Source: ASCA Survivor-to-Thriver Manual (Read the complete text of the manual here.)
Reading the information [below] may [stir] up many feelings in you. Recognizing that child abuse may continue to impact you past your childhood is a necessary step in your recovery. The tendency to sabotage yourself in various aspects of your life does not mean that you are a bad person; it means that you are a wounded person. Identifying the wounds and acknowledging the difficulties that grow out of them is an essential part of healing. Facing the anger that you have turned against yourself (and possibly against others) represents a cleansing of these wounds. As with the treatment of any wound - physical or psychic - the process will cause some pain. This may lead you to question whether the process of recovery is really good for you. Because you have become so used to pain in all of its myriad forms for so many years, you may wonder whether recovery can have positive effects.
When these doubts begin to surface, remember that you have survived the torment as a child, and that this is the worst part of the abuse. As an adult, you have new capabilities, new choices and a great deal more control over your life. Be open to new understandings of what you experienced. Allow yourself to draw inspiration from the positive elements in your life: your friends who support your recovery, empathetic family members, your children (if you have them), your spouse or lover who accepts you as a special person or your therapist, who is committed to helping you find your true self. There are many people like you who came back from total despair and confusion about their lives and recovered from their abuse. Others, such as your ASCA co-participants, are on the journey with you as well. We all can find our inner strengths and use them to turn our lives around.
Following is a discussion of some of the most frequently cited problems experienced by adult survivors. Not everyone shares all the different types of symptoms, nor do all survivors experience the same degree of intensity of the problems. You will have to determine which of the following problems are primary and which are secondary in your life. Recognize what seems to apply to you, make note of it, and leave the rest.
If there is one quality most survivors share, it is low self-esteem. Chronic feelings of being bad or unworthy are intricately connected to all the other "self" words that are used to describe the adult survivor: self-effacing, self-deprecating, self-conscious, self-blaming, and so on. Low self-esteem causes survivors to become their own worst enemies by turning against themselves in a damaging reenactment of their own abuse.
There are many abuse-related factors that contribute to low self-esteem. The way your parents/abusers treated you, the message they conveyed about your personal value and worth, the amount of power they granted you and the degree of control you had over your own life are a few examples. Of course, there is also a host of non-abuse-related factors that can lead to low self-esteem. Concerns about your physical appearance (especially during adolescence), your progress in school, your social standing among your peers and your family's financial or social position may all contribute to feelings of low self-esteem.
While self-esteem stays relatively constant over the years, it is still a learned behavior and, as such, can be changed by rethinking and reworking old attitudes and perceptions. The first step in reversing low self-esteem is recognizing how you feel about yourself. Then you must learn to see how your shame, sense of unworthiness and anger turned inward, pervaded your life and caused you to make bad decisions. Building self-esteem is a major task for adult survivors, [a task that you should address and devote energy to as early as possible.]
Where low self-esteem is the primary feeling of the adult survivor, self-sabotage is the corresponding behavior pattern in the external world. Self-sabotage is any kind of conscious or unconscious behavior that undermines your successful functioning in the world. Self-sabotage may range from buying a "lemon" of a used car to losing one's checkbook to becoming involved with an alcoholic partner to engaging in life-threatening activities. You may allow yourself to be exploited by a boss or engage in physically harmful or potentially dangerous activities such as cutting yourself or engaging in unsafe sex. Typically, one's pattern of self-sabotage is closely related to one's personal issues and family history. Survivors who grew up in addictive families may self-sabotage by driving while drunk or getting caught with illegal drugs. Survivors from violent families may tend to get themselves beaten or injured. Survivors from wealthy families often find themselves losing money, getting swindled or making bad investments. Studies have shown that survivors of child sexual abuse are more likely to be assaulted as adults.
Self-sabotage is linked to the survivor's instinct to become re-victimized in a way that continues or replicates the past abuse. Sometimes the self-sabotage is not directed against the survivor, but rather against someone the survivor loves. For example, the adult survivor of family-perpetrated sexual abuse who is now a mother may be surprised to find that her daughter is being molested by her husband or a friend of the family. In this case, the self-sabotaging behavior is the mother's inability or failure to see what is happening and to protect her child. Reversing self-sabotage begins with building awareness of everything you do in your daily existence that sacrifices your happiness, satisfaction and productivity.
Adult survivors often have a difficult time initiating, maintaining and enjoying relationships. Any kind of relationship, ranging from collegial relationships at work, to personal friendships, to parent-child relationships, to intimate, romantic relationships, may be problematic. Relationships for survivors may reflect the all-or-nothing syndrome: either too few or too many relationships that seem to come and go like people through a revolving door. In some relationships, the survivor may assume a particular role and proceed to play out a replication of the past abuse. Given that child abuse most often occurs in the context of family relationships, the possibility of your repeating old patterns in personal adult relationships should not be underestimated.
Relationships can be difficult because they call upon personal characteristics and emotional capabilities that are often new to adult survivors, such as trust, assertiveness, intimacy, self-confidence, good communication skills, the ability to give and receive affection, self-awareness and empathy for others, and acceptance of one's own feelings and needs. Many adult survivors find their personal relationships characterized by fighting, feeling misunderstood, projecting blame on each other, and feeling overwhelmed by powerful moods. Frequently, adult survivors anticipate rejection or non-acceptance and protect themselves by withdrawing or by becoming overly aggressive. These behaviors, and others, are probably ones you adopted as a child to help defend yourself against the abuse, but they may not be productive or healthy in adult relationships.
After years of not feeling their feelings or expressing them to others, many survivors feel limited in their daily dialogue with a loved one. Making changes in your relationships begins with developing awareness about which modes of communication work and which don't. Discuss with your partner when and how best to talk to each other.
All adults carry feelings that are rooted in their childhood developmental experiences. Adult survivors, however, may have particularly powerful feelings that are left over from their abuse. These feelings can be triggered by circumstances that are somehow reminiscent of the abuse and, in the context of being a survivor, may have particular importance. Anxiety is the result of not having known what to expect or how to act in social or family situations. Fear and anger are both natural responses to the threat or act of assault. Sadness results from recognizing that your parents or another trusted adult could abuse you. Shame and guilt tell you that you still hold yourself responsible for what happened.
Rage is the built-up reservoir of the anger that could never be safely expressed within your family. Frustration is the feeling you are left with when nothing seems to go your way. Confusion is a sign that you don't know why something has happened or what you can do about it. Alienation from others is the result of too many disappointments. Helplessness, hopelessness and powerlessness are the feelings that tell you that you are resigned to life as it is and may have temporarily given up on it ever being better. Your feelings always tell you something important about yourself, even if sometimes the message is frightening, troubling or saddening.
Survivors often use a number of mechanisms to numb themselves when the feelings get too strong. Some may adopt a "workaholic" lifestyle in order to avoid the feelings. Others may try to "stuff" the feelings by compulsive eating or to anesthetize them by drinking or using drugs. Certain feelings such as anger and rage may be so strong that they dominate a survivor's internal life and overshadow the other feelings that may also be there.
Learning to regulate the intensity of these feelings will be an important part of your recovery. For the time being, develop the habit of asking yourself what you are feeling at different times of the day. Run through a laundry list of common feelings and notice if and when you are feeling something in particular. Make a note of the feeling and try to identify what may have triggered it.
A variety of sexual problems are associated with childhood sexual abuse, although there is also evidence to suggest that physical and emotional abuse can affect the survivor's sex life as well. Survivors of sexual abuse often mistrust their partners, experience anxiety over the demands of intimacy and feel uncomfortable with their bodies.
During young adulthood, many survivors of sexual abuse tend either to avoid sex entirely or to engage in compulsive sexual activity. Either choice creates problems for adult survivors, particularly if they are still in denial about what happened to them as children. Where there is a history of sexual abuse, adult sexual activity and identification are colored by past associations, memories and conflicts. These may impair the development of a healthy sexual identity and lifestyle.
Survivors with sexual problems stemming from childhood abuse often consent to sex when they really don't feel like being intimate, and then experience the encounter as another episode of abuse. It is not uncommon for survivors to have flashbacks during sexual contact, in which a memory of the past abuse is triggered by a familiar touch, smell or position. If the sexual abuse included the use of violence or force, survivors may mix up sexual and aggressive urges. A history of sexual abuse can add confusion about a survivor's sexual preference.
How can you deal with sexual problems? You can start by confiding in a trusted friend or lover about your sexual feelings, reactions and associations. Sharing your personal reactions with a loved one can provide understanding and support. If you have specific symptoms or flashbacks, you may want to avoid sexual contact until you can resolve your feelings. If you are in therapy, you can discuss these issues with your therapist, although some sexual problems require the services of specialists.
Symptoms of Trauma
Psychic trauma is a psychological condition caused by overwhelming stress that cannot be controlled by normal coping mechanisms. It can result from a number of situations in addition to child abuse, including war or battlefront experience, natural disasters, being held hostage and being in the middle of a bombing, hijacking or shootout. Perhaps the most common symptom of such traumatic exposure is panic attacks involving hyperventilation and severe anxiety. These can be triggered by anything your senses associate with your past abuse. Insomnia, sleepwalking, nightmares and night terrors (a more extreme type of nightmare occurring during non-dreaming sleep cycles) are other signs of unresolved trauma of some sort.
Many adult survivors don't show signs of psychic trauma until years after the abuse ends. When they do show signs, survivors often report feelings of extreme anxiety, panic, general fearfulness and disorientation. In the most extreme cases, survivors may evidence dissociation (splitting of mind and body), numbing of the body and intrusive, repetitive thoughts and flashbacks to the abuse episode(s). The appearance of these symptoms lets you know that your psyche is still trying to resolve conflicts associated with your past abuse. There is growing evidence that survivors of extreme and prolonged child abuse are susceptible to developing multiple personalities as a means of self-protection and that child abuse may be the major cause of multiple personality disorders.
When any signs of trauma are noticed, the best suggestion is to get immediate help. Turn to members of your support network, trusted family and friends and your therapist, if you have one. If you experience any of the more severe trauma symptoms such as dissociation, we strongly encourage you to seek professional help. If you feel totally unable to function, you may need medication or hospitalization to control the anxiety. The goal during this time is to make sure you are safe and protected and to minimize the possibility of your hurting yourself.
Adult survivors of physical and sexual abuse frequently complain of a host of illnesses and psychosomatic problems during their adult lives. The most common generalized effects include stomach problems, difficulty in breathing, muscular tension and pain, migraine headaches, incontinence and heightened susceptibility to illness and infection. In addition, skin disorders, back pain ulcers and asthma are common ailments that are stress-related and may signify unresolved childhood abuse issues. In cases of sexual abuse, the breasts, buttocks, anus and genitals may be the site of discomfort, chronic pain and otherwise unsubstantiated sensations. If the survivor was forced to have oral sex, s/he may experience episodes of nausea, vomiting and choking that are unrelated to a physical or systemic cause. Incontinence has been found in survivors who have been sodomized. Again, we remind you that any or all of these problems may be caused by non-abuse-related factors or conditions as well.
In particular, sexual abuse has been linked with gastrointestinal functioning, while leftover feelings of anger may be related to migraine headaches. Some research indicates that eating disorders such as anorexia and bulimia are more frequently found in women who have survived prolonged sexual abuse. The bingeing and purging behavior that characterizes eating disorders offers survivors a sense of control over their bodies when they lack such control over their feelings. Phobias, such as claustrophobia, although not technically physical symptoms, may be directly related to the circumstances of the abuse, as in the case of a child being locked in a closet for hours on end. Sudden weight gain and obesity can also be related to childhood abuse, and are sometimes related to the survivor's need to feel more insulated from his/her body or to present a safer, non-sexual appearance to the world.
Depending on one's childhood experience and type of personality, illness can have different meanings for the survivor. Being sick can offer an opportunity to be taken care of either by yourself or someone else. For some survivors, the best care they ever received from their parents may have been when they were sick. Being sick may be one of the few instances in which survivors will care for themselves. In many cases, however, illness may be the body's message that all is not well emotionally. When strong feelings are repressed, the unexpressed psychic energy can cross the mind/body threshold and establish its presence in the form of bodily symptoms and illness.
Because of their abuse experiences, most adult survivors feel stigmatized and experience people as dangerous and not to be trusted. Attending parties or other social gatherings can evoke anxiety, insecurities and concerns over not being "good enough." Fear of rejection is also a common concern for survivors. And, because they were usually harmed by adults whom they trusted, survivors tend to carry their fear of being harmed by others into the present.
Many survivors end up living in isolation because it feels safer and less threatening to them. The role of the recluse, employed during childhood to avoid the abuse, becomes in adult life a means of protecting oneself against hurt. Sometimes the threat is real; other times it is imagined. When survivors do venture out into the world and attempt to establish contact with others, they may be tremendously sensitive about how they are treated. Survivors may experience joking or teasing - intended as lighthearted banter appropriate to the social situation - as critical or hostile and at their expense.
Much of survivors' difficulties in social situations have to do with never having learned how to communicate. Others may have ignored or invalidated survivors' childhood opinions and perceptions, and left them wondering how to relate to people. If you expect rejection, criticism and humiliation, it is hard to learn to speak with conviction, listen with interest and telegraph your receptivity to others via body language and non-verbal cues.