**The Physiological Impact of Sexual Assault**

92 Sexual Abuse – Breaking the Silence

Ross, C.A.; Ellason, J.W. & Anderson, G. (1995). A factor analysis of the Dissociative

Russell, D.E.H. (1986). *The secret trauma: Incest in the lives of girls and women.* Basic Books,

Sher, D. & Twaite, J.A. (1999). The relationship between child sexual abuse and alexithymic

Sifneos, P.E. (1973). The prevalence of alexithymic characteristics in psychosomatic patients.

Sifneos, P.E. (1975). Problems of psychotherapy of patients with alexithymic characteristics and physical disease. *Psychotherapy and Psychosomatics,* Vol.26, pp. 65-70 Taylor, G.J.; Bagby, R.M. & Parker, D.A. (1997). *Disorders of affect regulation: Alexithymia in medical and psychiatric illness,* Cambridge University Press, Cambridge Thomas, R.K.; Krystal, J.H.; Giller, E.L.; Frank, J. & Dan., E. (1992). Alexithymia as a

Tzeng, O.C.S. & Schwarzin, H.I. (1990). Gender and race differences in child sexual abuse correlates. *International Journal of Intercultural Relations,* Vol.14, pp. 135-161 Vorst, H.C.M. & Bermond, B. (2001). Validity and reliability of the Bermond-Vorst

Walker, J.L.; Carey, P.D.; Mohr; N.; Stein, D.J. & Seedat, S. (2004). Gender differences in the

Wool, C.A. & Barsky, A.J. (1994). Do women somatize more than men? Gender differences

Yapko, M.D. (1994). *Suggestions of abuse: True and false memories of childhood sexual trauma*,

Zeitlin, S.B.; McNally, R.J. & Cassiday, K.L. (1993). Alexithymia in victims of sexual assault:

Zlotnick, C.; Shea, M.T.; Pearlstein, T.; Simpson, E.; Costello, E. & Begin, A. (1996). The

abuse, and self-mutulation. *Comprehensive Psychiatry,* Vol.37*,* pp. 12-16 Zlotnick, C.; Mattia, J. I. & Zimmermann, M. (2001). The relationship between post traumatic

*Psychotherapy and Psychosomatics*, Vol.22, pp. 250-262.

*of women's mental health*, Vol.7, Nr.2, pp. 111-121.

in somatization. *Psychosomatics,* Vol.35, pp. 445-452

235

New York

*Sexual Abuse,* Vol.8, pp. 25-40

Simon & Schuster, New York

*of Traumatic Stress*, Vol.14, pp. 177-187

661-663

Vol.*5*, pp. 563- 573

Experience Scale (DES) in dissociative identity disorder. *Dissociation, Vol.8,* pp. 229-

symptoms in a population of recovering adult substance abusers. *Journal of Child* 

predictor response in post traumatic stress disorder. *Journal of traumatic stress*,

Alexithymia Questionnaire. *Personality and Individual Differences,* Vol.30, pp. 413-434

prevalence of child sexual abuse and in the development of pediatric PTSD. *Archive* 

An effect of repeated traumatization? *American Journal of Psychiatry*, Vol.150, pp.

relationship between dissociative symptoms, alexithymia, impulsivity, sexual

stress disorder, childhood trauma and alexithymia in an outpatient sample. *Journal* 

**6** 

*USA* 

**Psychobiological Effects of Sexual Abuse** 

Sexual abuse represents a stressor that challenges psychobiological homeostasis. Basic survival requires an ability to maintain internal equilibrium by adjusting physiological processes to match the demands of the external and internal environment. "Stress" is a broad term representing any physical or psychological demand that challenges equilibrium. When outside temperatures rise, physiological systems respond with multiple changes so as to keep internal temperatures from rising to a dangerous level. As nourishment is depleted, hunger is an internal cue that prompts food seeking. If ignored, energy resources will be shut down to non-critical bodily functions and shunted to those most critical for continued survival (e.g., the brain). Threat of physical or psychological harm activates biological systems that facilitate an appropriate response, including aggressive defensive actions ("fight") or avoidance behavior ("flight"). Unfortunately, a protective response is often unavailable or ineffective in the context of sexual abuse. Alternatively, a psychobiological response may prove effective in the short-term, but ultimately lead to a chain of processes

In this chapter, we will: a) describe the biological systems most closely involved in regulating stress responses; b) review existing literature on the psychobiological consequences of child and adult sexual abuse; c) discuss limitations of existing data; and d) introduce a conceptual framework for understanding sexual abuse as it relates to future

Stressful experiences bring about a complex and counterbalancing set of hormonal responses in the sympathetic-adrenomedulary (SAM) and the hypothalamic-pituitaryadrenal axis (HPAA) systems, as well as the immune system. The basic components of these systems have been mapped out through animal studies, which allow for scientific control over the timing, frequency, type, and severity of the stress. Widely examined in animal and human research, the HPAA is best known as the regulator of the "fight-flight" response to threat, diverting energy resources needed for protective actions and promoting a subsequent return to homeostasis when the threat is no longer present. Such a system exists in all vertebrates (Lovejoy, 2005). Thus, the HPAA has been a central focus of basic animal research on fear conditioning, general effects of environmental stress, the developing brain, "learned helplessness" models of depression, as well as human studies of anxiety and mood

that set the stage for long-term mental and physical health risk.

**1. Introduction** 

mental and physical health.

**2. The biological response to threat** 

Dorie A. Glover, John K. Williams and Kimberly A. Kisler

*UCLA Semel Institute for Neuroscience and Human Behavior* 
