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In general, Freud's early followers supported his shift in focus from actual sexual trauma of sexual abuse to fantasy. More recent analytic (e.g., Ulman and Brothers, 1988) and other writings (e.g., Browne and Finkelhor, 1986; Finkelhor et al., 1986; Russell, 1986) support the contention that chronic symptoms with acute episodes follow sexual abuse and indicate the devastating effects of actual sexual traumas in childhood. Several major long-term effects of childhood sexual abuse are noted in the literature. These are depression and self-destructive behavior, somatic disturbances, diminished self-esteem, difficulties in interpersonal relationships, and problems regarding sexuality.
In the psyche of the adult survivor, childhood sexual abuse is ongoing (i.e., traumatic), but a history of sexual abuse may remain undetected. The first section of this paper includes a brief consideration and literature relevant to sexual abuse detection and sexual abuse prevalence. In the second section, some analytic attitudes that may be useful in identifying, diagnosing, and treating adult survivors of childhood sexual abuse are suggested.
Three analytic attitudes seem likely: First, analysts need to be alert and open to the hypothesis of the event of sexual abuse as well as the fantasy of sexual abuse. Second, diagnosis of borderline personality disorder (BPD) or multiple personality disorder (MPD) is often a necessary but not a sufficient explanation when the symptomatology is a defensive reaction to the traumatic event of childhood sexual abuse. Third, the abuse may need to be central to the treatment. If it is not central, there may be no or little return of the repressed or working through of the traumatic early sexual abuse.