EFFECTS OF CHILDHOOD SEXUAL ABUSE; A CASE PRESENTATION. Kanyanya M. I. , M. Mmed (Psych. ) Hotel La Mada, Nairobi JUNE 14, 2013 Kenyatta National Hospital
INTRODUCTION Sexual violence- a serious human rights and public health issue, A problem in Kenya and the world over. Affects both males and females of all ages (1, 2). Children at greatest risk. The prevalence; approx. 12– 35% (women) and 4– 9% (men). About 2/3 of survivors develop long-term effects (3). Kenyatta National Hospital
EFFECTS include a variety of adult psychiatric conditions; MDD, borderline PD, somatoform disorders, substance use disorders, PTSD, dissociative disorder, and eating disorders (2). Other long-term effects include selfdestructive behavior, anxiety, feelings of isolation and stigma, poor self-esteem, a tendency toward revictimization, and sexual maladjustment (4). Kenyatta National Hospital
THE CASE: NAME: MM SEX: MALE AGE: 20 YRS RESIDENCE: DONHOLM, NBI. MARITAL STATUS: SINGLE EDUCATION: F 4 Kenyatta National Hospital
PRESENTATION Patient staggered in and requested not to sit in a chair but to lie on the examination couch. Lay in prone position, a position he maintained throughout the interview. Avoided eye contact. Complained of; - Feeling sad angry - Bitterness towards women Kenyatta National Hospital
Complaints (cont’d) Feeling worthless Emptiness Feeling hopeless and suicidal Social withdrawal Self blame Poor sleep Poor appetite Kenyatta National Hospital
HPC Sad, withdrawn and angry since childhood when he was sexually assaulted on diverse occasions by a female cousin and two househelps and a cousin. low self-esteem. poor at making and keeping friends. girlfriend studying in SA; poor relationship poor sleep and nightmares. Kenyatta National Hospital
HPCs (Cont’d) Withdrawn - bedroom. often blames himself for his condition. dreams a lot about his own death, lost 8 kg over the past two months. bitter towards women and forces them in to sex just to hurt their feelings. watches pornography, in an effort to sooth himself, only to get more frustrated. Kenyatta National Hospital
HPCs (Cont’d) Suicidal attempts- innumerable times, (with medication pills). Planning to use charcoal stove. inform his mother of the abuse but mother would be angry with him and assault him physically and one time threatened to throw him in to the toilet. Kenyatta National Hospital
FAMILY 2 nd of 4 siblings. The elder sister is educated to masters degree level and is independent while his only brother and immediate follower dropped out of school in F 2 and disappeared from home 4 months ago. Nobody knows where he is. His younger sister is in F 2. The father is an engineer. He takes alcohol and is often violent towards the mother. Mother is a primary school teacher. Kenyatta National Hospital
SCHOOL/ SUBSTANCE USE The patient does not take psychoactive substances. Educated to F 4 (2011) and scored B+ and has been admitted to study Petroleum Engineering in China from September 2013. In primary school he used to be teased because he was bigger and older than his classmates; this made him to sit KCPE in class seven, scoring 387/500. In high school was bullied. No positive forensic history. Kenyatta National Hospital
PHYSICAL & MSE wasted afebrile, not pale v/s normal systems essentially normal Sad Persecutory auditory hallucinations. Paranoid Suicidal ideation Kenyatta National Hospital
MULTI-AXIAL DIAGNOSES Axis 1: MDD with parasuicidal behavior. Axis 2: ? Borderline PD. Axis 3: 0 Axis 4: childhood sexual abuse, poor social support, dysfunctional family, lack of friends due to poor inter-personal relationships. Axis 5: GAF 41 -50 Kenyatta National Hospital
PLAN OF MANAGEMENT Baseline blood work up Corroborative history Supportive counseling Trauma Focused CBT Family therapy Group therapy Antidepressants (Antipsychotics). (Referrals: social worker, police) Kenyatta National Hospital
ISSUES Long term GBV effects Be supportive Multi-disciplinary approach *Loss to follow up. Kenyatta National Hospital
REFS: 1. National Guidelines on Management of Sexual Violence in Kenya, 2 nd Edition (2009), xi. 2. Putnam, F. W. (2003). Ten-year research update review: Child sexual abuse. Journal of the American Academy of Child and Adolescent Psychiatry, 42 (3), 271. 3. N von Fraunhofer (2006). Working with the victims: adult survivors of child sexual abuse, 4. Browne, Angela; Finkelhor, David. Impact of child sexual abuse: A review of the research. Psychological Bulletin, Vol 99(1), Jan 1986, 66. Kenyatta National Hospital
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