Cycles of abuse nurtured by concealment: a clinical report

J Psychosom Obstet Gynaecol. 2007 Sep;28(3):155-60. doi: 10.1080/01674820601096062.


At present, health care staff do not seem to have sufficient knowledge about their patients' abusive experiences. The aim of the present study is to analyze and discuss what the implications might be for the encounter between patients and health care professionals, when experiences of abuse are concealed. The methodology of this article is varied: a personal narrative, medical records, sociological theoretical literature and empirical evidence. From the narrative we learn that concealment of abuse was devastating for the patient. She was "treated" in vain as a correct diagnosis was not made, while abuse by her father continued. Health care staff also violated her, which she told her therapist, but her protests were not acknowledged. Ten years of treatment thus made her even more sick. This case story focuses on the mechanisms which nurture concealment of a patient's history of abuse, such as structural and symbolic violence. We also suggest ways to break "cycles of abuse". Help the patient to stop concealing also means that she/he leaves a victim role, gets in charge of the situation and takes a first step towards empowerment. In this way, health care settings can become enabling and empowering environments.

Publication types

  • Case Reports

MeSH terms

  • Adolescent
  • Adult
  • Anorexia Nervosa / psychology
  • Borderline Personality Disorder / psychology
  • Bulimia Nervosa / psychology
  • Child
  • Child Abuse, Sexual / psychology*
  • Child, Preschool
  • Confidentiality*
  • Female
  • Guilt
  • Humans
  • Mental Healing
  • Patient Admission
  • Power, Psychological
  • Professional Misconduct / psychology
  • Psychotherapy
  • Shame
  • Symbolism
  • Truth Disclosure*
  • Violence / psychology