The survivor syndrome: childhood sexual abuse leaves a controversial trail of aftereffects

Science News, Sept 25, 1993 by Bruce Bower

Carol Tavris, a psychologist with a private practice in Los Angeles, welcomed the new year with a bang that reverberated throughout the mental heatlh field. In a Jan. 3 NEW YORK TIMES BOOK REVIEW article titled "Beware the Incest-Survivor Machine," she argued that a number of self-help books for victims of child abuse encourage a growing tendency to portray nearly all psychological problems -- and particularly those of women -- as consequences of incest.

"The evidence that [sexual] abuse is more common than we knew is being trivialized by unvalidated claims made by pop-psychology writers that abuse is nearly universal, and that if you can't actually remember the abuse, that's all the more evidence that it happened to you," Tavris argued. "The problems is not with the advice [self-help books] offer to victims, but with their effort to create victims."

Her assertions sparked numerous angry responses, including condemnations that her view supports a backlash against legal and social gains recently made by those who have suffered sexual abuse as children.

Although debate rages, scientists lack a comprehensive model of the damage wreaked by sexual abuse. Such a theory might address the interplay among responses to specific abusive acts, a child's prior emotional condition, family psychological health or disturbances, and adult responses to the discovery of the abuse.

Self-help books cited by Tavris -- such as the best-selling The Courage to Heal by Ellen Bass and Laura Davis (1988, Harper-Collins) -- offer checklists that identify purported symptoms spawned by incest. These signs of past abuse include feeling bad or ashamed, feeling powerless, always needing to be perfect, low self-esteem, lack of motivation, phobias, having problems with sex and relationships, arthritis, and the desire to change one's name. Even researchers and clinicians who welcome the support and information self-help books bring to survivors generally take a dim view of such sweeping checklists.

"Symptom checklists cannot establish that someone was sexually abused," says Lucy Berliner, a social worker at Harborview Sexual Assault Center in Seattle. "But I'm not persuaded that therapists commonly diagnose sexual abuse with checklists or engage in a wholesale tendency to talk people into recalling childhood abuse."

In a way, symptom checklists that draw on a grab bag of miseries and distress run parallel to a trend noted in much research on the aftereffects of sexual abuse. Corroboration of adult reports proves difficult, but many researchers assert that the frequency of childhood sexual abuse rises significantly in conjunction with many psychological problems, including borderline personality disorder (marked by volatile relationships, moods, and self-image), multiple personality disorder, substance abuse by women, eating disorders, and somatoform disorders (such as pseudoseizures, pelvic pain, and gastrointestinal disturbances with no known physical cause).

Some investigators further argue that severe, repeated sexual assaults often produce post-traumatic stress disorder (PTSD), a cluster of symptoms including persistent sadness, feelings of unreality, social isolation, and either amnesia for or constant reliving of traumatic events.

Yet no consensus exists regarding how childhood sexual abuse might induce bulimia in one person, multiple personalities in another, and cocaine addiction in a third. In fact, considerable debate centers on whether sexual abuse by itself, or as a relatively small part of much broader family upheaval, incites the slew of psychological troubles observed by researchers, mainly in studies of women.

It is a controversy that currently envelops the mental health professions, encompassing the highly publicized issue of whether some adults harbor repressed memories of child abuse that suddenly step out of the shadows if nudged by an inspirational book or a concerned therapist (SN: 9/18/93, p.184). but at its core, the dispute hinges on how best to conceptualize the still poorly understood legacy of child abuse in adults' lives.

A report issued this month by the National Research Council in Washington, D.C., concludes that "we do not yet understand the consequences of children of particular types or multiple forms of abuse." Researchers have yet to clearly distinguish the effects of child maltreatment from those of poverty, drug abuse, and other social problems, according to the 16-member panel of child-abuse researchers and clinicians.

The effects of various types of mistreatment--sexual abuse, physical abuse, neglect, and emotional abuse -- at specific ages and points in development remain largely unexplored, the panelists contend in their report. Few studies have addressed possible differences between boys and girls in their responses to child abuse, they note.

No evidence exists for a characteristic psychological response or "survivors syndrome" in sexually abused children, according to a review of the most rigorous studies on this issue published in the past decade. Three psychologists -- Kathleen A. Kendall-Tackett of Wellesley (Mass.) College and Linda Meyer Williams and David Finkelhor, both of the University of New Hampshire in Durham -- conducted the review.