Differential Constructions of Trauma in Cases of Suspected Child Sexual Molestation

Despite increased attention within psychiatry and psychoanalysis to childhood sexual abuse, the problem of cases in which sexual abuse is suspected but cannot be verified has received relatively little consideration. Just as underattention to the possibility of molestation as a cause of sexual trauma can fail to address the child’s environmental and therapeutic needs, so a premature conclusion that molestation did occur may skew the course of treatment and have adverse medicolegal ramifications. Although the occurrence of molestation may be verifiable, its absence generally cannot be proven. However, some cases of suspected or equivocal child sexual abuse may involve trauma other than frank molestation. In unclear or equivocal situations, extended diagnostic formulation or treatment with attention to reconstruction may lead to an explication of the symptoms that is at least plausible. In this report, cases thought to involve possible sexual molestation are presented to illustrate alternative formulations or constructions of the trauma. A psychoanalytic perspective can be useful in the approach to such cases.