Borderline States: Incest and adolescence

This paper is derived from my experience in the National Health Service setting where severely disturbed adolescents are treated on psychodynamic principles.

For some time I have been interested in the occurrence of borderline functioning within the adolescent phase of development, both as a manifestation of psychopathology and as characteristic of normal adolescent psychology. During the past few years an additional factor has emerged, alongside the more usual aspects of severe disturbance in adolescence, which has made a great impact on my own clinical setting, as it has on most others where children and adolescents are the focus of therapeutic attention. This new factor is a history of sexual abuse in childhood. In 1990 33 per cent of our new cases were known to be victims of past sexual abuse. Currently over half of the adolescents in the treatment programme have a history of child sexual abuse. This in itself is no longer outstanding. Most agencies working with adolescents have similar figures and in children's homes estimates have been even higher.

This change has produced a number of challenges: in clinical practice, in interaction with other agencies, in interaction with families, and in the therapeutic relationship with adolescent patients.

In this paper I will explore the impact of sexual abuse on development with reference to the adolescent life stage and provide some illustrative material from the therapy of a female adolescent patient.

Before proceeding with the case material, I will first refer to a paper by Briere in which he presented the results of a survey on a random sample of adult female ‘walk-in’ psychiatric patients (Briere 1984). He found that sixty-seven women out of 153 gave a history of childhood sexual abuse, and that these were statistically more likely to be taking psychoactive drugs, to have a history of alcohol or drug abuse, to have been the victims of battering in an adult relationship, and to have made at least one suicide