By Shady Shebak, MD
The following is an important but understudied topic. It is one that includes several common diagnoses, and severe inner-psychic conflict regarding sexual assault. This case and discussion should serve as a reminder about societal biases, as well as a reminder that sexual trauma does not go away with time, and comes back in the form of personality disorders, stress disorders, while often playing a role in the progression of otherwise organic disorders such as bipolar disorder. I will provide a short vignette and then lead into a discussion, and conclude with a closing opinion. Names, ages, and events have been changed to protect the identity of involved parties.
Mr. X is a middle aged gentleman, with a history of bipolar disorder, post traumatic stress disorder, borderline personality disorder, and several psychosocial stressors, including two divorces within 2 years. At the age of 5, he was sexually molested on a school bus by several teenage boys who held him down, and a teenage girl who performed forced acts of a sexual nature on him. He still has nightmares about this trauma, as well as intrusive thoughts, hyper-vigilance, and panic attacks. He also has feelings of guilt, as well as embarrassment associated with the incident. I will not go into more details about the case itself, and will discuss some concepts related to sexual abuse, specifically of men, below.
Early sexual trauma strongly and directly influences the development of posttraumatic stress disorder, and indirectly influences suicidal behavior, substance abuse, psychotic symptoms, and leads to an earlier age of onset of bipolar disorder (Maniglio, 2013). Other complications of sexual trauma include the development of borderline personality disorder (McLean, 2003).The patient in this case has both diagnoses. One important distinction in this case is that he was sexually abused by a female teenager, and society generally does not react the same way, as recently reported by USA Today (Ramaswamy, 2013). Men tend to feel shameful and find it hard to open up about sexual assault (from both men and women). They feel as if they should be able to protect themselves, and men are particularly ashamed due to the involuntary physical response to assault, such as erection and ejaculation (Peel, 1985).There is also a sense of isolation due to the silence surrounding sexual abuse of men/boys. It is important to encourage any who faces sexual assault to begin psychotherapy, and to provide assurance that they are not alone, and are not to blame for the crimes committed against them. Research remains lagging with regards to the reactions and struggles that men and boys face when and after sexual assault.
It struck me as offensive when I read several reactions people had on social media when commenting on stories where boys were molested by women. People were saying things like, “That’s one lucky kids”, or “I wish that was me at that age”. These comments are not at all helpful to victims of sexual abuse, and reactions to rape, molestation, and other sexual assaults must be outrage, regardless of gender. Let us remember that sexual assault knows no boundaries and is cross-cultural, cross-gender, and affects human beings of all ages.
Maniglio, R. (2013, Jan 24). The impact of child sexual abuse on the course of bipolar disorder: a systematic review. doi: 10.1111/bdi.12050.
McLean L, G.R.(2003). The American Journal of Psychiatry. Implications of childhood sexual abuse for adult borderline personality disorder and complex posttraumatic stress disorder; 160: 369-371. doi:10.1176/appi.ajp.160.2.369
Ramaswamy, S.(2013, Nov 18). USA Today. Double standard seen when boys abused by women. Retrieved from: http://www.usatoday.com/story/news/nation/2013/11/18 double-standard-seen-when-boys-sexually-abused-by-women/3615947/..
Peel, M.(1985).Medical Foundation for the Cure of Victims of Torture. Men as perpetrators and victims; Rape as a Method of Torture. Chapter 4.London.
Bruce, M. (2012). Otago Daily Times. An End to Silence. Retrieved from:http://www.odt.co.nz/lifestyle/magazine/215130/end-silence