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PubMed1995

Repair of a recto-vaginal fistula as a result of sexual assault.

A thorough and careful examination should always be performed for a child with a presenting complaint of sexual abuse. Rarely will a child suffer extensive injuries requiring surgical repair. This case study is of a 4-year-old girl who sustained severe penetrating trauma of the vagina and rectum resulting in a recto-vaginal fistula. She presented 2 months after the assault and required anogenital reconstruction with a temporary colostomy. Initial and long-term surgical management of this case is discussed.

Child Abuse, Sexual↗
PubMed1994

[Sex abuse and sexual health in children: current dilemmas for the pediatrician].

Epidemiologic research in nearly two dozen countries shows that sexual abuse is a real danger for 5-20% of all children, girls being 2-3 times more at risk than boys. Sexual abuse has proved an important risk factor in many behavioral or even somatic disorders, including posttraumatic symptoms such as nightmares, phobias, nutritional problems, aggressivity and school problems. Unfortunately the problem is surrounded by shame, denials and numerous misleading prejudices which make it hard to diagnose. Diagnosis is also complicated by the frequent absence of reliable physical evidence, the lack of serious research into the child's normal sexual behavior and development, the fact that many small children express themselves awkwardly, and finally the existence of reasons for making untruthful statements, e.g. in child custody disputes. In North America experience has shown the importance of certain arrangements when public health authorities need to respond effectively to the problem of sexual abuse: these arrangements are: (1) Education of the pediatric and medical communities to ensure that the majority of personnel are thoroughly aware of the symptoms and are willing to accept the diagnosis. (2.) Training of specialists capable of interpreting the physical signs, where these are present. (3.) Interdisciplinary cooperation, in practice, of the police and social and psycho-medical institutions with medical personnel when investigating individual cases. (4.) Serious efforts must be made to ensure that children do not suffer the negative iatrogenic effects of investigations into sexual abuse: that is, by minimising the number of interviews and examinations, respecting the child's privacy, and doing everything possible to ensure positive follow-up of the child by the primary social network surrounding him/her.

Adolescent↗
PubMed1994

[Non-epileptic crisis: which therapeutic strategy to follow?].

About 20% of patients with intractable epilepsy do not have epileptic seizures. The exact diagnosis is in fact difficult because most of the time, the seizures are not directly visualized. In case of uncertainty, prolonged EEG/Video monitoring and clinical observation are necessary to avoid escalated drug therapy and behavioural problems. We describe two such cases. The diagnosis of non epileptic attacks was told to the patients, the antiepileptic drugs were progressively withdrawn and an intensive psychotherapy was started. The seizures decreased in number and severity. In both cases, sexual abuse in childhood was discovered.

Adult↗
PubMed1994

Aggression, trauma, and hatred in the treatment of borderline patients.

This article focuses on the etiology of aggressive affect, behavior, and fantasy in the treatment of patients with severe personality disorders in an effort to further our understanding of the psychopathology and treatment of these patients. In the process, the relationship between inborn disposition to aggressive behavior and the effect of severe trauma and psychosocial pathology in early childhood are examined. Various types of transferences marked by aggression and specific approaches to each of these are outlined. Particular reference is given to the management of intense hatred--as a derivative of aggression--in the transference, and of the unconscious identification with both victim and victimizer in patients who have experienced sexual or physical abuse.

Adult↗
PubMed1995

Multiple personality disorder.

This paper presents a description of Multiple Personality Disorder--its development, etiology, and presentation. The paper stresses the criteria for diagnosis that can help professionals to identify individuals at an early stage. An overview of treatment approaches and indications for hospitalization, length of treatment, and goals are also explained.

Adolescent↗
PubMed1994

Paradise lost: a case of hysteria illustrating a specific dynamic of seduction trauma.

This paper presents extensive clinical data illustrating the case of a middle-aged woman, who as a child participated in an extended sexual relationship with her elder brother. The patient suffered from an hysterical personality disorder with somatic distress and a compulsion to repeat disastrous social and work situations. In her treatment, the patient re-enacted the seduction and subsequent experience in various ways. The analysis and understanding of her symptoms, social problems and re-enactments in the transference strongly suggested that the trauma of her seduction was the result of the loss of precociously stimulated and experienced pleasure rather than loss of impulse control. The compulsion to repeat apparently represented the wish not only to master, but the desire to return to the pleasure of the experience as a true compromise formation. Although many other dynamics were of course operative, interpretations of her wish to recreate the lost pleasures were most helpful.

Female↗
PubMed1994

Sexual abuse of adults with mental retardation: who and where.

Over a 5-year period, of the 461 cases of sexual abuse of adults with mental retardation, 37% were confirmed by the Abuse Investigation Division of the Connecticut Office of Protection and Advocacy for Persons with Disabilities. As expected, most of the victims were women (72%); their average age at the time of the incident was 30 years. Victims, for the most part, had no problems communicating verbally and had few, if any, secondary disabilities. As is the case in the general population, the majority of the perpetrators were men (88%) and included other adults with mental retardation, paid staff, family members, and others. Most sexual abuse occurred in the victim's residence, and in 92% of the cases the victim knew his or her abuser. Results were discussed and several concerns raised.

Adolescent↗
PubMedDate not supplied

Trust and betrayal.

Explore the source record for details and available documents.

Adaptation, Psychological↗
PubMed1993

[How do mothers experience and cope with sexual abuse of their daughters?].

Previous studies especially research done by systemic family-therapists stressed the importance of the role of the mother in sexual abuse of children by male family members. The literature on the reactions of mothers and their coping with the situation after disclosure will be reviewed. Our own qualitative studies on the reactions of mothers showed, that the disclosure is a multiple crisis for the mother: (a) A crisis and/or breakdown of the hitherto existing concepts of partnership; (b) the mothering-competence is called in question; (c) breakdown of the previous self assertion and self concept as a woman; (d) psychosocial crisis of bereavement and/or conflicts and changes in all relationships (isolation, loneliness); (e) material and economical crisis. Different case examples will be given in order to illustrate the findings. Finally the importance of these findings for consulting and therapeutic work with mothers will be discussed.

Adaptation, Psychological↗
PubMed1993

["I have never said anything"--a retrospective biographical study of sexual abuse of boys].

A summation will be provided concerning the extent of the sexual abuse of boys and the consequences arising there from. A qualitative study involving 10 interviews with men who were abused will be introduced. Previous studies have tended to be one sided concerning the emphasis placed on the development from having been abused, to becoming an abuser. Through our research we have discovered two additional types of coping mechanisms outside the established criteria. These being, complete avoidance of known masculine behaviour and, the emulating of known masculine behaviour thus creating a facade to disguise insecurities. In conclusion, specific gender characteristics concerning the coping patterns of abused boys will be discussed.

Adaptation, Psychological↗