery is having good accountability, whether from an individual, a group, a minister, or a counselor.

We wanted to share four key jobs every good accountability partner has:

cheerCHEER – The person in recovery needs to know that they are not alone. Someone is on their side. Someone is rooting for them. Not just from the sidelines, but right in the war with him. The cheerleader encourages, but is always genuine in his encouragement. He doesn’t say “good job” if it’s not merited. But he always says, “You can get there. With God’s help, you can do it!”

 

ChallengeCHALLENGE – The addict will plateau at times and settle in to a comfortable level. The accountability partner is always challenging them. Putting the Big Picture of sexual purity, glorifying God, and healthy sexuality in front of them. The accountability partner sees farther than where the addict is and challenges him to shoot higher. Challenge happens when there is positive momentum or plateauing.

 

confrontCONFRONT – Confrontation happens where there is negative momentum. When sin happens and failures happens they need to be addressed. When an addict is hardening his heart or not willing to take the next step the accountability partner needs to take the role of confronting them. When the addicts behavior is hurting others, it must be confronted. Confession and repentance are the right responses to confrontation.

 

encourageCOMFORT – The recovery process is full of hurts, wounds, disappointments, failures, and consequences. The recovering person needs an arm around him when times are tough. He needs someone who understands where he is at and just sits with him. Prays for him. Cries with him. Supports him. Cares.

An accountability partner can be an ear to hear venting. Sometimes he needs needs to pray for him. Sometimes he just needs to show that he cares with a phone call.

The grief process can be tremendous for the addict. The consequences can sometimes seem unbearable. This is where an accountability partner can be a big help.

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S**** Escapes Porn and Sex Work!

The next few posts on Castimonia.org will focus on former female pornstars that have come forward to burst the fantasy bubble and expose the harsh reality of the pornography industry.  I urge everyone who reads this NOT to go searching on the internet for more information on these women as it would most likely bring up old ponographic content and constitute acting out.  Be satisfied about what you read here and praise God for delivering these women from the bondage of the pornography industry. 

S**** Escapes Porn and Sex Work!
by admin| Mon, 02/07/2011 – 10:32pm

I grew up in a Christian home in the East part of Germany. But somehow I never felt the love & affection of my father, so my search for love & acceptance began in primary school, where I got molested by older boys.

I felt guilty & used, but it also made me feel important for the first time in life. Somebody finally took a real interest in me, so I’d thought.

It was about the same time that I got introduced to porn. I found these magazines hidden under some bathroom towels… I was wondering what they were doing there & why they were kept hidden… I never have seen women & men “behaving or doing stuff like that” before. But when I saw how these women were desired by men it left a longing in my heart… I thought I had found out about a secret. So it became my secret & my thoughts started to turn around these images.

I saw my first hardcore porn movie at a friends’ house while her single mom was absent. It shook my world, but led me even further into that already existing dependency on these “nude love-making images” & sex fantasies. It felt like there was a “hook in my flesh” that wasn’t going to leave me. I started to touch myself.

Comparing myself to the women I saw in the magazines or movies I felt unwanted, fat, ugly & stupid.

I even prayed to GOD to make me more attractive to be loved. Soon thoughts of suicide crept into my mind & I sought of ways to die. To escape the hurt inside I fled into my fantasy world of perversion & day dreams.

As I grew older I realized that I started to receive a lot of attention for my looks and body. So I got involved with a lot older men Nazis & Satanists & started to sing their songs & to worship their idols. I became a racist along the way & hated every weak & imperfect being around me. Though I couldn’t believe what was happening: They were betting on “Who will get her first” with money & I felt so desired. I was known for a hot ‘n’ hard shell to crack & I was proud to be a “naughty virgin”!

But my longing for approval wasn’t satisfied much longer by only playing men like I had seen in the porn movies. By then these women on screen had taught me well how to lure a man & how to tease him. So I’ve got the look, the moves & the dirty talk. I was confused because I hated men & wanted them so badly at the same time. What was wrong with me? But being exposed to porn & hurting inside, everything got twisted.

I called it the GAME to trick men & let them fall when they got “high on me”. Not all men were happy to be treated this way by me, so I got violated a few times.

One of my first boys recognized my talent for the sex industry & made me table dance with a tiny miniskirt without underwear for the first time. Oh how I loved the attention. I was so desperate for his approval.

I started to dress up like a sexbomb whenever I went out. I was seeking for attention & I wanted everyone to notice me.

I never had real girlfriends because they were competition for me & I even cheated on them with their boyfriends. I got entangeled with married men, had many affairs at the same time but never called anybody “my boyfriend”. I didn’t even know how to do a relationship with anybody. I felt so lonely on the inside, but on the outside I was a tough chick who had everything under control.

I wanted to be free. I wanted to make the rules & I didn’t want anybody to leave me, so I never got together with somebody. I lowered my desires for a real loving & caring relationship & exchanged it with abusive, superficial fake ones. That was my soul protection, I thought.

I’d seen that it was all about the sexual attraction & it gave me value & satisfaction, when I could get men to cheat on their women.

Finally when I couldn’t stand living with my parents anymore, to pretend to be a sweet girl in church which I had to attend & my teacher wanted to leave his family for a relationship with me, I needed to get “outta there” & moved to the US after I finished my A-levels.

As a smart girl, I covered my escape with the excuse to learn some english as an AuPair.

The first family threw me out right away, because the Lady accused me of hitting on her husband which was not true at all… But my body language must have been so obvious screaming for lust & affirmation out of every pore.

I moved to Long Island, but NYC is not the best place to turn an already messed-up young life around, when the devil is already out there about to destroy you.

I found myself enjoying a glamorous lifestyle, became very proud, arrogant & careless, which led me into a few very dangerous situations.

I got pampered for my looks with free beauty treatments & finally got the playboy-look with the blonde hair & the long nails. Even the girl I took vacation with in LA called me “The hooker on the sunset strip” coz the Ferrari stopped right in the middle of the street but I was too proud to hop into his car.

I wasn’t a prostitute, I thought.

My destiny was to become a smart “RichMenBunny” & a famous porn actress. That is what I had been told during all my time at school: That I was born for acting & for sinful things. The name “Sin-ful-Sin-dy” how I had been called – haunted me all along. It really had become my identity.

I wanted to pay back the men what they had done to me or for what they hadn’t done to me. I was full of hatred. I wanted that power over men & I knew I could only get it through sex & manipulation. So I started to get paid for the exchange of sexual favours. It was pathetic. I never wanted money – but gifts, quality time, words of approval & just some nice treatment. I was so empty & I wanted to feel special. Valued. Normal.

But my plan of taking off in the adult industry got stopped by the painful experiences of abuse along the way.

I knew my life was out of control somehow. I had deceived myself to believe that everything was alright. I didn’t know who I was or what I was supposed to do, so after a few month on a french island, I finally went back to Germany to study & to try to impress my father with some other skills of mine, after he wasn’t impressed by what a great looking girl I had become by then.

Bored of my life I started internet “hooking up” & called it dating.

My profiles became my own escort service to feed my own addiction to my sex-driven lifestyle. I had different identities and names. Sunny-Bunny was my favourite.

Since I was completely empty on the inside, I needed phone & cyber sex to survive emotionally. Yet the “entertainment industry” didn’t satisfy neither.

I got many offers for a web cam flat or “high profile escort” but it all became tasteless & shallow to me.

One night I was with a regular client when his wife called, asking him when he was about to come home… They had children & after I had just disgraced their family car, I felt sick on the inside, thinking of my future: Dreaming about a husband who would be faithful to me, while here I was sitting destroying family lives.

I longed for deep intimacy but found it nowhere. I was devastated.

I got totally obsessed with my body- & beauty-image and didn’t leave the house if I didn’t look perfect. I didn’t eat or ate too much. Alcohol and parties were again the cure for my depressions. I couldn’t sleep or had horrible nightmares (of demons raping me*) when I did. (*Every morning – better every afternoon I woke up – for I mostly lived during the night & slept during the day, it felt it had really happened to me – later I found out that I wasn’t crazy & that this is really happening to other people as well & is part of how the enemy tries to wear you out – these “dreams” are called succubus or incubus…)

In this state I couldn’t keep up with going to uni anymore. But after I got raped at the dorm rooms, which was so physically painful, that I couldn’t walk, sit or use the bathroom for days, I never went back there again. Instead I moved into a lesbian couples’ house to be protected from male violence.

When my “Saviour boyfriend” at the time & drug dealer turned out not to be “Mister Right” and I caught Genital Herpes, a non curable sexual transmitted disease, my feeling of being “on top of the world” tumbled.

From this moment on I just existed. I felt paralyzed & couldn’t leave my bed for weeks.There I sought through religions, the occult and by psychologist treatments for a solution out of my mess. I wanted to kill myself and had so many voices in my head to kill others too. I thought I would go crazy. I hated everything & everybody around me. There I also prayed to GOD again to rescue me.

Years ago I had picked up a Christian magazine while going to church with my parents (to keep up the family reputation), where I had read a story about an Ex-Porn Actress who had turned to Christ for her salvation.

I found Shelley Lubbens story on the internet & cried so much while reading her testimony. For the first time I thought somebody would understand me. So I wrote her an e-mail & then we talked over the phone. Shelley told me that I need GOD, JESUS and the Holy Spirit. But I didn’t know where to start, what to do… I just knew… I needed to stop this kind of life otherwise I would die inside out. Shelley counseled me over the internet which was very precious to me & gave me hope for a better future.

Through Shelley I got introduced to a lot of other amazing women who had left their past & old identities behind to live a devoted life in submission to Jesus Christ – the source of life on earth & for eternity.

I trusted those testimonies to be true & moved to Paris where I raised my hand to become a Christian in Hillsong Paris on the 3rd of November 2006. I wanted a brandnew life & for the first time I felt that it could be possible. Nobody judged me. Instead they introduced me to the redeeming love of Jesus Christ.

I got sponsored to attend Hillsong Women’s Conference in London, where GOD broke my heart over my past & what I had done to myself & others. I understood that I had to repent. But He also gave me a glimpse of my future and the promise that He would restore and heal me.

In London I found out about Mercy Ministries.

Back in Paris, I got baptised in the Holy Spirit, which made a massive difference in my relationship to GOD. For the first time I could sense His presence and it was very precious to me.

But even though something had changed on the inside, my past still haunted me & I couldn’t stop certain habits & behaviours.

I felt lost in my own war for freedom.

The voices in my head just wouldn’t shut up & I had no idea how to silence them.

GOD’s truth was hard for me to digest, because I had to realize that I had been lied to for 23 years by the enemy & it had destroyed my life, self worth & the ability to trust & to function in normal relationships.

I just couldn’t break with my old lifestyle in my own strength.

On the 1st of October 2008 I walked through the doors of Mercy Ministries UK for 7 months of recovery & Christian life skill training.

So much has happened there. So many chains were broken. I was taught fantastic tools to use now in my everyday life. Christ’s unconditional love was poured out to me. I could fill pages about what has happened there…

Maybe one thing, that will indicate the war that was going on over my life: The devil had tried to mess with my identity all my life and had called me SIN, the first three letters of my name. “Sindy – made for sinful things,” the enemy had wispered on any occasion into my ear.

At Mercy I cried out to GOD: “Give me a new name – I don’t want to be called SIN anymore!”

And GOD answered gently to me: “You never have been, Sindy! SINDY contains two letters more: DY-DIE – SIN HAS TO DIE!!! – Sindy, you are called FREEDOM!”

I completely broke down after that revelation of GOD Himself. My sinful past had no power over me anymore. I was set free.

That was real love, I had never experienced before.

See that is the total opposite what the the devil wants for you through the experience of porn: He makes you think that you are in control, that you are lord over your life, but you are not! I had become a slave to pornography. Now it was me the client. I didn’t take a penny – I even felt that I had to pay them to make me happy, to satisfy the hunger inside. That is how sick it had become. It got so bad that wherever I turned I saw everybody naked. Every noise you hear, your brain turns into something perverted. Then I knew, I live in a cage! I was trapped.

But now GOD is still walking me through the hurts & consequences of the past & shows me how to live life different. He teaches me through His Word, other peoples testimonies (there is so much power in testifying what GOD has done for us & the devil doesn’t want us to encourage each other) and through lessons learnt myself with the assistance of the Holy Spirit.

I have worked over 1 and a half years in fulltime ministry (“Zukunft-für- DICH” which means there is a “future for you” in Jesus Christ) in Berlin, reaching out to lost girls – in the Red Light District, where I was also able to take girls in into our girls-accommodation to get them off drugs & alcohol & teach them how to live a normal life with Jesus.

I also got totally blessed by teaching the girls twice at the Mercy House in October 2010. And spending 3 days with them just made me cry & so thankful over what JESUS had done to me through that wonderful place & precious staff!

Today I get invited to speak at conferences & seminars on how JESUS has set me free & how to deal with the topics that I struggled with! I love to share the gospel!

Now I am about to move home to my precious sister who is trapped in the lies of the enemy as well. I have treated her very badly & have abused her with my words & actions while we were growing up together… Now it’s about time to show her the LOVE OF CHRIST & to spend time with my family. JESUS gave me the love for my family back! I am so thankful that I am welcomed home into my parents’ house after all that I did to them. GOD is good & faithful!

I am currently building up a Self Help & Recovery Group for (Ex-) Sex, Love & Porn Addicts in cooperation with an Austrian based ministry called “love is more”, which I am really excited about to develop & work with.

In February 2011 I’ll join Shelley to fight the lies of PORN at Cambridge University!

Finally I’ll be able to meet her for real & thank her personally for all she had been pouring out into me over the last 4 years! …awww Shelley – I love you so much!

… & the best is yet to come – for with JESUS – everything is possible & life gets better & better & better & I am not afraid to grow old & get wrinkles anymore !!!!  🙂

Please let me encourage you, if you are single: I am single & free from porn & masturbation & I am not having sex until I am married!

I am praying for my future husband & I will wait until that day of my wedding before I will have sex again. I am SURE that this is possible because JESUS lives in me & HE has totally changed me & gives me GRACE to work out my salvation in every sphere of life.

If you wanna WIN, you gotta FIGHT! It may take you some time, but with Jesus & a group of faith filled friends or support group on your side you can DO it! It is worth it!

To all those men, women & children that have been hurt by my past life & behaviour: I am really SORRY for what I have done to you & how I have been such a negative role model! I prayed to GOD for forgiveness & I hope & pray that you can forgive me too?!

Sharing my life story with others isn’t always easy, it makes you vulnerable. But I know how I had been desperate for a glimpse of hope when I realized that I was living a lie & an illusion.

The truth & nothing but the truth is: Freedom & the purpose of your life is found in Jesus Christ!

And THANKS to Shelley sharing her testimony online 5 years ago, I am a changed woman today! 🙂

I hope & pray that I can encourage you right now to consider the option of inviting JESUS into your heart where ever you are & start THE LIFE you were meant to live!

JESUS loves you so much & wants you to enjoy your life here on earth & for eternity!

And if you have a story to tell, then be brave & share yours too! People need to know & GOD deserves all our praise!

… to be continued for HIS GLORY !!!!!! – JESUS I LOVE YOU !!!!!!

My message to a world addicted to pornography: 

PLEASE STOP WATCHING PORN !!! I was one of the statistics when I got exposed to porn at the tender age of 9. It almost destroyed my life.

PLEASE “turn to the wife/husband of your youth”, love, honor & treasure her/him & protect your children from that filthy lie of the enemy.

GOD has created sex to be very special in the wonderful & secure setting of marriage. GOD knows best – He created us.

SOME FAQ’s about PORN & Co. and my answers:

I’ve heard it said that people who star in porn films do it because they love it.  What’s your response to that?

I do understand why they have to say that: otherwise how can you support what you do?! You gotta sell your product! & just don’t tell anybody about the side effects until they almost or sadly sometimes kill you yourself. Often we are so abused & hurt inside that we don’t feel the pain anymore coz we numb it. To survive.

Yes, I also said that I love all that bodily fluids all over my face. All the women in porn convinced me of that too. It seemed like so much “fun”. But it is disgusting, degrading. But if you tell yourself often enough you like it, otherwise men won’t “love & accept” you, you add a big convincing fake smile, it almost becomes a truth!

What happened to make you decide that enough was enough?

All sorts of abuse, rape, trauma, depressions, STD & the thought about my future without a happy family. Realizing that you live a lie & desire truth more. Sick of being cheated. When I felt that “somebody/something” wants to kill you, but you want to live !

Why do you think more and more women are becoming producers of porn films?

They want the power they never had. They are so hurt inside that they wanna hurt others.

There is a lot of money in that business & some “glamour” & some might be addicted to sexual images like me as well… and to not be on the suffering end of an actress they produce what they like, but know that its war between short term satisfaction and pain in the long run.

How can we as Christians make a difference in this industry? 

Support the Pink Cross Foundation & raise awareness through organizations like XXX-Church. There are good resources out there. Get your friends, church, community educated on the true(!) effects of porn & the pain porn “stars” suffer !

FACE the truth! Don’t ignore the big pink elephant that wants to trample into your BEDroom !

Get Shelley’s new book “Truth behind the fantasy of porn” or read “Redeeming Love” of Francine Rivers & feel the pain inside of us.

What is the best piece advice you have for young women who feel the pressure of society bearing down on them to conform to an idealised image that doesn’t even exist?

To really look behind the scenes & again face the Truth about the whole issue. Look to GOD for your calling & destiny, ask Him for goals & visions for your life. Every girl has a special purpose on this planet, but that does not include to become a sex slave of the sex industry!

I know how it feels: women in porn look so flawless & hot, so powerful, Though I somehow knew that it was fake, Though I couldn’t imagine them to be really happy – still they are adored & wanted by many & That wanted me to be like one of them.

I know that many teenage girls, who don’t feel loved think the same way – and it kills me inside, that they compromise their innocence on that lie of perversion of the enemy.

If I only somehow can prevent them walking down that path of destruction and to find their true love in Jesus Christ instead, my heart would overflow with joy!

That is the cry of my heart.

Girls, don’t believe the father of the lies!

Believe your caring & loving Daddy who treasures you and your sexuality!

LOVE YOU ALL !!! S****

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Why Boys Do Not Tell About Sexual Abuse

Why Boys Do Not Tell About Sexual Abuse
By Karyl McBride, Ph.D.
Created Jun 12 2012 – 3:14pm

The dark cloud over PennState revealing a sexual abuse Penn Statescandal also holds a painful overcast shade for male victims of sexual abuse. The news of the cover-up and victimization of boys at this prestigious university has understandably caused a flurry of confusion, surprise, and concern for parents, educators, football fans, and all who care about children. Having worked in the sexual abuse treatment field for three decades, I’ve seen the difficulty for boys and men in reporting sexual abuse. Why is this so? Cover-ups, denial, and internalizing feelings seem to dominate rather than vulnerable exposure of abusive acts perpetrated on male victims. In general, people don’t like to believe these things happen. It is difficult to understand that adults can be sexually attracted to children. For most healthy individuals, this concept does not compute.

But, let’s take a look at why it is particularly difficult for males to report sexual abuse when it involves them. We know from studies done on sex offenders in prisons, that boys and girls are sexually abused at alarmingly high rates and most are shocked by the statistics. It is also well documented that sexual abuse of boys is underreported. Why?

It is difficult for any child to report sexual abuse because they feel guilty, they may have received threats from the offender, they fear they won’t be believed, and they don’t want to cause family problems. But for male victims, there are additional barriers to disclosure:

1. In our culture, boys are socialized not to be victims. “If I am a victim, can I then also be a man?” Big boys fight back and are not supposed to be victims or it somehow obliterates their identity of “manhood.”

2. Guys are expected still, to tough things out and not ask for help. Fewer men, for example, seek therapeutic treatment and many are still adverse to this concept unless dragged to therapy by their families or spouses. Family therapist, Terry Real, wrote eloquently about this issue in his much-needed book about male depression titled: I Don’t Want To Talk About It. Asking for help is still seen by many males in our culture as a sign of weakness.

3. It’s likely an understatement that our society is still somewhat homophobic? It’s getting better, but we have seen much in the current news about this issue still rearing its ugly head in military circles, same sex marriages, and legislative changes and discussions. So, for a young boy who is molested by a male offender, the issue of sexual identity comes into play. We see young males in therapy asking the question frequently: “If I am abused by a male and I am also male, does that mean I am gay?” Little children, ages 8-10, ask this question frequently in therapy, and teen male victims often just choose to suffer in silence because of this fear. “Will my peer group label me as gay if I tell?”

4. When young boys are touched in the genital area, they can have an erection. It is visible to them, different from female victims. The touching can feel good to both boys and girls and then cause great confusion. “Did I want this?” “If it feels good, is it my fault?” “If there is pleasure, I must be the one in the wrong.”

5. When young boys are sexually abused by female offenders, there is another interesting mind assault. If a young male is getting attention sexually from an older woman, he is often seen as lucky. Boys can be experimental with sex and that is often regarded, as “boys will be boys.” And if the offender is the child’s mother, you can only imagine the difficulty in reporting, and the devastation for the child.

6. Often boys report that they don’t view the sexual acts perpetrated on them as that abusive. They minimize or deny the impact to avoid feelings of helplessness or confusion.

So taking these reporting issues for boys and putting them in the context of the male world of football, one can see the great impediment to reporting something as vulnerable as being sexually abused. If I’m a big tough guy…this did not happen to me. It is more typical for young male victims to use coping strategies like becoming aggressive to overcome the feelings of helplessness, or trying to numb the feelings with drugs or alcohol. In many cases they internalize the trauma and become depressed.

In a college football environment, the players are still young, developing men. The coaches, as well as other instructors, play an almost parental-like role with these young people. The power differential is obvious and the effects devastating when the power of the leader is misused in a secretive, abusive, and flawed manner that actually encourages a wall of silence for compliance that results in reward.

The bottom line is that it is up to adults to protect young people and the need for further education for parents and educators in this arena remains a constant call for clarity and direction. While much has been done in prevention and education regarding child sexual abuse, unfortunately there is more to do. We can start with creating emotionally safe environments for males to disclose sexual abuse and let it be known to boys that this can happen to them too. Boys should be taught more realistic roles to emulate other than the classic tough guy.

And finally, let’s not forget that sex offenders are the prime narcissists in this culture. Their lack of empathy is palpable. They are most concerned with getting their own sexual and power needs met and therefore the impact on the victim… is not on their radar.

(Some resources taken from Virginia Child Protection Newsletter, Volume 29, fall 1989)

Additional Resources:

Book: Will I Ever Be Good Enough? Healing the Daughters of Narcissistic Mothers http://www.amazon.com/Will-Ever-Good-Enough-Narcissistic/dp/1439129436/ref=sr_1_1?ie=UTF8&s=books&qid=1252439024&sr=8-1

Audiobook: Will I Ever Be Good Enough? Healing the Daughters of Narcissistic Mothers http://www.willieverbegoodenough.com/buy-the-book.php

Website: http://www.nevergoodenough.com  and http://www.karylmcbridephd.com

Survey: Is This My Mom? Use this to assess if your parent has narcissistic traits. It is applicable for men as well.  http://www.willieverbegoodenough.com/survey.php

Research: Interview You? http://www.willieverbegoodenough.com/for-men.php

FB Parties for Adult Children of Narcissists: http://www.facebook.com/DrKarylMcBride

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Adult Manifestations of Childhood Sexual Abuse

Adult Manifestations of Childhood Sexual Abuse
Full PDF article and figures can be found here:
http://publichealth.lacounty.gov/wwwfiles/ph/media/media/TPH-409.pdf

Background

While childhood sexual abuse (CSA) continues to be a major public health problem, an equally severe and silent epidemic are the estimated 39 million adult survivors of childhood sexual abuse in the United States who continue to exhibit aftereffects of CSA that predispose them to adverse psychosocial outcomes throughout their adolescent and adult life.

Early childhood traumas such as sexual abuse can have lifelong effects throughout adulthood, and the cost to society is high. Ninety percent of cases go unreported and untreated, as the symptoms of CSA are often misdiagnosed and unappreciated.

This article attempts to provide clinicians with awareness of the neurodevelopmental effects of CSA, the adult clinical symptoms, and the adverse psychosocial outcomes of CSA. It will also present tools to help identify the aftereffects of CSA in adulthood and provide mandated reporting protocols.

Definition

Sexual abuse is defined as any sexual activity that a child cannot comprehend or consent to. It includes acts such as fondling, oral-genital contact, and genital and anal intercourse, as well as exhibitionism, voyeurism, and exposure to pornography. A central characteristic of any abuse is the dominant position of an adult that allows him or her to force or coerce a child into sexual activity. Researchers have determined that child sexual abuse victims come from all cultural, racial, and economic groups. The lack of a universal definition of CSA contributes to the complexity of data collection and estimates.

Incidence and Prevalence

Currently, CSA prevalence in the U.S. is not known, but estimates vary from 12% to 40%. Incidence studies suggest that while on average 5.5 children per 10,000 enrolled in day care are sexually abused, a greater number of children (8.9 children per 10,000) are sexually abused in their home. Further CSA studies suggest that 53% of the abuse occurs in the home, 57% report the perpetrator was a family member, and 65% report repeated abuse. Overall, studies show that 1 in 3 females, and 1 in 6 males have experienced childhood sexual abuse by the age of 18.

While nearly 90,000 cases of child sexual abuse are reported each year in the U.S., between 88%-90% of CSA cases are estimated to be unreported and interestingly, between 21%-49% of CSA victims appear asymptomatic following victimization. The lack of disclosing a history of sexual abuse contributes to the lifelong effects of the abuse.

Neurodevelopmental Damage of CSA

Controlled studies have shown that adult survivors of child sexual abuse (ASCSA) are more likely to exhibit adverse psychopathologies in adulthood, and neuroimaging studies confirm that exposure to sexual abuse in childhood alters the neurobiology and neurostructures in the brain, leading to scarring, an abnormal neurohormonal response to future stressors, and predisposes the victim to a lifetime of negative consequences.

Neurological damage from sexual abuse alters early brain development, increasing the risk for psychopathology in adolescence and adulthood (Table 1). The hippocampus, responsible for new learning and memory, plays a critical role in recording emotions that are attached to a stressful event such as sexual abuse. The hippocampus is known to be very sensitive to stress. During stress, high levels of glucocorticoids are released, and over time (as observed among CSA victims, including those re-victimized) elevated levels of glucocorticoids damage neurons in the CA3 region of the hippocampus and lead to atrophy. While the hippocampus has been shown to regenerate neurons, stress inhibits neurogenesis.

Abnormalities of the hippocampus have been shown to be associated with pathological fear, mood imbalances, and anxiety reactions in trauma-related disorders (also hallmarks among ASCSA).

Magnetic resonance imaging (MRI) studies have demonstrated a 12% left hippocampal volume size reduction among adults who have been sexually abused in childhood as compared to healthy controls (Figure 1). Similar reductions are exhibited among subjects with trauma-spectrum disorders such as depression, dissociation, PTSD, and borderline personality disorder. In addition, the amygdala, responsible for emotional and fear regulation, is affected by early sexual trauma, resulting in similar psychopathologies.

Studies suggest sexually traumatized children are also less able to utilize both brain hemispheres to process experiences. The corpus callosum, a longitudinal fissure that connects the left and right cerebral hemispheres, is shown to be abnormal in sexually abused children. Generally, the left side of the brain processes positive emotions and logical thinking, and the right processes negative emotions such as fear. When the corpus callosum is not operating properly these processes are unable to function at the same time, thus supporting theories why many abused individuals divide people into “all good” or “all bad” and exhibit mood swings, as observed in borderline patients.

Adult Manifestations of CSA

There is no adopted definition to identify the symptoms exhibited among ASCSA; however, evidence-based research has confirmed long-term effects of CSA in adolescence and into adulthood. Later in their lives, many ASCSA, whether reported or not, exhibit psychopathology, acting-out behaviors (social dysfunction), relationship problems (interpersonally), somatic symptoms, and sexual disorders.

CSA survivor studies suggest that ASCSA use health care services more often than the general population, are shown to exhibit more somatic symptoms that do not respond to medical treatment, and present more severe and complex symptoms.The response to sexual abuse during childhood varies, and is largely dependent on 1) age at onset; 2) severity; 3) duration; 4) relationship to the perpetrator; 5) the child’s resiliency; and 6) stability of and support from the family.

Childhood survivors might initially seem unaffected by the trauma; however, by adolescence and adulthood, the consequences eventually become symptomatic, resulting in eating disorders, dissociation, phobias, obsessions, borderline personality disorder, depression, anxiety, bulimia, obesity, post traumatic stress disorder, hallucinations, conduct disorder, substance abuse disorder, panic disorder, antisocial personality disorder, affective disorder, and impaired sense of self.

Behavioral Effects of CSA 

Acting out

Children are limited in their physical, cognitive, and emotional development and, thus, dependent upon adult and often sibling caregivers to provide love, trust, and support. Once a child is violated however, shame and stigma often follow, as well as fear that disclosing the abuse will result in re-victimization, loneliness and isolation, physical violence, and death. Poor coping skills are common among this cohort, such as substance abuse, tobacco use, overeating, addiction, lying/stealing, poor academic performance, expectation of early death, poor adherence to medical treatment, suicide, anger, prostitution, and increased risk of sex crimes.

Relationship problems

Controlled studies identify an association between childhood sexual abuse and adult relationship problems. Adult manifestations of CSA increase the risk of intimate partner violence victimization and perpetration, rape after 18 years of age, low self-esteem, intimate relationship problems, divorce, interpersonal problems, victim-perpetrator cycle, superficial idealization of sexual relationships, and the inability to trust others.

Somatic symptoms

Evidence illustrates that CSA also results in biophysical changes. ASCSA show a decreased threshold for pain. Other effects include a heightened sensitivity in the pelvic or abdominal region, various bowel symptoms, musculoskeletal disorders, back pain, severe headaches, gastrointestinal problems, sleep disorders, asthma, and pseudocyesis.

Sexual disorders

Adult manifestations of CSA increase adolescent and adult risk of exposure to sexually transmitted diseases, compulsive sexual behaviors, early sexual activity, extreme masturbation, sexual promiscuity, poor sexual adjustment, poor contraceptive practices, and teen pregnancy.

Functional amnesia

Functional amnesia (dissociative amnesia–dissociative disorders) can develop after severe trauma, such as child sexual trauma. This is especially true among children experiencing severe sexual trauma or in those aged 5 years or younger. Functional amnesia among CSA cases varies widely, from 19% to 88%. While theories about amnesia and delayed recall of CSA vary and may be controversial due to false memories, it is important to recognize that later in adolescence or adulthood, the victim may not recall the experience. Additionally, if the abuse occurred in middle childhood, ages 6-12, the victim may 1) develop false memories that the abuse ever occurred; 2) be in denial; or 3) be unaware that the type of experience was determined to be sexual abuse. 

Role of the Clinician

The clinician plays an important role in caring for adult survivors of childhood sexual abuse. Because the presenting symptoms can be somatic in nature, the role of CSA in the patient’s illness or presenting symptoms can be overlooked.

Despite never reporting the abuse, 85% of adult survivors of child sexual abuse favor physician screening. Directly asking patients about the occurrence of abuse has been shown to elicit more positive responses compared to self-reporting, 29% versus 7% respectively. Further, especially among adolescent patients, it is important to remember that early disclosure of sexual abuse by the victim is critical to reducing the effects of CSA and to helping reduce psychological distress later in life. Symptoms of ASCSA can vary greatly and, in fact, the patient can be asymptomatic.

Evidence-based research suggests that many interventions can be useful in this population. For example, coping-skill interventions seem to help diminish or prevent post traumatic stress disorder and related adult aftereffects of CSA. Physicians can use the SAVE universal screening tool (Table-2) for childhood sexual abuse in adulthood, developed by the Florida Council Against Sexual Violence. This useful tool screens patients for sexual violence.

Physicians should also be familiar with their own hospital, clinic, or HMO policies and procedures regarding sexual violence reporting, as well as the use of specific reporting forms. The California Medical Training Center develops instructional materials and conducts training in clinical forensic medicine techniques for physician and other health care professionals, social workers, and related reporters.

 

James M. DeCarli, MPH, MPA, CHES
Injury and Violence Prevention Program
Los Angeles County Department of Public Health