 In his article Dissociation in Complex Post-Traumatic Stress Disorder, Julian Ford wrote the following. If I succeed to find it, here it is. The unique feature of sexual violation symptoms in complex post-traumatic stress disorder is their dissociative quality, sex and physical contact, elicit fragmented and unstable self-representations and relational schemas that are infused with alternately intense and empty effect. Patients, says Julian Ford, describe being unable to reconcile or even live with a split between one, their nurturing self-awareness. Example, I need and deserve physical and psychological privacy, safety, comfort, intimacy and pleasure. So they can reconcile this with their intense disgust or terror in response to thoughts of or desires for touch or sexual contact. So what Julian Ford says is that there's a conflict between self-nurturing telling yourself, you know, I need touch, I need love, I need intimacy, I need to be cared for. I need privacy, I need safety, I need comfort, etc., etc., I need pleasure. So there's a conflict between this and the fact that when they are touched, there is intense disgust or intense terror or extreme anxiety. Julian Ford quotes one of his patients, one of the patients, the patient says, being touched makes me long to be held forever. Then I feel disgusted with myself for being weak and I remember that it's my job to take care of other people and I don't deserve anything that makes me determined to hurt anyone who tries to touch me. Just like they are going to hurt me. My name is Sam Vaknin, I am the author of Malignant Self-Love, Narcissism, visited and former visiting professor of psychology. And today we are going to discuss how sexually abused children grow up, become adults and intimate partners. What does it feel like? What's the experience of being with an intimate partner who has a history of sexual abuse in childhood? And of course before we proceed, there are gradations of sexual abuse, the touching and molesting on the one hand and there's rape on the other of children. So the reactions to each type of sexual molestation or sexual abuse are very different. Generally speaking, if we have to generalize, then low grades so to speak, sexual offenses against children are likely to produce borderline personality disorder while very extreme violations of the physical integrity of a child are likely to yield dissociative identity disorder, previously known as multiple personality disorder. And of course again, dissociative identity disorder is a whole forest of diagnosis and I would say that in majority of cases we are likely to be faced with OSDD, which is the form of DID, which is very closely aligned with borderline personality disorder. I recommend that you watch the video about BPD and OSDD, a video that I've made here. But let's delve a bit deeper to the experience of being with an intimate partner who has been sexually abused egregiously or not in childhood. And we start by realizing that victims of sexual abuse in childhood dread intimacy. They dread intimacy because they sexualize intimacy. They are afraid of being loved and being cared for because in their minds they have to pay for it. They have a transactional mindset. Love is always conditioned upon sexual services. Being cared for is only a prelude, a foreplay, a prelude to sex. So they misidentify, they conflate intimacy and being loved with pain and boundary-wracking abuse. These are very important observations because it's a very complex multi-layered phenomenon. It's not just triggering. Of course someone who has been sexually abused as a child is likely to be triggered in almost all sexual situations. It's not only about triggering, which is a typical reaction to trauma. It's a post-traumatic reaction. But it's also about much deeper issues of identity, emotions, emotional regulation and so on. For example, the sexual abuse in childhood destroys the child's ability to generate and enforce boundaries. Child cannot separate from usually the parental abuser. Sometimes the abuser is a member of the family or friend or whatever. But in majority of cases these are the parents. So the child cannot separate from the sexual abuser, who is also a parent. A child cannot individuate. And consequently the child cannot set boundaries. So having sex in adulthood is perceived as an unboundary experience. Experience where a suspension of boundaries is a prerequisite and a demand and a requirement. Similarly sex is associated with pain. Sometimes sex in early childhood is painful period. Penetration of a child is likely to inflict serious physical harm and pain. But sometimes the pain is merely psychological. So both psychological and somatopharm or somatic responses are very common in victims of childhood sexual abuse. The pain lingers there. It's like a kind of prolonged grief disorder. It's like mourning one's own body, what one could have become had one not been subjected to such egregious, soul-wracking mistreatment. So victims of childhood sexual abuse, sexualized intimacy, sexualized love, misidentified love and intimacy with pain. And all this is superimposed on the idea I am not allowed to resist. My job is to please. My role is to gratify. So I am having boundaries is evil, is wicked, is bad, is vicious, is malevolent and malicious. And I'm not going to set boundaries. Why? Because I'm a good person. I'm a good person when I gratify someone sexually. But when I deny sex or I insist on boundaries in sex, I'm a bad person. It's a bad object voice inside the victim, which never lets go. It's a kind of inverse or reversed inner critic. The inner critic informs the victim of sexual abuse, childhood sexual abuse. The inner critic says, if you want to be good, you need to be sexually corrupted. If you want to be good, you need to engage in all kinds of practices that are demanded of you. And so you need to suspend yourself. You need to not be if you want to be good. So the victim of sexual abuse, childhood sexual abuse, comes to identify being good with not being at all. A suspension of oneself during the sex act, because the sex is about not being. The only way to gratify your sexual partner, which is the sexual partner is a stand-in for your molesting father or molesting uncle or sexually abusive mother or whatever. Or a teacher or a neighbor. So any sexual partner in the future stands in for these people. He fills in for them. He represents them. So you need to gratify and please and satisfy the sexual partner by not being. Not only by not being you, that's not satisfactory. That's not enough. You need to do all this by not being at all. And anyone who has had sex with victims of childhood sexual abuse would tell you how they suddenly disappear. How they become like a dummy. They become inert, immobile, frozen and so on and so forth. It's a very common, it's commonly described by spouses and boyfriends and girlfriends of people who are intimate partners who have had sexual abuse in childhood. In short, it's a freeze response. Sex becomes an anxiety reaction or a stress response. And the strategies used by these children who have been abused sexually. Strategies are implemented in late childhood adolescence and go way into adulthood. And these are the strategies. Number one, self-objectification. I'm just an object. You can do to me as you please and you can do with me as you please. I'm just going to lay there and let you do to me whatever you wish. Number two, absenting oneself from the sex and from the intimacy attendant upon the sex via dissociative mechanisms. Most common of these mechanisms is known as depersonalization. The victim of childhood sexual abuse. Absents herself and her persona. She's no longer there. She's going into either an internal space or into deep space, an external space. She disappears and this is known as depersonalization. It's as if she's telling herself, that's not me there. The things that are being done to this object are not being done to me because I am not here. I am not here to suffer these indignities and to accommodate the wishes and needs and desires of my sexual intimate partner. I'm not here. I'm gone. I'm gone inwardly into my mind or I'm gone outwardly, very similar to a drug trip or an LSD trip or something. So the absenting oneself from the sex and intimacy are a major instrument of dissociation, depersonalization. The second strategy is known as derealization. The victim of childhood sexual abuse who finds herself or himself in a sexual situation begins to regard the whole situation as unreal. It's as if it were a movie or a theater play or something she observes. It's as if she, I'm saying she because the vast majority of childhood sexual abuse victims are female, but of course it applies to male victims. So it's as if they split the world. They split the world and they become mere, polite, uninterested observers. They observe the proceedings. They see themselves gratifying the sexual partner, participating in sex acts, complying with wishes and so on and so forth. And all the time it doesn't feel really, doesn't feel as if it's happening. So depersonalization is a mechanism that says it's happening, but it's not happening to me because I'm not here. Derealization is a mechanism that says it's happening, but it's happening in a theater play, in a movie, in a production of some kind. It's not real. So because it's not real, it's not really happening and it's not because it's not really happening. It's of course is not happening to me. And of course the third mechanism, if all else fails, is amnesia. So people with borderline personality disorder and of course people with dissociative identity disorder lose time. They just lose time. They forget. They can't recall either the details of events or even the occurrence of events. They don't remember. They wipe off whole swathes of memory. And then they later try to make up for it by confabulating. That's a different video. But it's also a defense mechanism against the intolerable proximity of sex, sexuality, intimacy and potentially love emotions. Victims of childhood sexual abuse are terrified when exposed to these things. They're terrified when they're exposed to intimacy, someone falling in love with them, offering love and care, compassion, attention, affection, someone initiating sex. They just freeze. The next strategy adopted by these victims is self punitive choices. They self harm by sexually self-trushing. They let themselves behave in ways which are very humiliating and degrading. Anything from group sex that they don't want and they don't like to, I don't know, engaging in sex acts which are seriously disgusting and so on. So these are self punitive choices. And the aim of the self punitive choices is to restore the good object. It's as if the victim of childhood sexual abuse says to herself, I'm a bad object. I'm an unworthy object. I've been defiled and degraded by the people who were supposed to love me because I'm not lovable. I'm a bad object and bad people, bad objects need to be punished. They need to be penalized. They need to learn a lesson. They need to be put in their place. They need to suffer. They need to harm, to go through harm. So I'm going to punish this bad object that is me. And I'm going to punish this bad object that is me by engaging in very degrading and defiling and horrific and sadistic sex. And I'm going to do this to me because by doing this, I'm demonstrating to myself, to my sexual partner and to the world at large that I'm on the side of good. I'm opposed to my bedside. I'm opposed to my bed object. I'm punishing. I'm self punitive. I'm punishing my bed object. And since I am the one who is punishing the bad object, it must mean that I'm a good object. In short, splitting. The main defense mechanism of victims of sexual abuse, childhood sexual abuse, when they come across an intimate partner who loves them, wants to be intimate with them, and of course engages in sex, the main defense mechanism is splitting. The victim splits herself to all good and all good part and an all bad part. And the role of the all good part is to subdue, subjugate, penalize, destroy, demean, debase, defile, degrade the bad part. Thus restoring virtue. Thus restoring morality and good citizenship if you wish. It is a civil war. The victim of childhood sexual abuse whenever she has sex, whenever she's exposed to intimacy and love, she's in a state of civil war between her good side, the good object, and her bedside, the bad object, split as it is, self splitting. And an all out war erupts, which is very visible. It resembles very much switching in DID or switching in borderline personality disorder. Partners of victims of childhood sexual abuse report that during sex there's a lot of sudden aggression. Incredible ups and downs, crazy making behavior, freezing, fearful reactions, extreme anxiety which cannot be quieted, terror on the other hand extreme self trashing and total gratification of the partner's wishes, fantasies and dreams. Ability to engage in totally impersonal sex and objectifying sex, self harming, self trashing and so on. So this is the experience of loving someone who has been the victim of sexual abuse in childhood. Your love, the intimacy you offer, and even the sex itself, which is a mode of communicating, I love you, I want to be intimate with you. They're all going to be met with dread, anxiety, evasion, or submission, but extreme submission, submission to the point of saying, look, do to me whatever you want because I'm not here. I'm just not here. And this is not real. This is not happening. And I'm going to forget all about it anyhow. So I'm going to upset myself. I'm going to leave my body here. I'm gone. I'm going to leave my body here. Use it as you see fit. And when you finish, let me know and I'll reclaim my body. It's more or less the experience. So I would be interested to hear your reactions to this video in the comments section. And if you have noticed or come across any additional features of intimate relationships with victims of childhood sexual abuse, please feel free to share. It's a very painful experience because everything that is supposed to create a healthy, ongoing, loving intimate relationship actually provokes the victim of childhood sexual abuse into a spiral, a downward spiral that she cannot control and she drags the intimate partner with her. The more the intimate partner tries to love her, to compensate for her fear of intimacy, to hold her, to contain her, to reassure her, the more the victim of childhood sexual abuse panics, hates him, rejects him. It is a kind, it is very similar to the twin anxieties in borderline personality disorder. Approach, avoidance, repetition compulsion, abandonment anxiety, separation insecurity versus enmeshment and engulfment anxiety. So it's a bit of a mirror or BPD and it is therefore not surprising that in the etiopatology, in the etiology, in the causation, in the reasons for borderline personality disorder, when we interview borderline personality disorder patients and we ask them about their childhood and so on, we find an inordinate proportion, an inordinate percentage of people who have had sexually abusive experiences in childhood. Borderline personality disorder is intimately linked with early childhood abuse, especially sexual. Dissociative identity disorder is almost exclusively linked to sexual experiences in early childhood, inappropriate sexual experiences. In early childhood, so there is causation, there's a direct line connecting these experiences in childhood and the unfortunate pathological outcomes. However, regrettably, the person who pays for all this is usually the intimate partner. He ends up paying, he ends up paying the Bible, he ends up, you know, suffering. Because to overcome these defenses against intimacy and love associated with pain and vulnerability and boundary breaking, to overcome these, you need to really be a tuned patient and to work nonstop towards somehow convincing the borderline or the dissociated DID. A patient convincing her that your love is going to be different, your intimacy is not going to be the same. You're going to offer her a variant of variety of love and intimacy and caring and affection and compassion and holding and containment and support and sacro and everything. You're going to offer her all this unconditionally. It's not, you have to convince her that it doesn't necessarily have to do with gratifying you sexually. That means sometimes abstaining from sex for a very long time and few intimate partners are willing to do this. So this is the price one has to pay in order to, you know, love a victim of childhood sexual abuse. The scars are forever. The damage is permanent. The trauma is all pervasive. The coping strategies are dysfunctional. The hurt, the pain, the fear dominate and dictate and drive the victim forward. Actually, not forward, but away from her intimate partner.