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It is estimated that up to fifty percent of sexual abuse victims who receive medical treatment after episodes of abuse carry no physical scars at all. However, it is also estimated that all of them will carry the mental scars for most, if not all of their lives. This makes perfect sense. Abuse victims often report that the physical touch was not the worst part of the abuse but the burden of carrying the “secret” and knowledge of the abuse which stays with them at all times superseded this many times over. This burden also carries the responsibility of what to do with this information. Revealing it could mean being taken away from loved ones or the break-up of a family as well as legal consequences for the abuser. This can cause great hardship for a young mind.

The mental aspects of abuse are cleverly manipulated by the abuser. While the physical boundaries are being destroyed and violated, so is the mind. A child can be lead to believe that their body and mind are under the control of others.  Abusers often try to convince a child that what they might believe is happening is really not or when it is mentioned, the child is blamed and the abuse often denied and ignored. Another method is to rename the abuse as a “special” game that only the child is allowed to play. Statistics tell us that most incidents of abuse take place at night, often leading the child to believe it was a dream and making recollection hazy. The sad fact is that many sexually abused children are denied the right to justice due to the mental manipulation of the abuser and carry these scars for a lifetime, trying to cope with life as best they can. However, mental health issues as a result of the abuse are often played out later in life as the subsequent adult tries to deal with the torment of the past. Let’s look at some of these :

Dissociation:

Children who are abused tend to emotionally shut off while the abuse is taking place. However, they often take this defence mechanism into adulthood and dissociate when confronted with anything that reminds them of the abuse. Hence, they find it hard to enjoy close relationships and intimacy. This dissociation can range from the mild, referring to oneself in the third person, to extreme complete depersonalisation. Due to the abuse, many victims have been taught (or indeed taught themselves) to ignore feelings and emotions, so they often see this behaviour as “normal”. In some cases, when the abused has not been believed, the dissociation acts almost as a “friend” and in a way protecting and validating them as it did at the time of the abuse. Many hold onto this and are afraid to let it go, fearing life without it. Since there is a strong likelihood that the victim was in a dissociative state at the time of the abuse, they often find that large chunks of memory of the abuse and other times in their life are blurred, often returning briefly in dreams and flashbacks.

Multiple Personality Disorder:

The most extreme example of dissociation is the formation of two or more distinct personalities that take over control of behaviour. Research tells us that most sufferers of MPD had a history of sexual abuse in childhood.  Multiple personality disorder typically develops at a young age because of some kind of very traumatic experience, usually long-lasting and severe abuse. The earliest age when MPD can develop has not been clearly established, but seems to coincide with early infancy. Abuse that leads to development of multiple personality can be emotional, physical, or sexual, or combinations thereof. In reality, all abuse is mental. The mind perceives and interprets the harmful acts as abusive. The after effects of childhood sexual abuse seem to be responsible for more than 90% of all MPD cases. By contrast, non-abusive traumatic events do not cause multiplicity. Multiple personality disorder only develops when a person is helpless and unable to escape  suffering or the threat of suffering, especially when the abuse is repetitive or lasting weeks, months, and years. A significant factor leading to the development of multiple personality is the dependence of the victim on the abuser and establishment of a personal relationship . The abuser becomes an essential and psychologically inseparable part of existence, but also the torturer in the mental sense. The cognitive substrate of the brain is unable to reconcile these dramatically opposing experiences and is forced to split into pieces. The likely triggers (severe traumas) of permanent dissociation hint that the number of possible personalities could run in the dozens. In extreme cases, when the abuse is lifelong, several hundred personalities might be expected to exist.

Mentality:

One of the most crippling aspects of sexual abuse is the development of an unhealthy outlook on life in the form of a set mentality. Unlike the diagnosable disorders above, mentalities are often more subtle but just as destructive in their own way. For example, many abused children take on a victim mentality as the child starts to organise the world around its own wound. The abused child sees the world as unsafe, unpredictable and dangerous. The child has learnt through the abuse that what they feel, want or think make no difference and they feel hopeless, ineffective and lack the ability to contradict this with evidence to the contrary. They are often tormented with the thoughts they they were somehow to blame for the abuse and they asked for it or deserved it. Life is consequently full of “shoulds”, leading the abused to the mistaken belief that they had a choice. The basic assumptions about life that most of us take for granted are challenged in a victim mentality, that is invulnerability, I can’t or won’t get hurt, I have worth and the world is understandable and has meaning. These thoughts often lead to problems in later life by seeing poor treatment by others as “normal”, an acceptance that abilities to change are limited and an exaggerated sense of self-blame. Most adults in these cases are passive people. However, paradoxically, some can become aggressive…treating others poorly as defence against being hurt. Some become perfectionists, wrongly believing that one needs to be perfect to be accepted. Other attempt to keep control over others while fearing losing control themselves.

Once again, the attitude of the offender has a lot to do with the formation of a victim mentality in the abused. Many abusers show characteristic of “other”-blame as opposed to the self-blame shown by victims and they fit well together. Often an offender will blame the child for “seducing” them or blame circumstances for the abuse. A person with offender mentality will continue to abuse without being overwhelmed with guilt or remorse so there is no internal motivation to stop. They can always find a justification for it. They often paint themselves as “misunderstood” or “framed” by society and sometimes the victim. There is some feeling that people with the offender mentality are often substance abusers as well. In one recent study, up to 45 % of abusers who “blamed” the victim were either alcoholics or took drugs to some degree. This could suggest that substance abuse causes sexual abuse but more likely, the offenders were looking to find a reason to justify what had happened.

This is just a small portion of the disorders that can arise from abuse..there are many others. However, in therapy, the biggest gift a therapist can give an abuse victim is to believe their story and help them relive it in such a way that they can reconstruct their world and gain new insight. It helps to show abuse victims how to question long held beliefs about themselves and the world and their place in it. This is incredibly important as in some quarters, there is the belief that victims often lie about abuse. In my experience of treating victims (and being one myself), they rather tend to minimise it. It is also vital that the therapist feels the need to show emotion towards the act of abuse and the abuser. Many victims have been met with stonewall faces and attitudes all their lives and it can be refreshing to come across someone who feels outrage when talking about it.