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Dr Sacrifice Chirisa Mental Health Matters
Sexual abuse is so underrated in terms of the extent of damage it causes to the survivor. Besides the physiological effects ranging from contracting HIV, pregnancy and gynecological damage, I am of the opinion that the psychological effects are far more reaching and underestimated as some manifest years later and even in adulthood.

Below is a synopsis of the psychological effects:
Psychological effects

1. Fear – The offender may swear the child to secrecy and say that if they tell something bad will happen.
2. Helplessness/powerlessness – Children in this situation often feel that they have no control over their own lives
3. Guilt and shame – The child knows something is wrong and blames him or herself not others.
4. Responsibility – The offender often makes the child feel responsible for keeping the abuse a secret.
5. Isolation – Incest victims feel different from other children. They must usually be secretive. This even isolates them from non-offending parents and brothers and sisters.
6. Betrayal – Children feel betrayed because they are dependent upon adults for nurturing and protection
7. Anger – Not surprisingly this is one of the strongest feelings which many children have about their sexual assault.
8. Sadness – Children may feel grief due to a sense of loss, especially if the perpetrator was loved and trusted by the child.

Psychiatric effects
1. Depression
2. Anxiety
3. Trouble sleeping.
4. Low self-esteem.
5. “Damaged goods” syndrome. i.e. negative body image due to self-blame.
6. Dissociation from feeling.
7. Social isolation.
8. Substance abuse or
9. Suicide attempts.
10. Sexual difficulties such as fear of sex or intimacy,
11. Parenting problems such as fear of being a bad parent

The Child Sexual Abuse Accommodation Syndrome

The five categories of the syndrome are:
1. Secrecy – Abused children tend to keep the abuse a secre
2. Helplessness – Children are inherently helpless and subordinate as they are small, dependent and emotionally immature. For all of these reasons, they cannot escape from a dangerous situation.
3. Entrapment and accommodation – Children who keep their abuse a secret and continue to feel helpless inevitably feel trapped. However, they learn to accept the situation and survive. The helpless child faced with continuing victimisation must learn to somehow achieve a sense of power and control. The child may eventually come to blame him or herself, believing s/he has provoked the abuse.
4. Delayed, conflicted and unconvincing disclosure – Adults who ask a child to disclose abuse must recognise that this request may precipitate an acute crisis for the child. Initial disclosures may be fraught with anxiety, retractions and inconsistencies. Therefore it may sound unconvincing.
5. Retraction – Children who do disclose abuse may be flooded with guilt, fear and feelings of betrayal or confusion.

Post-traumatic Stress Disorder (PTSD)
PTSD describes symptoms, which are characteristic in many cases of sexual abuse. PTSD can sometimes appear many years after the original event. The criteria for a diagnosis of PTSD are:

1. The person has experienced an event that is outside the range of usual human experience and that would be markedly distressing to almost anyone.
2. The re-experiencing of the trauma in at least one of the following ways:

Recurrent and intrusive recollections of the event. Recurrent distressing dreams of the event. Sudden acting or feeling as if the event were recurring e.g. “flashback” episodes, hallucinations, illusions. Intense psychological distress at exposure to events that symbolise or resemble an aspect of the traumatic event.

3. A numbing of responsiveness or reduced involvement in the external world some time after the trauma, indicated by:

Diminished interest in activities and/or Feelings of detachment or estrangement from others and/or Constricted affect e.g. unable to have loving feelings or to feel anger. In addition, at least two of the following sets of symptoms must be present: Hyper alertness or being easily startled. Sleep problems. Guilt about surviving or behavior required to survive. Problems with memory or concentration. Avoidance of activities that arouse recollection. Intensification of symptoms if events symbolise or resemble the traumatic event. The Stockholm syndrome

This is a reaction which occurs in incest victims and sexually abused children. It is a universal phenomenon, which is instinctive and it plays a survival function for hostages who are victims of abuse.

It is presence is suggested by:
1. positive feelings to perpetrator
2. negative feelings towards the police or authorities trying help

As can be seen, sexual abuse is a great evil. All victims of sexual abuse need psychological help so as to minimise the effects. Dr Sacrifice Chirisa is a mental health specialist at Parirenyatwa Hospital, one of Zimbabwe’s major referral hospitals.