Detecting Sexual Abuse

May 15, 2012
Richard P. Kluft, MD, PhD

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.