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Incest and substance abuse: implications for treatment professionals.

Seventy-seven volunteer participants enrolled in eight substance abuse treatment facilities were surveyed using the Substance Abuse and Incest Survey. Of the sample, 36 (48%) reported histories of incest. For participants reporting incest, data on substance abuse history, perceptions of the relationship between incest and substance abuse, and opinions regarding incest-related counseling in the context of substance abuse treatment are presented. Recommendations for substance abuse professionals and facilities are made, including intake screening, barriers to treatment, counselor education, and future research.

Adult↗

Psychic loss in adult survivors of father-daughter incest.

Studies show that adult survivors of childhood incest comprise a significant percentage of female psychiatric patients. The varied and multidetermined presenting symptomatology of these patients frequently leads to misdiagnosis and treatment interventions that fail to address core issues of the incest experience. One such issue is the child's experience of the psychic loss of a physically present parent that is part of the emotional trauma of incest. The goal of this paper is to discuss psychic loss as a core element of the incest experience, particularly in father-daughter incest, and to describe the conditions of childhood mourning that inhibit successful resolution of this loss. Attention is addressed to the psychoanalytic understanding of mourning as a basis for interventions in the treatment of adult survivors.

Adult↗

Substance abuse counselors' experiences with victims of incest.

Counselors delivering substance abuse treatment from within 39 treatment facilities throughout the United States were surveyed using the Substance Abuse Counselor Survey on Clients with Incest Histories (SACSCIH). The sample of 114 participants reported upon experiences and perceptions related to their incest-related training, identification of incest victims, prevalence of incest victims on their caseloads, and referral and treatment practices. Additionally, group comparisons provided information on differences based upon participants' gender, educational degree, recovery status, and experience with incest counseling.

Adult↗

Substance abuse and past incest contact. A national perspective.

Seven hundred thirty-two volunteer participants enrolled in 35 substance abuse treatment facilities across the United States were surveyed to examine the prevalence and nature of incest contacts among adults receiving substance abuse treatment. Results indicated that approximately 36% of the sample reported histories of incest: by gender, 29% of the male and 55% of the female participants reported incest histories. Data are presented regarding the age during incest contact, frequency of contacts and involvement of force, alcohol, and drugs. In addition, comparisons between incest and nonincest groups of participants are presented. Implications for substance abuse treatment facilities and staff are presented.

Adolescent↗

Incest diagnosis by comparison of alleles of mother and offspring at highly heterozygous loci.

BACKGROUND: Methods that detect a child's homozygosity by examination of allelic products are insensitive for diagnosing incest because, at a given locus, a homozygous state is expected with a frequency of only 0.25 when parents are first-degree relatives. Furthermore, these methods are not specific if the population contains many homozygous individuals or silent alleles that cause apparent homozygosity. STUDY DESIGN AND METHODS: Use of highly heterozygous loci improves specificity, but not sensitivity. Sensitivity may be increased by observing for two kinds of mother-offspring similarities: an offspring of incest tends to be homozygous or heterozygous-identical with respect to its mother's phenotype. At each locus, two conditional probabilities may be calculated for a genetic observation, using allele frequencies expected under a state of incestuous mating versus mating within a specified population. The conditional probabilities at each locus are compared in a likelihood ratio to express a relative probability of incest. RESULTS: In a case of known sibling incest, three likelihood ratios were derived from variable number of tandem repeat phenotypes at five loci. When only offspring homozygosity was observed, the likelihood ratio was 75.3:1. When both homozygous- and heterozygous-identical phenotype similarities of offspring and mother were noted, the likelihood ratio was 130.4:1. When maternal obligatory alleles of the offspring were considered, the likelihood ratio was 262.4:1. CONCLUSION: Comparison of maternal and offspring phenotypes at highly heterozygous loci increases both sensitivity and specificity of genetic tests in cases of suspected incest.

Adolescent↗

Identifying and treating the sexual repercussions of incest: a couples therapy approach.

Given the significant number of adults who were sexually victimized as children and the serious negative effects that sexual abuse can have on sexual functioning, clinicians need to be prepared to recognize and treat the intimacy concerns of adult incest survivors. Broadening the definition of incest to include nontouch sexual abuse, this paper describes types of sexual problems commonly expressed by survivors, such as sexual dysfunction, fear of sex, conditioned negative reactions to sex, flashbacks to the abuse, and mind-body dissociation. The intimate partner of the survivor is viewed as a secondary victim of the incest, who often displays a unique set of sexual and emotional concerns as well. A four-stage couples therapy approach is presented which includes identifying the problem, working together on incest resolution, changing old sexual intimacy patterns, and creating positive sexual experiences. This model is a dynamic combination of incest resolution therapy, sex therapy, and couples therapy. Therapeutic dilemmas and considerations are discussed and recommendations given for increasing the effectiveness of therapy. An argument is made as to why a couples therapy approach is the preferred method of treatment.

Female↗

Does morality have a biological basis? An empirical test of the factors governing moral sentiments relating to incest.

Kin-recognition systems have been hypothesized to exist in humans, and adaptively to regulate altruism and incest avoidance among close genetic kin. This latter function allows the architecture of the kin recognition system to be mapped by quantitatively matching individual variation in opposition to incest to individual variation in developmental parameters, such as family structure and co-residence patterns. Methodological difficulties that appear when subjects are asked to disclose incestuous inclinations can be circumvented by measuring their opposition to incest in third parties, i.e. morality. This method allows a direct test of Westermarck's original hypothesis that childhood co-residence with an opposite-sex individual predicts the strength of moral sentiments regarding third-party sibling incest. Results support Westermarck's hypothesis and the model of kin recognition that it implies. Co-residence duration objectively predicts genetic relatedness, making it a reliable cue to kinship. Co-residence duration predicts the strength of opposition to incest, even after controlling for relatedness and even when co-residing individuals are genetically unrelated. This undercuts kin-recognition models requiring matching to self (through, for example, major histocompatibility complex or phenotypic markers). Subjects' beliefs about relatedness had no effect after controlling for co-residence, indicating that systems regulating kin-relevant behaviours are non-conscious, and calibrated by co-residence, not belief.

Adolescent↗

The incest taboo and family structure.

The evolutionary advantage of outbreeding has influenced the family structure and the mating, attachment, and dominance behaviors of all animals. Nature has selected for those species that have evolved family structures with detachment and dominance patterns that create a relatively intact incest barrier. Man inherits from his animal forebears the biological imperative of an incest barrier but brings to it his special complexity of psychology and symbolization--incest barrier becomes incest taboo. We present a discussion of human patterns of speparation-individuation and Oedipal conflict and relate this to the detachment and dominance behaviors of animals. This is an interface between psychoanalysis, family theory, and ethology. In addition, we pursue in detail the asymmetrical operation of the incest taboo within the family: that it is stronger for mother-son than for father-daughter than for brother-sister.

Dominance-Subordination↗

Multiple overt incest as family defense against loss.

A case report of father-daughter incest is presented that illustrates the way in which overt incest can function as a multi-determined familial defense against separation and loss. The case is further distinguished by: (a) multiple incest and (b) family therapy--an approach infrequently described in the literature on this problem. The authors have adopted the psychodynamic view that incest expresses the collective psychopathology of all the family members as well as their common adaptational capacities. Specifically, we have attempted to demonstrate that separation anxiety was a shared dread in this family and that incest defended against this painful prospect.

Adolescent↗

Mother-son incest as a defence against psychosis.

In the following, a case of mother-adult son incest is described and explained from a psychoanalytical viewpoint. Two theories are put forward: (a) Mother-son incest may occur as a defence against psychosis, and (b) the incest represents an unconscious search for triangulation, a process in which external authorities (such as, for example, a court of law) may function as surrogates for persons who have been missed in the pre-oedipal past. It is therefore possible to understand mother-son incest symbolically as an indicator of pre-oedipal needs of the son and of the mother's longing for the absent partner. The incest is, however, not only a cry for help; it is also to be regarded as an attempt to solve the problem for both people involved. Looked at in this way, new ways of understanding and new possibilities for therapy emerge.

Adolescent↗

Posttraumatic stress symptoms in victims of childhood incest.

The relationship between posttraumatic stress disorder (PTSD) and the experience of severe childhood incest was investigated in a comparison of 97 adult female victims of incest and 65 matched controls. It appeared that 62% of the incest victims and none of the controls met the DSM-III-R criteria for PTSD. The best predictor for the development of PTSD appeared to be the subjective reaction at the time of the event, consisting of anxiety, freezing and dissociation. The incest victims also displayed other psychiatric symptoms, such as self-mutilation and conversions. Although the relation incest-PTSD is quite obvious, the diagnosis may easily be missed because the symptoms may be masked by other psychiatric phenomena.

Adolescent↗

Incest reported by children and adolescents hospitalized for severe psychiatric problems.

This study of 65 children and adolescents hospitalized for psychiatric problems revealed a history of incest in 37.5% of the nonpsychotic female subjects. Ten percent of the psychotic girls and about 8% of all the boys had such a history. A comparison of the nonpsychotic girls who had a history of incest and those who had no known history of incest or sexual abuse showed no specific effects of incest. It seems that social and psychological pathology serious enough to warrant hospitalization is not a simple effect of incest itself but is a consequence of severe family disorganization and the resulting ego impairment.

Adolescent↗

Psychiatric correlates of incest in childhood.

OBJECTIVE: The purpose of the study was to describe more precisely the type of psychiatric illness associated with incest during childhood. METHOD: The Diagnostic Interview Schedule was administered to 52 adult women who had been victims of incest during childhood and to 23 age- and race-matched comparison subjects from local self-help agencies. RESULTS: The prevalence of 19 psychiatric disorders was higher in the incest group than base population rates. Rates of anxiety disorders (panic disorder, agoraphobia, social and simple phobia), major depression, and alcohol abuse and dependence were significantly higher in the incest group than in the comparison group. More severe types of incestuous abuse were associated with a higher risk for the development of psychiatric disorders. CONCLUSIONS: There was an association between incest and psychiatric disorders in this community-based treatment population. All patients, especially those who present with these specific psychiatric disorders, should be queried about childhood sexual abuse during the history.

Adult↗

Rethinking Oedipus: an evolutionary perspective of incest avoidance.

The author presents a biological hypothesis of incest avoidance. Pertinent literature from evolutionary biology, ethology, anthropology, and clinical research is reviewed. Secure early bonding to immediate kin predicts later adaptive kin-directed behaviors, including preferential altruism (kin selection) and incest avoidance. Impaired bonding predicts aberrant kin-directed behavior, including diminished altruism, neglect, and an increased incidence of incest. Failed bonding predicts the highest frequency of incest. Secure bonding to kin may function to establish adaptive kin-directed behaviors, including incest avoidance. Bonding is conceived of as the developmental foundation of a form of social attraction, here called "familial attraction," which is evolutionarily distinct from sexual attraction.

Altruism↗

Incest and women of color: a study of experiences and disclosure.

Clinical literature on incest trauma assumes a homogeneity of experience of all incest survivors including women of color. Experiences relating to community, culture, and family need to be acknowledged as salient aspects of the experiences of women of color who are also incest survivors. Twelve participants were interviewed regarding their experiences related to disclosure and coping. Participants described value systems, community mindedness, social attitudes, negative consequences amongst other social and cultural issues as factors affecting incest disclosure. Participants described cognitive reframing, determination and separation from the perpetrator as ways of coping with incest.

Adult↗

Long-term effects of sibling incest.

Although sexual abuse of children is recognized as a serious problem, sibling incest has received relatively little attention. A distinction has been made between power-oriented sibling incest and nurturance-oriented incest. The authors review the relevant literature and present four clinical examples. The cases illustrate the broad range of sibling incest and demonstrate its effects, including the long-term consequences for the perpetrator. Lasting difficulties in establishing and maintaining close relationships, especially sexual ones, are prominent features of each case. Without denying the occurrences of benign sex-play between siblings, the authors emphasize exploitation and abuse as pathogenic aspects of sibling incest.

Adult↗

Incest and the family physician.

This paper is a review of incest from epidemiologic, familial, and individual points of view. The incest taboo has characterized almost every culture and society throughout the ages. Respect for the incest barrier is a cultural demand made by society and is not a physiological or biological imperative. Overt incest occurs in a dysfunctional family through tension-reducing "acting out." The family physician is in a unique position to observe and understand the family dynamics which both help maintain defenses against the incestuous wishes as well as, in some families, contribute to the practice of incest. For 2,000 years physicians have taken the Hippocratic oath, with its explicit love relationship clause, as a reminder of their ethical responsibilities towards their patients. Examples of para-incestuous relationships between vulnerable individuals and authoritative helping figures are cited. A psychodynamic rationale is offered as to why sexual relationships between patients and their family physicians are not therapeutically beneficial. Clues for assessment and ten preventive measures are presented to enable physicians to monitor themselves and the families in their practice.

Acting Out↗

Post-traumatic stress disorders in women who experienced childhood incest.

Symptoms exhibited in a clinical population of 17 women who had experienced childhood or adolescent incest appear to fit the features of a chronic and/or delayed post-traumatic stress disorder. These women, entering individual therapy an average of 17 years after the abuse had ended, ranged in age from 24 to 44. All regarded their incest experience as the most damaging event of their lives, and had manifested, in adulthood, such symptoms as intrusive imagery of the incest, feelings of detachment or constricted affect, sleep disturbance, guilt, and intensification of symptoms when exposed to events resembling the incest trauma. Treatment included establishment of trust, expression of feelings, guilt reduction through an understanding of family dynamics and acquisition of new, adaptive behaviors.

Adolescent↗