ADULT LIFE CONSEQUENCES OF CHILDHOOD SEXUAL ABUSE: CASE REPORT STUDY Mushtaq A. Margoob MD, Arshad Hussain MD, Farooq Ahmad Dar MSc*, Taha Mustafa MS**, Zaid A. Wani MD, Akash Yousuf Khan MBBS, Muhammad Mudasir Firdosi MBBS, Yasir A. Malik MBBS, Shiekh Ajaz Ahmad MBBS, Abdul Majid MD and Abdul Hamid Zargar DM* Sexual abuse has existed since ancient times, in all strata of every society, but has remained under reported. The few cases that do get reported are an important source of knowledge about the patterns and consequences of abuse. Following five vignettes show-case abuse experience and sequelae in the victims. The victims experienced trauma between the age of 4 to 12 years, three of them were males and four were the eldest issues in their families. In four cases the perpetrator was a relative. None of the subjects was abused by more than one perpetrator and only one was abused continuously over the years. The commonest manifestations were anxiety, depression, dissociation, somatization and obsessive traits. All these facts would hold a key value for clinicians posed with challenges of evaluating abuse patients. (JK-Practitioner 2006;13(Suppl 1):S79-S81 Keywords : Childhood sexual abuse, anxiety, depression, dissociation, somatization. The detremental effects of child sexual abuse on inter- personal, social and sexual functioning in adult life though very relevant has not been adequately researched so far even in the west. The self disclosure of adults about their abuse as children led to the initial phase of modern research into the subject with the result that over the last 10 to 15 years, child abuse has come to be widely regarded as a cause of mental problems in adult life. Sexual victimization has been documented in various literary and historical sources since ancient times. It has existed in all strata of every society . Sexual abuse of children living in their families in non-western societies is not so uncommon as is generally believed. Child sexual abuse can be defined as sexual exploitation or misuse of a child upto the age of 14 years. It also refers to sexual behaviour between a child and an adult or between two children where one of them is significantly older or uses coercion. The perpetrator and the victim may be of the same sex or opposite sexes. In the absence of any accurate data on the subject from oriental societies, study of possible association between history of sexual trauma and its late appearing psychological effects and lasting medical consequences assume a high significance. Case report of three male and two female adults with history of severe sexual abuse during childhood between the age of 4-12 years is discussed here to highlight the predisposing circumstances, variation in presentation and a need for early detection of sexually abused victims. Eldest of 4 issues, 29 year old single male doctor spoke about his sexual abuse while the first author (MAM) casually talked about case reporting regarding this topic. He had been abused by his maternal uncle at the age of 3 or 4 years when he did not understand the nature of the act. He thought it is play when his uncle asked him to climb the bed. After experiencing severe pain for 2 days, he realized something wrong had happened. He avoided intimacy with his uncle and would not visit his maternal home so frequently after the episode occurred. Eight years later, he was playing with the same person at maternal grandparents place and he decided to sleep with him having forgotten about the last episode. He woke up in the middle of the night feeling again pain in the anal region. He quickly moved out of the bed and slept with his grand mother. Since then he has been very sensitive to the physical proximity of men around him, including his friends and even family members. Was operated for right undescended testis at the age of 10 years. Had obsessive compulsive disorder at the age of 24 years which was preceded by an immense period of anxiety regarding relationship with a college girl. Had the first episode of major depressive disorder at the age of 26 years which was successfully treated with an SSRI for more than 9 months and continues to be in remission. First issue of her parents, she had reported first time 6 years back to the first author (MAM). As a 22 year old single female who after college education had left her recently acquired job without any apparent reason. She presented with severe complaints of intrussive thoughts and preoccupations with cleanliness. She was accompanied by her younger brother, a medical student who suspected possibility of a psychiatric problem in his sister after attending few classes in psychiatry. Initial interview with the patient revealed severe distress about her blasphemous ideas and her preoccupation with excessive cleanliness and fear of contamination. Subsequent interaction with the patient revealed 1 2 Case 1 Case – 2 Past Medical History: From Department of Psychiatry, Govt. Medical College, Srinagar *Department of Endocrinology, SKIMS, Srinagar **Department of Surgery, SKIMS, Srinagar Dr. MushtaqA. Margoob (M.D.) AssociateProfessor, Post Graduate Department of Psychiatry Government Medical College, Srinagar E-mails: mushtaqmargoob@yahoo.com mushtaqmargoob1@rediffmail.com Correspondence to: JK-Practitioner2006;13(Suppl1) S79 traumatic stress