Why is important to take into account about symptomatology that can be developed by minors victims as following of sexual abuse?

Psychological disorders and symptoms can affect how your child presents at the hearing;

The manner in which the child presents him/herself at the hearing and faces it also impacts the manner and degree to which the child’s allegations are assessed as credible and/or truthful

Knowing the possible symptomatology developed by the post-abused child can help us in regulation and adjusting our own perception of how the child looks and behaves as a victim of sexual abuse, and can help us in correcting our own clichés or preconceptions.

Which is the specific symptomatology post-abuse?

Studies and clinical observations shows us that there is in fact no specific disorder or symptomatologic picture that follows sexual abuse. Although we would expect victims of sexual abuse to behave, feel and think in certain way after the sexual abuse event, this thing is not reality. The development of post-abuse symptomatology, i.e. the way in which the child reacts at abusive situation is influenced by a multitude of factors at micro (individual) and macro (demographic, cultural, socio-economic) level. The development of post-abuse symptomatology is not mandatory; studies shows us that about a third of children who have been sexually abused never develop symptoms or psychiatric disorders or these are not identifiable or difficult to detect. The type of abuse, the length of time the abuse took place, the age of the victim at the time of abuse, number of abuse events, the victim relationship with the perpetrator, the child’s coping mechanism, the culture and subculture to which the child belongs and in which he/she grew up – these are just some of the factors that can influence how the child reacts to abuse and can influence the symptoms that may occur after sexual abuse.

As I said below, there is currently no precise symptomatologic picture of sexual assault victims. Rather, studies and clinical observation show the fact that certain symptoms or disorders appear more frequently than others in sexual assault cases.

Among the best-known disorders that may occur in sexual abuse cases are Post Traumatic Stress Disorder (PTSD). It can be developed if the person is the direct victim of the traumatic event, if they witnessed a traumatic event that other people are going through, if they learn that the traumatic event has affected someone close to them (family, friends), or if the person is repeatedly exposed or with extreme intensity to the repulsive details to the traumatic event (vicarious trauma). For a diagnosis of post-traumatic stress disorder to be made, a number of criteria or symptoms need to be met, and the diagnosis is made only by a psychiatrist. An adult or minor person may have all the criteria or symptoms and then be diagnosed with post-traumatic stress disorder, or they may have only some of the criteria or symptoms and not meet the number needed to make the diagnosis. Among the specific symptoms of post-traumatic stress disorder that may impact how the victim copes with the hearing or any other investigative procedures (e.g. psychological expertise) are (as presented in the DSM-V Diagnostic and Statistical Manual of Mental Disorders):

► Intense or prolonged psychological distress in response to internal or external stimuli that symbolize or resemble some aspect of the traumatic event;

► Avoidance or efforts to avoid unpleasant memories, thoughts, or feelings about or closely related to the traumatic event;

► Avoidance of or efforts to avoid external elements (people, places, conversations, activities, objects, situations) that would trigger painful memories, thoughts, or feelings about or that are closely related to the traumatic event;

► Inability to recall an important aspect of the traumatic event;

► Persistent negative emotional state (e.g. fear, horror, anger, guilt or shame).

Avoiding or striving to avoid any stimuli that may bring the event of sexual abuse back into the victim’s consciousness can directly and significantly impact how the minor responds and copes with the hearing. The hearing, provided that it requires the victim to recount the abuse event in as truthful and complete detail as possible, seems to contradict the need of the PTSD victim to avoid by any means possible the recollection of the abuse. We may thus encounter in the hearing, as a result of distressing symptoms, short, unelaborated, fragmented, ambiguous or too general accounts, or even the child’s inability to relate or continue the account.

Intense or prolonged psychological distress or persistent negative emotional state of the minor can also impact the quality and quantity of the hearing. The mental discomfort experienced by the minor may also lead the minor to give short, unelaborated, short, un-detailed answers, or to appear disinterested or unaffected by the events under investigation, just to bring the hearing to a quicker conclusion.

The inability to recall an important aspect of the traumatic event can significantly impact the hearing by making it difficult for the child to access memories and information about the event. The shock and traumatic impact of the abusive event may on the one hand have affected the child’s very recall of parts of the traumatic event, so no matter how much effort the child may make in the hearing to recall, some information may not exist in their memory in the first place. And on the other hand, the distress experienced as a result of the traumatic event may negatively impact the child’s recounting of the event at the time of the hearing. Thus, the child may have difficulty in reactualizing information that he or she has in his or her memory, but which may be difficult to access at the time of the hearing.

A proper understanding of the mental state of the child victim and the correct identification of the symptoms that the child victim manifests in the context of the hearing can lead to informed decision-making and behavior of the investigating body. Thus, observing the difficulties of the minor at the time of the hearing and understanding them adequately, the investigating body may either through encouragement and empathic attitude try to alleviate the distressing symptoms of the child, decide to take a break or even reschedule a new hearing, decide to call for the support of the psychologist attending the hearing, or decide to order a psychiatric or psychological evaluation in order to adequately understand the post-abuse state of the minor.

Article written by Patricia Aramă, clinical psychologist, Barnahus Center