“Sexual Abuse in Infancy” by Bruce D. Perry, M.D., Ph.D

from Trauma, Violence and Abuse:
A Review Journal Because You Asked

Can infants recall sexual abuse later in life?

The key word in this question is “recall.” Unfortunately, for most, the concept of memory is limited to the storage and recall of cognitive, narrative memory. In this conceptualization, a pre-verbal infant would not be capable of “remembering” and “recalling” any event. Furthermore, we are all familiar with the developmental amnesia that occurs at approximately age three. In this normal developmental phase, there appears to be a reorganization of cognitive and memory functions such that narrative memory for events prior to age three or four are difficult to access later in life. These two points have led to the pervasive, inaccurate and destructive view that infants do not recall traumatic experience, including sexual abuse. Nothing could be further from the truth.

The human brain has multiple ways to “recall” experience. Indeed, the brain is designed to store and recall information of all sorts – motor, vestibular, emotional, social and cognitive. When you walk, play the piano, feel your heart race in an empty parking lot at night, feel calmed by the touch of a loved one or create a “first impression” after meeting someone for first time, you are using memory. All incoming sensory information creates neuronal patterns of activity that are compared against previously experienced and stored patterns. New patterns can create new memories. Yet the majority of these stored memory templates are based upon experiences that took place in early childhood – the time in life when these patterns of neuronal activity were first experienced and stored. And the majority of our ‘memories’ are non-cognitive and pre-verbal. It is the experiences of early childhood that create the foundational organization of neural systems that will be used for a lifetime.

This is why, contrary to popular perception, infants and young children are more vulnerable to traumatic stress – including sexual abuse. If the original experiences of the infant with primary caregiving adults involve fear, unpredictability, pain and abnormal genital sensations, neural organization in many key areas will be altered. For example, abnormal associations may be created between genital touch and fear, thereby laying the foundation for future problems in psychosexual development. Depending upon the specific nature of the abuse, the duration, the frequency and the time during development, a host of problems can result. In many ways, the long-term adverse effects of sexual abuse in infancy are the result of memories – physiological state memories, motor-vestibular memories and emotional memories, which in later years can be triggered by a host of cues that are pervasive. Incestuous abuse in infancy is most destructive in this regard. It will result in the association of fear, pain and unpredictability into the very core of future human functioning – the primary relational templates. If these original ‘templates’ for all future relationships are corrupted by sexual exploitation and abuse, the child will have a lifetime of difficulties with intimacy, trust, touch and bonding – indeed the core elements of healthy development and functioning throughout the lifecycle will be altered.

Furthermore, if the child is sexually abused during early childhood, they may not have any cognitive “memory” and be completely unaware that the source of their fears, difficulties with intimacy and relationships has its roots in this betrayal in infancy. This can lead to problems with self-esteem and, will make any therapeutic efforts more difficult.

Can infant sexual abuse arrest cognitive, emotional or behavioral development?

The sexual abuse of an infant is often accompanied by extreme disruptions of normal caregiving behaviors and by extreme and prolonged stress responses. Altered caregiving and a prolonged stress response will alter the development of the infant. The major mediators of emotional, cognitive and social environment and, therefore, learning during infancy are the primary caregivers. Development in all domains can be disrupted if these primary relationships are compromised. As mentioned above, it is almost inevitable that emotional, behavioral and cognitive development will be arrested by early traumatic experience.

Does infant sexual abuse affect attachment?

The development of attachment and healthy socio-emotional functioning depends upon the presence of consistent, responsive, attuned and nurturing caregivers. One of the central tasks of these relationships is to keep the child safe. If these caregivers are unable to protect, or worse, if they participate in the sexual abuse of the child, the core of all future relational interactions is corrupted. The distortions in attachment that result from sexual abuse in infancy can be toxic to all future relationships. Again, the cascade of problems that result from impaired socio-emotional functioning due to early life sexual abuse can impact all domains of functioning and be a source of ongoing confusion and pain to anyone experiencing sexual abuse in infancy.

Are there physiological changes in the brain resulting from a traumatic event?

As mentioned above, the brain is designed to change in response to experience. Indeed, all experience changes the brain. With traumatic experiences, the changes are in those parts of the brain involved in the stress and fear responses. Many studies with adults and, now with children, have demonstrated a host of neurophysiological changes that are related to traumatic stress. While many more well-controlled studies are needed, it is likely that certain brainstem catecholamine systems (e.g., locus coeruleus noradrengergic), limbic areas (e.g., amygdala), neuroendocrine (e.g., hypothalamic-pituitary-adrenal axis) and cortical systems involved in regulating stress and arousal may all be altered in traumatized children.

Do infants display sequelae similar to older children who are sexually abused?

The sequelae that result from sexual abuse will vary as a function of several keys factors: what is the nature of the abuse, the duration, frequency, intensity, time during development and the presence of attenuating factors such as other caring, attentive caregivers in the child’s life. In general, however, with all traumatic experiences, the earlier in life, the less “specific” and more pervasive the resulting problems appear to be. For example, when traumatized as an adult, there is a specific increase in sympathetic nervous system reactivity when exposed to cues associated with the traumatic event. With young children, following traumatic stress, there appears to be a generalized increase in autonomic nervous system reactivity in addition to the cue-specific reactivity. Due to the sequential and functionally interdependent nature of development, traumatic disruption of the organization and functioning of neural system can result in a cascade of related disrupted development and dysfunction. Examples of this include the motor and language delays in traumatized children under age six. The “causes” of these delays are likely due to the primary, trauma-induced alterations in other domains (e.g., the stress response systems, thereby influencing physiological reactivity, hypervigilance, concentration), which, in turn, impair the young child’s willingness to explore, capacity to process new information and ability to focus long enough on new information to learn.

Bruce D. Perry, M.D., Ph.D.
Thomas S. Trammell Research Professor of Child Psychiatry
Baylor College of Medicine
Chief of Psychiatry, Texas Children’s Hospital

Exodus International Freedom 2009 Conference

Exodus International is a Christian ministry whose mission is to set people free from homosexuality through the love of Jesus Christ. This week, Exodus is holding its annual Freedom Conference on the campus of Wheaton College. I have had the privilege of attending some conference sessions and learning in the process.

PFLAG

Tuesday night, I headed to Edman Chapel to attend the first plenary and participate in praise, worship, and prayer. But the first thing I encountered was a group of protesters from PFLAG (Parents, Families, and Friends of Lesbians and Gays) of DuPage County and a number of police and public security officers who were standing between the protesters and the entrance to the campus. PFLAG folks were chanting, “Please go home!” They waved large rainbow flags and held up signs that said, “Your lies kill.” I was instantly reminded of the conflict between pro-life and pro-choice street demonstrators I had seen so often when I was a child being raised in the pro-life movement.

I ended up having a conversation with three parents who were standing apart from the main group. One said his daughter told him she knew she was a lesbian from the time she was seven. (Later, I thought about the fact that a seven year old is prepubescent, and I wondered what had happened to this girl and what knowledge she had gained at such a young age to begin thinking she was attracted to other girls.)

Another said that she is part of PFLAG because she wants people in the community to know that there are gays and lesbians all around, and furthermore, she wants her child to know that her child is “okay” the way her child is. (This made me think about how Christian psychological explanations for the roots of same-sex attraction, which often point to some failure of the parent to bond with the same-sex child in a healthy way, would be very wounding to a parent who loved her son or daughter.) In our conversation, I shared three thoughts.

First, I said I thought PFLAG members had courage to walk in the Wheaton Parade on the Fourth of July, which I saw a week ago, considering the support in Wheaton is not like San Francisco or Chicago. Second, in response to the PFLAG signs accusing Exodus of spreading lies that kill, I shared my belief that when someone commits suicide, friends and family are not to blame. Third, I mentioned that the effects of trauma on the survivor of assault change the pathways of the brain. The mother instantly asked if I was saying sexual abuse was the cause of same-sex attraction. I said no, but I was saying that early childhood experiences shape the way the human brain responds to sexuality.

That’s when the third parent said what it comes down to is that he believes being gay is a perfectly acceptable way to be whereas Exodus does not.

He’s right.

For Christians, same-sex attraction is a temptation to sin and homosexual practice is sinful — one of many temptations and sins Christians face throughout their lives. Since Christians have determined to live lives of spiritual and sexual purity so that they may become more like Christ, Exodus provides a way out of temptation and sin that is compassionate and supportive. Although it does minister to people outside the church, Exodus is particularly helpful to those who believe in Christ and need understanding and strength from other members of the body of Christ to live rightly.

TUESDAY NIGHT

When I did finally make it through the protesters and the police, I went to the chapel to listen to Alan Chambers, the president of Exodus International. He asked three questions: “Who are you? What are you doing here? And do you know that God has a purpose for your life?” Although these are weighty questions, he spoke with humor that kept the audience listening and laughing even while we seriously considered his points.

Then Dennis Jernigan came to the piano, and we all joined together in singing and praising God. I would say that Dennis has a special anointing on his life to lead others in worship. Listening to him reminded me of listening to Keith Green praise God at JESUS WEST COAST when I was a little girl growing up in California.

Afterwards, anyone could go forward for prayer. I went forward with many others, thankful to God for the chance to speak to him with someone else’s support. I had cried to the entire service, feeling a lot of tension in my body that was caused by fear and the memory of fearful things. To receive prayer was a blessing.

Later, I stopped by the newcomers’ orientation where I happened to meet Alan Chambers and his wife, Leslie. I gave them a copy of my newest book of poetry, MADE IN THE IMAGE. I was just so delighted that they wanted to have it!

WEDNESDAY WORKSHOPS

Causes and Healing of Male Homosexuality: In this peaceful and informative workshop, Jim Katsoudas of Clean Heart Ministries in Charlotte, NC and Rusty Angell presented the factors that influence the development of male homosexuality and the healing of it.

Environmental factors can include an absent father, a combative or alcoholic father, or a father who causes his son to fear him excessively. A son’s relationship with his mother may be emotionally enmeshed, combative (causing hatred of women), or simply overly-protective. Siblings may play a role, especially if a younger son feels he is not good enough in comparison to an older brother, which may ruin his self esteem and self-image. Peers can play a similar role to siblings if they are cruel. Sexual and emotional abuse by the same or opposite sex parent will certainly influence a child’s understanding of himself and his sexuality, which will be confused and damaged as a result of the abuse.

The workshop leaders considered the possibility of genetic or inborn influences on the development of male homosexuality. Scientific research in this area has not been conclusive. There is no gene marker tied directly to the development of homosexuality. But what about a psychological predisposition?

In 1973, Dr. Robert Spitzer re-wrote the definition of homosexuality in The Diagnostic and Statistical Manual of Mental Disorders in response to gay activist protests of the American Psychiatric Association in such a way that homosexuality no longer had to be considered a mental illness. However, Exodus later approached Dr. Spitzer to do a study of men and women who had come out of homosexual lives. Dr. Spitzer’s “findings challenge the widely-held assumption that a homosexual orientation is “who one is” — an intrinsic part of a person’s identity that can never be changed.” (For more info, see “Evidence Found for Effectiveness of Reorientation Therapy.”)

It is the view of Jim Katsoudas that “the only genetic influence towards the possibility of male homosexuality is that some males are naturally more sensitive, which may gift them with certain affinities in the arts. This then may set them up in their early adolescent years to struggle with same-sex attraction due to ostracism from other males.” When Jim asked how many of the same-sex attracted men in the room played an instrument or drew pictures or enjoyed interior decorating, about 80 of the 100 men present raised their hands.

The workshop leaders also discussed emotional and spiritual factors in the development of male homosexuality, which can include an inferiority complex (from a lack of affirmation from the father), poor self-esteem (feeling isolated), self-loathing and self-hatred (of the physical body), narcissism (in the sense of putting on a front, a false self, to suggest to others “I’m better” and “I’ve got it going on” in order compensate for interior feelings of worthlessness), sexual and relational idolatry (worshiping another man, desiring him and wanting to possess him, in part because of wanting to become like him), poor understanding of God the Father, and deep-seated anger.

Healing from homosexuality involves the whole person: the will, the heart, the soul, the mind, and the body. Healing includes acceptance of the broken self, which means honesty with oneself and others, receiving affirmation from other men, developing a healthy view of the opposite sex, replacing the false or negative sense of self with a true understanding that we are made in the image of God, getting real and being accountable on a regular basis, taking risks, allowing God to move us out of our comfort zone, and asserting a true masculine nature.

Healing will include spiritual growth, which means living in a new identity as a son of God and a warrior of faith, willing to stand in the gap for those the man loves. Spiritual growth also means forgiving others, surrendering the right to get revenge, taking a rightful place in the church, participating in Christian service and living with God daily, allowing him to reveal strengths and weaknesses, to renew the mind, and to help the man stay accountable as he lives in healthy fellowship with other believers.

In the question and answer period that followed, the workshop leaders fully admitted that this was only an introduction to the issues and that sustainable healing takes time and exploration of issues at a much deeper level.

How to Minister to Children of Homosexual Parents:

This workshop was led by Julie Fernandez, a woman who was raised by a mother who had multiple lesbian partners over the years. She never knew her father, but she always identified as a girl interested in traditionally girl activities, despite her mother cutting her hair short, putting her on an all boys baseball team, and calling her by a boy’s name. When she grew up, she became a Christian, married, and had five children. She now runs For Such a Time as This Ministries.

She noted that a study in Developmental Psychology found that 12% of children of lesbians became active lesbians themselves, a rate which is at least four times the base rate of lesbianism in the adult female population (Daly 2002). She also noted that the third of homosexuals’ children become homosexual (Chambers 2006).

She pointed out that children of homosexual parents typically have two different types of upbringings. It may be that their heterosexual parents were married, then divorced to be with same-sex partners. The trauma of divorce, with the added complications of same-sex relationships, has a powerful impact on children. Other children are born into the lifestyle and only know a gay, lesbian, bisexual or transgendered home-life.

For the children, this raises questions about belonging. They do not always feel like they belong in the GLBT culture, but they may recognize they are not necessarily part of a larger culture, mainstream society, or the church. Julie advised those who want to minister to these children to be available, avoid stereotypes, provide a place for them to connect to other believers, give examples of biblical gender roles and identities, create a safe and healthy environment for sharing and prayer, avoid compromising God’s word, and be aware of the insensitive remarks others may make around the children and try to protect the children from hurtful conversations by people who lack understanding and empathy.

Sexual Abuse – Theological Issues and Practical Responses:

Dr. Andrew J. Schmutzer Moody Bible Institute, an overcomer of years of incestuous sexual abuse and assault, presented this workshop – one of the best I’ve ever seen on the issue of recovery from sexual abuse.

He began by noting three crushing lessons that victims have learned: “I do not have control over my own body,” “the world is not a safe place for me,” and “God, the Almighty One, did not step in to prevent it.” He then noted that sexual abuse causes brokenness to the whole person in relationship to the self, others, and faith.

After giving an explanation of Genesis 1:26-28 and discussing personhood in creation theology – the fact that we are made in the image of God as male and female, as sexual beings – he observed that sexual abuse fractures the unity of personhood, impairs sexual expression, distorts delegated authority, disfigures the “face identity” of others (because the abused person perceives others without natural trust but instead with suspicion), isolates itself from community, destroys family relationships, and mars connecting metaphors for God.

He noted the horrifying statistics: one in three girls and one in six boys are sexually abused before age 18. Standard effects of abuse are emotional (anxiety, anger, depression, dissociation), physical (sleep paralysis, headaches, stomach ache), and behavioral (hyper arousal, compulsive behaviors, self mutilation, inability to trust others, over-controlling, too submissive, sexualized acting out, aggression). He also noted that sexually traumatized children are 15% more likely to suffer from cancer, heart disease, gastrointestinal problems, liver use, and diabetes as adults.

He discussed reasons why admission of sexual abuse by the one abused may be delayed by many years (fear, shame, denial, confusion, desire to protect the abuser and the family, and so on) and then outlined the stages of recovery for victims of sexual abuse. He noted how friends and family can help a survivor of childhood sexual abuse.

Most interestingly, he gave suggestions for how the local church can acknowledge the experience of those who have been abused in their congregations. The church can build healing rituals into worship, integrate a robust theology of embodiment into preaching and formation programs, incorporate the life experiences of victims into the liturgical calendar and the prayers, and put the wounded who are in recovery into leadership in the church to help others. He said it is also important to show how Jesus, in his sufferings, can empathize and connect with human beings who have suffered. He said it would be helpful to use fresh metaphors to help victims rehabilitate their view of God. He urged leaders to foster transcending connections.

In this workshop, I had the opportunity to speak, connect with other survivors of abuse, and have a long and meaningful conversation with Dr. Schmutzer about ministry in this area.

THURSDAY WORKSHOPS

Overcoming Depression and Anxiety: Jayson Graves, M.MFT of Healing for the Soul, which seeks to facilitate recovery from sexual addiction and unwanted same gender attraction through therapy conducted over the phone for those all over the world in groups and one-on-one consultations (#1-877-590-SOUL), led this workshop.

He began by giving a self-assessment questionnaire designed to help test-takers identify the areas of their brains affected and causing anxiety and depression. He then explained the major areas of the brain. He described prefrontal cortex, anterior cingulate gyrus, basal ganglia, deep limbic system, and the temporal lobe particularly, the psychological and physical functions controlled by different parts of the brain, and how improper functioning of certain areas of the brain results in various negative conditions. He then presented natural and medicinal treatment options.

Some insights that I gained? I was reminded that trauma and Post-Traumatic Stress Disorder (PTSD) literally impair proper brain functioning in multiple areas of the brain, but I was also encouraged as I remembered that the recovery process literally changes the blood flow, shape, and pathways of the brain so that true healing becomes possible. Healing may actually restore a lost sense, like the sense of smell, or make the perceptions of the senses sharper as the one in recovery reintegrates the fragmented self into a greater whole that includes full acceptance of the self and the body.

Furthermore, I learned that anxiety is linked to hypoglycemia (which I hadn’t realized before), intense aerobic exercise helps keep all parts of the brain in excellent health, and fish oil is good for you! It’s a natural anti-inflammatory for the brain.

This workshop had far more information than can be easily summarized, but Dr. Henslin’s book, This is Your Brain on Joy, is a helpful substitute for attendance!

Healing and Freedom from Sexual Addictions:

In this workshop, Curt Calas, LCPC, and Ken Taylor, LCSW, described the advantages of treating same-sex attraction from an addictions perspective. They also considered other types of sexual addictions to heterosexual activity and pornography. They discussed ways of assessing whether or not someone has a sexual addiction. They gave definitions of addiction such as:

“a pathological relationship with the mood altering substance or behavior” – Carnes

“including obsession, compulsion, trancelike states, and repeated poor judgment for one’s spiritual, emotional, and legal safety) – Weiss

“a destructive reliance on ungodly sexual thinking and behavior in opposition to the conviction of the Holy Spirit” – Calas and Taylor

They discussed criteria for addiction, which include a pattern of out-of-control behavior, failure to stop the behavior even though it causes severe problems socially, legally, financially and physically, the pursuit of self destructive or high risk behavior, efforts to stop or reduce the behavior that repeatedly fail, sexual obsession and fantasy, progressive increase in amount and variety of sexual behavior (because of an increasing tolerance – that is, the chemical effect of needing increase sexual stimuli to get the high), mood changes, significant loss of time doing or recovering from the behavior, and an inability to fulfill obligations to work, school, family, and friends.

They discussed the cycle of addiction and the cycle of recovery, providing a handout of tasks that those in recovery from sexual addiction go through as they become healthier.

Tasks 1-7: breakthrough denial, understand addiction, surrender, limit damage, establish sobriety, establish physical integrity, live in a culture of support

Tasks 8-19: deal with multiple addictions, work through cycles of abuse, reduce shame, grieve losses, bring closure to shame, work on relationship with the self, establish financial viability, do meaningful work, achieve lifestyle balance, build support, pay attention to exercise and nutrition, develop a spiritual life

Tasks 20-30: resolve conflicts, restore healthy sexuality, engage in family therapy, work on family relationships, commit to recovery fully and over the long term, and deal with issues with your children, issues with your extended family, differentiation, primary relationship, coupleship, and primary intimacy.

One encouraging point: Calas said that one doctor investigated the 198 studies of successful people (as in, for example, Seven Habits of Highly Effective People). The doctor found a commonality in these successful people; they had minds like those of addicts, who are able to focus exclusively on one thing for extended periods of time. Addicts need to focus on recovery, not substances or sex or addictive self-destructive behavior, and they will be able to live life fully.

RESOURCES

I picked up the following helpful books at the Exodus bookstore as well.

Dawn Stefanowicz, Out from Under: The Impact of Homosexual Parenting

This is a memoir and the testimony. It discusses the author’s experience of sexual abuse, neglect, and over-exposure to her father’s multiple homosexual partners while her mother passively did nothing about the situation. It also describes her journey to faith and healing.

Henslin, This is Your Brain on Joy

This book is a layperson’s description of how the brain works and what will strengthen the brain so that anxiety and depression are minimized.

Carnes, Facing the Shadow: Recovery from Sexual Addiction

This is a textbook for individuals working through their own sexual addiction issues. It describes the cycle of addiction, the cycle of recovery, and how to take the first seven steps toward healing: breakthrough denial, understand addiction, surrender, limit damage, establish a variety, establish physical integrity, and live in a culture of support. To get help, see Patrick Carnes’ website.

CONCLUSION

I praise God for the ministry of Exodus International, and I will continue to pray for this ministry and its effectiveness in the world.

Dr. Jane Beal
JSASSN International