Detecting Sexual Abuse
Few circumstances confront the psychiatrist with more complex, painful, and potentially problematic clinical dilemmas and challenges than the treatment of the incest victim. Here are some factors that may lead to memory of a trauma becoming inaccessible or withheld by a patient.
Few circumstances confront the psychiatrist with more complex, painful, and potentially problematic clinical dilemmas and challenges than the treatment of the incest victim. When evaluating a patient, attention must be paid to evidence of dissociation in the patient’s history and to the patient’s overall symptoms. Here are factors that may lead to memory of a trauma becoming inaccessible or being reported as inaccessible for long periods. For more on this topic, see "Ramifications of Incest," a 2011 Psychiatric Times article by Richard P. Kluft, MD, PhD, from which this Tipsheet is adapted.
TIPSHEET: WHY MEMORIES OF INCEST TRAUMA MAY BE INACCESSIBLE (OR WITHHELD) BY A PATIENT
Familiar mechanisms of defense
Dissociated storage processes and structures
Conscious coping mechanisms
Guilt and shame
Loyalty to/protection of the abuser
Protection of family members and of the family
Perceived moral or religious imperative to withhold
Bargaining
Confusion about the reality of events and their meanings
Confusion about the source and nature of and misunderstanding of the meanings of available mental contents; obsessing over the reality of mental material
Consequences of obfuscation or gaslightinga or promoted reinterpretations of events
Obsessing over the meanings of terms
Deliberate or inadvertent discouragement of reporting by others
Encouragement to doubt or dismiss memories
Contaminationb
Rationalization
Strategic withholding with goals and objectives in mind
Driven withholding, motivated by higher priorities (personal or cultural, including defending loved ones)
a Gaslighting involves providing a person with false information in order to bring that person to doubt his or her perceptions and memories. The term comes from a play and movies about a husband’s attempt to drive his wife insane by raising and lowering the illumination in their home and denying that any changes had occurred.
b Contamination is information that is not autobiographic but to which one was exposed; it influences memory or may become the basis for a memory with no basis in autobiographic fact.
