Acknowledging complexity in the impacts of sexual victimisation trauma
- The complexity of trauma - clarifying terminology
- The manifestation of complex trauma
- The pathway to complex trauma - revictimisation, and poly-victimisation
- How sexual victimisation trauma impacts on victim/survivors
- Acknowledging complex trauma in service delivery
- Acknowledging trauma from the policy perspective
How sexual victimisation trauma impacts on victim/survivors
Child sexual abuse victimisation is strongly associated with a range of issues around health and wellbeing well into adulthood (Cashmore & Shackel, 2013). Adults with child sexual abuse histories have been found to have a higher risk of mental health problems such as depression, anxiety, substance abuse and self-harm when compared to community populations (Cutajar et al., 2010; Henderson & Bateman, 2010; Horvarth, 2010; Mullen & Fleming, 1998).
The coping mechanisms that victim/survivors develop to deal with the impacts of abuse - namely traumatic sexualisation, betrayal, stigmatisation, and powerlessness - can have an effect on the rest of their lives (Herman, 1992). For instance "avoidant coping", or more simply learning to cope with the abuse by avoiding dealing with it, has been associated with trauma symptoms (Fortier et al., 2009). Survivors of child and adult sexual abuse use a range of strategies to cope with these impacts, for example, psychological escape, socially withdrawing, and reframing. In the short term and depending on context, these can be effective ways of minimising distress. However, the available research shows that in the longer term, such strategies can become ingrained avoidant coping strategies. Examples such as substance use, emotional numbing, and self-harm, can have negative outcomes for mental health (Walsh et al. 2010) and interpersonal relationships (Davis & Petretic-Jackson, 2000). One obvious example is where greater levels of depression and mental health issues can lead to women who have experienced sexual abuse to have more difficulties with parenting.3
Complex trauma and substance abuse
It is very clear from research that many people with substance use disorders have experienced interpersonal violence, including sexual and physical violence (Cohen & Hien, 2006). It has been suggested that the abuse of drugs and alcohol may have an anaesthetic effect on negative feelings or to induce a more pleasurable bodily sensations or emotions to alleviate a sense of emotional numbness or to reduce stress and tension (Briere & Spinazzola, 2005). In the fields of substance abuse, users with additional mental health and other problems are associated with poorer prognosis in substance abuse treatment (Covington, Burke, Keaton, & Norcott, 2008). Past victimisation may intersect with mental health issues and is often exacerbated by drug and alcohol abuse (Battle, Zlotnick, Najavits, Cutierrez, & Winsor, 2003; Sarteschi & Vaughn, 2010). Substance users with abuse histories (including child sexual abuse) reported higher rates of suicidal ideation and attempted suicide compared to users without such histories (Rossow & Lauritzen, 2002). This was particularly the case for those who had experienced multiple adverse experiences in childhood.
Making the connection between a history of trauma and the range of problems related to that history has implications for substance abuse support services who may have to acknowledge the traumatic origins at the basis of the substance abuse problem (Cohen & Hien, 2006). Services may not always feel equipped to deal with the complexity of issues related to a history of trauma.
As well as being at risk of experiencing difficult and often violent interpersonal relationships (Davis & Petretic-Jackson, 2000), women with a history of child sexual abuse are more likely to engage in casual and unprotected sex while reporting less satisfactory sexual rewards and greater sexual costs (Lemieux & Byers, 2008). In examining self-dysfunction (i.e., dysfunctional behaviour such as substance abuse and indiscriminate sexual behaviours) as an aspect of sexual revictimisation, a study by Messman-Moore et al. (2005) noted a link between risky sexual behaviour and sexual revictimisation, suggesting tension reducing and maladaptive sexual behaviour may function as a strategy to cope with post-traumatic symptoms related to previous victimisation experiences.
Complex trauma and incarcerated women
Complex trauma appears to have a disproportionate profile in the incarcerated female population, where sexual victimisations histories are more common than not and correspondingly high rates of poor mental health and substance abuse characterise these women's lives. Complex trauma in the form of childhood sexual and physical abuse plays a role in the offending pathways of women - with mental disorders, anger problems, substance abuse, housing instability and other social disadvantage contributing to women's offending (Stathopoulos, 2012).
Complex trauma and Indigenous women
It has been acknowledged that Indigenous women and children are the most victimised groups in Australian society and often suffer repeated and ongoing trauma within their families and communities (Lievore, 2003). Violence, including sexual violence, is prevalent in the lives of those in many Indigenous communities (Atkinson, 2002).
There is a limited body of scholarship that suggests complex trauma as a useful construct for describing the impacts of sexual abuse on Indigenous women and within Indigenous communities (Haskell & Randall, 2009; Söchting, Corrado, Cohen, Ley, & Brasfield, 2007). The historical factors that play out for Indigenous women and children exacerbate the concept of trauma in an Aboriginal context. The influence of many factors, such as the historical impacts of colonisation on Aboriginal people, poverty, racism and substance abuse in Indigenous communities are part of a multifaceted historical picture of disadvantage and oppression (Keel, 2004). Intergenerational and transgenerational trauma are also a feature of the Indigenous experience. This refers to trauma passed down through the generations. Intergenerational trauma carries down to children from traumatised parents. Sometimes this can include the secondary trauma of witnessing a parent being traumatised, possibly by family violence or racism. When trauma is transmitted across a number of generations, this is known as transgenerational trauma (Atkinson, 2002). The younger generations can experience this type of transmitted trauma as entrenched to the point that it becomes a cultural norm. The consequences of transgeneration trauma must also consider the disruption that has occurred over time to the relationships between family, community and between the genders. Atkinson (2002) described this as a fracturing of the responsibility to nuture and protect children, that has been undone over time as the learning of younger generations comes from experiencing violence within institutions, families and as social support networks of traditional Aboriginal life were gradually disrupted and dismantled.
Complex trauma provides a framework through which drug and alcohol addiction, high-risk behaviours, and violence can be viewed as responses to accumulated and entrenched trauma, rather than see them as pathologies and health problems.
The insidiousness of complex trauma as the underlying service need for Indigenous women can be even more difficult to pin down as the silence around sexual assault can be magnified by issues such as lack of culturally specific services and responses, concerns about gossip and shame in small communities, and a risk of ostracism from family and community (Taylor & Putt, 2007).
The literature on culturally competent trauma interventions stresses the need for awareness about values and paradigms of knowledge/belief, particularly in relation to:
- the reliance on the individual as the locus of action and meaning;
- the reliance on scientific knowledge compared to spiritual knowledge and meaning;
- conceptions authority and respect; and
- the political, historical and institutional sources of trauma that interact and compound the particular trauma of sexual abuse.
Complex trauma and homelessness
Australian and overseas research indicates that trauma, including sexual abuse, is prevalent among homeless populations (Morrison, 2009; Buhrich, Hodder, & Teesson, 2000). Australian researchers also found that homeless adults in Sydney reported exceptionally high rates of multiple trauma and high rates of psychopathology including psychosis, substance abuse and depression. In a study by Taylor and Sharpe (2008), 98% of participants (n = 70) had experienced a traumatic event, commonly physical or sexual abuse, with 93% experiencing more than one event. A trauma history and PTSD often precede homelessness and are characteristics of a high proportion of homeless people (Foster, LeFauve, Kresky-Wolff, & Rickards, 2010). Taylor and Sharpe's (2008) findings are similar to other homelessness research, indicating that complex trauma plays a role in facilitating homelessness as well as being a traumatising experience in itself. Housing services deal frequently with traumatised people, often with serious mental health problems and comorbidity of other disorders such as substance abuse that can impede their ability to maintain housing and could be an ongoing issue (Taylor & Sharpe, 2008; Foster et al., 2010). Sexual victimisation trauma appears to be a risk factor for homelessness and a result of homelessness, with very high rates of sexual violence victimisation seen in women, men and young people who are homeless (Morrison, 2009).
3 For a more complete discussion on parenting with a history of sexual abuse see ACSSA Research Summary, Mothers With a History of Childhood Sexual Abuse: Key Issues for Child Protection Practice and Policy (Tarczon, 2012).