Working With Adolescents



Working With Adolescents

Introduction

Sexual assault can cause serious psychological squeal, both acute and prolonged.' Burgess and Holmstrom (2004) have delineated a specific trauma syndrome in which the assault victim characteristically undergoes a two-phase reaction. The initial acute phase is characterized by physical symptoms and disorganization of lifestyle. The second phase is one of reorganization in which the woman must develop coping mechanisms to deal with the trauma.

Sexual assault can challenge a woman's ability to maintain her defenses and can arouse feelings of guilt, anxiety, and inadequacy (Notaan & Nadelson, 2006). The result can be a traumatic neurosis that leaves the patient with a sense of powerlessness and loss of control (Gelinas, 2003). In addition, distortion of body image as a result of the physical assault has been reported (Schuker, 2009). The physical and psychic injury following such a trauma may also exert a profound effect on an individual's body image, which in turn can alter the victim's self concept, personality, and social behavior (van der Velde, 2005). This distortion includes primitive fears of loss of bodily control, fear of mutilation, and feelings of disgust with one's body. In short, the squeal of sexual assault can be intense and can have significant impact on the victim's capacity to function.

Distortion of body image and a subjective sense of ineffectiveness are also characteristic of women suffering from anorexia nervosa (Bruch, 2002; Schwabe, 2001). In fact, the anorexic's body typically becomes the actual and symbolic focus of a struggle with family members for control of weight, body contour, and larger general issues of control.

The onset of anorexia has been noted to occur at times of significant, life change (Bruch, 2008). Stressful physical injury and consequent distortion of body image may result in posttraumatic anorexia nervosa (Damlouji & Ferguson, 2005). Although it is presently unknown whether specific environmental factors can precipitate or aggravate anorexia nervosa, there are similarities between the psychological sequelae of sexual assault and the typical psychologic manifestations of anorexia nervosa. Common to both are feelings of guilt, inadequacy, loss of control, and distortion of body image. Surprisingly, there have been no reports linking these two conditions. The cases reported here describe two instances of sexual assault with subsequent development of the sexual assault syndrome associated with the onset or exacerbation of anorexia nervosa.

Case Study

Ms. A., a 17-year-old student, was admitted to a hospital medical service for treatment of hypotension, dehydration, and hypokalemia after a 23 lb weight loss over a 3-month period. On admission she was 5 ft 4 in. tall and weighed 97 b, which placed her in the 25th percentile for her age. After 3 days of intravenous hydration and caloric supplementation, she was transferred to the psychiatric service. She described a 1-112 year period of altered eating patterns that began after being sexually assaulted. She had been forced into a car when walking home from school and taken to nearby woods where she was assaulted. Her assailant inserted his fingers into her vagina while ...