Honoring E. Sue Blume

April is Sexual Assault Awareness Month

Honoring E. Sue Blume

Back in 1985 E. Sue Blume developed “The Incest Survivors:  Aftereffects Checklist”, which later was published as a book. Her list was widely used by survivors and at the time by mental health professionals as a standard diagnostic tool.   

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The Incest Survivors' Aftereffect Checklist

© (1985) by E. Sue Blume, LCSW, DCSW

INCEST is any use of a minor child to meet the sexual or sexual/emotional needs of one or more older or more powerful persons in ongoing emotional relationship(s) with that child (parent, step- or grandparent, sibling, babysitter, mother’s boyfriend, teacher, rabbi, priest, family doctor, etc.). Although incest has traditionally been defined as sex and/or marriage between close relatives, above all, it is child abuse—an assault on the child’s sexual boundaries by the very person(s) entrusted with her care. It is a violation of a dependency bond, not of a blood relationship. And it does not require touch. A child can be violated through inappropriate photographs, the way she is talked to or by the way she is looked at.

Incest is such a traumatic experience that its victims may forget that it even occurred. But its scars live on, confusing in their seeming meaninglessness. Problems with sex, trust, touch, addictions, paralyzing depression, memory, shame and guilt can feel crazy and out of control, especially when the cause is unknown. This Checklist describes the consequences of incest trauma. It offers a profile of the post-incest experience in women (although many items apply to men as well), or “Post-Incest Syndrome”. It can be used as a guide to help survivors understand that there are legitimate reasons for their unrelenting difficulties—that, in fact, these “problems” are actually valiant attempts to cope with an impossible situation, and to meet healthy underlying needs.

Many of the items on this list can also apply to survivors of childhood abuses such as battering, or adult children of families where there is a history of alcoholism. Incest is especially common in alcoholic families, although not all alcohol-involved abuse is attributable to the disease of alcoholism. Incest perpetrators often apply the same defenses to their behavior as those used by alcoholics: denial, minimizing, and projection of blame. Additionally, perpetrators, just like victims, may dissociate the abuse. Still, incest is always the responsibility of the abuser. Although incest perpetrators are often described as “sick,” for the most part, this behavior is a choice—intentional, planned, and purposefully hidden.

Have you been struggling with problems that nothing seemed to help, for which even therapy could not find a cause? If the majority of the items of this list apply to you, you might want to consider whether you are a survivor of incest. Of course, you should never allow a checklist, or another person, to determine whether you have been abused. Only you can determine this, and the quest for such answers is long and painful. Even then, remembering is not the end of the process of recovery, but the beginning. If you are a survivor, above all, know this: you are not to blame. And healing is possible; with help, you can break free from the self-blame, isolation, and the entrapment of Post-Incest Syndrome.

This Checklist is based on an original list by New York Women Against Rape, as well as extensive observation of and communication with survivors. To all who contributed: your generous sharing of your experiences and pain is a gift to all survivors.

1. Fear of being alone in the dark, of sleeping alone; nightmares (especially of rape, pursuit, threat, entrapment, blood); night terrors.
2. Swallowing and gagging senstivitiy; repugnance to water on face when bathing or swimming (suffocation feelings.)lings)
3. Poor or distorted body image; alienation from, not at home in, failure to heed signals or take care of body; manipulating body size to avoid sexual attention; compulsive cleanliness, incl. bathing in scalding water; or, total inattention to personal appearance or hygiene
4. Somatization, stress-related diseases: gastrointestinal problems, GYN disorders (including spontaneous vaginal infections); headaches; arthritis/joint pain; fibromyalgia. Also internal scarring. Aversion to doctors (esp. gynecologists, dentists)
5. Wearing a lot of clothing, even in summer; baggy clothes; failure to remove clothing even when appropriate to do so (while swimming, bathing, sleeping); extreme requirement for privacy when using bathroom
6. Addictions, eating disorders, drug/alcohol overuse/abuse/or total abstinence; compulsive behaviors (including busyness)
7. Self-injury (cutting, burning, etc.) (physical pain is manageable) (this is an addictive pattern); self-destructiveness
8. Phobias, panic, anxiety
9. Need to be invisible, perfect, or perfectly bad
10. Suicidal thoughts, attempts, obsession (including “passive suicide”)
11. Depression (sometimes paralyzing); seemingly baseless crying; sadness
12. Anger issues: inability to recognize, own or express anger; rage; fear of rage (actual or imagined); constant anger; misdirected anger, intense hostility toward entire gender or ethnic group (“race”) of the perpetrator
13. PTSD symptoms, including shock or shutdown in crisis (stressful situation always = crisis); psychic numbing. “Hysterical” symptoms: physical pain, paralysis, numbness associated with particular memory, emotion (e.g. anger) or situation (e.g. sex). See also “flashbacks” in item 26.
14. Rigid control of thought process; humorlessness or extreme solemnity
15. Childhood hiding, hanging on, cowering in corners (security-seeking behaviors); adult nervousness over being watched or surprised; feeling watched; startle response; hypervigilance
16. Inability to trust (trust is not safe); absolute trust that turns to rage when disappointed; trusting indiscriminately
17. High risk taking (“daring the fates”); inability to take risks
18. Control, power, territoriality issues; fear of losing control; obsessive/compulsive behaviors (attempts to control things that don’t matter, just to control something!); power/sex confusion (see also #27)
19. Guilt/ shame/ low self-esteem/ feeling worthless/ high appreciation of small favors by others
20. Pattern of being a victim (victimizing oneself after being victimized by others), especially sexually; no sense of own power or right to set limits or say “no;” pattern of relationships with much older or more powerful persons (onset in adolescence); OR exaggerated sense of entitlement; revictimization by others (adult sexual violence, including sexual exploitation by bosses and “helping” professionals
21. Must “produce” to be loved; instinctively knowing, doing what the others need or want; relationships = big tradeoffs
22. Disturbances in attachment; abandonment issues; desire for relationships with no separateness; avoidance/fear of intimacy
23. Dissociation: blocking out some period of early years (esp. 1–12), specific person, place, event; creating fantasy worlds, identities (incl. women imagining self to be male, = not a victim); Dissociative Identity Disorder (DID) (was MPD)
24. Feeling of carrying an awful secret; urge to tell/ fear of its being revealed; certainty that no-one would listen. Being generally secretive. Feeling “marked” (the “scarlet letter”)
25. Feeling crazy; feeling different; feeling oneself to be unreal and everyone else to be real, or vice versa; cognitive problems
26. Denial (no awareness); repression of memories; pretending; minimizing (“it wasn’t that bad”); strong, deep, “inappropriate” negative reactions to a person, place or event; flashbacks, which may occur as dreams, or sensory flashes (a brief image or feeling) with no meaning; or memories of surrounding details but not event or identity of abuser. Memory often begins with least threatening event or abuser. Details of experience may never be fully or accurately known, but much recovery is possible without full recall. Your inner guide will release memories at the pace you can handle (see also #13, #23)
27. Sexual issues: sex feels “dirty;” aversion to being touched; strong aversion to (or need for) particular sex acts; feeling betrayed by one’s body; trouble integrating sexuality and emotionality; confusion or overlapping of affection/ sex/ dominance/ aggression/ violence; having to pursue power in sexual arena which is actually sexual acting out (self-abuse, manipulation [esp. women]; abuse of others [esp. men]); compulsively “seductive,” or compulsively asexual; must be sexual aggressor, or cannot be; impersonal, “promiscuous” sex with strangers concurrent with inability to have sex in intimate relationship (conflict between sex and caring); prostitute, stripper, “sex symbol” (Marilyn Monroe), porn actress; sexual “acting out” to meet anger or revenge needs; sexual addiction; avoidance; shutdown; crying after orgasm; pursuit feels like violation; sexualizing of all meaningful relationships; erotic response to abuse or anger, sexual fantasies of dominance/ real rape (results in guilt and confusion); teenage pregnancy. Note: Homosexuality is not an aftereffect!
28. Pattern of ambivalent or intensely conflictual relationships (abuse is familiar; also, in true intimacy, issues are more likely to surface; in problem relationships, focus can be shifted from real issue of incest). Note: Partner of survivor often suffers consequences of Post-Incest Syndrome also (especially sex and relationship issues)
29. Avoidance of mirrors (connected with invisibility, shame/self-esteem issues; distorted perceptions of face or body, DID)
30. Desire to change one’s name (to dis-associate from the perpetrator or take control through self-labeling)
31. Limited tolerance for happiness; active withdrawal from/ reluctance to trust happiness (“ice = thin”)
32. Aversion to noise-making (including during sex, crying, laughing, or other body functions); verbal hypervigilance (careful monitoring of one’s words); quiet-voiced, especially when needing to be heard
33. Stealing (adults); fire-starting (children)
34. Food sensitivities/avoidance based on texture (mayonnaise) or appearance (hot dogs), which remind the survivor of abuse, or smell/sound which remind survivor of perpetrator; aversion to meat, red foods
35. Compulsive honesty or compulsive dishonesty (lying)
36. Hypervigilance regarding child abuse, or inability to see child abuse, or avoidance of any awareness or mention of child abuse; tendency to develop relationships with incest perpetrators
37. Personality disorders, characteristics; Psychiatric illness (NOTE: Post-Incest Syndrome is often misdiagnosed as these)
38. Note to therapists and survivors: Some items on this list are strongly associated with childhood sexual abuse; however, over 25 items should be identified before incest is suspected. Proceed with caution!
39. Survivors and partners, be gentle with yourselves—and each other.