HEALTH CONSIDERATIONS FOR

Studies and surveys have documented the effects, both physical and psychological, that sexual abuse can have. However these consequences do not occur in all persons who have been abused: genetics, personality, and other factors play a role in susceptibility.
Medical research on PNI (psychoneuroimmunology), done since the early 1990s, has shown evidence of mechanisms, which offer promise in prevention of disease by behavioral methods.

The information in these pages provides additional assistance on your journey of healing. There are two major things to consider: knowledge and taking charge. Knowledge of how your body works and how it can resist disease is essential in fighting the effects of sexual abuse. Taking charge means that you assume the leadership role in all aspects of your health. As a courageous survivor read as much as you can; learn from others in your support group; visit doctors as needed - but remember you, as the quarterback of your health care team, are responsible for your healing. Knowing what the future can bring and learning about prevention will help you to lead a long and happy life.

Dr. Bernie Siegel is a retired surgeon who for many years used mind-body principles in his practice. He labeled his cancer patients according to their attitudes: some had poor attitudes for survival and most were only average patients. But, he called about 15-20 percent of them, "exceptional cancer patients," meaning that they took charge, questioned, learned, and took on the role of a fighting survivor. The intent of this section of the website is to help you to become an exceptional survivor of sexual abuse (ESSA).
Without knowledge and without a take-charge attitude, long-term health effects of chronic stress will catch up and cause disease. That is predictable. So, it's your choice.

I have divided this section into three parts: (1) statistics that demonstrate what kind of effects on health sexual abuse can have, (2) the mechanism that causes these effects in the body, and (3) ways to prevent such adverse health problems.

STATISTICS
There have been studies and surveys of those who have been sexually abused. However, it is uncommon for a hospital or a physician to screen for sexual abuse (SA) so there is a lot unknown at the present about long-term effects. For surveys to be successful, people must respond openly and without fear. As you know, many SA survivors still carry shame and guilt and are reluctant to divulge their past history. Some have this trauma repressed into their subconscious and cannot remember. So the resulting data may be reported on the low side.

Let's divide the statistics into three categories: psychological problems, social problems and physical diseases. The following are some aspects but may not include all problems associated with SA.
Psychological problems that may ensue for those with SA include: post-traumatic stress disorder (nightmares, flashbacks, intrusive thoughts), anxiety, depression, suicide, phobias, panic attacks, dissociative identity disorder, multiple personalities, self-mutilation, anorexia nervosa, and bulimia (binging and purging food), sexual dysfunction. Some persistent psychological issues seem to be lack of self-love (poor self-esteem), guilt, worry, fear, anger, and helplessness.

Social problems can include drug abuse, alcohol abuse, divorce, lack of ability to trust, social isolation, and violations of the law. ESSAs work to overcome all of these obstacles.

Physical disease can be induced by lack of effective management of chronic stress, which can be related to SA. Dr. Herbert Benson, a Harvard cardiologist, has written extensively on the mind-body interactions and has founded the Mind/Body Medical Institute in Boston. He is a pioneer in mind/body wellness and wrote a classic book, The Relaxation Response, in 1975. He is well respected in the medical community and is a professor of medicine at Harvard Medical School.

His institute lists the stress-related diseases he treats at his institute as: allergies, angina, arthritis, asthma, back Pain, cancer, carpal tunnel syndrome, chest pain, chronic fatigue syndrome, depression, diabetes, fibromyalgia, headache/migraine, heart disease, hypertension, gastrointestinal illness, infertility, insomnia/sleep disorders, joint pain, lupus and other autoimmune diseases, muscle tension, palpitations/arrhythmias, perimenopause/menopause, rashes/skin problems, shortness of breath, tinnitus (ringing in the ears), TMJ pain. Yes, all those conditions can be caused by stress. People with SA who are affected by chronic stress have a higher than average risk to develop some of these conditions.
One of the most intriguing diseases associated with SA is cancer. One study found that SA persons were two and a half times more likely to develop cancer when compared to the non-abused population.

Another study of 13,494 adults at an HMO showed that exposure to childhood trauma correlated with health risk behaviors in adults and with the presence of serious diseases leading to premature death, including cancer.

Keep in mind, while all these psychological, social, and physical problems can seriously affect one's quality of life, they are not automatic responses to SA. Whether sexually-abused people develop these depends on many factors: their attitude, their physical fitness level, their genetics, and their personality. While genetics may not be able to be controlled at this time in this regard, the other factors can be consciously modified to prevent these diseases and to allow one to live a normal and happy life, a goal common to all ESSAs.

MECHANISMS OF PNI

PNI (psychoneuroimmunology) is a relatively new term in medicine, coined by Dr. Robert Ader in 1975. This demonstrates some theoretical and some actual pathways from the brain (psycho) through the nervous system (neuro) to the immune system. Many, many researchers have been investigating these pathways over the past 20 years and have discovered fascinating data and facts that will help you to understand why the body can develop disease and more importantly how to keep the body healthy.
First, stress is not a dirty word: rather it is a neutral event, a random change in one's life. We all have changes daily. Without warning, a car pulls out in front of you; you trip on a step and tear your clothes; a store clerk is rude, etc. Some stresses have more meaning than others; the death of a spouse, a close relative having cancer; a serious car accident. Our health can be affected by how we interpret stress and how we manage life's daily challenges.
When we are under stress, our brain sends neural messages via the pituitary and adrenal glands to release cortisol, a chemical hormone that can have a number of damaging effects on the body. Some of these effects are: inactivate immune system, irritates stomach/intestines, stimulates glucose production and the release of rennin.
Recently studies have shown that long-term release of cortisol can decrease the activity of one's NK cells. These are cells that normally fight infections and cancers. (Most people have some cancer cells inside them but their NK cells are numerous and strong enough to keep the cancer from growing.) The adrenal glands also release epinephrine during stress which has several damaging effects: increases blood pressure and heart rate, irritates G.I. tract, and increases blood cholesterol. This is called the stress response.
The stress response of the body can be negative (distress) or positive (eustress). We can also elicit the opposite response, called the relaxation response, although this takes some training and discipline, especially in time of extreme stress.
If we choose to view the stressful change as a challenge, then the stress can help us to achieve great things. This called eustress, or good stress. And it explains how professional athletes perform: they allow the stress to motivate and inspire them. Look at the winners (Superbowl teams, Tiger Woods, Roger Clemens, Lance Armstrong) – they all go through highly stressful times of intense competition, often in front of millions of TV viewers. However, sporting events last only a few hours to a few days. If these competitions would last weeks or months, the athletes would be mentally and physically drained. Most athletes balance their lives with relaxation. The stress of SA can last a lifetime, if not controlled. ESSAs can choose to control their stress, rather than being controlled by it.
If we choose to view the stress as a problem or hassle in our life, this is called distress. This way, we may suffer from the negative side of stress. Reactions to stress such as anger, guilt, worrying, fear can lead to anxiety and depression. A lifetime of this will result in one's immune system being depleted with the result of disease occurring.
Let's say that your spouse of 30 years has recently had a heart attack and has had open-heart surgery. Thoughts of death enter the picture as the medical treatment lasts for months. You become tired, losing energy daily, and frustrated at this turn of events. Substitute a child, parent, or another loved one and you begin to understand that the closer the stress is to home, the harder it is to cope with effectively. A lifetime of dealing with such stress, such as childhood SA, can take its toll on the body.

PNI studies have shown the following:

▪ cortisol interferes with NK cell activity and impairs wound healing

▪ meditation reduces cortisol significantly

▪ caregivers of people with Alzheimer’s disease have a high risk of getting cancer;

▪ women with greater social support had higher NK cell activity

▪ anxious moods are associated with lowered NK cell levels

▪ relaxation and guided imagery increase immune response in cancer patients.

There are two major nervous systems in the body: the sympathetic and the parasympathetic. The sympathetic system involves the release of hormones and chemicals that allow the body to gear up for the flight or fight situation. (If you're being attacked by a grizzly bear, you need lots of energy to escape.) But if these chemicals linger for a long time, the body wears down and burns out. On the other hand, the parasympathetic system allows the body to slow down and rest. This system decreases blood pressure, slows breathing, enhances digestion, and stops the flow of cortisol and other potentially harmful chemicals.
So, the next time something causes stress in your life, understand that you have choices in how you react to this change. You can let your body go into distress (boo!), eustress (yea!), or the relaxation response (yea, yea!). Learning effective stress management is critical in becoming a conquering survivor of SA.

PREVENTION

The most important thing to understand is that the person who has been sexually abused does not automatically develop disease. Modern medicine focuses on diagnosis (testing, which can be time-consuming and elaborate), treatment (may include surgery), and drugs (can be sophisticated and expensive). However preventing the disease eliminates the need for all three of these aspects of medicine. The rest of this section will explain ways in which the SA survivor can help prevent health problems.

1. Learn and keep up to date on modern methods of behavioral ways to deal with this issue. Books, the Internet, and friends are excellent ways to keep current. Be wary of news items in the media - TV, movies, radio. Many are misinformed and may be misleading.
2. Learn to practice deep relaxation at least two or three times a day for 10-20 minutes a session. This is essential to stimulate your relaxation response and to stop the flow of harmful cortisol. If you become skilled in these methods, you may be able to avoid taking medicine to relax.
3. Complete the process of the three emotional roadblocks: worry, fear, and anger. These cause distress and the secretion of cortisol. As long as you remain stuck in these three reactions, your perpetrator still has control. You can learn to experience these emotions safely.
4. Self-love. Separate out who is truly responsible for your sexual abuse. Put the guilt where it belongs – on your perpetrator. You are loveable. You are valuable. This might sound impossible, but it is a vital part of the healing process and will help prevent illness.
5. Remember that your inner self-image is what is important. Our external appearance is greatly impacted by what you think about yourself inside. If you are unhappy with your external appearance, work on the physical things you can, but focus on doing the internal work of discovering the wonder of you!
6. Get in good physical condition. The better aerobic shape you are in, the better your body can resist the damage of acute or chronic stress. Run, swim, walk, or whatever you like to do to keep the healthy hormones flowing.
7. Learn about nutrition and be disciplined. The food industry flavors our food with fat, salt, and sugar, which is not in the best interest of our health. An excellent book is The Three Hour Diet by Jorge Cruise. This approach stresses eating small meals every three hours. It is based on common sense and it works. Avoid fad diets, which come around every six months: they don't work over the long haul.
8. Find something important to get involved in: become passionate about something positive and invest some of yourself in the issue.

9. Be selective about the type and length of television programs you watch. Most shows feature violence and negative reactions to stress: anger, frustration, worrying, etc. That can reinforce what you are working to change. Consider reading a book or take a walk.
10. Approach things from a positive perspective. Process the experience or thought, and strive to identify a positive possibility. Avoid using the words, “no,” “can’t,” and “have to.”
11. Join a support group and gain energy by knowing that others share your same problems and concerns. Don't isolate, there is healing in relationship.

12. Faith. PNI studies show that belief in God, religious meaning, and belonging to religious groups all improve immune function. For some, this means learning new truths about who God is in spite of what happened to you.

13. Have Fun. Take a Break. Even if it’s for one hour. Do something fun.

14. Find a Soothing Activity. Perhaps a bubble bath with scented candles around you; perhaps writing; perhaps drawing; perhaps doing a crossword puzzle, whatever brings you a moment of peace.

15. Sleep. Get in a routine of a normal sleep cycle. It will increase your energy level; will stop the epinephrine and cortisol flow; will enhance your immune system.

17. Do something good for someone and don’t tell anyone about your good deed. This will boost your self-esteem tremendously as well as making the world a little nicer place.

18. Walk or run in a 5K. OK, so you won’t finish first; you probably won’t finish last, either. And, if you do, that’s OK. The exercise is what counts!

19. Celebrate reaching goals. Start wherever you can – even if it is for the day, and even if it appears small. Planning, stretching and focusing forward bring satisfaction.

RESOURCES

There are many excellent websites on stress management on the Internet. The following are sites of three important medical pioneers of PNI and self-healing: Dr. Herbert Benson, Dr. Carl Simonton, and Dr. Bernie Siegel.

I WOULD HIGHLY RECOMMEND THAT YOU INCLUDE READING A BOOK BY EACH OF THEM. IT WILL HELP YOU SIGNIFICANTLY TO COUNTERACT THE EFFECTS OF SEXUAL ABUSE IN AN EFFORT TO REMAIN HEALTHY THE REST OF YOUR LIFE. THEIR BOOKS AND TAPES CAN HELP YOU TO FIGHT THE LONG-TERM EFFECTS OF SA-INDUCED STRESS AND PREVENT DISEASE.

Herbert Benson, MD. Dr. Benson is a cardiologist who found that he could teach his patients to lower their blood pressure by using meditation. His patients could often reduce the amount of high blood pressure medication and sometimes eliminate it entirely by meditating three times a day. Dr. Benson became interested in fighting the effects of distress and founded the Mind/Body Medical Institute in Boston, which has a large staff for treatment of many stress-related diseases. Dr. Benson is on the staff of Harvard Medical School and commands respect in the medical community: a chair in his name will be dedicated at Harvard when he retires, which is an honor reserved for a select few. His first book, The Relaxation Response, discusses stress, stress management, and his early work, which includes a meditative technique. His other books are also worth reading, especially Timeless Healing. Meditation is a simple, inexpensive and effective way to manage long-term chronic stress. Two or three times a day will reduce disease.

Website: www.mbmi.org.
Books: The Relaxation Response, Timeless Healing, etc.

O. Carl Simonton, MD. Dr. Simonton, a radiology oncologist (cancer doctor) by training, became interested in mental strategies for fighting cancer in the late 1960s. He was the first physician to use guided imagery to help cancer patients. He treated his first patient with guided imagery in 1971 – a terminal throat cancer patient who was given only a few months to live. By practicing imagery three times a day, in combination with radiation therapy, the patient lived and his cancer disappeared, surprising everyone. Even though you may not have cancer, please be aware that SA survivors have a greater than average risk to develop this disease. By using Dr. Simonton's tapes or CDs on a daily basis, you can learn how to mobilize your body's defense system to prevent not only cancer, but other diseases as well. Research studies have shown that terminal cancer patients have doubled their survival times by such an approach. His book, Getting Well Again, is a classic.

Website: www.simontoncenter.com
Books: Getting Well Again.
CDs: Getting Well (2 CD package)

Bernie Siegel, MD. In 1978 Dr. Bernie Siegel, a surgeon, took a workshop given by Dr. Simonton that changed his life and his practice of surgery. He became much more concerned with the person behind the body and learned about stress management, incorporating it into his profession. He also has found a significant link with religion and healing. His books and tapes have helped thousands of patients.

Website: http://www.ecap-online.org
Books: Love, Medicine, & Miracles. 101 Exercises for the Soul. 365 Prescriptions for the Soul.

FINAL NOTE: By now, if you have read this entire section, I hope you have a better understanding of long-term effects of stress, diseases associated with distress, and how, as a survivor of SA, you can help prevent these diseases.

Not long ago, this information was not available. Even today, many surveys may not be accurate because SA persons may not report their past history. But slowly the shame and stigma about SA will leave our society and data will be reported so that the medical profession can better serve this population.

As a survivor, you can get proactively involved in denying the stress the power to cause physical illness. You can take charge, utilize resources available and participate in healing yourself through prevention.

Clinical management guidelines for obstetrician-gynecologists. Adult manifestation of childhood sexual abuse.

Review of adult psychological, physical and behavioral symptoms in survivors of childhood sexual abuse, who have "disproportionately high use of health care services, more severe symptoms with more complex patterns of presentation, and often somatic symptoms that do not respond to routine treatment." Includes step by step how to handle a screening interview, provide positive messages, referrals, and how to avoid retraumatization via medical examinations and procedures. ACOG (American College of Obstetricians and Gynecologists) educational bulletin. number 259, July 2000.

2001 Int J Gynaecol Obstet 74;3:311-20

Health risk behaviors and medical sequelae of childhood sexual abuse

22% of 511 Midwestern family practice clinic patients reported a history of sexual abuse on a questionnaire. They had significantly more medical problems and health risk behaviors, with a direct correlation between the more severe abuse history and more severe medical problems. Fewer than 2% had discussed the abuse with a physician.

1992 Mayo Clinic Proc 67;6:527-32. Springs, F. E. and Friedrich, W. N.

Adult health status of women with histories of childhood abuse and neglect

1225 Seattle women from an HMO who had experienced any type of childhood abuse had significantly poorer overall health, greater physical and emotional disability, more distressing physical symptoms, and increased health risk behaviors.

1999 Am J Med 107;4:332-9. Walker, E. A., Gelfand, A., Katon, W. J., Koss, M. P., Von Korff, M., Bernstein, D., and Russo, J.

Chronic pain and health care utilization in women with a history of childhood sexual abuse. Canadian women with a history of sexual abuse had more chronic pain conditions, surgeries, hospital visits and physician visits than those without abuse.

2000 Child Abuse Negl 24;4:547-56. Finestone, H. M., Stenn, P., Davies, F., Stalker, C., Fry, R., and Koumanis, J.

The effects of daily stressors on physical health in women with and without a childhood history of sexual abuse. College age healthy women with a history of childhood sexual abuse were more susceptible to daily stress, manifested by physical symptoms.

2000 Child Abuse Negl 24;2:209-21. Thakkar, R. R. and McCanne, T. R.

Pituitary-adrenal and autonomic responses to stress in women after sexual and physical abuse in childhood. Hypothalamic-pituitary-adrenal axis and autonomic nervous system hyper-reactivity, presumably due to CRF hypersecretion, is a persistent consequence of childhood abuse. This may contribute to the many increased physical and psychological problems these patients experience. 2000 JAMA 284;5:592-7. Heim, C., Newport, D. J., Heit, S., Graham, Y. P., Wilcox, M., Bonsall, R., Miller, A. H., and Nemeroff, C. B.

Negative life experiences, depression, and immune function in abused and nonabused women. Domestically abused women were significantly more likely to have experienced higher levels of depression, and have impaired T cell function.

2000 Biol Res Nurs 1;3:190-8. Constantino, R. E., Sekula, L. K., Rabin, B., and Stone, C.