
The Fallout
153
The resulting damage from incest therefore extends over several
possible psychiatric diagnoses. An early diagnostic category was
(and still is), Post Traumatic Stress Disorder, which focuses on the
effects of the trauma the child experienced at the hands of the per-
son she trusted. Borderline Personality Disorder has been con-
nected to invalidating childhood experiences, the most extreme
form being childhood sexual abuse. According to Linehan (1993,
53), “It may be that sexual abuse, in contrast to other types of
abuse, is uniquely associated with BPD.” For those who present
with marked dissociating problems, the diagnosis would usually be
Dissociative Identity Disorder, which includes the earlier diagnosis
of Multiple Personality Disorder (American Psychiatric Associa-
tion 2000).
True, one approach to understanding incest’s damage is to give the
survivor a diagnosis. Whether her abuse history is known or not,
what do her symptoms most closely resemble? As Finkelhor and
his associates (1985) have observed, there’s not one single diagno-
sis that fits all survivors. Although there is heuristic value in spot-
lighting symptoms to enable treatment, the symptoms can be better
understood as stemming from the effects of traumagenic power-
lessness; stigmatization (the feelings of being damaged goods); be-
trayal, and sexualization (Finkelhor and Browne 1986).
Rather than get lost in the gamut of possible diagnoses, which in-
clude personality disorders, anxiety disorders, depressive disor-
ders, sexual disorders, and memory disorders in addition to PTSD,
Briere has suggested that instead of a pathology-focused stance,
survivors do better with an abuse-focused therapy which suggests
that “the client is not mentally ill or suffering from a defect, but
rather is an individual whose life has been shaped, in part, by on-
going adaptation to a toxic environment” (1992, 82).
Briere summarizes the therapeutic approach as focusing on the de-
fensive and adaptive components: “From this perspective, severe
sexual and/or physical abuse is seen as a stressor that would induce
significant psychological disturbance in almost anyone, such that
later ‘abnormal’ behavior is reinterpreted as situationally appropri-
ate coping responses and/or normal reactions to an overwhelm-
ingly aversive event” (ibid., 130).