**Gender Differences in the Impact of Child Sexual Abuse on Alexithymia, Dissociation and Self**

Peter Paul Moormann1, Francine Albach3, Bob Bermond2, Annemieke van Dijke4, Jakob de Jong1, Jaco Wineke1, Kalliopi Metta1 and Argyro Karanafti1 *1Leiden University, 2University of Amsterdam, 3Private Psychotherapeutic Center in Amsterdam 4Delta Psychiatric Center, The Netherlands* 

### **1. Introduction**

74 Sexual Abuse – Breaking the Silence

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

relationship between dissociative symptoms, alexithymia, impulsivity, sexual

Childhood Sexual Abuse (CSA) is a topic with a long history in both psychiatry and psychology. In fact grand old theories such as Freud's Psychodynamic Theory, its predecessor the Seduction Theory, and Janet's Dissociation Theory were based on the investigation of hysteria in cases of sexual abuse. In those days sexual abuse primarily concerned women. The recent attention in the media for male victims of sexual abuse, particularly young boys having been molested by Catholic priests and very young children having been abused in crèches and being exposed on the secret internet websites of paedophile networks, has led after the second feministic wave to a renewed interest in CSA and its adverse effects. Therefore in the forthcoming research the following questions will be raised:

What is the impact of severe CSA on alexithymia, dissociation and self? Do female subjects differ from male subjects on the impact of CSA?

In the theoretical part first the issue of credibility in relation to gender will be briefly discussed in a historical perspective. Sexual abuse is a criminal act and the credibility of a victim who accuses a perpetrator of sexual abuse has always been, and still is, a delicate subject in court. After having dealt with the literature on the impact of CSA upon alexithymia, dissociation and self the theoretical part will be concluded with some general findings on how the sexes cope with CSA, as no systematic studies have been conducted yet on gender differences in alexithymia, dissociation and self in CSA.

#### **2. Gender and the issue of credibility**

In contrast with female victims of sexual abuse from the 19th century on up to the recent case of DSK (Dominique Strauss-Kahn) the credibility of war victims in the 1st World War was

Gender Differences in the Impact of Child Sexual Abuse on Alexithymia, Dissociation and Self 77

*priests apparently is not an issue of serious debate*. If this line of reasoning is true then, even in the 21st century the impact of sexual abuse for women is far greater than for men, as the credibility of women is even nowadays under debate. They are still considered to be liars, fantasy-prone, too emotional and therefore their credibility is dubious. The recent case of 'DSK' seems to confirm that 'pseudologia phantastica' still rules in court. This almost archetypal denigrated attitude towards women might also explain the negative self, commonly reported by

Alexithymia has been introduced by Sifneos and literally means *'wordless affect'*, indicating the incapacity to recognize and express the emotional experience in verbal forms. Sifneos (1973) came up with this term after observing that a great amount of patients suffering from psychosomatic complaints were not able to verbally express and describe their affective experience and also distinguish it from bodily sensations; such difficulty constituted only a part of a wider cluster of cognitive and affective characteristics also including restricted imagination characterized by a marked paucity of fantasy and a literal, utilitarian cognitive style that is externally oriented. This cluster of characteristics constitutes a major obstacle in the process of treatment and contributes to the failure of

Krystal (1988) was probably the first to emphasize that alexithymia is one of the sequelae of traumatic experiences. From research data evidence exists for the idea that psycho-traumata can indeed induce alexithymia (Hyer et al., 1990; Thomas et al., 1992; Berenbaum & James, 1994; Zlotnick, et al., 2001; Frewen et al., 2008). Victims of both rape (Zeitlin et al., 1993) and CSA (Albach & Everaerd, 1992; Berenbaum, 1996; Cloitre et al., 1997; Moormann et al, 1997; Sher & Twaite, 1999; Bermond et al., 2008) are known to suffer from alexithymia. Milder forms of CSA are not always associated with alexithymia (Paivio & McCulloch, 2004;

Pierre Janet (1889) was the first to describe the concept of dissociation as a result of his extensive work with hysteric patients. He referred to dissociation as a process involving the breaking down of those structures of the mind that are interconnected within a single stream of consciousness. More specifically, the mind is constructed by separate compartments constituting from emotions, cognitions and actions; however as a consequence of trauma, stress or weakness the breakdown of this stream of consciousness may occur as a result of the splitting of one of those structures from the rest. Such alternations then in those structures inhibit the normal integration of information to the components that are involved and induce alternations in memory and identity, promoting in such way the development of different kinds of dissociative disorders, depending on the

Dissociation, one of the adverse effects of CSA (Chu & Dill, 1990; Ensink, 1992; Kirby et al., 1999; Kisiel & Lyons, 2001 ), is often studied together with alexithymia, and both constructs

victimized women (Russell, 1986).

**3.1 Impact of CSA on alexithymia** 

response to therapy (Sifneos, 1975).

**3.2 Impact of CSA on dissociation** 

severity of the symptoms (Putnam, 1993).

Kooiman et al., 2004; Modestine, Furrer, & Malti, 2005).

**3. Impact of CSA on alexithymia, dissociation, and self** 

not an issue of importance. There were no doubts on what had happened to them, because quite often there was a whole regiment of witnesses. However doubts existed on whether soldiers were really ill as they displayed a wide array of behavior that nowadays would be classified as conversion hysteria. Since Horowitz's (1976) introduction of the Theory of Stress Response Syndromes there has been a growing interest in the effects of exposure to traumatic events, and the systematic investigation of complaints reported by male survivors of war resulted in the description of Post Traumatic Stress Disorder (PTSD). However it took much longer before reports of CSA in women were taken seriously. Already from the end of the 19th century reports on female sexual abuse were considered to be false sexual allegations ('sexuelle Falschanschuldigungen' in German, see Birnbaum, 1915) and in France it was called the phenomenon of the 'accusatrices hystériques' (see Garnier, 1903). This tradition was kept alive when Psychoanalysis dominated the academic scene, as accounts of sexual abuse were simply treated as 'Oedipal Fantasies'. Hence, the term 'pseudologia phantastica' is firmly rooted in the history of CSA. Only quite recently, during the second feministic wave in the last two decades of the 20ieth century it was acknowledged by academic psychology that CSA really occurs and that the effects can be traumatic enough to meet the criteria of PTSD (see Finkelhor & Browne, 1985; Albach & Everaerd, 1992; Albach, 1993; Zeitlin et al., 1993). However, the battle had not been won yet. In particular women with repressed memories of sexual abuse (those who experienced episodes of inability to recall the event) had a long history of being treated with great suspicion (Albach et al., 1996). The last revival of this skeptic tradition (the abuse did not really happen) evolved after 1990 and was based on the idea of false or implanted memories created under hypnosis in psychotherapy (Ceci & Loftus, 1994; Loftus, 1993, 1997). The foregoing on credibility illustrates well that war victims and CSA women have in common that both were accused of pretending or lying, however on different grounds. Soldiers were accused of lying about their illness; by malingering they tried to avoid being sent back to the deadly frontlines, while CSA women were accused of lying about what had happened to them, e.g. about the sexual abuse as an excuse or explanation for their current miserable psychological state (Crombach & Merkelbach, 1996).

Until recently studies on CSA were almost uniquely based on women. Empirical studies on the impact of CSA in male victims were beyond the scope of the feministic perspective. However the numerous recent reports of male CSA victims within the Roman Catholic Church in the media inevitably had to lead to a shift of focus in this female-only approach. Comparisons between female and male victims are a logical consequence. It is striking that in all female cases fantasy-proneness or high suggestibility is used as a personality trait causing women to report such lies or false memories, while in the recent cases of male sexual abuse, in the media hardly any doubts on the credibility of the reports of the male victims has been expressed. It might be that under enormous political pressure from the media, the already badly wounded Catholic Church had no other way-out than to stand in a white sheet, and the priests, some of whom are still alive, lost their status of inviolability and as a consequence had to confess their misconduct. Although it cannot be denied that in some cases women do lie about or simulate sexual abuse (see the literature on false memories, for instance Yapko, 1994), as by the way happens with many other events in court, it remains remarkable that *even the second feministic wave has not been robust enough to prevent women from being accused of hysteria, making up stories or lying about sexual abuse, while the credibility of men reporting being molested by*  *priests apparently is not an issue of serious debate*. If this line of reasoning is true then, even in the 21st century the impact of sexual abuse for women is far greater than for men, as the credibility of women is even nowadays under debate. They are still considered to be liars, fantasy-prone, too emotional and therefore their credibility is dubious. The recent case of 'DSK' seems to confirm that 'pseudologia phantastica' still rules in court. This almost archetypal denigrated attitude towards women might also explain the negative self, commonly reported by victimized women (Russell, 1986).
