Transgenerational trauma and child sexual abuse: reconceptualizing cases involving young survivors of CSA.(PRACTICE)(child sexual abuse)(Clinical report)

While current research on child sexual abuse (CSA) has delineated the immediate and long-term effects of sexual trauma, little has been written about intergenerational influences on the presence and etiology of CSA among young children. Dass-Brailsford (2007) defined transgenerational trauma as trauma that has been passed down from one generation to another, either directly or indirectly. In this paper the authors review the literature on CSA, the influence of primary caregivers, and transgenerational trauma, followed by a case illustration. Specific interventions are pointed out to offer mental health counselors innovative tools for ameliorating the effects of transgenerational trauma with this client population. The authors also highlight effective clinical programs on CSA among young children that acknowledge the influence of intergenerational trauma.

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Each year, an estimated 150,000 to 200,000 new cases of child sexual abuse (CSA) are reported (McLeer, Deblinger, Atkins, Foa & Ralphe, 1988). Finkelhor (2007) has charged that the problem with CSA research is the focus on adults, when CSA is more common with children under 5. In addition to developmental problems, many such children have an increased risk of severe psychosocial, emotional, and behavioral problems (Bosquet, 2007; Gil, 2006). The purpose of this paper is to introduce transgenerational trauma as a lens for conceptualizing and treating young survivors of CSA and their primary caregivers. Defined as trauma that has been passed down from one generation to another, either directly or indirectly (Dass-Brailsford, 2007), transgenerational trauma extends the current discussion on trauma theory (Goodman & West-Olatunji, 2008). The authors illustrate how intergenerational issues impact the presentation of CSA symptomology among young children, particularly those under 5, and their nonoffending primary caregivers. We offer both recommendations for practice to address the multilayered effects of transgenerational trauma due to CSA and suggestions for research to advance knowledge in this emergent area.

REVIEW OF THE LITERATURE

CSA and Trauma

About 48% of children who are victims of sexual assault meet the criteria specified for posttraumatic stress disorder (PTSD) (Deblinger, McLeer & Henry, 1990). Defined as the re-experiencing of an extremely traumatic event, PTSD is accompanied by symptoms of increased arousal and avoidance of stimuli associated with the trauma. Re-experiencing the event can be evident in a client's intrusive recollections of the event, as in recurrent or distressing dreams. Some individuals present dissociative states, which can last from a few seconds to days, in which the victim experiences intense psychological distress or psychological reactivity. This often occurs when a person is exposed to events that resemble or symbolize some aspect of the traumatic event, such as anniversaries of the trauma (Olatunji, 2000; American Psychiatric Association [APA], 2000).

For young children, the primary symptoms of CSA are avoidance behaviors and developmental delays (Arata, 1998; Ketring & Feinauer, 1999; Kaufman & Henrich, 2000). The avoidance behaviors are often described as phobic or irrational fears of being left by caregivers. Survivors go to great lengths to avoid stimuli associated with the event and make elaborate efforts to escape thoughts, feelings, or conversations about the traumatic event (McLeer et al., 1988). They also avoid any activities, situations, or people that may trigger recollections of the event. CSA survivors may also suffer from psychic numbing, often described as diminished responsiveness to the outside world; this symptom is common immediately after the event (Ferrara, 2002). Survivors may lack interest in activities they had previously enjoyed. They may also have feelings of detachment or estrangement and increased anxiety and arousal that were not present before the traumatic event (Olatunji, 2000).