Childhood Sexual Abuse
Reina Attias and Jean Goodwin
This chapter reviews concepts of body image and body ego in order to provide a theoretical framework for those body-related pathologies that may coincide with the presence of dissociative symptoms and histories of sexual abuse.
Normal development of body image and body ego is necessary for selfcohesion, emotional containment, physical coordination, bodily pleasure, accurate reality testing and the overarching achievement of effectiveness, including self-mastery ( Fisher and Cleveland 1958). Bodily symptoms reported after sexual abuse include disordered eating and other self-injury syndromes, sexual and somatization spectrum disorders, depersonalization syndromes in which the body image develops gaps or disappears and the multiple body images and body egos that characterize dissociative identity disorder (DID).
Internal shifts in body image may underlie these body problems and often can be traced back to children's ways of understanding their sexual abuse. These constructs include: (1) incorporation experiences in which garbage, vermin, inanimate objects, body parts of the abuser, fantasized pregnancies, parent figures or other victims or their ghosts are felt as internal presences; (2) loss experiences including fragmentation, mutilations, amputations, holes or gaps, invisibility or transparency, soul-loss, disembodiment or emptiness; or (3) distortions including genital changes, dehumanization and size or age changes. We will use clinical examples to