Posttraumatische Belastungsstörung nach sexuellem Missbrauch | Asklepios

Welcome to the Asklepios health program when a person experiences something very bad because it can take root so deeply in their soul that it develops a life of its own. This is called post-traumatic stress disorder. If those bad experiences happen again and again. This also has greater consequences for the person affected. And it is what is called complex post-traumatic stress disorder. Children develop something like this, for example, after repeated sexual abuse. Dr. Emanuel Severus, head physician of the personality and dream disorders clinic. At Asklepios Clinic North in Ochse. Do we thank you for the invitation? Tell us again who are those affected by these types of disorders.

In principle, many people can be affected by these types of disorders, often experiencing very dangerous events individually or in groups. a sequence or events of catastrophic proportions that go beyond normal experience. In fact, it is also the case that these complex post-traumatic stress disorders that you mentioned occur when such events happen in early childhood, when something like this happens in adulthood, for example. For example, as an example of a normal prestomatic stress disorder, which may occur after a car accident, but if this happens in childhood and in a family context, possibly even in the nuclear family, if there is sexual abuse there that occurs repeatedly for a longer period.

After a while, the consequences are much more serious, especially if there is no person independent of the aggressor, who unfortunately is usually a man. Often, also the parent, these people could comfort this child, they could calm down, they could be there to help the child. Does it have to be sexual violence in the strictest sense or can it also refer to sexual violence? On a purely psychological level, how far would you take it? Unfortunately, an experience of sexualized violence is also possible. Abuse often occurs in a context of emotional neglect or emotional experiences of violence. Emotional neglect would mean that the child does not have the experience that there is someone whose ass is protected and can be spilled while growing up, but the emotional one.

Experiences of violence are something like humiliation, terror, confinement and abandonment of very, very serious experiences, which in themselves can trigger complex post-traumatic stress disorder, which, however, everyday clinical practice shows that sexual abuse often occurs in combination with these two, in addition to emotional neglect and experiences of emotional violence because I think it is also somewhat understandable in a sheltered parental home in a company it would not happen that something like this would happen repeatedly. Then there is another parent who could be contacted, but unfortunately it often happens that this other parent looks the other way, ignores, trivializes, if necessary, somehow blames the child and that is a terrible scenario.

Now we are talking about a clinical picture of post-traumatic stress disorder if you imagine that children are very stressed but how. Does that manifest itself? These are very different symptoms. I think if we think about them, if a child has an experience like that, it leads to a loss of any sense of security or normal children growing up with the idea that the world. It may not be a good place, but predictable and manageable things would fit. For children who experience something like this, it's exactly the opposite: there is no safe place, which is the consequence.

These children often experience constant threat, which means that. We assume that ultimately every person walking is potentially threatening. There is no feeling of security in everyday life in relationships and that is a very serious thing. We have this hyperbalance as one of these symptoms. Vigilance, this also massive nervousness that we see. Another symptom is often or not only a typical symptom of what we call intrusions or flashbacks, that is, they are fragments of memories of this traumatic event that burst into daily life and into oneself in an uncontrolled, unexpected, very present way, feel threatening and sometimes with flashbacks it is especially so that sometimes these people can no longer distinguish between what is really reality and what is not, which means that sometimes the partner is misunderstood, who is then seen as the perpetrator, for example, which is something Yes, it is often comes unexpectedly and is experienced as a threat and what often happens as a result is that they naturally try to avoid something like that and that can look like they avoid any situation that might serve as a carrier or who avoid themselves permanently. keep busy to avoid the possibility of said carriers becoming effective and you experiencing something like this again.

Yes, that means more activity, whether it's constantly doing something or staying busy simply to minimize the likelihood of something like that happening. Sometimes it is a bit like walking away and not being able to perceive things correctly in order to discard feelings of this type as much as possible. I've heard that something like this often has to do with a certain type of self. -hate that perhaps arises from the fact that the parents have told the children. It's your fault, just like yours, that's exactly what these symptoms that come with complex PTSD are. The ones I just mentioned are the ones that.

It can also occur in classic post-traumatic stress disorder, such as after a car accident. Then there's this negative self-concept, as we call it, which is this idea of ​​being ultimately evil, guilty, worthless, which is often accompanied by massive self-hatred, which sometimes leads to people punish themselves. Another symptom is that these people have great difficulties in relationships, especially in closer relationships, which I think is also somewhat understandable, on the one hand, because they generally distrust people because of their experiences. Close relationships would just be more difficult and the other point is certainly that they don't even know how close relationships work because if we take the example of the father who abuses his own child, then this nuclear family is the same.

In reality, our parents and the child are actually a safe haven for the child, especially when he is still young. He completely depends on the parents to take care of him and what the children then experience is that these good parents like you are necessary for the children. in order to grow up, if they then do something like that, then in some way it means that the child is obviously bad. He is bad, he doesn't deserve anything more, especially because, as you said, in some cases you also said it. The children themselves, how can they help when such a child comes to them?

Often, because we are in adult psychiatric care, these children only come when they do. When they are 18 years old, they are in child and adolescent psychiatry before, but what do we try to do when these children come to us or when these former children come to us? I think the first thing is a recognition of the path these children have taken. They survived, that's exactly what you mean, they managed to survive despite it. The most adverse circumstances even find their way into therapy and that is the colossal thing. So it is a huge achievement that is by no means a fact and I think this needs to be recognized first.

Do that in talk therapy, yes, that's you, of. Of course, you are in contact with doctors and psychologists, but what is also supported by the team is what you want, in reality it is a matter of routine that many times we do not take into account enough, we try to open it and then I think that a Sometimes it's a little bit too fast to move forward and I think our experience is that this is a very, very important component. First of all, recognize this achievement. Secondly, what we call psychoeducation is also very important, which means enlightenment, transfer of information. transfer of knowledge What is happening is about this clinical picture, the complex post-traumatic stress disorders, about the mechanisms that are active, that often helps a lot, that those who can classify it a little better and the third thing may also be very important : the therapeutic situation in the maximum possible contrast.

Giving form to the trauma that almost those of us who have lived in these dramatic situations for a year is a feeling of being at the mercy of helplessness, helplessness, that is, what we want is a healing therapeutic relationship that has a lot to say about the patient. The patient has the greatest possible control and experiences the greatest possible self-efficacy. And predictability also means that we would discuss all the therapy steps that often need to be taken as a result, very precisely. In detail, in front of the patient, the patient has a lot to say, what about the situations that the patient has tried?

He tries to avoid them, he tries to face them, he tries to break them or how do you face it? a step-by-step approach, which means that first of all it is about creating a sense of security because many of these patients do not always experience this at all and that is a prerequisite. Then, being able to do something like the synthesis of the trauma, the trauma. integration, where you can do something like what we call confrontation or exposure of trauma that generates awareness, but the prerequisite is that those in this confrontation or synthesis of trauma are not flooded with emotions as is the case with trauma. being able to establish a feeling of security.

There is also this concept of resource activation, which means that the person has developed a feeling of what was good, what good relationships there were and what is also important to the person who he has achieved it. the background of this very low self-esteem that they often have because it makes no sense to try a trauma confrontation, a synthesis and integration of the trauma if you have a minimum of self-acceptance, otherwise it can happen in this The procedure that reaches the The conclusion is definitely My bad, we don't want that. How long will the treatment of such a patient last?

We often offer interval treatments, meaning in this first phase it was often six weeks, eight weeks. We don't even do it. for us to face this trauma, but it is about activating resources, having an idea of ​​what happened, developing a feeling of security, it is important to transmit to be able to deal with stronger emotions so that we can then in a later phase, we can do a trauma confrontation because, ultimately, that involves a measured mobilization of these intrusive elements in small, finely dosed ways so that they do not overwhelm. Thank you very much for the interesting conversation.

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