In the stories of both writer Virginia Woolf (DeSalvo,1989) and the also profoundly abused Minerva (Wood & Hatton,1989), there can be seen the struggles to survive, to cope with what no child should have to, but millions do.

In 2006, after keeping it private for decades, actor Teri Hatcher ("Desperate Housewives") revealed in Vanity Fair magazine that she was sexually abused by an uncle as a child. Thanks in part to her testimony, he was sentenced to 14 years in prison for abusing another girl.

"He pleaded guilty, and even though it wasn't to my crime, it was because of my crime, and that made me feel validated," Hatcher said. "That's a victim thing; you ask yourself, 'Am I just crazy? Did I make all this up?' Somehow it might be easier to accept that you're crazy and you made it all up than to admit that it happened, and how awful it was," she said.

The litany of  both initial and long term sexual abuse consequences  is extensive and may include traumatic sexualization: shaping a child's sexuality - both feelings and attitudes - in a developmentally inappropriate and interpersonally dysfunctional manner; betrayal of trusting dependence; engendering of an enduring sense of powerlessness. 

A survivor may incorporate into their self-image negative connotations such as personal "badness", shame, guilt, being wrongfully different or inferior. Abuse may incite behaviors such as acting-out, self-mutilation and substance abuse.

There may be experiences of depression; various eating disorders; low self esteem; social alienation; sexually related problems (e.g. prostitution, frigidity, promiscuity, sexual orientation confusion, masochism, gynecological problems, feelings such as revulsion and fear associated with anything sexual); dissociative strategies including multiple personality; various gastrointestinal tract disorders such as allergies and speech problems such as stuttering (Bagley & King,1990, Finkelhor & Browne,1985).

There is an almost overwhelming complexity for both survivor and therapist in the aftermath of sexual trauma such as rape by a sibling: "The existence of the incest element involves...an emotional complication of the therapeutic situation. It is the hiding place for all the most secret, painful, intense, delicate, shame-faced, timorous, grotesque, immoral, and at the same time the most sacred feelings that make up the indescribable and inexplicable wealth of human relationships and give them their compelling power" (C.G. Jung, The psychology of transference, quoted in Ganzarain & Buchele,1988).

The cognitive model developed by Aaron Beck posits an intimate interaction among four elements of experience : emotions, thoughts, behaviors and physical-biological factors. This construct helps provide explanation of why there is such a complex and convoluted symptomatology resulting from abuse, and how therapy may be efficiently oriented toward resolution or at least relief of problematic behaviors in survivors. 

One of the more troubling kinds of symptoms is acting out behavior, which may be seen as "an incipient attempt to communicate unbearably painful mental contents that cannot reach consciousness, and can be discharged only as spontaneous actions" (Ganzarain & Buchele,1988).

Another factor may be lessened impulse control due to the presence of brain abnormalities, e.g. in the temporal lobes, seen more often in victims of sexual abuse (Davies,1978-9).

But a child victimized by abuse and needing to express these pains is put in a double bind : if they choose to survive by acting out their anger in various delinquent activities, they are discounted and discredited for causing further problems, and if they attempt to hide their pain and shame under a serene exterior, they are seen as not having suffered any 'real' harm. 

As one women relates, "Each increase in my guilt, shame and disgust caused an equal increase in my need to create a glossy pleasing surface. The darker the inside the brighter the outside must be to hide it" (Rush,1980). 

The "dark inside" - thought content disturbances in adult survivors, who are primarily women - may include nightmares, especially with themes of the dreamer being pursued/chased and attacked, and feeling helpless (Garfield,1987), recurring and unsettling obsessions such as impulses to harm children, persistent phobias, illusions such as sensing an evil presence in their home or body, visual/auditory/tactile hallucinations even to the point of sensations of pressure on the skin from another (non-existent) person's body against theirs (Bagley & King,1990). 

Women who experience distortions in their sexuality as an outcome of abuse may utilize elaborate erotic fantasies to tolerate sexual contact (Shainess,1984).

One of the aspects of sexual abuse, seen as a post traumatic stress disorder, is a compelling need on the part of the victim/survivor to make sense of the experience, regaining a sense of mastery over the event and enhancing one's self-esteem (Draucker,1989). 

There may be an acceptance to some degree on the part of the victim of at least some of the offender's arguments used to justify their abusing a child, such as "It isn't really sexual abuse; it's sex education", or "You are such an unusually mature girl" (Berliner,1990). 

Some therapists have pointed out the danger in the survivor's searching for meaning when there may be none : "The ability to block or interrupt thoughts of a negative event may be crucial in living with events that have, in fact, no resolution...the victims of undesirable life events are relieved of pain by making conscious attempts to block thoughts of their negative outcomes" (Silver,Boon & Stones,1983).

But in general it is the consensus of theorists and clinicians that suppression is likely to be traumagenic or maladaptive. In recent research on lies and their detection, it has been found that women are far superior to men at reading nonverbal messages through tones of voice, gestures etc., except when it comes to "leaks" - those nonverbal clues which unintentionally expose hidden feelings : the more leaky a tone of voice, or the more incongruent a message, e.g. facial expression (such as in the case of, perhaps, a perpetrator), the less women seem to be capable, or at least willing, at detecting the deception. 

Perhaps women are socialized to avoid eavesdropping, or have learned (especially in an abusive relationship ?) there may be social hazards to knowing too much about others' feelings; "but the dynamic can operate to hide facts that are not so innocent. What begins as a white lie, an innocent agreement to keep touchy facts out of frame, can shade over into less innocent social uses" (Daniel Goleman).

To a considerable extent, the cognitive adaptations to trauma, including sexual abuse, may delimit or interfere with the ongoing cognitive developmental tasks of childhood. Concrete operational thought, the solving of problems clearly tied to physical reality, can become impossibly challenging in the face of an overwhelming adult demanding gratification of their needs at the expense of the child's. 

The process of formal operational thought involves creation of rule systems through understanding the relevant interacting variables, but abuse demands secrecy and suppression, denial and avoidance of knowledge or distortion of understanding. 

The development of social cognition involves differentiation of the child's own needs and perspectives from others' : within an abusive relationship, their needs and perceptions are abrogated to those of the offender's. Perhaps one of the most critical tasks of development is the area of attribution style formation: concepts of adequacy and power in the self and others, of locus of control in various situations, and resultant levels of self-efficacy and achievement. 

And abuse is a blatant distortion in the child's sense of power : "I believe the sexual use of a child's body/being is the same as the phenomenon of adult rape...To be raped, as a woman or girl-child, is to experience...an act of aggression in which [the survivor] is denied her self-determination" (Driver & Droisen,1989).

There can be a value to highly emotive experiences in childhood, ones which press toward clarification of values and self-concept, but sexual abuse is precipitous and overwhelming. 

One of the most common results of the complex mix of abuse-engendered thoughts and behaviors is depression (Kovacs & Beck,1977), which may include self-assessment as deficient, inadequate, unworthy, physically or mentally or morally defective.

Survivors may perceive their interactions with the world in terms of defeat and failure, or deprivation, and hold presumptions that the abuse will last on and on into an unending future of suffering. Some researchers have postulated a personal mood-dispositional dimension or trait, negative affectivity, NA, and individuals with high NA levels tend to be more susceptible to distress and upset, and have more negative self-concepts and self-esteem, regardless of the levels of threat and stressors in the environment (Watson & Clark,1984).

One of the primary developmental tasks of childhood and adolescence, the definition of sexuality - of one's sexual identity and orientation, of the meaning of sexual experience and interpersonal relationships with respect to sex - may be profoundly altered and disrupted through sexual abuse. 

Normal onset of secondary sexual characteristics, or menstruation, may be so mishandled by a parent as to be traumatizing : "I had for the first time my period, and I had no idea what it meant. I was so scared, but I couldn't talk. My mother didn't tell me. When she saw it, she just gave me a pad and said that I would always have it. I thought I was terribly sick" (Konopka,1966). 

Writer Naomi Wolf believes that "shame, silence and secrecy" linger around female sexuality. She believes a double standard persists in today's culture that encourages girls to embrace sexuality before they're emotionally ready and then damns them for doing so. "We need to sever the link between girls' and women's sexuality and the sense of shame," she said in an interview.

To experience sexual feelings for the first time as a child under healthy circumstances may be frightening; within the ongoing terror of abuse it can be additionally traumatizing : "When I was thirteen I actually had an orgasm, but at first I thought my father was trying to kill me" (Rush,1980). 

There may be no more serious result of abuse than alienation of the victim from their sexual selfhood : "Perhaps the deepest damage that sexual abuse can do to a child is to shake her trust in her own instincts, so that s/he becomes a stranger and an outcast to her own body" (Driver,1989). 

As R.D.Laing pointed out, this kind of divorce of the body and the self is developed at the time of abuse as a necessary defence, but in adulthood, "the self wishes to be wedded to and embedded in the body, yet is constantly afraid to lodge in the body for fear of there being subject to attacks and dangers which it cannot escape" (Laing,1960).

The rich inner life of imagination in the victims of sexual abuse is perhaps one of the factors leading them to be more susceptible to hypnotic induction, which can function as a powerful tool in the recovery of suppressed memories (Nash et al,1984). 

Other powerful and helpful therapeutic approaches toward the recovery of memory, self and power include bibliotherapy (Pardeck,1990), which may be especially apt for children, and drama therapy (MacKay,1989). To go beyond simply recovery of memory and experiencing feelings, to make significant improvements in depression, self-esteem and empowerment, it is necessary to effect changes in the distorted beliefs that the experience of abuse has helped create. 

Thoughts and beliefs representative of the various kinds of cognitive distortions may be used by abuse survivors, but can be restored to more healthy styles of thinking through cognitive restructuring approaches.

~ ~ ~

References and additional books :

Allender, Dan. The Wounded Heart: Hope for Adult Victims of Childhood Sexual Abuse 

Bagley, C. & King, K. (1990). Child sexual abuse - the search for healing.

Bass, Ellen and Davis, Laura. The Courage to Heal : A Guide for Women Survivors of Child Sexual Abuse

Berliner, L. (1990). The process of victimization: the victim's perspective. Child Abuse & Neglect, 14,29-40.

Cox, Pat. Child Sexual Assault : Feminist Perspectives 

Davies, R.K. (1978-9). Incest: some neuropsychiatric findings. Int'l. J. Psychiatry in Medicine , 9(2),117-121.

DeSalvo, L. (1989). Virginia Woolf - the impact of childhood sexual abuse on her life and work.

Draucker, C.B. (1989). Cognitive adaptation of female incest survivors. J. of Consulting and Clinical Psych. ,57(5),668-70.

Driver, E. & Droisen, A., eds. (1989). Child sexual abuse - feminist perspectives.

Finkelhor, D. & Browne, A. (1985). The traumatic impact of child sexual abuse: A conceptualization. Amer. J. Orthopsychiatry, 55, 530-41.

Freyd, Jennifer.  Betrayal Trauma : The Logic of Forgetting Childhood Abuse 

Ganzarain, R. & Buchele, B. (1988). Fugitives of incest : a perspective from psychoanalysis and groups.

Garfield, P. (1987). Nightmares in the sexually abused female teenager. Psychiatr. J. Univ. Ottowa, 12(2),93-7.

Goleman, Daniel. Vital Lies, Simple Truths - the psychology of self-deception.

Jehu, D., Klassen, C. & Gazan, M. (1986). Cognitive restructuring of distorted beliefs associated with childhood sexual abuse. J.Social Work & Human Sexuality , 4:49-69.

Konopka, G. (1966). The adolescent girl in conflict . 

Kovacs, M. & Beck, A. (1977). An empirical-clinical approach toward a definition of childhood depression. In J.G. Schulterbrandt & A. Raskins, eds., Depression in childhood (pp.1-26). 

Laing, R.D. (1960). The Divided Self 

Langberg, Diane Mandt, PhD. Counseling Survivors of Sexual Abuse

MacKay, B. (1989). Drama therapy with female victims of assault. The Arts in Psychotherapy , 16:293-300.

Morris, Larry, et al.  Males at Risk : The Other Side of Child Sexual Abuse 

Nash, M.R., Lynn, S.J. & Givens, D.L. (1984). Adult hypnotic susceptibility, child- hood punishment, and child abuse. Int.J.Clinical & Exp. Hypnosis ,32:6-11.

Pardeck, J.T. (1990). Children's literature and child abuse. Child Welfare , LXIX(1):83-88.

Rush, F. (1980). The best kept secret : sexual abuse of children. 

Shainess, N. (1984). Sweet suffering - woman as victim .

Silver, R.L., Boon, C. & Stones, M.H. (1983). Searching for meaning in misfortune: making sense of incest. J. Social Issues , 39(2),81-101.

Watson, D. & Clark, L.A. (1984). Negative Affectivity: the disposition to experience aversive emotional states. Psych. Bulletin ,96(3),465-90.

Wolf, Naomi quotes: Jewish Bulletin of Northern California, July 11, 1997 - 
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Wolf, Naomi.  Promiscuities : The Secret Struggle for Womanhood