Long after Sigmund Freud suggested--and then backed away from the concept--that the source of many psychiatric problems in adults was sexual molestation in childhood, mental health therapists are only beginning to identify the problems that follow molestation victims into adulthood.
But recent progress has been significant, experts say, as more adults come forward to reveal past abuse and seek treatment for emotional wounds.
From family counselors to psychiatrists to sex therapists, professionals are just now beginning to look for symptoms of childhood sexual abuse in adult patients who may have no memory of it, says Dr. Joshua S. Golden, co-director of the human sexuality program at UCLA.
"We have just awakened to the fact that there are a whole range of behaviors that, until now, we have not understood to be caused by childhood sexual abuse," Golden says. "Lots of the problems of people, such as (hospitalized) psychiatric patients and adolescent psychiatric patients, we are now beginning to recognize, are often the results of childhood sexual abuse and other forms of childhood abuse. We are awakening to the fact that these problems are very abundant."
One of the most common consequences of childhood molestation is sexual dysfunction, the topic of a conference sponsored by UCLA Extension that ended Saturday. The conference, titled "Treatment of the Sexual Problems of Adults Molested as Children," is thought to be the first of its kind, Golden says, and will become an annual event.
Many factors conspire to keep childhood sexual abuse and its lifelong consequences shrouded in secrecy, even in an age of relative enlightenment, experts report. Among the obstacles:
* Americans still find any discussion of sex difficult.
* Society still dismisses children who report abuse and, according to some experts, generally regards the feelings of children as unworthy of adult attention.
* Children who hide sexual abuse often work hard to forget about it so that if and when emotional and sexual problems occur, the cause is buried.
The fact that many adults who seek therapy do not remember abuse is of great importance in trying to assess the prevalence of child molestation, Golden says. While recent surveys reveal that 15% to 25% of adults report they were molested as children, those figures represent only those who remember the abuse.
"The more severe the damage, the earlier it occurs, the less likely people are to remember it," Golden says.
Now, while children are still often ignored, therapists are beginning to listen to adult patients who give clues of sexual abuse deep in their past. That progress has required therapists--even sex therapists--to shed their own distaste for dealing with sexual abuse, says Dr. Roland Summit, a psychiatrist at Harbor UCLA Medical Center.
"Until very recently, people in human sexuality were kind of morbidly offended by sexual abuse," he says.
Therapists will find no easy answers in treating these patients, Golden says. Victims of incest or molestation often have inhibited sexual desires and are unable to sustain a healthy sexual relationship as an adult. A smaller number lean toward promiscuity or become prostitutes, Golden says.
All the victims "tend to feel that they themselves are responsible for whatever misfortune has fallen on them. That is often the message that is given to them from perpetrators. These people have great difficulty trusting. They tend to be frightened and anxious because they have been traumatized."
If the patient is involved in a relationship, the problems usually affect the partner as well, he says.
"The effects of (sexual abuse) ripple out like a stone on a pond. You not only have the effects on the patient, primarily women, but if they are in a relationship, those relationships are going to be affected in profound ways."
Adults often do not report incest or childhood molestation during interviews with therapists. But under hypnosis they recall the abuse, says Dr. D. Corydon Hammond, a Utah-based sex and marital therapist.
"Later, in doing hypnosis, we'll uncover incest (that occurred) usually at a preschool age," Hammond says. "I think the figures on incest and child molestation are serious enough. But that is only of conscious, reported rape."
Surveys of childhood sexual abuse taken in the last decade have triggered a new determination among therapists to explore the effects of abuse. In an often-cited 1985 survey, a Los Angeles Times Poll found that at least 22% of Americans were victims of childhood sexual abuse. One-third of them told no one at the time and lived with their secret into adulthood, the survey showed.
However, many victims will divulge their secrets only in an anonymous survey, experts say. Both therapists and victims need to become more comfortable in talking about sexual abuse, Summit says.