Childhood Sexual Abuse and PTSD

With as much as I know personally about childhood sexual abuse, and even as much as I’ve learned over recent years through reading and research, I was clueless that childhood sexual abuse can and does cause posttraumatic stress disorder (PTSD). The first I’d ever heard of the connection was when a young woman in one of the support groups I was leading a couple years back told me she’d been diagnosed with PTSD. Then about a year later, another young woman shared the same fact. Say what? I think of big, burly combat veterans when I think of PTSD. I don’t think of frightened little girls (or boys) who sometimes grow up to share the same barrage of symptoms that oftentimes stop those burly combat veterans right in their tracks.

So what is the connection? PTSD symptoms can include intrusive memories, nightmares, reliving the trauma as if it were happening again (flashbacks), hypervigilance, emotional hyperarousal, social impairment (problems relating to or interacting with others), withdrawn behavior, memory and concentration problems, addictive behaviors, emotional or physical distress in reaction to something that brings the trauma back to mind (triggers), avoiding thinking or talking about the trauma, negative self-esteem, emotional numbing, lack of interest in activities, feelings of hopelessness, angry outbursts or aggressive behavior, overwhelming guilt or shame, trouble sleeping, suicidal thoughts. Many of these symptoms are common in adult survivors of childhood sexual abuse. I’ve dealt with several over the years myself. I don’t suffer with PTSD now, but I likely did.

I read one study on maltreated children that said, “In clinically referred samples, the reported incidence rates of PTSD resulting from sexual abuse range from 42% to 90%.” (Neurodevelopmental Biology Associated With Childhood Sexual Abuse by Michael D. De Bellis, M.D., MPH, Eve G. Spratt, M.D., and Stephen R. Hooper, PhD.) This research studied children, so those percentages are likely reflective of the time of disclosure or shortly thereafter. But some of those children wind up with chronic PTSD that follows them into adulthood. PTSD symptoms are common within the first month after a trauma and may be a normal response to extreme stress. Those types of PTSD symptoms usually fade away within three months. There are those whose symptoms persist and cause the impairment found with chronic PTSD. There are also complete and partial PTSD responses. It’s generally not an all or nothing kind of outcome. The previously cited article describes PTSD as a “dimensional process.”

PTSD is obviously a complex subject, and I’m obviously not a doctor or psychiatrist, so there were some surprising things I learned about the stress of sexual abuse and PTSD. I learned and wrote a bit about how childhood sexual abuse affects brain development and the body’s stress systems in my previous post, Childhood Sexual Abuse and Long-Term Health, but there was more to learn in researching PTSD. Like a lot of people, I’ve thought of PTSD as a “psychological” condition. While it is psychological because its symptoms are often behavioral, it’s more than that. Those psychological symptoms stem from actual physical changes in the brain, changes that can be seen on CT and MRI scans. While some chronic stress-related brain changes happen during the growth and development of childhood, there’s a difference in the brains of adults who experienced childhood sexual abuse but don’t have PTSD and adults who experienced childhood sexual abuse and do have PTSD.

Damage to the hippocampus can cause problems with memory and can also impair new learning. Diminished right hippocampal volume (as evidenced in PTSD patients in general) is associated with short-term memory loss. The same results were found in PTSD sufferers who were victims of childhood sexual abuse. Recent studies show that hippocampal volume reduction is specific to PTSD and not associated with other anxiety disorders. Damage to the hippocampus may explain why victims of childhood sexual abuse often seem to have incomplete or delayed memories of their experiences. PTSD patients often have impairments in the medial prefrontal cortex as well, the area of the brain responsible for response to fear and stress. (This paragraph is a paraphrase of information taken from The Invisible Epidemic: Post-Traumatic Stress Disorder, Memory and the Brain by J. Douglas Bremner, M.D.)

There have been a couple of studies done to see if it’s possible to determine which victims of childhood sexual abuse will go on to later develop PTSD. One study, Pathways to PTSD, Part II: Sexually Abused Children by Julie B. Kaplow, PhD, Kenneth A. Dodge, PhD, Lisa Amaya-Jackson, M.D., MPH, and Glenn N. Saxe, M.D., FRCP, cited three direct paths to PTSD: dissociation (detachment from immediate surroundings or detachment from physical or emotional experience), avoidant coping (denial or minimizing what happened), and anxiety/arousal responses (reexperiencing symptoms of the trauma), all of these being measured for the study during or immediately after disclosure of sexual abuse. The subjects of this study were children who were referred to a treatment facility because of possible sexual abuse. The evidence for the study was gathered from the videotaped forensic interviews of the children. Studies of this type are promising in possibly leading to early intervention for those children likely to experience later PTSD. Because these pathways to PTSD are assessed at time of disclosure though, I can’t help but think of the millions of survivors who never tell anyone. Help is available, and not only for children, but also for adults who’ve lived under the heavy weight of that secret for a lifetime. Speak! Along with cognitive therapies, and because PTSD is experienced with physiological brain changes, there are drug therapies that work in helping to combat symptoms. Knowing there are physiological reasons for PTSD should help to lesson some of the stigma often associated with it.

Certainly, not every childhood sexual abuse survivor experiences PTSD. One article suggested absence of PTSD symptoms may be associated with resilience. There’s also a recently labeled phenomenon called posttraumatic growth or PTG. Stay tuned! More on resilience and PTG to come.