Again, at the risk of being obnoxiously repetitive, it is most important to understand is that the person who has been sexually abused does not automatically develop disease. Modern medicine focuses on diagnosis (testing, which can be time-consuming and elaborate), treatment (may include surgery), and drugs (can be sophisticated and expensive) – all of which can have undesirable side effects. However preventing the disease eliminates the need for one or all three of these aspects of medicine. The rest of this section will explain ways in which the SA survivor can prevent health problems.

If you put "stress management information" in your Internet browser, you will find millions of websites (20 million at Yahoo and 88 million at Google – on a recent search). Many of these sites (such as www.stress.org, sponsored by the American Institute of Stress in cooperation with the American Psychological Association) offer useful advice, usually without charge, that helps to prevent disease.

Two of the most significant parts of healing for the SA survivor are learning to love oneself and having fun each day. If you can accomplish these two objectives, you will decrease your risk of contracting the diseases that so commonly affect the sexually abused population. Before delving into stress management, let’s first understand stress and some of its ramifications.

Stress is a neutral and normal event, a change in life that is often unexpected. This change could be a salary raise, a demotion, being criticized, having a car accident, going on vacation, and even celebrating a holiday with relatives. However, the critical part to understand is that this stressful change is neutral, not necessarily bad, as the term, “stress,” implies in today’s society. It may help to realize that stress is an everyday occurrence and that no one can avoid it. How we interpret the stressful event determines how it affects us.

If we interpret the change in a positive way, this is called “eustress,” or good stress. If we look at the event in a negative way, it is called “distress,” or bad stress. And this is the type of stress that can cause disease. Everybody is different and therefore most life events affect individuals in various ways. A promotion and raise in pay in one’s job might be a joyous occasion for one person (who views it as a reward and cherishes having more responsibility, etc.) but it might cause unhappiness for someone who doesn’t want the additional duties and doesn’t care about the increase in income. Same event but different results. If you can turn lemons into lemonade, you will conquer the stress demons.

During eustress, the body releases epinephrine (produced in various parts of the body) – just as it does during distress. This chemical allows us to do our best in any situation just as gasoline fuels the powerful engines in our cars. Golfers who compete at high levels want to feel this rush of adrenaline on the first tee so that they can hit their best shot. The Boston Celtic’s Bill Russell, the all-star center during so many of their championship years, would always vomit before important games, not intentionally but because his body was becoming highly charged. If he did this, he knew he was ready to give his best performance.

However, if this condition of released epinephrine persists for long periods of time, the body eventually becomes tired, worn out, and susceptible to disease. On the other hand, by viewing problems as hassles, one goes into distress, the negative and disease-producing way of handling stress. Distress can manifest in several ways including anger, frustration, jealousy, pessimism, repressed emotions, negative moods, hostility, and depression. SA survivors must become masters of their emotions to avoid the perils of distress.

Dr. Thomas Holmes, a psychiatrist at the University of Washington, and Richard Rahe, a Navy scientist, interviewed thousands of people hospitalized for various stress-related diseases and compiled a scale of life events. In 1967 they published their findings in the article, Social Readjustment Rating Scale, in the Journal of Psychosomatic Research (vol. II p. 214). They assigned each event a point value and, based on their research, found a direct correlation between points accumulated in a twelve-month period and states of disease. If a person had accumulated over 150 points, he would have a 37% chance of illness; if over 200 points, a 51% chance; and if over 300 points, a 79% chance. Death of spouse was listed as the highest on this scale and was given a point value of 100. By typing Holmes-Rahe stress scale into your browser, you will find many sites that offer this test or a variation of it. If you think that your life has become extremely hectic, you may want to take this test to see where you stand. Bear in mind that it was compiled in 1967 and that stress management research since then has revealed many contemporary life events that could place high on the list. Events such as caring for a family member with Alzheimer’s disease, having a terminal cancer or other debilitating disease, or having been sexually, physically, or emotionally abused, would account for a high point value.

Ironically the authors chose not to include abuse incidents in this survey, nor did the authors of a more modern survey, adapted from the Holmes-Rahe scale, which is found at http://www.markhenri.com/health/stress.html. Sexual abuse, from its very nature, should rank very highly on these scales since many studies have linked it to various diseases, psychological aberrations, and social problems.

Time magazine's June 6, 1983 cover story called stress "The Epidemic of the Eighties" and referred to it as our leading health problem. A 1996 Prevention magazine survey found that almost 75% feel they have "great stress" one day a week and one out of three indicate that they feel this way more than twice a week. It has been estimated that 75 to 90 percent of all visits to primary care physicians are for stress related problems. Even the famous Mayo Clinic reports that most of its patients have stress-related conditions. Stress on the job is the leading source of stress for adults and adverse childhood experiences can continually wreak havoc on a survivor’s psyche.

Family structures have changed over the past century. The 2002 U.S. Census showed that about half of all U.S. marriages have ended in divorce. Attendance at religious worship has declined significantly. The Institute for Social Research at the University of Michigan periodically conducts the World Values Survey. About 20 percent of Americans attend church at least once a week. The importance of religion, according to this institute’s data, has been declining in developed countries. The percentage of 12th grade students who report weekly religious attendance has declined from 41 percent in 1976 to 32 percent in 1992, where it has remained constant through 1995. Ironically many medical studies have shown a positive correlation between strong religious beliefs and healing.

Contemporary stress tends to be more pervasive, persistent and insidious because it stems primarily from psychological rather than physical threats. Certainly losing one’s temper in a two-hour traffic jam is not as threatening as being robbed at gunpoint. But it may be just as damaging if we allow it to be. During this time of distress, our body performs many automatic reactions including the following: increased heart rate, increased blood pressure, increased hydrochloric acid in the stomach, and increased fat metabolism.

During times of distress, the body releases catecholamines, particularly those known as known as dopamine, norepinephrine, and epinephrine, which cause the heart rate to rise and blood pressure to increase. Cholesterol is mobilized from fat cells and is dumped into the bloodstream, setting the stage for a blood clot and predisposing to a heart attack or stroke. Blood sugar rises, increasing the risk of contracting diabetes, and hydrochloric acid is produced in the stomach, leading to irritable bowel syndrome and peptic ulcers (in combination with bacteria). The steroidal hormone cortisol is rapidly released in acute stress and significantly reduces one’s NK cells, a major part of the immune system. In chronic stress, this can lead to infections, both bacterial and viral. Although a direct link between cancer and stress has not been demonstrated, depressed NK cell activity, the body’s defense against cancer, has been associated with stressful situations.

Distress has been also associated with obesity, bulimia, and anorexia, conditions often found in SA survivors. And while being angry at one’s abuser may be inevitable, hostility has been shown to be a risk factor for coronary artery disease. In 1983, Shekelle (1) found that workers in Western Electric who scored high on the hostility scale (of the MMPI, a personality survey) were more likely to die of all causes, including heart disease and cancer. Barefoot and associates in 1983 followed up on 255 physicians who had taken the MMPI in medical school 25 years earlier. Their study (2) showed that those doctors with a higher hostility score were nearly seven times more likely than those less hostile to be dead by age 50.

Enduring stressful life changes and chronic negative moods (anger, frustration, anxiety, depression) has been shown in many studies to increase the risk for physical disease and early death (3,4,5)

There are countless other medical studies that link various diseases to distress. One particularly interesting area is autoimmune disease, especially those diseases associated with excessive immune response, where research has found a link with psychogenic factors. Numerous medical studies have demonstrated the relationship between distress and skin flare-ups in patients with psoriasis (6) and other studies show that hypnosis and meditation (7,8) have helped to reduce these symptoms.

Although it’s accepted that there is a genetic predisposition for the autoimmune disorder, rheumatoid arthritis, some researchers have found that distress can predict worsening of the disease in patients (9). Graves’s disease, an autoimmune disorder affecting the thyroid gland, has been linked to distress (10). Distress has also been shown to worsen the condition of multiple sclerosis, a chronic autoimmune disease of the central nervous system (11).

Since distress has been shown to elevate blood glucose levels and decrease insulin level, it is a potential contributor to diabetes. Studies have shown that behavioral interventions can improve the prognosis for diabetic patients (12), which means that stress is also linked to this disease.

Making lemonade out of lemons is what positive people do, rather than letting the lemons of this life drag them down into the depths of anger, jealousy, fear, and a host of other negative mental states. Naturally, it may be nearly impossible to stay happy during a serious life crisis, but studies have shown that some handle emergencies much better than others. How to convert stress into eustress can be learned. So, while it is impossible to eliminate stress from one’s life, especially the lingering effects of sexual abuse, there are many, many ways to cope with stress and live a very happy and healthy life.

1. Shekelle, R.B. et al. (1983) Hostility, risk of coronary disease, and mortality. Psychosomatic Medicine 45, 219-228.
2. Barefoot, J.C. et al. (1983) Hostility, CHD incidence, and total mortality: A 25-year follow-up study of 255 physicians. Psychosomatic Medicine 45, 59-63.
3. Booth-Kewley, S., and Friedman, H.S. (1987) Psychological predictors of heart disease: A quantitative review. Psychological Bulletin 101, 342-362.
4. Cohen, S., and Williamson, G.M. (1991) Stress and infectious disease in humans. Psychological Bulletin 109, 5-24.
5. Schneiderman, N. et al. (1989) biobehavioral aspects of cardiovascular disease: Progress and prospects. Health Psychology 8, 649-676.
6. Gaston, L. et al. (1991) Psychological stress and psoriasis: Experimental and prospective correlational studies. Acta Dermato-Venereologica (Stockholm) 156, 37-43.
7. Kabat-Zinn, J. et al. (1998) Influence of mindfulness meditation-based stress reduction interventions on rates of skin clearing in patients with moderate to severe psoriasis undergoing phototherapy (UVB) and photochemotherapy (PUVA). Psychosomatic Medicine 60, 625-632.
8. Tausk, F. and Whitmore, E. (1999) a pilot study of hypnosis in the treatment of patients with psoriasis. Psychotherapy and Psychosomatics 689, 221-225.
9. Zautra, A.J. et al. (1997) Examination of changes in interpersonal stress as a factor in disease exacerbations among women with rheumatoid arthritis. Annals of Behavioral Medicine 19, 279-286.
10. Rabin, B.S. (1999) Stress, immune function, and health: The connection. New York: Wiley-Liss.
11. Grant, I. et al. (1989) Severely threatening events and marked life difficulties preceding onset or exacerbation of multiple sclerosis. Journal of Neurology, Neurosurgery, and Psychiatry 52, 8-13.
12. Grey, M. et al. (1998) Short-term effects of coping skills training as adjunct to intensive therapy in adolescents. Diabetes Care 21, 902-908.