(135) CASE REPORT OF SEXUAL VIOLENCE VICTIMS PRESENTING PHYSICAL AND PSYCHOPATHOLOGICAL SYMPTOMS: DO THE LIFETIME OF ABUSE, SOCIAL SUPPORT, AND TIMING OF TREATMENT MATTER?

Abstract Introduction The consequences of experiencing sexual violence (SV) are linked to the time in life when it occurred and the relationship with the perpetrator. The connections among receiving late social support and treatment with worsening of SV outcomes need more clarification. These are three case reports describing SV episodes occurred in childhood or adolescence and their psychological and physical consequences. Objective Description of three case reports of SV occurred in childhood or adolescence and their psychological and physical consequences. Methods Description of sociodemographic data, psychiatric assessment (Mini International Neuropsychiatric Interview (MINI) – Brazilian Version 5.0.0), SV episode and adverse childhood experiences - ACE (Childhood Trauma Questionnaire-CTQ), emotional and stress-related symptoms (Depression Anxiety Stress Scale - DASS-21; Difficulties in Emotion Regulation Scale - DERS; Dissociative Experiences Scale - DES; Posttraumatic Stress Disorder Checklist for DSM-5 - PCL-5; Tonic Immobility Scale -TIS) and physical characteristics regarding pain and muscle rigidity (McGuill Pain Questionaire -SF, Stibor and Schober tests, fleximeter, exploratory palpation) of three victims of SV, enrolled in a referral psychiatric-medical center. Results In these three cases (case A and B female; case C male), the SV occurred at childhood (cases A and B) and adolescence (case C), with a minimum period of five years for SV disclosure, neither one with early medical/social support. In addition to SV, at least one ACE (CTQ) was found: emotional abuse (case A = 19; case B = 15; case C = 16; cutoff = 9), emotional neglect (A = 23; B = 23; C = 10; cutoff = 10), physical abuse (A = 15; B = 13; C = 10; cutoff = 8) and physical neglect (A = 12; B = 11; C = 9; cutoff = 8). Regarding psychopathological aspects we found symptoms of stress (A = 20;B < 10;C = 20;cutoff = 10), depression (A = 22; B = 20; C = 22;cutoff = 10) and anxiety (A = 8; B < 8; C = 12; cutoff = 8) – DASS-21; high scores of PTSD – PCL5 (A = 55; B = 55:C = 57;cutoff = 33); dissociative symptoms - DES (A = 96,5; B = 45,14; C = 156,5; cutoff = 30); moderate (36-65%) to severe (66-90%) difficulties in emotion regulation - DERS (A = 66,45%; B = 44,37%; C = 72,57%). In psychiatric assessment (Case B and C) beyond the classic symptoms of PTSD (guilty, dissociation, dodge, avoidance, and interpersonal harm), symptoms of emotional dysregulation (self-mutilation and dysphoria) characteristic of complex PTSD, dullness and impoverish ideas (Case A), stand out. Regarding physical-somatic symptoms, we found high score of tonic immobility reaction -TIS (A = 29; B < 21:C = 42;cutoff = 21); pain complaints (A = 22; B = 31; C = 25; score = 0-45), muscle rigidity in the axial axis inferred by Stibor test (A = positive; B = negative; C = negative), Schober test (A = positive; B = negative; C = positive) and reduced range of cervical flexion (A = 43°; B = 34°; C ≥ 65°; normal 65°), extension (A ≥ 50°; B = 33°; C = 48°, normal 50°). Through palpatory exploration, the pain was mainly localized in the pelvic (psoas and iliac) and respiratory (diaphragm) muscles. Conclusions The physical and psychopathological findings in these case reports seems to be in line with literature evidence of a higher frequency of pain and psychopathological symptoms in victims of SV in childhood–adolescence. The lack of early medical/social support appears to increase the severity of the outcomes. It highlights the need for more comprehensive therapeutic approach, integrating physiotherapists, clinicians, and mental health professionals, and early investigation by health care providers. Disclosure No.

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