Healthcare Training Institute - Quality Education since 1979
CE for Psychologist, Social Worker, Counselor, & MFT!!
Depressive symptoms including feelings of guilt and shame, low self-esteem, low self-efficacy, and unresolved grief.
Anxiety symptoms including generalized anxiety, phobias, panic attacks, trauma symptomatology (e.g. nightmares, flashbacks, dissociative experiences), and fear of invasive medical procedures.
Sexual problems including sexual dysfunction (e.g. impaired arousal, orgasmic difficulties, vaginismus, painful intercourse, impotence), avoidance of sexual intimacy, sexually aggressive and compulsive behaviors, sexual identity confusion, and general sexual dissatisfaction.
Interpersonal problems including difficulty forming and maintaining intimate relationships, a pattern of involvement in unsatisfactory relationships (sometimes involving continued physical, emotional, or sexual abuse), distrust of men or women, isolation, poor social skills, and parenting problems.
Self-destructive behaviors including substance abuse, eating disorders, self-mutilation, suicide attempts, and self-defeating behaviors (e.g. occupational underachievement, inability to provide enjoyable or relaxing activities for self).
Perceptual disturbances including visual (e.g. seeing 'shadowy' figures), auditory (e.g. hearing footsteps at night), and tactile (e.g. being touched by another) sensations.
Somatic complaints including pelvic pain, migraine headaches, and chronic sleep disturbances.
Aggressive behaviors including sexual offending, physical abuse of others, and antisocial conduct.
Models That Organize Presenting Symptoms
A predictive syndrome Ellenson, noting the wide variety of symptoms experienced by incest survivors, attempted to specify a 'syndrome that is exclusively related to a history of childhood incest' (1985: 525). He called this a predictive syndrome because he believed that the presence of certain characteristic symptoms could differentiate women who had been incestuously abused from those who had not. The framework is divided into symptoms reflecting thought content disturbances and perceptual disturbances. Certain combinations of the symptoms (e.g. seven total symptoms, five symptoms including at least one perceptual symptom) are thought to be highly predictive of incest, as these symptoms differ from symptoms that constitute other related syndromes (e.g. posttraumatic stress disorder (PTSD) resulting from a catastrophic event experienced in adulthood).
The recurring thought disturbances identified by Ellenson (1985) as characteristic of incest and the specific content of these disturbances are as follows:
The recurring characteristic perceptual disturbances identified by Ellenson (1985) and the form these disturbances take are as follows:
Hallucinations - sensory perceptions of non-existent phenomena
Disguised presentation of undisclosed incest Gelinas has organized the varied and commonly reported symptoms of incest survivors into a 'coherent, explanatory, and heuristic framework' (1983: 312). She identifies three underlying negative effects: chronic, traumatic neurosis, continued relationship imbalances, and increased intergenerational risk of incest.
The intense affect and vivid memories experienced by survivors following disclosure and discussion of the incest are referred to as chronic traumatic neurosis. Phases of denial or repression alternate with intrusive experiences of trauma repetition (e.g. nightmares, pseudo-hallucinations, obsessions, emotional repetitions, behavioral re-enactments). Symptoms such as depression, anxiety, and substance abuse are secondary elaborations related to the hidden and untreated traumatic neurosis.
The relational imbalances exhibited by survivors are considered to be a result of the family dynamics that produced and maintained the secret of the incest. Gelinas (1983) discussed a scenario that typifies the development of incestuous family dynamics.
Parentification occurs when a child, often an eldest daughter, assumes responsibility for parental functions. The child learns to protect and nurture her parents, thereby developing a caretaking identity. She becomes skillful in meeting the needs of others but denies her own needs.
She chooses as a partner a man who requires caretaking, typically one who is needy, narcissistic, or insecure. As she might still be meeting the needs of her family of origin as well, she soon becomes emotionally depleted. When she and her husband have children, maternal caretaking is added to her responsibilities. She is then less able to attend to her husband's needs and might attempt to enlist his support. He feels both threatened and abandoned and becomes increasingly unavailable to her. She might then attempt to get emotional support from her child, often her eldest daughter, and this daughter then begins to experience parentification. The husband, if unable to meet his needs outside the family, may do so through his daughter. Sexual abuse is most likely to occur if the father is narcissistic, exhibits poor impulse control, and uses alcohol.
The daughter, now an incest survivor, becomes an adult who is also very skillful at caretaking, but who has a poor self-concept and is lacking the social skills needed to meet her own needs (e.g. assertiveness). She is unable to establish mutually supportive relationships with others and becomes isolated or abused and exploited in the relationships she does establish. As she also remains emotionally depleted, she will experience parenting difficulties and another generation of parentification may begin.
The intergenerational risk of incest is due
to the establishment of the relationship imbalances discussed above. The incest
survivor's daughter becomes at risk for incest as the processes of parentification
and marital estrangement are repeated. The survivor, experiencing an untreated
traumatic neurosis, will avoid stimuli that provoke memories of her own abuse
and is therefore less likely to detect or attend to the sexual abuse of her daughter.
Gelinas (1983) stressed that this does not suggest that the mother is to blame
for the incest. Although each parent is responsible for the incestuous family
dynamics, the offender alone is responsible for the sexual contact.
Reflection Exercise #4