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 Post subject: Sexual abuse presenting as episodes of loss of consciousnes
 Post Posted: Sun Nov 27, 2005 8:45 pm 
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Sexual abuse presenting as episodes of loss of consciousnes

By Dr. Priyani Rathnayake, Senior Lecturer, Department of Psychiatry, Faculty of Medicine, Peradeniya.

@ Sri Lanka Journal of Medicine: 2000 Vol. 9 No. 1

A 17 year old girl who had been sexually abused at the age of 8 years presented with episodes of loss of consciousness. She recovered from the episodes after 3 months of therapy which consisted of ransposing her own problem to another little girl (X); a technique known as ‘alienation’.

There is increasing awareness created among the public about child sexual abuse, due to media coverage, discussion programmes and the setting up of the child protection authority. The children who get sexually abused, are likely to suffer from either short-term or long-term effects almost invariably. It is only the degree of suffering that varies. The long –term effects of sexual abuse can be multiple and include emotional, cognitive and sexual effects among others.

Case report

A 17 year-old student residing in Ampara was admitted to the Psychiatry ward, with a history of episodes of loss of consciousness. These episodes lasted for a variable periods of time, varying from 10-45 minutes but did not have the characteristics of generalized seizures or complex partial seizures. She continued to develop these episodes even on the ward and a contributory cause could not be ascertained for some time.

As we kept on exploring her past, and inquiring about any significant events, she finally revealed that she had been sexually abused at the age of 8 yrs. The abuser was a male school- teacher, who was a boarder at her maternal grandmother’s house. On the day the first incident occurred, she had been left in charge of her grand- mother as there was a pirith ceremony at the house. This young teacher around 30 years of age, had called her into the room, offering some sweets. She remembered him being very nice to her even on previous occasions and giving her sweets whenever she visited her grandmother.

The memory of the first incident was somewhat hazy, but she could remember him getting on top of her. She said she felt suffocated and that she felt a burning sensation near her vagina/urethra, which was very unpleasant. She was frightened, but he had spoken to her and assured that there was nothing wrong. She is unsure of anything else that happened on that occasion, but remembered that she had an urgent desire to pass urine, whereupon she felt a burning sensation. He had spoken very kindly to her, given her sweets and told her never to mention this to anyone at all. Afterwards such incidents had kept recurring, but she was uncertain about the number

of occasions. The abuse had stopped only when the abuser went on transfer after a few months. The patient had then forgotten about the incidents.

When she was 10-11 years of age she used to wake up in her sleep feeling frightened and found she was sweating, but did not realize why. This too had stopped after some time.

Around the age of 15 years, in the science class, the male and female reproductive systems had been discussed. She felt anxious for no apparent reason and soon after that she began to develop the episodes of loss of consciousness. She had taken treatment from several local hospitals without any improvement.

When she was 16 yrs of age a young man who was in the army had started showing an interest in her. The parents have not objected and he had started visiting her. As his intentions became clearer and he started talking about marriage, her episodes of loss of consciousness became more frequent and it was at this point that the mother brought her for treatment.

The connection between the sexual abuse and her present state of mind was made by some comments she made to the effect that she felt “worthless” and “not good” and that she “deserved to suffer”.

Therapy consisted of bringing this issue out into the open, for she was unable to even think about it, without having an episode of loss of consciousness. Over a period of 6 weeks she started talking, and we were able to obtain the details given in the history. A major issue that had to be dealt with was “guilt”. After the first couple of occasions she had liked and even welcomed the experiences and this she found extremely difficult to cope with. The other issue was her fear that she may not be a virgin. When the therapist initially suggested that she could get herself examined by a Gynaecologist she refused. Later during the course of therapy patient herself

requested an examination. Following examination by a gynaecologist, when she was informed that she was still a virgin she began to recover. Over a period of 2-3 months she stopped getting episodes of loss of consciousness and gained some awareness about her problem.

Discussion

This patient started having problems at the age of 15 yrs when she learnt about reproduction in the science class. Only then did she realize that what happened to her was not something that happened to little girls regularly. The impact of this realization had invoked fear, but she was unable to talk about it or clarify anything. Her fear was then converted to episodes of loss of consciousness, which enabled her to escape from the unpleasant thoughts. Such episodes of loss of consciousness are known as conversion seizures. With the entry of the suitor she would have felt more threatened because she then had to face issues like marriage, close relationship with a man and the problem as to whether she was still a virgin.

As she felt very threatened to talk, therapy consisted of transposing her own problem to another little girl (X). This is a technique called ‘alienation’ which is used in such instances to enable a patient to look at the issues involved with empathy, without identifying too deeply with the incidents. What ensued in this discussion was that ‘X’ was a little girl who was totally unaware that she was doing something wrong and if so was she immoral or bad to feel pleasure. Cultural values, the issue of virginity as well as other moral and ethical issues were discussed. Confirmation that she was still a virgin greatly helped her recovery. She recovered from the episodes of loss of consciousness gradually over a period of 3 months. Her reaction to the abuser was to trace and confront him, which she later decided was not very wise. Her mother who was informed of these happenings was very supportive.


Related Articles:
:arrow: Child abuse — a growing social problem


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