Sexually Abused Children Face a Long Road to Recovery

For "Mia," the decades since she was sexually abused as a young child have been marred by psychological distress, from her battle with disordered eating to recurrent major depression, debilitating anxiety and a diagnosis of post-traumatic stress disorder -- all stemming from the abuse.

The Baltimore resident, now in her 30s -- who asked that her real name not be used -- says her older brother began abusing her starting at age 5 -- it lasted until she was 7, when she told her mother about the ongoing sexual abuse. She recalls that her mother, with whom she still has a fractured relationship today, indicated that it would stop, and that they would move on. But though the abuse stopped, not being able to talk about it, Mia recalls, created two realities: There was, on the one hand, "the reality in which something really unspeakably horrific happened," Mia says, and on the other: "a reality in which we just can't discuss it." That tore her psyche apart, even as the would-be Ivy League graduate says she would have been perceived as high functioning.

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As is often the case, Mia was the victim of a cycle of abuse in a family vulnerable to it. Her brother had been sexually abused by baby sitters; there have been intimations that her mother was sexually abused by members of her own extended family as a child; her parents' relationship was rocky; and her father was an alcoholic. The sexual abuse she endured occurred -- in all but one case, she says -- when her parents were home.

Eventually, the elephant in the room stomped through her adolescence in the form of eating disorders. "I started receiving treatment for that in my teens," says Mia, who grappled with anorexia in high school and has struggled with body dysmorphia, obsessional eating habits and bulimia, as well. "The feeling of shame, kind of existing in the body, continues to be an ongoing struggle," she says. But it wasn't until her 20s that she began undergoing therapy focused squarely on the psychologically corrosive sexual abuse itself.

As when only symptoms are treated and not the underlying illness, very often the conditions caused by a previous injury -- or the so-called sequelae, in this case, of sexual abuse -- aren't recognized as relating to that abuse at all. That's because, experts says, medical and mental health professionals frequently fail to inquire as to whether patients may have been sexually abused. That can lead to a failure to recognize "the sequelae of sexual abuse as depression, anxiety disorders, substance abuse, dissociative disorders," says Dr. Richard J. Loewenstein, medical director of The Trauma Disorders Program at Sheppard Pratt Health System in Towson, Maryland; that's among other mental health issues. "If there are other diagnoses -- for example, bipolar disorder, schizophrenia -- a childhood abuse history complicates treatment response, and complicates symptom patterns. So it's actually a risk factor for poor response to treatment for non-trauma-related disorders." And in a culture where those who have been abused are often coerced or pressured to keep quiet by perpetrators as well as others, like family members, the offense frequently isn't disclosed.

"The victims are put in a tremendously difficult situation, because all the pressures are for them to not say anything," says Loewenstein, who is also a clinical professor of psychiatry at the University of Maryland School of Medicine in Baltimore. He asserts that mental health providers ask about these issues much less commonly than they should, and notes that many mental health providers are not systematically trained in the diagnosis and treatment of trauma disorders, or to look for trauma issues as an important part of treating other disorders. "At Sheppard Pratt, as in many places, the medical record mandates asking about a variety of traumas. However, even here, there needs to be more systematic training in how to ask, what to ask about and how to respond if one gets a positive answer -- a fear that clinicians have [is], 'If I ask, what do I do if someone says yes?'"

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Loewenstein, who Mia sees for therapy, has helped her deal head-on with the sexual abuse she experienced and address its far-reaching psychological implications. She first came to Sheppard Pratt when she was in her mid-20s for inpatient treatment and has continued to receive therapy on an outpatient basis, from one-on-one sessions to art therapy and treatment for multiple mental health conditions. "A very debilitating shame [had] manifest in a lot of different areas," Mia says, regarding the compounding mental health issues she experienced leading up to her arrival at the mental health treatment center. "I was suicidal at that time." Says Loewenstein: "When she started treatment, she was diagnosed with severe, recurrent major depression, PTSD, severe bulimia nervosa and an atypical dissociative disorder. ... Now all are substantially improved without active PTSD and depression, and significant reduction in dissociation."

Though Mia still doesn't consider herself fully recovered, she's made significant strides, from depression treatment to dissipation of her eating disorder behaviors -- though, she says, the obsessional thinking behind those is still present. And she's been able to develop trusting relationships again. That's a major area of difficulty for those who have had that trust broken by abuse in the past, Loewenstein says.

"We know with childhood sexual abuse specifically, 93 percent of children know the perpetrator, and about a third of them are family members," says Candice Lopez, director of anti-sexual assault advocacy organization RAINN's National Sexual Assault Hotline. That layers shame on shame, when individuals a child trusts push him or her to keep indiscretions quiet, and it can obstruct reporting of those crimes. "If somebody knows that it's happening, it is their responsibility to act in the best interest of the child. That means intervening in some capacity, whether it means reporting the assault to authorities in their local jurisdiction, giving that child support, letting that child know that what is happening is wrong, that they deserve to be safe, that this isn't their fault. All of those things are so imperative and so helpful for a trusted adult to take that responsibility and make sure that child is safe."

RAINN's hotline gives individuals the option to speak with trained operators confidentially about the assault online or by phone to gain support. "The telephone hotline is actually a decentralized hotline, so when you call it, it actually routes people to their local center," Lopez says. "We collaborate with over 1,000 sexual assault service providers across the country to make sure people are connected to that local service."

The goal after ensuring children are safe, experts say, is making sure they get the support and treatment they need -- whether still a child or now an adult wrestling with a trauma that's never fully in the past. "There are actually now effective therapies for at least child post-traumatic stress disorder, which is one of the outcomes of abuse -- sexual abuse and other forms of childhood abuse," Loewenstein says.

[Read: How to Find the Best Mental Health Professional for You.]

Time, therapy and developing new relationships with people she trusts, Mia says, have all helped. "Allowing myself to be loved in a relationship has been the biggest breakthrough," she says. "I'm married now to a wonderful man who accepts all of me and knows all of me and understands my past. And I think that allowing myself to be somebody who would be worthy or deserving of that has challenged everything I knew before, and has been really the biggest breakthrough. Because, if I accept that, 'Yes, this wonderful person can care for me and love me,' then it rewrites the story from when I was a kid [who thought], 'Oh, something's wrong with me, I feel bad, I feel wrong.'" Mia says her relationship with her husband has been most significant development in her ongoing healing process, adding that she's been fortunate to have great care.

"For someone who's really in the midst of it, [and] I would say it to my younger self: Be patient. It will get better," she says. "Don't give up."

Michael Schroeder is a health editor at U.S. News. You can follow him on Twitter or email him at mschroeder@usnews.com.