What do we know about how to support adults who have been sexually abused as a child and experience complex trauma?

  • Complex trauma
Dr Cathy Kezelman AM, Blue Knot Foundation

Last year, the National Centre for Action on Child Sexual Abuse (the National Centre) commissioned a report from the Gendered Violence Research Network at the University of New South Wales (UNSW) and Blue Knot Foundation. The report was to review the current literature about what the evidence says is helpful in supporting adults who experienced sexual abuse as children.

The review made some interesting points.

Firstly, trauma is described in so many ways that it remains confusing to understand. Post-traumatic stress disorder (PTSD) is still a label that is used very often to describe the impact of child sexual abuse. But it has its problems. It cannot escape its own history as a diagnosis developed to account for the impact of a single incident of violence between people, or arising from the experiences of a natural disaster.

The recently released Australian Child Maltreatment Study found that four in five people experienced child sexual abuse on more than one occasion. Critically, it also found that sexual abuse in childhood mostly occurs together with other forms of maltreatment; for example, domestic and family violence and emotional abuse.

For these and other reasons, the preferred way to describe the ongoing effects of child sexual abuse across the lifespan is “complex trauma”. It reflects more accurately how child sexual abuse shapes the ways that victims and survivors feel about themselves, their relationships and the meanings they give to their experiences.

Children who are sexually abused are betrayed at a fundamental level, often by those on whom they should be able to depend and trust. They feel and often are unsafe, unaware of when the next assault will occur – living in danger and driven by their biology to try and survive. 

All of this is happening as a child is growing, developing and trying to learn about the world. At the same time, their brain is also growing and developing and brain pathways are being laid down. These pathways are informed by the negative experiences of persistent threat rather than positive ones of nurture, safety and protection.

Children who are abused often blame themselves and the shame and self-blame they experience often continues well into adulthood. This is made worse by a society which often does not want to listen, hear or believe. Little wonder that survivors struggle to speak out and be heard, to reach out and seek help, to disclose and be believed.

Being sexually abused threatens a child’s personal safety and the danger to which they are exposed often continues over time. The threat posed during child sexual abuse activates a child’s survival response and throws them into a state of high arousal and/or, if sustained, shutdown. These reactions occur not only at the time but often continue throughout life. This can cause a person’s nervous system to stay reactive.

The repeated trauma a child experiences during their vulnerable childhood years often impacts many facets of their life and across their life course. 

Complex trauma refers to ongoing, repeated and often extreme trauma which usually occurs in relationships. A child who is sexually abused has their boundaries violated and often this happens many times. It occurs within the family or other care-giving relationships, with a young person, online or in other contexts. These experiences can seriously impact on a child’s development and lead to a range of emotional, psychological and behavioural challenges as a child, young person and adult.

Just as all experiences of child sexual abuse are unique, so too are the needs of victims and survivors. This means that the path to healing and recovery is unique, too. It is a path which often reflects the complexity of the trauma experienced and which has many twists and turns over time. Because survivors have experienced a childhood which is unpredictable, care needs to be predictable and accessible, regardless of where a person lives or what their background is.

To meet a person’s unique and complex needs, support also needs to be tailored to each individual in the context of their lives, and informed by them, when and where they are seeking support. Most importantly, whatever services a survivor accesses need to be offered in a safe and compassionate environment.

The report found that while there are many different approaches on offer — and some are promising — there is still so much more that needs to be known about supporting survivors to heal and recover. This includes more investment in research overall but, in particular, research and knowledge that is informed by the unique experiences and insights of people with lived and living experience of child sexual abuse.

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