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Section 4
Secondary Consequences of Childhood Sexual Trauma:
Panic Attacks, Objectification and Chronic Illness

Question 4 | Test | Table of Contents

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In the first two sections we discussed narrow range of emotions, emotional flooding, emotional numbing, confused thinking, feeling hopeless and helpless, nightmares and flashbacks, eight of the secondary consequences a sexually abused child can experience as the pressure to release the pain becomes stronger than the defenses being used.

In this section, we will continue to look at the last of the secondary consequences resulting from living with the secrets of childhood sexual trauma. The secondary consequences are: panic attacks, body objectification, chronic fatigue and minor illnesses. At the end of this section, we will look at using a Comfort List to calm a panic attack. We will also look at how "a view through the eyes of others" and an "I feel when" exercise can provide opportunities to discuss various self-perceptions your client is dealing with.

♦ Panic Attacks
As you know, panic attacks begin with overwhelming feelings of dread, pain and helplessness and can provide indicators regarding unresolved pain. Seventeen year old, Patty was sexually abused by Jake, a neighbor when he lived near her family 10 years ago. She began experiencing panic attacks as she began to deal with the trauma of her childhood sexual abuse, which she described as, "My heart would race and I couldn't catch my breath. I get so frightened. There is this sense of doom, right around the corner, I'm going to die. One time I went to the emergency room because I thought I was having a heart attack."

♦ Body Objectification
In addition to panic attacks, body objectification is another secondary consequence Patty experienced. She didn't see her body as her home or her own, but rather as an object. As she put it, "I didn't care what happened to my body. I saw it as defective, imperfect parts, not whole. It didn't have any real meaning or value to me." Another group member Kayla, age 14, experienced violent oral sex by her babysitter. Kayla also did not care what happened to her body and would mutilate and scar it with a paperclip, which she would run up and down her left forearm. Consider your Kayla. Is her perception of her own body as an object or a part of who she is?

♦ Chronic Fatigue
In addition to panic attacks and body objectification, Kayla also struggled with the third consequence of chronic fatigue. As you are aware, it takes a great amount of energy to suppress the pain associated with childhood sexual abuse and this can result in both emotional and physical exhaustion. Kayla described her fatigue as, "A total lack of energy. My friends call to go bowling or the movies, and I just don't want to go. I am tired all the time. I'm not sad or bummed, just too tired!"

♦ Chronic Minor Illnesses
Similar to chronic fatigue, is the fourth and final of the secondary consequences,chronic minor illnesses. As you know, the same energy it takes to suppress the pain that causes chronic fatigue can also surface as ongoing minor illnesses or accidents. If you recall Patty from the beginning of this tack was the 16 year old abused by her neighbor, Jake when she was six. She had a health history filled with accidents and illness. Patty's suffered from frequent headaches. Her accidents included falling down the stairs, spraining her ankle. She stated, "I just don't feel very well and seem to always be tripping over something."

She had no idea the accidents and illness were related to the abuse she experienced while her neighbor still lived in the neighborhood. In her journal she writes, "I remember being healthy up until the age of 6 or so and then all of a sudden I couldn't play soccer or baseball anymore, because I was sick all the time. And accident prone, you bet! I was always falling over my own feet or bumping into walls. I remember the first time my neighbor abused me. I think I was five or six." Think about your Patty? Does her health history provide any clues to her sexual abuse?

I found three techniques to be beneficial with the secondary consequences of panic attack, body objectification, chronic fatigue and chronic minor illness. These techniques are Comfort list, a view through the eyes of others and an "I feel when" exercise.

3 Techniques Beneficial for Secondary Consequences of Sexual Abuse

♦ #1 - Comfort List Technique
A Comfort List exercise I suggested Patty use to help her during a panic attack, began in a quiet session. I asked Patty to write down a list of things that helped her relax. I told her, "There are no right or wrong answers. This is an individualized list that is unique to you."

Patty's Comfort List:
1. Breathe.
2. Hug my teddy bear.
3. Call Sandy.
4. Call Karen if Sandy isn't home.
5. Pet my cat.
6. Take a warm bath.
7. Write ten times, "I'm safe. Jake can't hurt me anymore."
8. Go for a run.
9. Listen to my walkman.
10. Pray.
11. Watch MTV.

I explained to Patty that this was to work through and calm her during her panic attack. Patty thought it was a good idea to keep this list under her pillow where she could easily grab it.

♦ #2 - "A View Through the Eyes of Others"Technique
With Patty I also found it beneficial to work on "a view through the eyes of others" exercise. Patty finished the following statements about what she believed different people in her world would say about her Patty stated, "My best friend would describe me as quiet and caring; The person(s) who sexually abused me would describe me as easily frightened; Someone who dislikes me would describe me as weird; My mother would describe me as pretty and smart; My father would describe me as his little girl; My brother(s) and /or sister(s) would describe me as a squirt." After she used this exercise over a period of several sessions, she started to experience a broadening of her perspective of her own self image.

♦ #3 - "I Feel When"Technique
With Kayla, I used the "I feel when" exercise, which I have found often helps survivors who have difficulty identifying and expressing feelings. Kayla struggled at first to complete this exercise, which as you are aware, when drawing a blank or experiencing tension may signal a repressed memory.

Kayla completed the "I feel" statements as follows, "I feel okay when I am walking outside; I feel affectionate when I receive a compliment and hug; I feel hurt when my kids at school make fun of me; I feel loving when I am taking care of my cat; I feel shy when I am put on the spot to speak; I feel anxious when I have to say no to my friends; I feel happy when I have the energy to do things with my friends; I feel ashamed when a boy looks at me funny; and I feel confused when I am tired and have to think or concentrate."

in this section, we have reviewed the secondary consequences of panic attacks, body objectification, chronic fatigue and minor illnesses. This brings us to the three stages of recovery and the Family Mottos Technique which will be discussed in the next section.
Reviewed 2023

Peer-Reviewed Journal Article Reference:
Assink, M., van der Put, C. E., Meeuwsen, M. W. C. M., de Jong, N. M., Oort, F. J., Stams, G. J. J. M., & Hoeve, M. (2019). Risk factors for child sexual abuse victimization: A meta-analytic review. Psychological Bulletin, 145(5), 459–489.

Franz, M. R., DiLillo, D., & Gervais, S. J. (2016). Sexual objectification and sexual assault: Do self-objectification and sexual assertiveness account for the link? Psychology of Violence, 6(2), 262–270.

Levenson, J. S., & Grady, M. D. (2016). The influence of childhood trauma on sexual violence and sexual deviance in adulthood. Traumatology, 22(2), 94–103.

Schuler, M., Mohnke, S., Amelung, T., Dziobek, I., Lemme, B., Borchardt, V., Gerwinn, H., Kärgel, C., Kneer, J., Massau, C., Pohl, A., Tenbergen, G., Weiß, S., Wittfoth, M., Waller, L., Beier, K. M., Walter, M., Ponseti, J., Schiffer, B., . . . Walter, H. (2019). Empathy in pedophilia and sexual offending against children: A multifaceted approach. Journal of Abnormal Psychology, 128(5), 453–464.

Webster, G. (2018). Psychoanalytic complexity theory: An application to the treatment of child sexual offenders. Psychoanalytic Psychology, 35(1), 83–92.

QUESTION 4
If your client is experiencing panic attacks, body objectification, chronic fatigue and minor illnesses, what are three techniques you might consider utilizing? To select and enter your answer go to Test.

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