Echoes of Trauma: Evaluating Fourty-Year-Old Childhood Sexual Abuse Claims

In California, New York and several other states, the statute of limitations has been lifted related to childhood sexual abuse injuries and claims. This has opened the floodgates to civil cases and personal injury cases. Some of these cases allege sexual abuse from 30-40 and in some cases 50 years prior. This makes an evaluation of injuries challenging on multiple fronts. 

This article will briefly discuss this phenomenon and provide best practices for functioning in your role as an evaluator or as a treating psychologist. The first section of this article is for forensic evaluators and will touch upon the topics of delayed disclosure, alternative stressors, pre-morbid functioning and changes in functioning after abuse, the role of memory, and other variables such as record review, relationship history, and symptom validity concerns. The second section of this article is for treating psychologists and includes the process of an evaluation in a civil case and treatment of therapy records and other records.  Also provided are recommendations on documentation. Lastly, litigation stress is reviewed along with intervention recommendations that may help client’s mental health while undergoing this process. Associated articles and resources discussing the California law (AB218) and New York laws and other similar state laws are listed at the bottom of this article. 

Many of the organizations being sued are school districts, fraternities, universities, boy’s scouts, summer camps, churches, boys and girls clubs, and mentoring programs, etc. Many of these lawsuits involve allegations of negligent training and hiring and supervision of staff.  Allegations include allowing children to be alone with an alleged perpetrator.

Obtaining school records, psychiatric records, employment records or police reports is difficult and can prove impossible. Some records aren’t available, have been destroyed and some records are illegible due to poor copies and/or indecipherable cursive. 

The outcomes of childhood sexual abuse are well-known. Those that have survived childhood sexual abuse face many disadvantages to both their health and psychological health. Based on available research, children who are exposed to abuse are at increased risk for depression, anxiety, PTSD, low self-esteem and occupational problems (Zeanah, et al., 2018). 

Delayed Disclosure

Research on “delayed reporting” of childhood sexual abuse indicates that this phenomenon is quite common. The average age of disclosure to anyone (including spouses or authorities) is approximately 40-50 years old (Alaggia, et al., 2019). 

This indicates that many people hold on to the “secret of the abuse” for many years and into adulthood. People often delay reporting for a variety of reasons. People often wait to disclose or don’t disclose at all due to fear of not being believed, stigma around mental illness, as well as gender, cultural and religious dynamics and variables. Disclosure of childhood sexual abuse is seen as an ongoing, interactive, iterative process, with the person who discloses constantly evaluating how the disclosure is being received by others (McGill & McElvaney, 2023). Some researchers have argued that the disclosure process is a lifetime process. 

Law enforcement officials often seem to have a hard time understanding why someone would wait so long to report a crime of this nature. I have been asked in depositions and noted that law enforcement found the delayed nature of the reporting to be suspect or notable. While this may be true for other crimes – for childhood sexual abuse this type of delayed disclosure is the norm.

Reviewing Alternative Stressors (Or Trauma)

The plaintiff (or survivor) of the abuse has almost always faced other stressors since the abuse in childhood. Therefore, carefully reviewing other sources of stress and trauma is critical.  Research has found that individuals that have suffered sexual abuse in childhood are at higher risk for later trauma and victimization. Child sexual abuse survivors are approximately twice as likely to experience sexual victimization during adulthood (Lahav, Ginzburg, & Spiegel, 2020). Research has found this seems to be related to neurobiological changes, altered threat perception, increased vulnerability, maladaptive coping strategies such as alcohol, drugs, risky sexual behavior and other variables (Scoglio, et. al, 2021).

As such, the plaintiff (survivor) may have faced domestic violence, gang violence, gone to prison, had car accidents, sexual assault, or other stressors over this 30, 40 or 50 year period.  Detailing and documenting changes in beliefs, behaviors, symptoms and attitudes can be helpful to know what came from each traumatic event they faced. It is also important to identify the sources of behavioral avoidance consistent with PTSD – and knowing the emotional impact of each event on the plaintiff. 

For example, we can turn to a composite case – a childhood sexual abuse survivor who was abused at age 10 may have also been “jumped” into a gang and beaten at age 16. He may avoid certain neighborhoods, avoid gang tattoos, or signs of “macho” males that the person thinks might lead to a confrontation. This would be different from avoiding certain cues or triggers such as footsteps down the hall, body odors and smells, or certain sexual triggers, or confined spaces that are associated with the sexual abuse for example. Identifying behavioral avoidance and determining if it is tied to which traumatic event can be both challenging and ultimately necessary. 

  Often the expert is asked to apportion the percentage of “damage” from the traumatic event in question or “legally relevant event” (LRE) vs. damage from other alternative stressors. Research has recommended focusing on five aspects in these types of evaluations (Greenberg, Otto & Long, 2003): 

• Plaintiff’s baseline psychological functioning before the LRE 
• The nature and extent of the distress caused by the perpetrator
• Significant impairments to prior functioning
• Likely causes of psychological impairments
• Potential future psychological interventions and outcomes

 This process also includes generating hypotheses, not definitive conclusions, providing nuanced, contextual interpretations and corroborating test results with other evidence and data (Greenberg, Otto & Long, 2003). 

Foster care cases are also uniquely challenging. By definition, the plaintiff (or survivor) of abuse has faced some type of abuse, neglect or trauma that led the person to being removed from their family/caregivers and placed into foster care. If the plaintiff (or survivor) was then subsequently sexually abused (or other type of abuse) in foster care, it makes it much more difficult to determine which problems and symptoms in their life are from the original familial abuse vs. the symptoms that stem from the reported sexual abuse in foster care. I recommend looking for architectural differences in the context of the abuse and look for differential triggers or trauma cues. For example, trauma #1 happened at night, and the person held their hand over their face and the perpetrator was an adult man with blonde hair. The other abuse happened during the day and was outside near a garage that smelled of diesel and involved a closer-aged peer. The avoidance triggers are likely to be different and associated with cues in the environment when the trauma was imprinted on their brain. 

The Role of Pre-morbid Functioning and Changes in Functioning

Similar to car accident cases involving traumatic brain injuries (TBI’s), evaluating the client’s estimated pre-morbid functioning is important. It allows one to compare their premorbid functioning to any changes after the abuse. For example, let’s turn to another composite case, imagine a student who was getting straight A’s, was popular, never used drugs and appeared college bound, bright and motivated. However, after the sexual abuse the student withdrew from peers, their grades dipped to C’s and D’s, they started using substances heavily and broke up with their romantic interest. The person became unmotivated and started skipping school and eventually dropped out of school and struggled with shame and guilt which left them isolated. This is a significant deviation from their pre-abuse trajectory. This deviation in their trajectory could be significant for future employment, future education and future relationships and would be considered part of their “damages” in a personal injury case. 

The Role of Memory

A common question from attorneys goes something like this, “would you agree that memory gets worse over time and not better?” This seems like a logical proposition to assent to in general terms but can be an oversimplification. Psychologists and memory researchers alike know that memory is malleable and can change over time. However, certain significant memories of emotionally salient or arousing events are more likely to be captured in long term memory and with much more significant sensory detail than other events. Accordingly, there is cognitive neuroscience research that trauma memories are processed differently than regular memories (Lanius, et al., 2006). 

Other Important Variables

Exaggeration or magnification of psychological symptoms is understood to hover around 29% percent in personal injury cases (Mittenberg, et al., 2002). Accordingly, some studies show that exaggeration of symptoms may be higher in PTSD cases as up to 40% of these cases involve some element of exaggeration (Frueh, et al., 2007). Therefore, some form of validity testing or malingering testing may be indicated to evaluate the possibility of exaggerated symptoms.  This can be adequately addressed with the validity scales on the PAI, and/or MMPI in most cases. 

For these remote cases of abuse, it is important to review employment records, military records, and psychiatric records if applicable. Employment records are an important source of difficulties that many people with severe PTSD or trauma symptoms can have trouble functioning at work over time. 

Assessing a plaintiff’s relationship history including relationship problems such as romantic relationships, friendships or work relationships can also be a helpful source of information. There have been cases where the plaintiff either never married or has been married four times. I have seen cases where the person never married so that they would never have to disclose the abuse to a partner. In addition, this author has seen cases where the survivor of the abuse chooses not to have any children due to trauma related fears and concerns. 

There is a body of research that notes that the litigation process itself can cause stress and a resurgence or increase in symptoms.  This is called, “litigation stress.” A common example may be a person sitting for a deposition and being asked very hard, difficult and yet necessary questions about a rape or sexual assault and what the perpetrator did or said to the victim.  This can easily cause an increase in nightmares, intrusive memories and spikes in anxiety for some plaintiffs. The evaluation process for some can be “traumatic” and very stressful.

On the other hand, in my professional experience, I have seen that the independent medical evaluations (IME) for some plaintiffs can serve a therapeutic function and the person reports feeling better after disclosing the abuse and how it has impacted them. 

Your Role as a Treating Provider (Psychologist)

A treating psychologist can be subpoenaed and have your deposition taken to discuss your opinions as a fact witness or “treating expert.” The plaintiff (your client) is often unable to have the provider exert privilege or confidentiality as the plaintiff has “raised” the issue of their mental health via the lawsuit and thus it is only fair for the defendant organization to have access to their mental health records to evaluate the claim.

The plaintiff (survivor) often undergoes an “Independent Medical Evaluation” (IME) which is typically a full-day psychological evaluation with clinical interview and psychological testing portions. This typically occurs on two occasions – one by the defense expert and the plaintiff’s retained experts. These interviews typically involve considerable inquiry into the reported or alleged abuse. Discussing the details of the abuse in detail with a stranger can be challenging for clients.  

Records and Treatment of Records

The plaintiff’s life and mental health records are likely to receive strong scrutiny including employment records, pay stubs, social media posts, educational records etc. When treating survivors of abuse who are in litigation, your treatment records are very likely to get subpoenaed in these cases. Statements such as, “client is doing well” can be taken out of context and shown in court or during depositions to show they aren’t “damaged” by the abuse. Many treating psychologists may have briefer notes, and this could be a liability depending on the context. If the therapy notes are very brief – the forensic expert may wrongfully assume that the records accurately reflect all the problems you were working on with the client.