Common Concerns

Survivors who contact us raise many important questions. Here we offer some answers and perspectives.

What is abuse and what is trauma?

Many people contact us because they are not sure whether their childhood experiences count as abuse. Some compare their experience to other people’s and feel what happened to them was not as bad. Others are very clear that what they experienced should never have happened.

There are many formal definitions of abuse and trauma but the only one that matters is yours. Only you can know whether what you experienced felt abusive and has had a harmful impact on your life. If you are still struggling with what happened to you in childhood, if the memories of what happened still bring you pain or distress, it is very likely that you experienced some type of abuse or neglect.

Abuse and neglect, whether short term or over many years, are traumatic experiences for a child. They threaten our sense of physical or emotional safety or even our life and overwhelm our nervous system. The effects of the trauma are deepened if it’s not possible to escape the threat, which is naturally the case for (most) children.

All types of abuse—physical, emotional or sexual—and neglect can harm, regardless of whether it happened many times over many years or whether it happened just once. Once is too much. What matters is the impact it has had on your life.

Many different factors play a part in how well our bodies and minds cope under the stress of abuse and neglect – your age at the time of the abuse; the relationship to your abuser; the type of response you received when you first spoke about it; the level and quality of support you received (if any) and many more.

To further reflect on this issue, please review the NAPAC booklet “Was it really abuse?”.

Is my mental health diagnosis linked to the abuse?

Many survivors who contact us report a range of different mental health diagnoses that they received at different times in their lives and which many experience as labelling or confusing. These diagnoses typically end in the word ‘disorder’. One of the world’s main mental health diagnostics manual, the DSM-5, lists an astonishing 297 ‘disorders’.

It is not only many of our callers but also a growing number of mental health experts who actively challenge why we have come to view emotional distress as a ‘disorder.’

The traumatic experiences that caused the distress were abnormal – not our response to them. Emotional distress is an appropriate response to threatening, abusive, traumatic or otherwise harmful experiences. It tells us something is wrong.

We now know that chronic stress from abuse and neglect in childhood harms our developing brain and body, and therefore how we think, feel and behave in adulthood.  The good news is that there is also growing evidence that these effects can be healed over time.

Among the most common diagnoses reported by our callers are depression, anxiety, borderline personality disorder, bipolar disorder, schizophrenia, dissociative identity disorder, eating disorders and ADHD.  Recently, more callers are reporting a diagnosis of post-traumatic stress disorder (PTSD) which, while more accurate for one-off trauma, still does not fully capture the complexity of long-term abuse in childhood.

Complex trauma—the diagnosis that we feel most accurately describes the key symptoms of long-term child abuse—will be included in the World Health Organisation’s diagnostics manual (ICD-11) for the first time (albeit as Complex Post-Traumatic Stress Disorderand is already recognised by the NHS. This diagnosis was first suggested in 1992 by leading incest and traumatic stress researcher Judith L. Herman to capture the long-term effects of childhood abuse and other types of violence between people.

The key symptoms of complex trauma are:

  • consistent sense of threat (hypervigilance)
  • re-experiencing the abuse (flashbacks)
  • avoidance of anything that is a reminder of the abuse
  • difficulties managing emotions
  • difficulties relating to other people
  • a negative (or weak) sense of self

Many who have experienced abuse—or have been working with people who have—recognise that the medical community’s focus on symptoms rather than causes (“what’s wrong with you?” rather than “what happened to you?”) makes survivors feel blameworthy, powerless, deficient and separate – just like the original abuse made them feel.

It is worth noting that some survivors who call us initially embrace a diagnosis of a mental health disorder in the hope that it will finally open a door to receiving support. Others may simply experience relief from being able to give a name to the symptoms they are struggling with.

Whatever perspective you take, remember that you are the expert of your life experience. Only you have lived in your body all this time. When reaching out to someone to address any symptoms that you feel are linked to your abuse, practitioners should always work in close partnership with you instead of merely prescribing treatments that they feel are right for you.

Understanding the underlying causes for your distress is crucial to your recovery. If you aren’t already a dedicated researcher on the topic of abuse and trauma (many survivors who call us are), then now may be the time to start. Our Recommended Reading page lists what we consider important books on the topic of abuse, trauma and approaches to recovery.

 

How can therapy help?

Abuse in childhood has a profound impact on a person’s ability to trust other people. It therefore makes sense that one of the key tasks in our recovery from abuse is to learn how to regain that trust and connection to other people.

A therapist, counsellor or any other person who you feel safe with can play a key part in this process. Their main task is to offer safety, support and unconditional positive regard. Advice and direction should only be offered if you ask for it. Therapists should never try and convince you that they know what’s best for you or disempower you in any way. Their role is to show you what a healthy relationship with another person feels and looks like.

Therapists and counsellors will also support you in facing up to feelings that you may have suppressed for many years. S/he can also work with you in addressing many of the symptoms of abuse that you might be struggling with now – such as depression, anxiety, self-harm, addictions, self-sabotage and the like.

At first, you may feel worse as you go through the process of coming to terms with painful feelings. This is normal. You are facing up to something that you had to push aside for a long time. But the right support will make you feel stronger in the long run and allow you to take charge of your emotions, your thoughts and your life.

There are many different types of therapy but almost none of that matters. What matters is whether you feel safe with your therapist, counsellor or supportive person and whether working with that person is making a positive difference in how you feel about yourself and others.

Not all therapy is talk therapy. There is body-centred therapy, art therapy, dance therapy, equine therapy, psychodrama, EMDR, trauma release exercises, and many other approaches that can support you in dealing with the impact of the abuse without ever having to talk about what happened. Find out what resonates the most for you and explore.

If you choose to find therapy outside of the NHS, many private therapists or third-sector organisations offer “pay-what-you-can” or sliding scale options for anyone who is struggling financially. Don’t feel shy about asking for such options. They are common.

While qualifications and membership of a professional association may offer some protection from malpractice by therapists, they do not guarantee that he or she has the human qualities and skills needed to work with abuse survivors. We have heard from many callers who said they felt most supported by someone who simply had the capacity and willingness to do so – a neighbour, a community psychiatric nurse, a support worker, a student counsellor and many more who may never had any advanced training. Research has shown that most survivors feel best supported by people in the voluntary/charity sector where they felt heard, believed and respected.

If there is something that you do not feel comfortable with when working with a therapist or counsellor, you can contact their professional association or employer to get advice or make a formal complaint. BACP and UKCP, the two leading professional associations for therapists, outline the process on their respective websites.

Group work – whether it’s group therapy, psychoeducation groups or peer-led support groups – is also known to be highly empowering for abuse survivors who feel ready to join a group. Many survivors build up confidence in one-to-one counselling before connecting with a group; others feel more comfortable being part of a group before moving on to individual counselling or therapy.

NAPAC knows from experience that support groups can transform lives. We will continue to offer support groups whenever funding permits, but please also review The Survivors Trust website to find other organisations running groups in your area.

Some survivors have also found it useful to join peer-to-peer support groups such as CODA, Al-Anon or ACOA – all of which address the impacts of having grown up around people who were abusive, neglectful or otherwise unable to support a child.

How can I overcome my fear of medical examinations?

Many survivors we hear from talk about their fears when having to access health services, particularly sexual health, gynaecology and breast wellbeing for women, prostate cancer screening for men, and dentistry for both women and men.

Aside from the very real fears that many survivors feel about accessing these intimate forms of health care, NAPAC is also aware of the lack of self-worth many survivors suffer and their felt sense that they are not deserving of health care or they have no right to express their needs.

Although each survivor’s experiences are unique and different, we often hear description of similar experiences with medical examinations. For some survivors just receiving a reminder from a medical practice is enough to trigger flashbacks, panic attacks and much fear.  Any examinations themselves have the potential of being highly retraumatising.

Survivors may feel that they are not understood by health practitioners and that they are not in control of their body during examinations.  Female survivors also talk about their fears that a smear test will cause physical tension or freezing, making it an extremely painful experience.

Having a negative or even retraumatising medical examination can prevent survivors from attending future testing, which will increase the risk of illness and disease.  Survivors are of course aware of this risk, but we repeatedly hear that some would rather deal with the consequences later than face the experience of regular check-ups or testing.

The following steps may help you overcome at least some of your fears and feel in control when preparing for a medical examination:

  • Talk to your practitioner at the start of the appointment – explaining that you are highly anxious about medical examinations. You do not have to give any reason – even if pressed. Simply making them aware that this is an extremely challenging situation for you can alert practitioners to proceed with greater care.
  • Ask a friend or supporter to be present during any examination – giving the same reason as above.
  • Tell the practitioner how you want to be addressed and receive any instructions that are needed for a successful completion of the examination. The use of pet names (‘darling’, ‘love’, ‘sweetie’ etc.) that are still frequently used by health practitioners are triggering for many survivors. Telling a survivor to ‘relax’ during an examination can also be retraumatising as this is something that an abuser would tell a child. Although some NHS guidance has improved recently, many practitioners are unfortunately still not trained in trauma-informed practices and will have an opportunity to learn from you when you express your needs. Moreover, you will feel empowered by expressing your needs.
  • Explain that you need complete privacy when undressing or changing for the examination.
    • Agree a clear signal with the practitioner that will prompt them to halt the test at any time.

Always remember that you have the right to be treated respectfully and that you are equal to the practitioner working with you.  Just like everybody else, you have the right to ask for what you need to be able to take care of your physical health.

Why do I feel guilt and shame?

A large majority of survivors who contact us report that they were sexually abused by someone in their family or someone they knew. This means that they probably already had an emotional connection with their abuser or that the abuser deliberately developed this connection with the intent to abuse.

The process of developing a connection with the intent of sexual abuse, commonly referred to as ‘grooming’, typically involves the abuser identifying what is lacking in the child’s life and then meeting those unmet needs. The abuser might offer the child anything from food, attention, physical care and touch, clothing, toys, day trips or anything else that the child needs or desires.

It is completely normal—and crucial for survival—that children feel drawn to people who meet their needs.  However, abusers deliberately manipulate this need to get physically closer to the child, win their trust, and eventually sexualise the relationship. This process can take months or even years and often also involves the grooming of the child’s parent or caregiver. If the parent or caregiver perceives the abuser as a helpful, generous, upstanding citizen, they are far less likely to believe the child if she or he discloses the abuse at the time or in the future.

The main reason abusers go through such lengths is to prevent getting caught. The emotional manipulation leads to many children feeling that they chose to go along with the abuse, making them far less likely to disclose to someone else what is happening. In the long term, survivors are left with a crushing sense of self-blame, shame and guilt that can carry long into adulthood. The transfer of responsibility from abuser to child is complete.

The confusion a child experiences when abused by someone they loved and trusted is a form of psychological harm that for many survivors is more devastating than the sexual abuse itself. It robs them of the ability to trust anyone who offers care, attention or gifts later in life, deepening their sense of isolation and robbing them of the crucial benefits that come from the ability to form healthy and supportive relationships with others.

It takes time to untangle this “web of confusion” and free ourselves from the burden of responsibility that was never ours. Most survivors do so when they start connecting with a counsellor or therapist or another supportive and trustworthy person in their life.

Read more in “What does recovery look like?” in the section below.

Should I disclose my experience of abuse and, if yes, to whom?

There is a long list of reasons why people who suffered abuse in childhood are reluctant to talk about it and may never do so. The majority of our callers did not disclose until decades after the event.  Saying out loud what happened to you is a challenging but profound experience. For most, it is a crucial step in their recovery journey.

It is equally important to consider who to disclose to and what the consequences of the disclosure might look like. First and foremost, it is important to consider potential consequences of a disclosure for you. Disclosing to a person who is unable to listen and respond appropriately can be highly retraumatising – in other words, trigger physical and/or emotional responses reminiscent of the abuse. Reflect with care on who to choose as a safe and appropriate recipient of your disclosure – whether it’s within your family, among friends or a professional.

Making a disclosure may affect your family in many ways, irrespective of whether the abuse took place within the family or not.  Callers to our support line often speak about how their disclosure caused a split in their family or among their friends who, for their very own reasons, take sides with the survivor or the abuser.  For example, we frequently hear about mothers taking side with a father, step-father or partner who has been abusing their daughter. However, a disclosure also may unite a family to tackle the problem together, sometimes through family therapy. We hear more often about negative effects on the family, but of course that’s also because people who have had a positive experience with their disclosure are less likely to call us for support.

If you decide to disclose to an employee of a statutory organisation (such as the NHS, police, schools or any other organisation funded or regulated by the government), their Safeguarding policy may require them to share your information with others – even without your consent. However, we believe this should only happen when it is clear that they can prevent potential harm to you, a child, or a vulnerable adult or the breach of confidentiality is otherwise in the public interest.

When reaching out for support, it is important that you know in advance what the person or organisation who you disclose to is likely to do with the information. Before disclosing, ask them exactly what they can and cannot keep confidential so that you can make an informed choice and remain in control of the situation.

You never have to disclose any details of your abuse when you seek support. You don’t have to say what happened, who was involved or give any identifiable information. You don’t owe anybody anything. You could simply state that you were abused but are not ready or willing to talk about the details. This will help keep the focus on what you need now and ensure that the provider will offer appropriate support and services.

You might get pressed to provide additional information, but you are never under any obligation to give it. Without names, times and/or locations, a professional has no cause to breach confidentiality.

The most important questions you may want to ask yourself are:

  • Why do I want to disclose? What is my key motivation?
  • What do I hope the disclosure will achieve?
  • Will I achieve this outcome when disclosing to this particular person or organisation?
  • Who else could I speak with who I know will keep the information confidential?
What does recovery look like?

The short answer is that recovery looks different for every single survivor. There is no clear-cut path and many survivors talk about going through peaks and troughs as they face up to what happened to them and the effects it had on their lives.

Nevertheless, there are common patterns and useful approaches that some survivors find helpful. In her book “Trauma & Recovery,” Judith L. Herman developed a three-stage sequence based on her clinical experience of working with survivors.  You may find that reviewing the stages offers direction and hope or resonates with your own experiences so far.

The first stage of this model stresses the importance for the survivor to gain a sense of physical safety and stability. First and foremost, this will mean finding a safe place to live (where necessary and possible), ending any abusive relationships, and starting to engage with a counsellor, therapist or other safe and supportive person.

Learning to feel safe in your body can come in many ways, typically any type of exercise and/or relaxation techniques (such as yoga, meditation, trauma-release exercises, visualisations, mindfulness or listening to music). What is important is that you choose what feels right to you and that it feels comfortable and enjoyable to you. Learning to name your feelings can also be part of this stage.

The second stage typically involves work with your therapist or supportive person to connect to, normalise and feel the feelings you have long pushed aside. You should never feel pressured to say out loud what happened to you in the past. While many survivors experience a sense of relief when they do, others may not yet—or never—be ready to do so. Only you know when the time is right to disclose details of the abuse.

Recognising that the abuse you suffered is something that happened to you in the past but does not define you as a person is a crucial part of this second stage. Many survivors find it difficult to recognise and acknowledge their incredible strength, resilience and adaptability they used to survive as well as many other skills and competencies that they never had the chance to use. The second stage therefore may involve a review of thinking and behaviour that kept you safe and worked very well in the past but that may no longer serve you or even harm you in the present – for example any type of addictions, dissociation, anger, or always putting others’ needs before yours. You can then start identifying healthier ways to reduce stress and tolerate uncomfortable feelings.

The third stage of recovery typically involves moving into a life that is no longer dominated by memories or feelings linked to the abuse. You may feel triggered less frequently and intensely, develop a stronger sense of self, set and pursue personal goals, feel less threatened by relationships and intimacy, and start accepting healthy challenges.

Few people ever progress through these stages in a straight line. There is almost always overlap that may feel like taking two steps forward, one step back.  New life events, particularly stressful milestones such as marriage or divorce, birth or death, illness or retirement, moving to a new house or relocating to another country, may set off a new wave of post-traumatic stress symptoms. But as you progress in your recovery journey you have new skills and tools that will help you through challenges and you will find that any setbacks will feel less intense and are shorter than they used to be. Everything you experience are normal responses that are only to be expected. You are human!

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