1 Running head: PTSD AND CHILD ABUSE

Post Traumatic Stress Disorder and Childhood Sexual Abuse Susan C. Richardson Liberty University

2 Running head: PTSD AND CHILD ABUSE

Abstract The most prevalent cause of childhood Post Traumatic Stress Syndrome in the United States today is child sexual abuse (CSA). More than 90 percent of sexual abuse is perpetrated by family members. 48% of those experiencing CSA will develop PTSD. To recover from this trauma the child must be supported by a Christ like love. Many are called upon, due to no fault of their own to become single parents, foster parents, and custodial grandparents or otherwise help nurture these abused children. As well as professional therapy, support must be given by the caregivers and should include the ministries of the local church. Sufferers of CSA should be taught boundaries, communication and empathy to break the cycle of Transgenerational trauma.

3 Running head: PTSD AND CHILD ABUSE

PTSD and Childhood Sexual Abuse In this paper the author seeks to expose and illuminate the reader to the most prevalent cause of childhood Post Traumatic Stress Syndrome in the United States today. Child sexual abuse (CSA) not only affects the abused but can lead to a past vulnerability repeating itself in subsequent generations. Unfortunately, many parents in this society have not become equipped to be parents nor have these parents learned boundaries during their own childhood. They have been raised with no clear set of moral standards and without biblical teachings as a moral compass they drift in a sea of frustration without controls. Due to the lack of boundaries and controls many parents have not fulfilled the role guardian or have actively defiled that role. Mendenhall states, "It always amazes me that we warn our kids to beware of strangers, when more than 90 percent of sexual abuse is perpetrated by family members"(2007). Because of this horrible sin, many are called upon, out of necessity, to become single parents, foster parents, custodial grandparents or otherwise help nurture children that do not naturally belong to them. Included also in this work are practical suggestions for six principles that will help create openness and honesty in all types of interpersonal relationships including with those who suffer PTSD due to abuse. Defining Trauma Psychological trauma in children can be defined as the mental result of one sudden, external blow or a series of blows rendering the young person temporarily helpless and breaking past ordinary coping and defensive operations. According to the nature of the event childhood trauma can be divided into two categories: Type I, which involves a single, sudden, unexpected, relatively time limited, and public (i.e., affecting children from more than a single family)

4 Running head: PTSD AND CHILD ABUSE

stressor, such as a natural disaster or school shooting; and Type II trauma, which refers to a stressor resulting from a long-standing ordeal, such as repeated abuse (Ogawa, 2004). Defining PTSD Each year, an estimated 150,000 to 200,000 new cases of child sexual abuse are reported. Studies have charged that the problem with CSA research is the focus on adults, when CSA is more common with children under five. Many such children have an increased risk of severe psychosocial, emotional, and behavioral problems, in addition to developmental problems. Of the children who are victims of sexual assault about 48% meet the criteria specified for posttraumatic stress disorder (PTSD). PTSD is accompanied by symptoms of increased arousal and avoidance of stimuli associated with the trauma and is defined as the re-experiencing of an extremely traumatic event. Re-experiencing the event can be evident in a client's intrusive recollections of the event, as in recurrent or distressing dreams. Dissociative states, which can last from a few seconds to days, in which the victim experiences intense psychological distress or psychological reactivity can present in some individuals. This often occurs when a person is exposed to events that symbolize or resemble some aspect of the traumatic event, such as anniversaries of the trauma (Frazier, West-Olatunji, St. Juste & Goodman, 2009). Brown, Brack & Mullis (2008) relate that traumatic events give rise to various symptoms and consequences that differ among affected children. Children who experience the trauma of sexual abuse are no exception, as they exhibit a highly diverse group of symptoms. Trauma produces profound and prolonged changes in physiological arousal, emotion, cognition, and memory that may disconnect these normally integrated functions from one another. These changes always affect school functioning. Research has shown that traumatic symptoms that arise from sexual abuse may be exacerbated by the number of perpetrators; the duration,

5 Running head: PTSD AND CHILD ABUSE

frequency, and severity of abuse; the age of the victim and of the perpetrator at onset; and the victim's feelings of responsibility, powerlessness, betrayal, or stigma at the time of the abuse. Christian Mandate to Care When a parent is unwilling, unable or chooses not to fulfill their God ordained responsibility how should those appointed to care for that child do so? What if a parent or others abuse the child in such a way that only through the consistent and patient efforts of long term caregivers will this child have the hope of a normal life? How does one go about developing boundaries and constructing a plan for consistent and loving discipline in this situation? What responsibility out lined by Christ does the Christian Church have to help these children? All these questions need to be answered before one can understand how to help these hurting children. The Scripture paints a picture of Christs love for children in Mat. 18:2-6: And Jesus called a little child unto him, and set him in the midst of them, And said, Verily I say unto you, Except ye be converted, and become as little children, ye shall not enter into the kingdom of heaven. Whosoever therefore shall humble himself as this little child, the same is greatest in the kingdom of heaven. And whoso shall receive one such little child in my name receiveth me. But whoso shall offend one of these little ones which believe in me, it were better for him that a millstone were hanged about his neck, and that he were drowned in the depth of the sea. Mat. 19:13-15 also says: Then were there brought unto him little children that he should put his hands on them, and pray: and the disciples rebuked them. But Jesus said, Suffer little children, and forbid them not, to come unto me: for of such is the kingdom of heaven. And he laid his hands on them.

6 Running head: PTSD AND CHILD ABUSE

In these passages Christ shows his sensitivity to the needs of children when he not only calls them into His presence but uses them as an example of how the converted must approach the Kingdom of Heaven. Not only does Jesus bless the children with appropriate touch but He also warns of the judgment to come to those who offend these little ones. Secular Apathy Parents are tremendously demoralized in modern America. Failure to respect what they do is firmly ingrained in this culture. The secular world view is related by Reeves when he reminds us of Hillary Clintons use of the African proverb "It takes a village" to capture her message about community responsibility for children. But the trend is in the opposite direction. We have become less community oriented in our neighborhoods and more tragically, apathetic in our churches. Reeves (2003) goes on to say that people are less likely to welcome, watch out for, comfort or admonish children other than their own. If a child falls over, we dare not comfort them for fear of being seen as a pervert; if they behave antisocially, we dare not confront them. There has been a steady loosening of the bonds between people and children other than their own, expressed in the hostile response towards children in restaurants, trains and planes, in the constant vilification of parents who cannot "keep their children under control" and in the failure collectively to establish and enforce benign disciplinary boundaries for behavior. Even the nonreligious recognize that creating a secure foundation for our children requires the maintenance of a clear set of moral standards. According to Hewlett & West (1998), parenting is not just about nourishing a small child's body, but about fostering the development of the child's soul. Kingdom Principle

7 Running head: PTSD AND CHILD ABUSE

Christ shows that for an individual to excel in the Kingdom, he must first become a servant. The follower of Christ is given a mandate to receive the child in His name. Mark 9:3537 reads: And he sat down, and called the twelve, and saith unto them, If any man desire to be first, the same shall be last of all, and servant of all. And he took a child, and set him in the midst of them: and when he had taken him in his arms, he said unto them, Whosoever shall receive one of such children in my name, receiveth me: and whosoever shall receive me, receiveth not me, but him that sent me. It is important to remember that Christ illustrates the natural, normal role of the human father in Luke 11:11-13 and uses this as an illustration for the loving care of the Heavenly Father: If a son shall ask bread of any of you that is a father, will he give him a stone? or if he ask a fish, will he for a fish give him a serpent? Or if he shall ask an egg, will he offer him a scorpion? If ye then, being evil, know how to give good gifts unto your children: how much more shall your heavenly Father give the Holy Spirit to them that ask him? Perpetrators According to Lambie (2005), most abuse occurs at the hands of parents, with a minimum four out of five victims found to be abused by at least one parent. Mothers acting alone were most commonly found responsible for physical abuse, nonrelatives and fathers acting alone were most commonly found responsible in sexual abuse cases. Finally, most physical abuse fatalities are caused by enraged or extremely stressed fathers or other male caretakers. The average abuse parent is in his or her mid-20s, lives near or below the poverty level, often has not finished high school, is depressed and unable to cope with stress, and has experienced violence firsthand.

8 Running head: PTSD AND CHILD ABUSE

Sexual abuse initiated when a child is less than 8 or 9 years old by an adult, usually a man in the mid-20s, is often intrusive and violent. Many times it is the childs father or step-father. Children who are sexually abused also are likely to experience psychological or emotional abuse in the forms of betrayal or threats. They will probably also endure physical abuse in the forms of bodily harm or physical beatings to establish or maintain compliance. Perpetrators often induce and instill feelings of shame, guilt, and worthlessness through blame or stigmatization (Brown, Brack & Mullis, 2008). It tears at the very heart of God and without intervention sentences successive generations to hopelessness and despair. Continuing Results It's by now it is also glaringly obvious to mental health professionals that child abuse significantly increases the risk for mental and emotional disorders and associated risks for alcoholism, drug abuse, and smoking. Transgenerational trauma can also be passed down with the abused acting out the abuse and so becoming an abuser themselves. Childhood adversity is also a major risk factor for many of society's most prevalent biomedical illnesses and causes of death including heart and lung disease, diabetes, liver and kidney disease, some cancers, sexually transmitted diseases (including HIV), and autoimmune diseases. Being abused or neglected as a child increased the likelihood of being arrested as a juvenile by 59 percent, as an adult by 28 percent, and for committing a violent crime by 30 percent. In light of all this, it has been asserted that child abuse is the largest single public health issue in America. (Wylie, 2010) Caregivers Role For effective treatment of CSA with young children, a nonoffending caregiver is generally incorporates in the therapeutic process as a partner. Family and environmental support after disclosure of abuse is the key to CSA survivor functioning. When treating survivors of

9 Running head: PTSD AND CHILD ABUSE

sexual abuse, mental health counselors should attend carefully to the child's interpretations of the abuse. In attempting to understand how the child interprets events, counselors can correct any misunderstandings or false beliefs. The inclusion of caregivers is important because their responses have a significant effect on the way the child processes the event. It is very important to help both the child and the caregiver process the traumatic event which will allow the diminishing of both caregiver and survivor feelings of self-blame (Frazier, West-Olatunji, St. Juste & Goodman, 2009). How does the parent figure or counselor help the child who has had so much wrong perpetrated against them? The task seems daunting and the damage seems so irreparable. How can a child hope to form a secure attachment with the Heavenly Father when they have been so betrayed by the one who is to be the earthly example of that relationship? Reinert, Edwards & Hendrix relate that if God is functioning as an attachment figure for a client (not just an entity the client believes in but one with whom the client has a strong existential or affective bond), it could be expected that the client would find in that relationship a secure base and safe haven from which to deal with his or her world, particularly under stressful conditions (2009). Trust must be reestablished before an attachment can form but the child must begin to feel safe before that can happen. However, progression through trauma recovery is neither a straightforward nor a linear process, and some clients may never complete the entire process. Each step along the way must be bathed in prayer. Stage 1: Establishing Safety Within the first stage of establishing safety, the child will need to know that he or she will be physically protected from seeing or interacting with the perpetrator of the abuse. Brown, Brack & Mullis (2008) emphasize that survivors in this stage of therapy feel unsafe and out of

10 Running head: PTSD AND CHILD ABUSE

control. In children and adolescents, these feelings may manifest through anxiety, worry, or fright. The child may talk excessively or ask many questions, express fears that bad things will happen, or freeze up in social or academic situations. For this reason, the greater the amounts of predictability in the environment at home and at school, the easier it will be for the child to establish a sense of safety, order, and control. Stage 2: Remembering and Mourning During the second stage of remembering and mourning, the child will remember and recount his or her sexual abuse experiences to the therapist and mourn the losses ensued as a result of the trauma, which may include the integrity of the child's body and the intactness of the child's social network or family. Some refer to this stage as the "abyss as it is a deep and dark place in which the client must delve in order to resolve the traumatic experiences. The most intense part of the trauma recovery process occurs in this stage. Many sexual abuse survivors have the hardest time beginning their descent into the trauma work because of this intensity. Parents must continue to normalize the childs feelings and be accepting of the child even though strong emotions and a lack of vocabulary may make the childs acting out more intense. The child's sense of belonging often is shattered as he or she faces having to reconcile once shared values and beliefs about the world with new realities of making meaning of what the trauma destroyed. Children and adolescents may report feeling different from others their age and may isolate themselves from others. They may spend time alone, not talk to their friends, or not want to do anything that once gave them pleasure. At this time, validating and normalizing what the child or adolescent is experiencing is of the utmost importance (Brown, Brack & Mullis, 2008). Stage 3: Reconnecting with Others

11 Running head: PTSD AND CHILD ABUSE

The last stage of the trauma recovery process entails the client building new conceptions of himself or herself and more actively engaging with others and the world. What children come to understand in this stage is that they have been a victim of sexual abuse, that they now have control over their life, and that they can use this knowledge to further protect themselves in the future. One goal of this stage is "learning to fight" which entails the victim taking calculated and planned risks to exercise new responses to perceived threats (Brown, Brack & Mullis, 2008). Anderson (2003) recognizes the fact that one does not have volitional control over our emotions but believes that they are primarily a product of our thoughts. He believes it is not the circumstances of life that determines how we feel. How we feel is primarily determined by how we interpret the events of life (i.e., what we choose to think and believe) and secondarily by how we choose to behave (p.84). This is the reason why two people may respond very differently to the same stressful situation. If these statements are true, it is imperative that children be taught and encouraged to communicate their thoughts so that the caregiver may help them interpret their situation in a positive manner. Develop Self-Efficacy During this last stage the desire to be an overly protective parent or caregiver may be very strong. An article written for a British newspaper notes that over-protected children are likely to seek out danger when they escape the confines of home or school. They may become so bored that they look for exciting ways to amuse themselves. Overprotective parents, unwilling to let their offspring out of their sight, are also responsible for fostering what is described as a form of cabin fever. Youngsters who are cushioned from all danger are unable to learn to cope with risk. They are not allowed to learn crucial skills such as resilience and a sense of right and wrong. The author also notes that children need their own space to make their own mistakes, deal

12 Running head: PTSD AND CHILD ABUSE

with other children and push boundaries. Many parents don't allow children to play outside or walk to school. Life is getting harder for children from all backgrounds. Some of the reason is the lack of opportunities to develop self-efficacy, the ability to self-regulate their own behavior. Their opportunities have been severely curtailed to learn right from wrong, without adult intervention and to develop their everyday morality. In the playground, one should want children to have a challenging and potentially quite difficult experience. A scraped knee or twisted ankle is much more preferable than the consequences of less risky behavior ("Cabin Fever Cosseted Children," 2007, p. 43). Principles for Healing As Christian parents and caregivers, the standards of morality come from scripture and safe boundaries must be set at each stage of emotional healing. Cloud and Townsend (1989) teach that honesty is the best policy in communication. Without honesty about the trauma the experience of restoration cannot be accomplished. They list six principles that will help create openness and honesty in all types of interpersonal relationships: 1. Live the Law of Exposure in Front of Your Children- share your needs lovingly 2. Make Boundaries Clear- enforce the rules 3. Cure Their Fears and Make Communication Safe- do not withdraw from feelings, feelings are acceptable but expression has limits; put feelings into words 4. Do Not Reinforce Non-Expression- disallow actions and encourage words 5. Do Not Get in the Middle- allow for personal conflict resolution 6. Teach Them Boundary Words- role play using No phrases Teaching a child boundary setting and instilling security through the enforcement of established parental boundaries will indeed go a long way in reestablishing a sense of safety and

13 Running head: PTSD AND CHILD ABUSE

control within the childs life. Sharing needs with the child by using words may make the parent seem vulnerable but will establish trust and inspire mutual honesty among family members. This will also lay the groundwork for making communication safe and will put aside the fear that verbalized thoughts are unacceptable. Enforcing the discipline of using a vocabulary instead of inappropriate physical actions while encouraging but not intervening in personal conflict resolution will empower the child and break the cycle of lashing out while instilling self control. Lastly, teach and role play things to say when the child needs to set limits with those around them. Give them statements such as: No. I dont like that. No. I dont want to. No. I wont do that. No. God does not like that. No. That is not a safe place to touch. No. We dont touch each others private places. No. I dont like drugs. NO! Period. Teach them how to say it. Boundary of Love In conclusion, the most prevalent cause of childhood Post Traumatic Stress Syndrome in the United States today is child sexual abuse. More than 90 percent of sexual abuse is perpetrated by family members. To recover from this trauma the child must be supported by a Christ like love. Loving the abused child is the greatest boundary one can set for them. God requires His followers to accept and care for those who are helpless to defend themselves. Praying and fasting as the scripture prescribes in Mat 17:21 will avail much in seeking relief from the demons that

14 Running head: PTSD AND CHILD ABUSE

torment a child with PTSD. Exhibiting Gods love through prayer, consistency of discipline, acceptance, boundary setting and honesty will form the basis for reestablishing safety and trust in both others and with God. Christians must be made aware that to accept one of these little ones is to accept Christ and the One who sent Him.

15 Running head: PTSD AND CHILD ABUSE

References

Brown, S. D., Brack, G., & Mullis, F. Y. (2008). Traumatic Symptoms in Sexually Abused Children: Implications for School Counselors. Professional School Counseling, 11(6), 368+. Retrieved October 13, 2011, from Questia database: http://www.questia.com/PM.qst?a=o&d=5035238928

Cabin Fever Cosseted Children Can Go off the Rails Once They Get Their Freedom. (2007, February 22). The Daily Mail (London, England), p. 43. Retrieved October 13, 2011, from Questia database: http://www.questia.com/PM.qst?a=o&d=5019471591

Frazier, K. N., West-Olatunji, C. A., St. Juste, S., & Goodman, R. D. (2009). Transgenerational Trauma and Child Sexual Abuse: Reconceptualizing Cases Involving Young Survivors of CSA. Journal of Mental Health Counseling, 31(1), 22+. Retrieved October 13, 2011, from Questia database: http://www.questia.com/PM.qst?a=o&d=5035089693

Hewlett, S. A., & West, C. (1998, May/June). A Parenting Movement. Tikkun, 13, 29+. Retrieved October 13, 2011, from Questia database: http://www.questia.com/PM.qst?a=o&d=5035425218 Henry Cloud and John Townsend. (1998). Boundaries with Kids. Grand Rapids: Zondervan. Holy Bible. (1982). Iowa Falls: B.B.Kirkbride. Lambie, G. W. (2005). Child Abuse and Neglect: a Practical Guide for Professional School Counselors. Professional School Counseling, 8(3), 249+. Retrieved October 13, 2011, from Questia database: http://www.questia.com/PM.qst?a=o&d=5035522078

16 Running head: PTSD AND CHILD ABUSE

Mendenhall, T. (2007, May/June). Crisis Land. Psychotherapy Networker, 31,. Retrieved October 13, 2011, from Questia database: http://www.questia.com/PM.qst?a=o&d=5035218378

Ogawa, Y. (2004). Childhood Trauma and Play Therapy Intervention for Traumatized Children. Journal of Professional Counseling, Practice, Theory, & Research, 32(1), 19+. Retrieved October 13, 2011, from Questia database: http://www.questia.com/PM.qst?a=o&d=5044925331

Putman, S. E. (2009). The Monsters in My Head Posttraumatic Stress Disorder and the Child Survivor of Sexual Abuse. Journal of Counseling and Development, 87(1), 80+. Retrieved October 13, 2011, from Questia database: http://www.questia.com/PM.qst?a=o&d=5033508844

Reeves, R. (2003, October 20). The Battle for Childhood: We All Love Children; Even Politicians Do. Yet We Are in Danger of Taking from Them Everything That Is Most Precious Freedom, Health and Happiness. New Statesman, 132, 18+. Retrieved October 13, 2011, from Questia database: http://www.questia.com/PM.qst?a=o&d=5002039508

Schneider, R., Baumrind, N., & Kimerling, R. (2007). Exposure to Child Abuse and Risk for Mental Health Problems in Women. Violence and Victims, 22(5), 620+. Retrieved October 13, 2011, from Questia database: http://www.questia.com/PM.qst?a=o&d=5035149834

Wylie, M. S. (2010, March/April). The Long Shadow of Trauma. Psychotherapy Networker, 34,.

17 Running head: PTSD AND CHILD ABUSE

Retrieved October 13, 2011, from Questia database: http://www.questia.com/PM.qst?a=o&d=5040679967