Short/Long-term Effects of Trauma from Sexual Abuse

1. Short/Long-term Effects of Trauma from Sexual Abuse Dec. 7, 2012: Guardian ad Litem Training Institute Donna Dunn, Executive Director Caroline Palmer, Staff Attorney

2. Topics • Introduction • Child Sexual Abuse • Behavioral Responses • Perpetrator Profiles • Grooming Behaviors • Digging into the Trauma Response • As a child • Lifelong ramifications • Resources and Information

3. About MNCASA • MNCASA • Membership services and outreach • Prevention • Sexual Violence Justice Institute (Teams and Resources) • Public Policy

4. Costs of Sexual Violence • The Minnesota Department of Health released 2007 report on costs of sexual violence to the state • Estimated Cost: $8 billion (low number) • Sexual assault costs 3 times as much as drunk driving in Minnesota • 59% of government spending related to perpetration

5. Costs of Sexual Violence • 61,000 adults and children were sexually assaulted in 2005, some more than once for a total of 77,000 assaults (17,562 children) • 80% female; 29% under age 18

6. What is Child Sexual Abuse? • A crime • An abuse of trust, power and authority • Forms: • Sex acts involving penetration • Touching child’s breasts or genitals • Voyeurism and exhibitionism • Showing porn to child or using child in porn • Sexual exploitation (trafficking, prostitution) • Internet-based child sexual abuse • See NSVRC; Finkelhor, Turner, Ormrod, Hamby & Kracke, 2009 and Finkelhor, Hammer & Sedlak, 2008.

7. Childhood Sexual Abuse • Can occur over several years • Occasional contact to several times daily • Use of physical force (usually none or minimal) • Verbal and implied threats common • Emphasis on secrecy and loyalty

8. Childhood Sexual Abuse • Different dynamics based on relationship between perpetrator and victim • Intrafamilial • Outside the family

9. Warning Signs of Sexual Abuse • Bodily signs (bed-wetting, stomachaches, headaches, sore genitals) • Emotional signs (fear, sadness, mood changes, acting out, refusing to be left alone) • Sexual signs (inappropriate sexual behavior with objects or children) • Verbal signs (knowledge about sexuality that is not age or developmentally appropriate) • See NSVRC; Finkelhor, Turner, Ormrod, Hamby & Kracke, 2009 and Finkelhor, Hammer & Sedlak, 2008.

10. Warning Signs of Sexual Abuse • But . . . not always obvious • Many children do not report • Love and trust vs. betrayal • Fear of ramifications for self and family • High emphasis placed on secrecy • Powerlessness • Stigma • See NSVRC; Finkelhor, Turner, Ormrod, Hamby & Kracke, 2009 and Finkelhor, Hammer & Sedlak, 2008.

11. Warning Signs That Someone May be Abusing a Child • Unusual interest in a child of particular age/gender • Socializes more with children • Finds ways to spend time alone with children • Insists on contact even if child does not want affection • Encourages lack of privacy around the home • Discusses inappropriate topics with child • Disinterest in adult sexual relations but overly interested in sexuality of a child or teen See NSVRC; Finkelhor, Turner, Ormrod, Hamby & Kracke, 2009 and Finkelhor, Hammer & Sedlak, 2008.

12. People Who Sexually Abuse Children • Most perpetrators are adults • Not all abusers are pedophiles • Children are most often abused by people they know and trust • Persons in position of authority • Family members • Esteemed members of the community See NSVRC; Snyder, 2000

13. Grooming Behaviors • “At his commitment trial, Rubin described his ‘grooming’ behavior: he would get familiar with his victims, learn what their likes and dislikes were, and then ‘go from there.’ He said he never forced the children into anything. Rubin did not believe that they wanted him to do things to them, but his own sexual gratification was all that was important. The children wanted whatever gifts and treats he had to offer. He liked the younger victims because they were easier to control, and he liked power and control. He also testified that he knew that his conduct was wrong, but he did it anyway.” - In re. Civ. Commitment of Rubin, 2002 Minn. App. LEXIS 1116 at *6.

14. Grooming Behaviors • Building trust • Breaking down barriers, determine vulnerabilities • Takes time, planning and patience • Incremental behaviors that cross boundaries (words, gifts, actions, setting up a scene) • Identifying what the young person wants or needs • Grooms other adults in the child’s life • Citing “failures” of parents, guardians or other caregivers – interferes with protectors • Use of pornography

15. Recantation • Not a false report (rare) • “Taking it back” can be a way to reclaim normalcy • Likely scenarios for recantation • Abuse by a member of household • Non-offending parent expressed disbelief • Child is younger than 10 years old • Pressure from family members not to cause disruption

17. Delayed Disclosure

18. Child Sexual Abuse and Violence

19. Effects of Trauma on the Brain What do we think. . . • about the truthfulness of victims who are confused and have trouble remembering details of what happened – even when they are children? • when we see behaviors or emotions that differ from how we think a ‘real’ victim should act or feel • when we hear statements that are not chronological (i.e., do not start at the beginning and give a blow-by-blow account of what happened in sequence) and/or that are not told exactly the same way every time.

20. Conceptual Framework • Psychological trauma is a neurophysiological state stemming from neurobiological injury • The research on the human brain has virtually exploded with new information over the past decade • The brain is not rigid as we once thought, but rather it is plastic/pliable and has the ability to change its structure and function in response to experience From “Understanding the Neurobiology of Trauma: Implications for Treatment with Adults and Adolescents” (Janine D’Anniballe, Ph.D)

21. It Should Prompt the Question • What happened to her/him NOT • What’s wrong with her/him. . .

22. Humans. . . • In the predator/prey dichotomy humans are prey! • Our brains are designed to protect humans by giving us the FEAR system – • GET OUT OF THE WAY! • The cornerstone of understanding psychological trauma

23. The Fear System • Amygdala – the seat of fear in brain • Known as part of the limbic system – not connected to the cortex where higher level brain functions happen • Fear response • Freeze - the first response • Flight – second response • Fight – if all else fails. . .

25. Fear System • All about self preservation • Learning/Experience of trauma creates new neural pathways that serve self preservation

26. Fear System • Sensory Thalamus – takes in the sensory information - • Has taught us what we need to be afraid of • Trauma survivors learn what sensory fragment triggers reactions – returns them to fear state • Antidotes: rage/aggression or medication

27. When Fear System is Engaged • Reactions take the low road: • Do not involve the cortex; no critical process; no consciousness; no thought • Neural networks fire and one is in a flashback • These are exactly the same neurons that fire during the traumatic event = a literal reliving • Muzak and Lemongrass Stories • These fear networks are pretty much permanent

28. Prolonged Exposure to Trauma • Can likely cause anatomical changes • Children / stages of development • Brain can ultimately be structured around traumatic experience as it develops • Dissociation • PTSD

29. F/F/F • Freeze: orienting response (What is happening? I need to be afraid) • Flight: I need to get away – can I? • Fight: Couldn’t outrun the panther; can’t fight off the larger person

30. Tonic Immobility • “play” dead/state of complete paralysis • Not a conscious choice • Body functions shut down • All of those used during flight and fight • Respiration • Heart beat • Vocal chords • Same whether real or perceived entrapment

31. And sexual assault, abuse? • The hyper focus during fear state = tunnel vision allows only some information to enter the system – some details are slower to be recalled • Why didn’t you scream, fight back? • Paradoxical victim behavior, varying reactions to trauma • State v. Obeta, 796 N.W.2d 282 (Minn. 2011)(expert testimony in adult victim sexual assault cases) • State v. Myers, 359 N.W.2d 604 (1984) (expert testimony in child sexual abuse cases); also State v. Soukup, 376 N.W.2d 498 (Minn. App. 1985)

32. We have learned from survivors. . . Survivors tell how they learned about survival • Anticipation and Adaptation • Dissociation • Manipulation

33. How Trauma Affects the Whole Body and Memory • How are traumatic memories stored in the body and why are they so hard to access and heal from? • Memory is often interrupted, fragmented by trauma • New research on use of mind/body approaches to treat people with trauma histories • Integrative approaches including meditation, EMDR, EFT, Somatic/body oriented therapies, yoga, art, spiritual practices

34. Impact of Trauma • “Human beings who have been raped will . . . carry with them a network of neurons forever prepared to respond to the perception of any of the cues that were present during the rape. It might be the sound of a man’s voice; the feel of hands on a particular part of the body; or the look of anger in another’s eyes. The possibilities are literally infinite. At the sound, touch or sight of these cues, the rape victim will experience the same cascade of neurochemicals that were triggered during the actual rape.” – David Lisak, “The Neurobiology of Trauma”

35. Rippling Burdens of Sexual Abuse on Children and Society • Suicide attempts twice as common • Clinical depression (40% higher women, 20% for men) • Teen pregnancy twice as common • Being prostituted significantly more likely • Use of illegal drugs (70% higher women, 50% for men) • Perpetration of sexual abuse in adolescence (46% among those who reported child sexual abuse; 16% of non-sex offenders reported such abuse) • See handout for additional burdens and sources

36. How Adults Victimized as Children Present in Therapy • Observable behaviors • Depression • Anxiety and/or PTSD • Suicidal ideation with a history of attempts • Self-injurious behaviors • Dependencies • Poor relationship history • Dissociative symptoms • Panic attacks • Shame • Rage

37. How Adults Victimized as Children Present in Therapy • The internal landscape • Loss of the embodied self • Loss of reality • Loss of historicity • Loss of the sense of agency

38. Process of Recovery/Healing Work for Victims of Childhood Sexual Abuse • Type of intervention • Individual first • Group treatment later • Aspects of healing process • Building trust • Empowering process • Education for client • Depression management and evaluation • Management of self-injurious behaviors • Assessment of dependencies and intervention

39. Process of Recovery/Healing Work for Victims of Childhood Sexual Abuse • Allow memories to come to surface (can’t be forced) • Debrief abuse memories • Family work • Increase support in daily life • Spiritual healing • Help processing traumatic events and their implications for their lives

40. Bringing Attention to the Issue

41. The Role of the Advocate • Advocates support victims and family members who are dealing with the aftermath of a traumatic event. • Advocates can provide support to the extent of their training and ability. • Confidential services (but mandated reporters) • Referrals to trained and specialized medical and mental health providers are recommended. • Find advocacy programs at www.mncasa.org

42. How Can You Get Involved?

43. Resources • Minnesota Coalition Against Sexual Assault • www.mncasa.org • National Child Protection Training Center • www.ncptc.org • National Center for Missing and Exploited Children • www.missingkids.com • National Sexual Violence Resource Center • www.nsvrc.org

44. Thank you! • Donna Dunn • 651.209.9993 x201 • donna@mncasa.org • Caroline Palmer • 651.209.9993 x214 • caroline@mncasa.org • www.mncasa.org • Some resources in slides from 2011 presentation by Jennie Yngsdahl, MA, LP