Sexual and incestual abuse of children is both ancient and contemporary and commonly leave deep emotional scars that cause mental illness in adult survivors. These illnesses, classified in The Diagnostic and Statistical Manual, IV Revised (DSM IV-R), appear singly or in combination and devastate survivors lives.
Psychiatrist Callaghan defines incest as any sexual activity between a child and a related adult, no matter the specific kinship [and may apply] when there is only a symbolic relationship such as with a step- or foster parent, clergy, teacher or some other authority figure. Secondary victims are claimed by the abuse when survivors families are affected, or when the survivor becomes an abuser, such as in pedophilia. The risk factors that signal a predisposition to child sexual abuse include substance abuse, mental disorders, isolation, parental discord, poverty and unemployment. Also there are characteristic warning signals and identifiable characteristics of abused childrens mothers and families.
In Dr. Callaghans practice the victims are 95% female and 5% male. All of the male survivors had become perpetrators, a subject to which she devotes chapter 13, in the section on revictimization.
Section One covers the process of diagnosing a survivor and the environmental context in which child sexual abuse occurs.
Section Two devotes a chapter each, built around case histories, to diagnosis and specific treatment of ten disorders as identified in the DSM IV-R. Each case history ends with conclusions or prognosis. The disorders are:
Dissociative Identity Disorder (Formerly Multiple Personality) Dr. Callaghan discusses what elements constitute a personality, and from that how alternate personalities (alters) are formed, alter potential, appearance of an alter, meeting an alter in therapy sessions, diagnosis, dissociation, co-consciousness and blocking, core rage, ritual abuse, complexity of alter levels, therapeutic methods for DID patients, treatment models, and goals of therapy.
Psychogenic Amnesia People in this fugue-like state are unable to recall parts of their past, which is due to no organic injury and may be subject to depression.
Dissociative Disorder Not Otherwise Specified In this disorder patients have dissociation that doesnt fall into established categories, and there can be other symptoms that suggest a diagnosis, such as Joes scrotal pruritus.
Somatization Disorder While the pain of the ailments in this disorder is real, there is no physical basis for them. The basis lies in the past. Carlas past held sadistic and relentless sexual, emotional and physical abuse by her grandfather that were released only during a Sodium Anytal interview. Rita was used sexually by her father from age five to 21 and conswquently had a buried vein of rage that was expressed through physical and emotional ailments that were released and treated in therapy.
Generalized Anxiety Disorder Trembling, twitching, restlessness, choking or smothering sensation, dry mouth, nausea, hypervigilance all characterize people with this disorder. Eileen was born into a highly dysfunctional family and was molested by her older sister at age six or seven and carried on the dysfunctional pattern until therapy for severe anxiety as an adult.
Post-Traumatic Stress Disorder Sally presented with this now well-known diagnosis, traumatized by an abusive marriage. As a child she was abused viciously by her grandmother and over time the abuse caused splitting off of several alters. In this chapter Dr. Callaghan take time to answer some commonly asked questions, like Why are some people such easy victims? And Why are some people so determined to victimize?
Dysthymia, or Depressive Neurosis A cold and distant mother and a father who abused all of his daughters created Betty, who married the man who raped and impregnated her, consigning her to a life of depression and a dirty, neglected house. Her first therapist use