Breastfeeding and the Sexual Abuse Survivor

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Breastfeeding and the Sexual Abuse Survivor

• Kathleen Kendall-Tackett, Ph.D.
• Family Research Laboratory
• University of New Hampshire, Durham

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Assumptions Regarding Sexual Abuse

• There is no uniform response to sexual abuse.
• Other traumatic events during childhood can cause
  symptoms similar to those caused by child sexual
  abuse.
  
• Where a woman is in her own healing can influence
  how well she is functioning and the concerns she
  has.

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Breastfeeding and Sexual Abuse Survivors(Benedict
, Paine Paine, 1995)

• In a study of 360 primiparous women, a higher
  percentage of sexual abuse survivors (53.6)
  indicated an intention to breastfeed than did
  their non-abused counterparts (40.6).

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Definition of Sexual Abuse

• Sexual activity involving a child and an adult
• Inability to consent because of unequal power
  relationship
  
• age/maturation advantage
• position of authority or caretaking
• using force or trickery

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Overview of Sexual Abuse

• Incidence
• Peak age of vulnerability
• Perpetrators

• At least 20 of women 5-10 of men
• 7 to 13 years of age
• 90 are male 70-90 are known to their victims
  For girls, 33-50 of perpetrators are family
  members

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Factors That Influence Impact of Sexual Abuse

• Age of onset
• Duration and frequency of contact
• Type and severity of sexual contact
• Identity of the perpetrator
• Support from another adult during childhood
• Individual coping style/resilience

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Overview of Long-term Effects (Briere Elliot,
1994)

• Range of possible symptoms you might see
• Symptoms are logical extension of coping
  mechanisms developed during childhood
  
• Sexual abuse affects seven domains of functioning.

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PTSD

• Sudden, intrusive flashbacks experienced in the
  present
  
• Flashbacks can be visual, auditory, olfactory or
  tactile
  
• Triggers include sexual stimuli, abusive behavior
  by other adults, disclosure and reading/hearing
  about abusive experiences of others

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Cognitive Distortions

• Overestimation of danger adversity
• Underestimation of self-efficacy self-worth
• Chronic perceptions of helplessness and danger
• These distortions can contribute to emotional
  distress or depression

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Emotional Distress

• Depression
• Most commonly reported symptom. Survivors have a
  four-time greater lifetime risk for major
  depression
  
• Anxiety
• Anxiety disorder, panic disorder, phobias, OCD
• Anger
• Chronic irritability, uncontrollable anger,
  difficulties expressing anger

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Impaired sense of self

• May not be able to experience their own internal
  states independent of reactions or demands of
  others
  
• May result in increased suggestibility or
  gullibility, inadequate self-protectiveness, and
  a greater likelihood of being victimized or
  exploited by others

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Avoidance

• Dissociative Phenomena
• Derealization or depersonalization
• Periods of disengagement from immediate
  situation
  
• Alterations in bodily perception
• Emotional numbing
• Amnesia for painful abuse-related memories
• Multiple personality disorder

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Avoidance, contd

• Substance abuse addiction
• Suicide
• Tension-reducing activities
• Indiscriminate sexual behavior
• Bingeing and purging
• Self-mutilation

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Interpersonal Difficulties(Becker-Lausen
Mallon-Kraft, 1995)

• May experience intimacy dysfunction
• Avoidant style low interdependency,
  self-disclosure and warmth. Few interpersonal
  ties
  
• Intrusive style extremely high needs for
  closeness, engage in excessive self-disclosure
  and smotheringly warm. Intrusive, overly
  demanding and controlling
• Both styles may result in loneliness

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Physical Health and Susceptibility to Illness

• Higher rates of healthcare use
• Higher healthcare costs
• More reported symptoms
• More chronic pain syndromes
• severe PMS
• irritable bowel syndrome
• fibromyalgia
• frequent headaches and stomachaches
• overall less satisfaction with their health

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Physical Health contd(Kendall-Tackett, Marshall
Ness, 1999)

• Primary-care sample of 65 men women who
  reported a history of either child or domestic
  abuse with a matched sample of non-abused
  patients
• More reported diabetes and symptoms of diabetes
  even after controlling for family history,
  obesity, ethnicity, and age.
  
• Almost four times the rate of depression.
• More reported participation in harmful activities
  including smoking, drinking, recreational, and
  IV drug use.

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Why would victimization influence health?
Behavioral
Cognitive
Victimization
Poorer Health
Social
Emotional
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Behavioral Pathways

• Eating Disorders/Obesity
• Substance Abuse
• Smoking
• High-risk sexual behavior
• Suicide attempts
• Compliance with treatment regimens

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Cognitive Pathways

• Attributional style
• Self-efficacy
• Health Locus of Control
• Health Perception

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Social Pathways

• Breakdown of social networks
• More divorce
• Pandemic outcomes (agency vs. community)
• Revictimization
• Homelessness
• Poor doctor/patient relationships

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Emotional Pathways

• Depression
• Elevated cortisol levels
• Suppressed immune system
• Can magnify and intensify other problems
• Possible problems with memory as people age
• PTSD
• Possible problems with declining health and
  receipt of healthcare services

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Pain, Depression and Sleep
Pain
Serotonin
Depression
Sleep
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Levels of Resolution

• Where a woman is in her own healing process will
  influence the types of issues that arise.
  
• Levels of resolution overview
• No apparent memory of sexual abuse
• Some memory but sees no connection with present
  functioning
  
• Sudden memories of sexual abuse
• Beginning of resolution
• Resolution

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Level of Resolution 1

• No apparent memory of sexual abuse
• Women at this phase may be symptomatic but do not
  report a history of abuse
  
• They have concerns that seem unusual
• Often report that they cannot remember large
  blocks of their childhood

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Levels of Resolution 2

• Some memories but sees no connection to present
• May have a serious abuse history but minimizes
  its importance
  
• Women in this phase may have a number of serious
  parenting difficulties because of a maladaptive
  coping style or because of the effects of abuse
  (e.g., depression)
• May be manipulative or demanding in their
  dealings with adults as well

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Levels of Resolution 3

• Sudden memories of sexual abuse
• May experience sudden memories of sexual abuse
  during pregnancy, birth or breastfeeding
  
• Can precipitate a major crisis with a severe
  decline in functioning
  
• Breastfeeding may be too difficult or a life-line
  she clings to

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Level of Resolution 4

• Beginning of Resolution
• Sudden memories or life crisis may have moved the
  woman to deal with her abusive past
  
• May see a decline in functioning (in some cases,
  severe) during this time
  
• May observe compulsive disclosure of abusive
  past

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Level of Resolution 5

• Resolution of past abuse
• Women at this level are aware of the abuse, and
  feel some closure about their past experiences
  
• They are less symptomatic and may feel empowered
  by their experiences
  
• They may experience some new conflicts and
  concerns as they move into different phases of
  life but recognizes these concerns and are able
  to mobilize support.

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Some Reactions you Might Observe

• Lack of confidence in her own body
• Shame over breasts, breast milk, physical
  sensations associated with breastfeeding
  
• Inappropriate sexual remarks
• Lack of comfort with infant playfulness during
  nursing
  
• inaccurate attributions about needs of infant

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Reactions, contd

• Intense need to do everything right
• selfless devotion
• worry about abuse time bomb
• difficulty in establishing boundaries
• Tendency to see herself as very different from
  other mothers
  
• tendency to attribute all mothering difficulties
  to past sexual abuse

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What You Can Do

• Offer suggestions to make breastfeeding more
  comfortable.
  
• Help mothers learn what is normal.
• Make a referral.
• Educate care providers about normal course of
  breastfeeding, including breastfeeding on demand,
  co-sleeping, and late weaning.

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Having come to terms with the traumatic past,
the survivor faces the task of creating a future.
She has mourned the old self that the trauma
destroyed now she must develop a new self. Her
relationships have been tested and forever
changed by the trauma now she must develop new
relationships. The old beliefs that gave meaning
to her life have been challenged now she must
find anew a sustaining faith..In accomplishing
this work, the survivor reclaims her world. (p.
196) Judith Herman (1992). Trauma and Recovery,
Basic Books.