Defense mechanisms used by sexually abused children

Studies of groups of sexually molested children have described the immediate and long-term effects of their abuse--symptoms, diagnosis and problem areas projected into their future adult lives. Findings from groups convey valuable descriptive data on molested children, particularly on how much and for how long they suffer psychological harm from sexual abuse during childhood. Individual case reports of sexually victimized children deepen our perspective by constructing an unfolding scenario of the coping strategies employed by each child. In such reports, inferences are made about psychic defenses that aid or obstruct children in grappling with their abuse. Defenses are ordinarily studied as part of a larger motivational or psychodynamic exploration, but taken by themselves, defenses make a good beginning toward the dynamic assessment of a child.

This article discusses the psychic defense strategies used by a group of 27 children, ranging in age from 2-1/2 to 15-1/2, who were sexually molested. By looking at them both individually and as a group, we may be helped to understand not only what sexually abused children usffer but also how they internally defend against their unhappiness.

Methods

The 27 children--five boys and 22 girls--were given psychiatric evaluations at a child guidance clinic in 1978. In most cases the sexual abuse, known prior to the evaluation, constituted a basis for the child's referral. In a few instances, however, the sexual abuse became evident only during the evaluation. Each evaluation was performed over a consecutive 3-hour period on one day. Parents (or other primary caretakers) were seen, both together with their children and individually, in all cases where it was possible for parents to get to the clinic. All of the children were seen individually. Evaluations were performed by social workers, psychologists, general psychiatry residents or child psychiatry fellows. Other professionals on the staff of the child guidance clinic collaborated in formulating diagnostic impressions and recommending dispositions.

Two procedures were used. The children's charts were examined retrospectively to glean information about their defenses and use of defense mechanisms in relation to sexual victimization. In most instances, explicit references to defenses could be culled from written evaluations and psychological test reports. The types of defense mechanisms that I coded included all of those listed in the Comprehensive Textbook of Psychiatry--narcissistic, immature, neurotic and mature. The other procedure involved interviews with clinicians to corroborate and amplify what had been written about clinical evaluations and psychological testing.

After enumerating the subtypes of defense mechanisms (narcissistic, immature, neurotic and mature), the types of defense mechanisms were analyzed according to gender, age, severity of pyscholpathology and duration of abuse for each child. Moreover, for each child, coping strategies were examined while comparing the time elapsed between molestation and psychiatric evaluation, the identity of his or her molester and the level of support from caring adults.

In labelling the defense mechanisms, the children's behaviors, thoughts and emotions during evaluations were viewed in conjunction with accepted theories about defense mechanisms. For example, the defense mechanism of sexualization (a neurotic type) was inferred from the behavior of an 8-year-old girl who, during her psychiatric evaluation, continually flipped her dress up, showing the male evaluator her panties and asking if he liked them. When asked about her sexual abuse, she said emphatically that she was "hot" and asked to remove all of her clothes and sit on the evaluator's lap. Similarly, the mechaanism of projection (an immature type) was discerned from the recurrent thought of a 4-year-old girl that her mother would get mad and blame her for the sexual molestation by her father, and the mechanisms of regression and schizoid fantasy (immature types) were inferred from the emotions of a 14-year-old girl, raped by her stepfather, who alternated between muteness and sobbing with rageful, hostile screams.

Findings

Psychiatric diagnoses, spanning a continuum from adjustment reactions to psychosis, were recorded for 26 children; one child, a boy, had no mental disorder.

Sixteen of the 22 girls were molested by fathers or father surrogates, and four of the five boys were molested by boy age-mates. Most types of sexual abuse involved an adult's genital or manual contact with the genitalia of the child (54 percent). Almost one-third of the types were oral-genital abuse (31 percent), with the molester forcing the child to perform fellatio.

Preschool children had problems with sleeping, nightmares and bodily complaints; school-aged children with masturbation, school and home behavior problems and withdrawal. Adolescents were more often depressed and suicidal than younger children. The duration of abuse for these youngsters was highly varied, ranging from one-time victimization to eight years of recurrent sexual molestation, with a mean of 2.7 years.

The changes in the children's self-concept following molestation were overwhelmingly negative. They lost self-esteem and felt guilt and shame. Only one child, a 7-year-old girl, showed an upsurge in self-esteem. She regarded the molestation by her father as a sign that she had been singled out as special among her siblings. A 3-1/2-year-old girl, who voiced much anger with her father for his abuse, showed no loss or gain in self-esteem.

The children evidenced core value conflicts, reflecting their struggle to come to grips with the abuse and the degree to which they felt responsible for their victimization. Their conflicts differed depending upon whether the molester was a part of the immediate family or an outsider. FAther-molested children most often experienced conflicts over family loyalty versus blaming the father, and blaming the father versus blaming the other parent. Children victimized by peers, neighbors and distant relatives also evidenced conflicts over blaming oneself versus blaming the molester as well as over parents' blaming the child for the abuse versus parents' blaming the molester.

Defenses

One child, a 3-1/2-year-old boy, was said to have used no defense mechanisms and three other children (two girls and one boy, ages 3-1/2, 7 and 7-1/2), showed predominantly "undefended anxiety" with Gross Stress Reactions--restlessness, increased motor activity, constant sighing, tremulousness and increased frequency of urination. Narcissistic defense mechanisms were evident for 13 children; immature mechanisms for 25; neurotic for 15; and mature for 5 (see Table I).

Gender. Boy employed predominantly immature defense mechanisms and only one boy (a 4-year-old) used any neurotic coping maneuvers. Girls, too, employed many immature mechanisms but they also adopted a variety of neutrotic ones. Boys used acting-out as a coping maneuver somewhat more than girls did, but these boys had been molested most often by peers. On the other hand, girls exclusively employed the mechanisms of schizoid fantasy, passive-aggression, somatization and reaction formation.

Age. The youngest children, the preschoolers, had the fewest identified defenses of all age groups. School-aged children coped with their sexual abuse through the most wide-ranging variety to mental mechanisms. Denial was found prevalently in this age group, and a majority used introjection. The foremost neurotic type of defense mechanism employed was sexualization, found in both re-enactment behavior and in post-traumatic play.

Adolescents, from age 12 to 15-1/2, were more restricted than school-aged children in the variety of defense mechanisms they evidenced. Immature coping maneuvers were most frequent, especially acting-out and introjection.

Severity of Psychopathology. Severely disturbed preschoolers and school-aged children used relatively many and more varied defense maneuvers compared to children who were less emotionally impaired. The seven adolescents who were seriously disturbed employed fewer and more restricted defenses than their younger school-age counterparts. Regression, schizoid fantasy, acting-out and introjection were used primarily by these most distressed adolescents.

Duration of Abuse. No pattern (independent of the child's age) emerged in the defense mechanisms employed when a brief duration of sexual abuse (less than six months) was compared to a more lengthy duration of victimization (four to eight years). Acting-out, however, was seen more often in children who were victimized over a longer period. Thus, very young children coped with their abuse by using similar defensive functions whether they had been abused only once or over a 4-year period. Teenagers, too, used the same defensive maneuvers regardless of the duration of the abuse.

Time Elapsed before Evaluation. Children who were abused by their fathers or father surrogates did not receive psychiatric help until an average of nearly three years after the molestation occurred. When the perpetrators were peers, neighbors and more distant relatives, children obtained evaluations earlier--an average of four months following the molestation. Children victimized by perpetrators other than their fathers used acting-out, denial, introjection and schizoid fantasy as their main defenses. Boys molested by their peers showed the most undefended anxiety of any group. When they did use defensive coping techniques, these often were directed outward or anxeity was withheld from consciousness via such mechanisms as acting-out, projection and dissociation.

Dependding on their value conflicts surrounding the abuse, father-molested children used varied defenses. Those who valued family loyalty and who abused and denigrated themselves used denial and introjection a great deal. On the other hand, those who showed more autonomy (less self-abasement) and who blamed their fathers for the abuse more than they blamed themselves had little denial and used acting-out far more frequently than their counterparts. Interestingly, the mean time elapsed before help was sought was greatest among the children who blamed themselves for their father's molestation (3.6 years) compared to those who blamed their fathers for the abuse (1.5 years). Sexualization was used as frequently by each group.

Support from Caring Adults. The support each child received from a close adult following disclosure of the molestation affected the degree of conflict faced by each child which, in turn, affected the defense mechanism employed. Children who went unsupported for lengthy periods were most often victims of father-daughter incest who evidenced a high degree of family loyalty and hwo blamed themselves for the molestation. By and large, they denied the incest had created any problems for them and introjected the belief of their abusive fathers that the incest episodes were all right.

Children who received immediate support and aid from a parent were found in both the father-molested group and the group molested by others. Those abused by fathers showed much personal autonomy and blamed their molesters, even though they introjected some degree of culpability. Children molested by others showed Gross Stress Reactions and fewer defense mechanisms. Even children who had received support only recently (following a lengthy period of no support) fared better psychically; they were mor likely to be autonomous and to blame their molester. However, some children who had received support only recently had developed severe psychopathology and rigid and immature defenses of acting-out and schizoid fantasy through the long period of non-support.

Discussion

The children in the study varied their coping techniques for dealing with sexual abuse in ways that depended more on their age at the time of their psychiatric evaluation than on factors of gender or duration of sexual abuse.

Defense against anxiety was both minimal and primitive in comparatively less disturbed preschoolers. The very young displayed either unbound anxiety (Gross Stress Reactions) or primitive, less sophisticated (in a developmental snse) mechanisms that dichotomize psychic energy into "your fault/my fautl"; anxiety directed to others or to self. They defended themselves in ways consistent with immaturity of emotion, cognition and behavior. More disturbed preschoolers were "pseudomature" in their coping, adopting defensive maneuvers more similar in variety and sophistication to those of their school-aged counter-parts. Perhaps the stress of sexual abuse compelled intrapsychic strategies to "jump the gun" when very young children, being overwhelmed, attempted to cope by using ways beyond their years, forcing ego development to leap ahead in time. However, their defensive precocity did not enable them to master nor to adapt to the stressful even of rape at a young age.

Each school-aged child, using a variety of coping devices, attempted to find a few mechanisms or combination of mechanisms to dispel or reduce anxiety. Such wideranging diversity observed in the business of coping may reflect the augmented capabilities of the more developed ego but still did not enable this age group of children to succeed in mastering the cumulative stresses of sexual victimization. Of importance to clinicians serving these youngsters is the finding that more latency-aged children resoted to sexualization as a means of coping than did older or younger children. As a result, I believe that their sexual latency came ot abrupt termination, if, indeed, it even had a prior existence. The psychic insult with which they must deal is sexual in nature, after all and their response is one of sexualization.

While small children tried out coping mechanisms that were beyond their age level, teenagers regressed and dealth with sexual victimization through a restricted number of rather primitive defenses--the narcissistic and immature. Their regression was compulsive and debilitating and might better be called e"ego distortions," which resemble normal coping during periods of stress but which solidify as a way of life in which ego development is chronically immature but relatively unchangable. That conclusion is suggested by the severe psychopathology seen in the adolescent age group.

Interactions can be identified in the children's coping strategies according to the time elapsed between molestation and psychiatric evaluation, the identity of the molester and the level of support from caring adults.

The father-molested children coped with the abuse differently depending upon two external and related factors: the level of support received which, in turn, influenced the time lapse before evaluation. Non-support made itself known in the adult's failure to obtain for the child. Children who went unsupported for a long period valued their autonomy little and placed a major value upon keeping the secret of incest and preserving a semblance of family unity. Since no communications had come forth that blamed the father, they felt they were at fault. They may rightfully blame the mother for some aspects of their victimization because they told her and she did nothing, or they may wrongfully blame their mother for not knowing, for her lack of omniscience in knowing all that happens to her child--"She should have known even though I never told her." In this manner they displaced their anger with their molester onto their mother.

These youngsters regarded their fathers as infallible, denied their lack of trust in them and denied that the abuse may have been deleterious to them. They introjected the belief that "what Dad did was OK" and acted-out most often against themselves with suicide attempts. To some degree, the properly functioning ego necessitates that children rely on a notion of infallibility and trustworthiness of a parent. Their egos are not mature enough to blame the one whom they had learned to trust, especially where there is no disruption of the incestuous status quo. These children were distrustful of the "bad" molester but remained trusting of the "infallible father." They fragmented their view of their father-molesters. Such a fragmenting operation of the mind has been described as a vertical splitting in which mental images of a good and a bad parent are compartmentalized--isolated from one another--and yet are simultaneously coexistent.

Parents who supported their father-molested children sought help for them earlier. These children's conflicts revealed their value of their own autonomy over loyalty to the family unit, and they vituperatively blamed their fathers for their victimization. They werenot without problems, however, and maritalled a host of defenses to grapple with the conflicts surrounding their core values. On the whole, they did not deny the problems brought on by the incest, nor did they deny the anger and the betrayal of trust they felt by their fathers' actions. They acted out their conflicts far more than those who were not supported. These acting-out behaviors were directed toward the self--as with suicide attempts--but also included aggressive behavior toward others, such as running away, abusing pets and destroying property. It appeared that, with less denial, the "vertical splits" in their view of their fathers were more in conflict even though the children appeared to have stronger egos than those in the self-abasing group. These children internalized and identified with the breach of impulse control manifested by their father-molesters and they, too, acted out. Such impulsivity as a way of life leads them to character disorders and maladaptive behaviors.

The youngsters sexually abused by peers, neighbors and distant relatives, who were most likely to be supported by both parents who quickly sought help for them, were more successful at directing anxiety away from the self. Because of their distance from the molester, these children were usually able to blame the peretrator or, at least, to act out with other than self-punitive behaviors or dam up the anxiety by blocking or denying that much had happened to cause them distress. However, they did not escape self-blame entirely, and this can be compounded if parents blame the victim for the circumstances of the abuse.

In all of the foregoing, I did not intend to suggest that any onus is on children who respond pathologically to being sexually abused. In fact, their being sexually abused is viewed as a needless victimization and a deleterious experience from which children require protection and for which they need therapeutical aid.

Sexual victimization is a psychic injury that requires coping throughout the life of a child. His or, more commonly, her ego is constantly rechallenged with trauma as development ensues, even if actual seduction has ended. The events and memories of them must be grappled with in a different way throughout each stage of childhood.

Coming to terms with sexual violation of the self, be it by relatives, strangers, adults or other children, is a difficult task for a child. The core value conflicts, and the defense mechanisms martialled in coping with them, reveal that many victimized children muster many assets and display ego strengths. They blow the whistle. Many receive quick support from their parent(s). And they often obtain psychiatric help that dispels fear and provides relief from their stresses. However, as seen in these 27 children, ego strengths alone are not sufficient to dispel psychic debilitation. Lengthy clinical remediation is necessary so that these youngsters will not pass on to their children sexual cruelty and victimization.

COPYRIGHT 1985 U.S. Government Printing Office
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