Colarusso - The long shadow of sexual abuse developmental effects across the life cycle

The Long Shadow
of Sexual Abuse

The Long Shadow
of Sexual Abuse

Developmental Effects across the Life Cycle

Calvin A. Colarusso, MD

Jason AronSon

Lanham Boulder New York Toronto Plymouth, UK

Published by Jason Aronson

An imprint of Rowman & Littlefield Publishers, Inc.

A wholly owned subsidiary of The Rowman & Littlefield Publishing Group, Inc.

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Estover Road, Plymouth PL6 7PY, United Kingdom

Copyright 2010 by Jason Aronson

All rights reserved. No part of this book may be reproduced in any form or by any electronic or mechanical means, including information storage and retrieval systems, without written permission from the publisher, except by a reviewer who may quote passages in a review.

British Library Cataloguing in Publication Information Available

Library of Congress Cataloging-in-Publication Data

Colarusso, Calvin A.

The long shadow of sexual abuse : developmental effects across the life cycle / Calvin A.

Colarusso.

p. ; cm.

Includes bibliographical references and index.

ISBN 978-0-7657-0766-6 (cloth : alk. paper) ISBN 978-0-7657-0768-0 (electronic)

1. Child sexual abuseCase studies. 2. Adult child abuse victimsCase studies. I. Title.

[DNLM: 1. Adult Survivors of Child AbusepsychologyCase Reports. 2. Child

Abuse, SexualpsychologyCase Reports. 3. Personality DevelopmentCase Reports.

4. Sexual BehaviorpsychologyCase Reports. 5. Stress Disorders, Post-Traumatic

psychologyCase Reports. WM 167 C793L 2010]

RJ506.C48C646 2010

618.92 ' 85836dc22

2010014044

` The paper used in this publication meets the minimum requirements of American

National Standard for Information SciencesPermanence of Paper for Printed Library Materials, ANSI/NISO Z39.48-1992.

Printed in the United States of America

I dedicate this book to those individuals and families who have suffered for a lifetime from the calamitous effects of chronic childhood sexual abuse.

T his book has one simple purpose namely, to describe the profound interferences with normal developmental processes that occur in every subsequent developmental phase from the time of the abuse throughout childhood, adolescence, and young, middle, and late adulthood. I hope to demonstrate, convincingly, that the effects are lifelong.

Some of the case histories of older individuals provide truly unique clinical material to be studied and understood, because in the nearly fifty years since the childhood sexual abuse they had never been evaluated nor told their stories to any mental health professional. Indeed, many of them had never talked to anyone about what they had experienced. The details are horrific and difficult to read. It has been my experience that not only clinicians, for whom this book is primarily written, but also educators, parents, indeed all concerned adults often use the term sexual abuse but do not know in any detail what children who are victimized experience.

The book is organized as follows: a section on normal development for each developmental phase is followed by case histories, arranged chronologically according to the age of the victims at the time I evaluated them. Then the effects of the sexual abuse are traced from the time that the abuse took place in childhood to the chronological present. For those individuals who were evaluated in childhood or adolescence, the developmental histories will be relatively short. For those who were evaluated in adulthood, including some in their sixties, the developmental effects cover decades; indeed, half a century. As is standard practice, all names and identifying details in the case histories have been altered to protect the privacy of the subjects.

The following sequence of developmental phases that I will utilize is based on the ideas of Sigmund Freud (1905), Erik Erikson (1963) and Robert Nemiroff and myself (1981). Childhood, encompassing Freuds oral, anal, oedipal and latency stages, will cover the years from birth to adolescence. Adolescence will refer to the years from twelve to twenty. Adulthood will be divided into three phases: young, middle, and late adulthood, covering the remainder of the life cycle.

A board-certified child and adult psychiatrist and child and adult psychoanalyst, Ive spent most of my professional life in private practice treating children and adults and teaching at the University of California at San Diego and the San Diego Psychoanalytic Institute. However, the case histories in this book are the result of my more than thirty years of work as an expert witness in civil cases. During the course of those years, while serving as an expert witness for both plaintiffs and defendants, Ive evaluated approximately one hundred cases of child sexual abuse. I did not treat any of the individuals whose stories are presented here. To have done so would have been a conflict of interest. Some of the evaluations included psychological testing and a review of relevant records. Others, because the cases settled before a more thorough evaluation could be finished, are not as complete but all of them provide information that illustrates the basic purpose of this book.

This is not a book about diagnosis or treatment, although both will be addressed. DSM-IV diagnoses will be given for each individual and the obvious need for treatment will be described as I assessed it at the time that the evaluation occurred. Decisions on what kind of treatment and how much treatment will be needed will obviously be made by the mental health professional working with his or her patient at the time. But my recommendations, based on these evaluations and my forty years of experience with sexual abuse victims, do convey my belief that individuals who have been chronically sexually abused in childhood need psychiatric intervention in the form of psychotherapy and medication periodically for the rest of their lives. The efficacy of psychodynamic psychotherapy to treat childhood sexual abuse has recently been discussed in the literature (Shedler, 2009; Leichsenring and Rebring, 2008). However, one of the strongest insights that I have acquired from this work is that at our present level of understanding no amount of treatment can result in a cure for those cases in which the abuse was chronic. All we can realistically hope to do is diminish the harmful effects.

Because of the focus on the effect of the sexual abuse on developmental processes it may appear that I am attempting to describe an exclusive, cause-and-effect relationship between the sexual abuse and the psychopathology that developed at the time of the abuse and for decades afterward. That is not the case. I am suggesting that the sexual abuse had a profound deleterious effect on developmental processes and that these detailed developmental histories present unique clinical material that has not been previously presented in a format like this. However, I am fully aware that new developmental tasks and challenges that presented themselves as life progressed, other traumas, resilience and a plethora of other life experiences, among other factors, were also involved in the clinical presentation of each of the individuals at whatever age I happened to see them. Developmental processes, normal and pathologic, are enormously complex. I will discuss some of the most recent literature on the relationship between developmental processes and childhood sexual abuse in chapter 2.

I wish to state clearly that diagnostic thinking and treatment conclusions drawn from diagnostic interviews and psychological testing conducted for use in a legal process are distinctly different from opinions and conclusions that would emerge from an extended psychiatric diagnostic evaluation and/or treatment process. But the diagnoses and treatment recommendations described do serve to relate the case material to DSM-IV, the only widely accepted diagnostic nomenclature in the field, and the literature on childhood sexual abuse.