SAT, Oct 9 \ 15.00-21.00 \ From Understanding to Prevention

120
REFLECTIONS OF A CHILD PSYCHIATRIST ON SEXUAL ABUSE

Marianthi Kotea, MD

Victimizer and victim. Silence, concealment, guilt, shame. The child psychiatrist is invited to become a judge and find a fair solution. He is invited to be a therapist and heal a psychic trauma.

121
INCEST: DIFFICULTIES IN WORKING THROUGH THE TRAUMA

Hara Karamanolaki
Psychiatrist, Athens University Medical School
Full member of Hellenic Society of Psychoanalytic Psychotherapy
karamanic@ath.forthnet.gr

Incest is a severe psychic trauma referring to an overwhelming, paralyzing psychic state which implies a loss of ego functions, regression and obligatory psychopathology. According to Freud (1939) one of the effects of trauma is the attempt of the subject to bring it into operation once again, to revive it in analogous relationship with someone else. He summarized these efforts under the name of «fixations» to the trauma and as a «compulsion» to repeat.
There are a lot of difficulties for therapists in working through the trauma with incest victims. These difficulties are not only increased by the primitive defense mechanisms like splitting, denial and projective identification used by these certain patients, but also by the intense countertransference feelings deriving from the therapist's perception of the patient as a victim. The above issues illustrate clinical material from a long lasting psychoanalytic psychotherapy with a woman patient, who was an incest victim.

122
ALIVENESS AND LACK OF ALIVENESS IN SEXUAL DISORDERS: A CASE PRESENTATION

Grigoris Vaslamatzis
Associate Professor of Psychiatry, Athens University Medical School.
Full member of Hellenic Society of Psychoanalytic Psychotherapy
Fotini Bardi,
Psychiatrist

Psychoanalytic research on the «deviant sexuality» emphasizes the dehumanization of the object, as well as its regressive and adaptive functions. From an intersubjective perspective, Ogden proposed that the meaning of «deviant sexuality» lies in the interactional field of the analytic dyad.
Based on these conceptions, we argue that the «neo-aliveness»* contained in «deviant sexuality» represents attempts to deal with deadness and persecution. Detailed material from a case of a woman analysand illustrate the above issues as they are manifested in the transference-countertransference interaction.

* neo-aliveness: borrowing from McDugall's work on neo-sexualities, we constructed this term to include patient's need to sustain their psychic world's aliveness.

123
THE PERVERSE PLEASURE AS ANTI-DEPRESSIVE DEFENCE AGAINST THE LOSS

Christos Zervis
Psychiatrist – Psychoanalyst
Department of Adolescent Psychiatry, Gennimatas Hospital, Athens, Greece
zervis@otenet.gr

Stoller claims that, through the perverse ritual, the trauma is changed in pleasure, orgasm, victory.
Through the presentation of extracts from the treatment of one patient with multiform perverse tendencies, is sketched out a psychosexual course where the loss caused fixations. If this loss, periodically, causes painful depressing sentiments, the most frequent defence of the patient against the grief is the resort in perverse scripts, which either add pleasure in pain and/or transform, imaginary, the loss in a pleasure-receiving revenge-control over the object.

124
DISSOCIATIVE IDENTITY DISORDER (MULTIPLE IDENTITY DISORDER) AFTER TRAUMA

Alexandra Roussos
Child Psychiatrist, Director D' Child Psychiatric Department, Attiki Child Psychiatric Hospital
President, Society for the Mental Health of Children and Adolescents

The Dissociative Identity Disorder (Multiple Personality Disorder), a still disputed disorder, has a reported incidence of 1:10000 in the general population, with a higher prevalence among women. The most common etiological factor is early (infancy-preschool years), severe, continuous child abuse. Historically this disorder has attracted great interest and disbelief until its inclusion in the DSM-IV. The diagnosis is difficult especially in childhood when all the alters are of the similar age. Since the Dissociative Disorder mimics other psychiatric problems the diagnosis is made after a series of unsuccessful diagnoses and treatments.
Maria a 21 years old girl was referred to the Outpatient Services of the D' Child Psychiatric Department, because of “loss of contact” with the environment after a car accident, in which she suffered no injury. Maria was well known for similar problems in the past, which were diagnosed as epilepsy, without EEG findings or treatment. The diagnosis of Multiple personality was made. We identified 6 main alters along with several fragments of alters. She was treated with psychotherapy for 7 years. To day after 5 years after the completion of the treatment she remains well integrated except for brief dissociations under severe stress. The presentation will describe the nature of the abuse and it will focus on the diagnostic and therapeutic challenges.

125
FAMILY VIOLENCE IN GREECE: IDENTIFYING THE NEEDS FOR PREVENTION

Vaso Artinopoulou, Ph.D
Ass Prof of Criminology, Panteion University, Athens, Greece
vartinop@panteion.gr

The epidemiological research entitled “Domestic violence against women: First epidemiological research in Greece” was carried out during October 2002 – April 2003, with the initiative of the Research Centre for Gender Equality (KETHI). The objective of the research was the recording of domestic violence incidents in the Geek society. The choice of the sample was derived through methods of simple multistage random sampling. It was comprised by 1.200 women, aged from 18 to 60 years, residents of Greek urban, semi-urban and rural regions. The collection of the data was done with the method of structured interviews by the completion of a questionnaire that included 53 questions and 1 concerning the remarks of the interviewer derived from the interview.
According to the main results of the research, 56% of the women interviewed, experienced verbal and/or psychological violence, 3,6% suffered physical abuse and 3,5% was forced in sexual contact. Moreover, 23,6% of women mentioned that they know a woman from their related and/or friendly environment who has been or is a victim of domestic violence from the spouse/intimate partner. Finally, only 8,8% characterizes their spouse/intimate partners violent.
The commentary thet derived from the results of the survey has enabled us to propose the following.
- Creation of a support and counseling system for victims, professionals and perpetrators.
- Rapid response unit for domestic violence incidents.
- Implementations of present policies as well as further development of the judicial system.
- Educational curriculum for policemen and professionals that are directly eposed to the problem.
- Further research to in-depth exploration of the variables that comprise the problem.
- Awareness campaigns to sensitize and energize the people.
- Promotion of good practices.
- Women's access to resources (economic, political)
- Involvement of Non Government Organizations that will be utilized in the process of addressing and tackling with the problem in hand.
Utilizing the above we create a prevention attitude that will contribute to the confrontation of the described phenomena, thus ensuring services to victims as well as minimizing future victimization.

126
CHILD PHYSICAL ABUSE: A GREEC VERSION OF THE CAP INVENTORY

Lila Zaharaki, Argyro Sotiropoulou, Stavroula Diareme, Spyros Ferendinos, Vaso Hantzara, Vaso Artinopoulou, John Tsiantis
Department of child and adolescent Psychiatry, Athens University Medical School, “Ag.Sophia” Children's Hospital, Athens, Greece
itsianti@cc.uoa.gr

Child physical abuse constitutes an extensive problem of modern society, having serious consequences on the victim's physical and mental health and development, and is even considered as one of the major causes of child mortality. In addition, it has been reported that recurrence rates can reach up to 85% in high risk child abusing families. This indicates the need for the development of preventive approaches, and the detection and early identification of potentially abusive abusive parents, with the use of screening instruments. One such instrument is the Child Abuse Potential Inventory. This scale provides an abuse scale for the prediction of the respondent's physical abuse potential, which is further comprised of six factor scales corresponding to the major risk factors associated with child physical abuse.
Taking into account cultural differences and child rearing practices, it has been necessary to adjust the CAP-I for the development of a Greek version for use by professionals in Greece.
The aim of the present project is to further a preliminary study in the validation of the CAP-I in Greece. The sample consists of physically abusive parents, recruited from the Child Psychiatry Department of the “Aghia Sophia” Children's Hospital, who completed the questionnaire prior to any intervention, in addition to a demographic characteristics questionnaire. Preliminary findings will also be presented.

127
THE PERSONALITY AND PSYCHIATRIC PROFILE OF CHILD MOLESTERS

Orestis Giotakos, MD, MSc, PhD
Hellenic Society for Research and Prevention of Sexual Abuse
giotakos@tri.forthnet.gr

The aim of the present study was to investigate the personality dimensions, the levels of impulsivity, aggression, and suicidality, as well as the psychiatric profile in individuals who have been convicted for child molestation. For this purpose 37 child molesters and 25 healthy controls have completed the Temperament and Character Inventory (TCI), the Aggression Questionnaire, the Barratt Impulsivity Scale, the Suicide Risk Scale, and the Life-Time History of Aggression. In addition psychiatric disorders were investigated with SCID.
The score of the TCI dimension Novelty Seeking, and the scores of aggression, impulsivity, and suicidality were significantly higher, while the scores of the dimensions Reward Dependence, Self-Directedness, and Cooperativeness were significantly lower, as compared to the controls. Also, the levels of aggression were associated with the risk of suicidality. Finally, more than half of child molesters had a life-time diagnosis with an Axis I, and about the two thirds with an Axis II psychiatric disorder.
The present sample of child molesters showed high psychiatric morbidity and a personality profile characterized by impulsivity, purposelessness and lack of empathy. The results indicate the need for development of treatment programmes inside the prison. Given the high levels of recidivism of child molesters, similar preventive treatment programs following their discharge from, may serve as major preventive factor of sexual aggression.

128
“SURVIVAL” OF CHILD SEXUAL ABUSERS AFTER ARREST & LONG-TERM OUTCOME OF SEX OFFENDERS: A REVIEW OF THE LITERATURE

Athanasios Douzenis
Senior Lecturer in Forensic Psychiatry, Athens University Medical School, A' Psychiatric Clinic in General Hospital “Attikon”, Athens, Greece
thandouz@med.uoa.gr

Sex offenders are always stigmatized by the nature of their crimes and esp. those who attack children. The child sex abusers are a very small minority of the offenders population but the nature of their crime renders them very unpopular and makes them the subject of intense disgust, aggression and violence. Each country deals with these individuals in a way that reflects overall the attitude of the general population about this type of crime. All societies aim to reduce the sex crimes mostly by means of incarceration but also some countries offer treatment. Sexual attacks on underage individuals carry the maximum penalties.
Psychiatric literature on the “survival” of sex offenders discusses mainly issues that have to do with recidivism and re-arrest. Not all countries deal with this criminal population by means of treatment. Imprisonment carries a substantial risk for sex offenders and nowadays the common practice is to keep this population in isolation from other prisoners.
This paper discusses the origins of this widespread practice as well as the medical literature available on long-term outcome of sex offenders.

129
PERCEPTIONS AND ATTITUDES TOWARDS THE CORPORAL PUNISHMENT AND CHILD EMOTIONAL ABUSE IN GREECE

Olga Themeli, PhD – Vasileios Pavlopoulos, PhD
University of Crete / School of Social sciences - Department of Psychology, Crete, Greece
University of Athens / School of Philosophy - Department of Psychology, Athens, Greece
themeli@psy.soc.uoc.gr, vpavlop@psych.uoa.gr

Very little has been published on the subject of emotional abuse as differentiated from physical abuse. Professionals in the field continue to have difficulty in recognizing and operationally defining emotional abuse.
Corporal punishment is an under- recognized but actually common form of child abuse that is still perceived as an acceptable form of discipline act by a significant proportion of parents.
The present research is concerned with the Greek student and general population views on the issues of emotional abuse and corporal punishment.
A sample of 307 persons was administered an anonymous questionnaire which aimed at exploring their perceptions and attitudes towards corporal punishment and child emotional abuse as well as several myths and realities surrounding these issues.
Their personal experience as victims of abuse during their childhood, it is also investigated.
The discussion of the research findings aims at raising awareness of possible risk factors surrounding this issue. Implications for effective prevention are also highlighted.

130
THE PROBLEM OF THE STARTING POINT OF PRESCRIPTION IN THE CASE OF SEXUAL OFFENCES

Antonis Manganas
Professor, Panteion University, Section of Criminology, Athens, Greece

In the case of the commission of serious criminal offence, especially of child molestation, the following question arises: The starting point of the prescription begins after the commission of the offence or after the realization by the victim of the damage?
The presentation will describe the legal and ethical aspects of these cases.

131
CHILD SEXUAL ABUSE IN GREECE: THE CHALLENGES FACED BY MENTAL HEALTH PROFESSIONALS WITHIN THE PUBLIC SECTOR

Ioanna Giannopoulou, Amalia Fasilaki, Georgios Tsobanoglou
NHS Community Mental Health Centre of Peristeri, Athens, Greece
Department of Sociology, University of Aegean, Greece
ioannag@mycosmos.gr

This presentation will highlight those areas of concern that deal with the interface between socio-medical practice and the law in cases such as child sexual abuse. We are using cases referred for either assessment or treatment to NHS Community Mental Health Centre of Peristeri (Athens) to examine how the strengths and weaknesses of the public care system in Greece is affecting the effectiveness of our intervention. Such case studies will be presented in order to exemplify the key problems in case management, including the investigative process and the process of decision making, in cases of child sexual abuse. The lack of both, agreed national professional practice guidelines on procedures to be followed and formal organizational framework for the protection of children from abuse (statutory and otherwise), often leads to secondary abuse of the child, who besides suffering the psychological effects of sexual abuse is traumatized by the deficient public care system. The lack of formal training in child and adolescent forensic child psychiatry in Greece restricts the expertise in the field of child sexual abuse (survivors and juvenile perpetrators) and may be affecting dramatically the quality of our socio-medical practice. In this paper we are putting forward a comprehensive proposal aiming at providing better service, using an integrated approach, to children who have been sexually abused.