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Sexual abuse presenting as episodes of loss of consciousness

There is increasing awareness created among the public about child sexual abuse, due to media coverage, discussion programmes and the setting up of the child protection authority. The children who get sexually abused, are likely to suffer from either short-term or long-term effects almost invariably. It is only the degree of suffering that varies. The long –term effects of sexual abuse can be multiple and include emotional, cognitive and sexual effects among others.

Case report

A 17 year-old student residing in Ampara was admitted to the Psychiatry ward, with a history of episodes of loss of consciousness. These episodes lasted for a variable periods of time, varying from 10-45 minutes but did not have the characteristics of generalized seizures or complex partial seizures. She continued to develop these episodes even on the ward and a contributory cause could not be ascertained for some time.

As we kept on exploring her past, and inquiring about any significant events, she finally

revealed that she had been sexually abused at the age of 8 yrs. The abuser was a male school- teacher, who was a boarder at her maternal grandmother’s house. On the day the first incident occurred, she had been left in charge of her grand- mother as there was a pirith ceremony at the house. This young teacher around 30 years of age, had called her into the room, offering some sweets. She remembered him being very nice to her even on previous occasions and giving her sweets whenever she visited her grandmother.

The memory of the first incident was somewhat hazy, but she could remember him getting on top of her. She said she felt suffocated and that she felt a burning sensation near her vagina/urethra, which was very unpleasant. She was frightened, but he had spoken to her and assured that there was nothing wrong. She is unsure of anything else that happened on that occasion, but remembered that she had an urgent desire to pass urine, whereupon she felt a burning sensation. He had spoken very kindly to her, given her sweets and told her never to mention this to anyone at all. Afterwards such incidents had kept recurring, but she was uncertain about the number

Summary: A 17 year old girl who had been sexually abused at the age of 8 years presented with episodes of loss of consciousness. She recovered from the episodes after 3 months of therapy which consisted of transposing her own problem to another little girl (X); a technique known as ‘alienation’.
Priyani Rathnayake, MBBS, MD, MRCPsych., Senior Lecturer, Department of Psychiatry, Faculty of Medicine, Peradeniya.

Correspondence: Dr. Priyani Rathnayake, Senior Lecturer, Department of Psychiatry, Faculty of Medicine,

Sri Lanka Journal of Medicine 2000; 9(1): 17 - 18

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