Sexual Abuse in Childhood:  Its Neurodevelopmental Effects on the Brain, and the Treatment

Despite the self-regenerative capacity that the brain possesses, a great many studies have put forward that the brain development is affected by the challenging experiences of one’s childhood (prenatal and postnatal maternal stress, malnutrition, violence, etc.).  Of those challenging experiences, sexual abuse suffered in childhood can lead to a number of adverse outcomes that include the decrease in cognitive functions.  Sexual Abuse can be defined as “an act in which an adult forcefully, threateningly or deceivingly takes advantage of a child or an adolescent, who has not yet completed their sexual development, in order to satisfy their sexual desires or needs (Çetin et al., 2008).

Based on the reports provided, the global rate of incidence of sexual abuse in childhood is 8-31% in girls, and 3-17% in boys.  Of the victims, %9 of the girls and 3% of the boys were forced to have sexual intercourse (Barth et al., 2013).  Nevertheless, these rates may be lower than they actually are due to reasons such as the individuals’ fear of reliving the trauma, the threats of the molester, or the individuals blaming themselves.

Sexual Abuse in Childhood: Its Neurodevelopmental Effects

The studies, which researched the effects sexual abuse in childhood on the brain development, put emphasis on the structure and function of the brain.  In a compilation of studies carried out by Blanco et al (2015), it was observed that, based on the findings obtained through the PET, MRI and fMRI methods, people who experienced sexual abused in their childhood:

1. Suffered a decrease of volume in a number of parts of the brain, such as the cerebral cortex that takes part in high cognitive activities; the prefrontal area that controls the faculties of reasoning and language; the hippocampus that is in charge of the memory; the amygdala that controls the sense of fear; the corpus callosum that enables the connection between the two hemispheres of the brain; the cerebellum that is the center of balance of the brain; the limbic system that enables the management of stress, and the hypothalamus-pituitary-adrenal (HPA) axis, in addition to an increase or decrease in the blood flow, which is an indicator of the activities in the aforementioned areas.
2. The abnormalities in those areas were found to be associated with disorders, such as depression, anxiety, post-traumatic stress disorder, attention and memory disorders, somatization disorder, anger, suicidal thoughts, alcohol addiction.
3. The patients, who experienced cognitive and psychological problems as a result of neurodevelopmental abnormalities, were found to have employed some maladaptive coping methods, such as substance use, dissociative behaviors, sensitivity to environment induced by the expectation of danger, self-harm, or suicidal behaviors, excessive bipolar sexual behaviors.
4. These behaviors persisting throughout the adulthood were reported to have negatively affected the partner selection in the adulthood, the sexual functions, and the academic and professional achievements of the children who were sexually abused.

Sexual Abuse in Childhood: Treatment

The trauma-oriented cognitive behavior therapy (CBT) is a psychotherapy method with proven effectiveness in the treatment of patients with a history of sexual abuse in childhood, alongside the medical treatment of comorbid disorders like depression, anxiety, post-traumatic stress disorder.  Trauma-oriented CBT covers:

• The education on trauma and its effects;
• The relaxation techniques, and the proper methods that can be used to cope with problems;
• The techniques that deal with false and useless thoughts regarding the abuse;
• The graded exposure method that enables children to share the details of their experiences, and to process the trauma-related thoughts and feelings that they have;
• The common parent-child sessions carried out to improve open communication about abuse and its effects;
• The parenting skills to manage problematic child behaviors that surfaced prior to the sexual abuse in childhood, or that is intensified as a result (Hanson and Wallis, 2018).

Consequently, although a great number of studies show that the cerebral structure and functions become impaired in individuals who experienced sexual abuse in their childhood, it must be kept in mind that the protective and rehabilitative factors in one’s life (the presence of supportive parents, early diagnosis, implementation of scientifically-proven treatment techniques) can slow down and repair this process, and that it is never too late for treatment.

REFERENCES:
– Çetin FÇ, Pehlivantürk B, Ünal F, et al (Editors). Çocuk ve ergen psikiyatrisi temel kitabı. In: İşeri E. Cinsel istismar. 1’inci Baskı, Ankara: Hekimler Yayın Birliği, 2008;470-7.

– Barth, J., Bermetz, L., Heim, E. et al. The current prevalence of child sexual abuse worldwide: a systematic review and meta-analysis. Int J Public Health 58, 469–483 (2013). https://doi.org/10.1007/s00038-012-0426-1

– Blanco, L., Nydegger, L. A., Camarillo, G., Trinidad, D. R., Schramm, E., & Ames, S. L. (2015). Neurological changes in brain structure and functions among individuals with a history of childhood sexual abuse: A review. Neuroscience & Biobehavioral Reviews, 57, 63-69.

– Hanson, R. F., & Wallis, E. (2018). Treating victims of child sexual abuse. American Journal of Psychiatry, 175(11), 1064-1070. https://doi.org/10.1176/appi.ajp.2018.18050578