Alpert J L
Psychoanal Rev. 1991 Fall;78(3):425-35.
This paper includes a brief consideration of literature relevant to childhood sexual abuse detection and prevalence. That literature indicates that such detection may be difficult and that the occurrence of childhood sexual abuse is widespread. These findings, as well as a consideration of literature relevant to trauma, stress, and the identification of survivors of sexual abuse, suggest an analytic attitude of receptivity to the hypothesis of the event of sexual abuse as well as the fantasy of sexual abuse. A second analytic attitude suggested concerns diagnosis. Childhood trauma is implicated in the development of BPD, as the majority of borderline patients have experienced the trauma of child abuse. Further, trauma can lead to dissociation as a defense against stress, and multiple personality disorder is an extreme example of dissociation. The analytic attitude suggested here is that the diagnosis of BPD or MPD may be a necessary but not a sufficient explanation when the symptomatology is a defensive reaction to the traumatic event of childhood sexual abuse. Lastly, it is suggested that the abuse may need to be central to the treatment in analytic work with sexually abused victims. This is suggested in light of the importance of recovery and integration of traumatic memories with their associated affects.
本文简要探讨了与儿童性虐待检测及发生率相关的文献。该文献表明，此类检测可能存在困难，且儿童性虐待事件普遍存在。这些发现，以及对与创伤、压力和性虐待幸存者识别相关文献的考量，表明应持一种接纳性的分析态度，既要接受性虐待事件这一假设，也要接受性虐待幻想。另一种建议的分析态度涉及诊断。童年创伤与边缘型人格障碍（BPD）的发展有关，因为大多数边缘型患者都经历过儿童虐待的创伤。此外，创伤可导致解离作为应对压力的防御机制，而多重人格障碍是解离的极端例子。这里建议的分析态度是，当症状是对童年性虐待创伤事件的防御反应时，BPD或MPD的诊断可能是必要的，但并非充分的解释。最后，有人认为在对性虐待受害者进行分析治疗时，虐待可能需要成为治疗的核心。鉴于恢复创伤记忆及其相关情感并使其整合的重要性，这一点得到了提示。
