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 then "This also has greater consequences for the person affected. And this is what is called complex post-traumatic stress disorder. Children develop something like this, for example, after repeated sexual abuse. Dr. Emanuel Severus is the head doctor of the personality and dream disorders clinic at the Asklepios Norte clinic in Ochse. Thank you for the invitation?

Tell us again who exactly are those affected by this type of disorders. In In principle, many people can be affected by this type of disorder, who repeatedly experience very threatening events individually or in a group. A sequence or events of catastrophic proportions that go beyond normal experience. In fact, there is also the case that these complex post-traumatic stress disorders that you mentioned occur when such events occur 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 strict sense or can it also refer to sexual violence? On a purely psychological level, how far would you take it? This is also possible. Unfortunately, an experience of sexualized violence like this in sexual 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 there, the ass is protected and can be poured out while growing up, but emotional abuse experiences of violence are something like humiliation, terror, confinement and the 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's also kind of understandable in a sheltered parental home in a company it wouldn't 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? These are very different symptoms. I think if we think about them, if a child has such an experience, then it leads him to lose any sense of security or normal children grow up with the idea that the world might not be a good place, but predictable and manageable things would fit. .

For children who experience something like this, it is exactly the opposite: there is no safe place, which is the consequence. These children often experience constant threat, meaning they assume that ultimately every person they walk by 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 massive nervousness that we see is another symptom, often or not only a typical symptom of what we call intrusions or flashbacks, that is, they are fragments of memory of this traumatic event that burst into daily life and into oneself. uncontrolled, unexpected, very present, they feel threatening and sometimes have flashbacks. above all, 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, who is something.

Yes, it 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 then look like avoiding any situation that could serve as a carrier or permanently avoiding themselves. busy to avoid the possibility of such 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. It's a bit like moving away and not being able to perceive things correctly in order to be able 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-control. hatred that perhaps arises from the fact that the parents have told the children It's your fault, as well as yours, that's exactly what these symptoms that accompany complex PTSD are, the ones I just mentioned are those that 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, that often goes along with it. by massive self-hatred, which sometimes leads people to punish themselves.

Another symptom is that these people have great difficulties in relationships, especially the closest ones, which I think is also understandable, on the one hand, because they generally distrust people due to their experiences. Close relationships would simply 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 actually our parents and the child is actually a refuge of safety for the child, especially when he is still small. It completely depends on the parents to take care of it and what the children then experience is that these good parents like you are necessary for the children to grow.

If they then do something like that, then it somehow means that the child is obviously bad. It's bad, it doesn't deserve anything more, especially since, as you quite rightly said, in some cases you also said it to the children themselves, how can they help when a child like that comes to them? Often, because we are in adult psychiatric care, these children only come when they come. When they are 18 years old, they are in child and adolescent psychiatry before, but what? 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 the most adverse circumstances and they even found their way to therapy and that's the colossal thing. So it is a huge achievement that is by no means self-evident and I think this needs to be recognized first. Do that in psychotherapy, yes, that's you, of course. 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, complex post-traumatic stress disorders, about the mechanisms that are active, that Many times it helps a lot, that those who can classify it a little better and the third thing is perhaps also 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 as much control as possible and experiences as much self-efficacy as possible. 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? Try to avoid them, try to face them, try to tear them down or how to face them? 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 that at all and that is a prerequisite.

Then, being able to do something like trauma synthesis, 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 do not become inundated with emotions as is the case with trauma. capable of establishing 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, what too. The person who has achieved this is also important against the background of this very low self-esteem that they often have because there is no point in trying to confront the trauma, a synthesis and integration of the trauma if one has a minimum of self-acceptance, otherwise it can happen. in this The procedure that comes to the conclusion It's definitely my fault, we don't want that.

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

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