September 2010

Psycho-Mode

approved copy of the author and publisher

Victims Compensation - Dissociative identity disorder as a result of sexual abuse?

An interim report

Jürgen Voss, chief director of the Pension Office, Hanover

from Z / 4 / 2005, S 100, Asgard Verlag, St. Augustin,

ZfS: The International journal of social insurance, social assistance and care

first Introduction

Since the late 90's been in a number of cases, requests for supply of supply under the Victims Compensation Act (OEG) provided by women who submit, that the gap with mental disorders based on sexual abuse has been of the earliest childhood by people from the family environment. Not infrequently, ben-specified that they first fortdauerndem sexual abuse since Years were suspended.

is further alleged that they forget the sexual abuse and completely until many years later, mostly in connection with an inpatient or outpatient psychiatric or psychological treatment, had reminded. The complete oblivion is explained by the fact that they suffer a "dissociative identity disorder" for the purposes in which the memory of severe trauma by splitting into several inner personality shares (multiple personality) "saved" will. constitutes It is a survival strategy of the child's brain.

But even in cases with other diagnostic, applications have been submitted with the claim that the sexual abuse had been completely forgotten and only recently reminded.

is striking that the applicants see often unable to describe details of the se-sexually abuse. They therefore refer to her treating therapist psychotherapy, could describe the details of the action. For the therapy reports results in straight In the most cases descriptions of extreme sexual abuse since early childhood. Descriptions are given of ritualistic abuse as part of satanic cults in which the patient as well as witnesses of child killings had become. The scope of the described sexual abuse is impressive, but raises especially given the frequency of presenting the most extreme abuses the question of the truth.

is, in practice the supply office to deal with these cases is to be extremely problematic, because the clarification of the situation is severe difficulties con-nected. The range of difficulties ranging from the assertion of the statement-refusal right with respect to close relatives about the lack of accurate memories of sexual abuse to influence the conduct of the investigation. Not uncommon in relation to measures of evidence was to the danger to health, so even hinted at the risk of suicide.

The examination of these cases - in spite of temporary nature - now produced results that should be of general interest.

second An example (part 1)

The applicant, born 1968, and the granting of Supply of the OEG requested on grounds that the present with her mental disorders on sexual abuse by her father in the period 3 to 13 Years (1971 - 1981) and her foster father of 14 to 16 Years (1982 - 1984) carry back are. A description of the abuse suffered was not possible for her. She referred to an staatsanwaltschaftli-CHES process in which against the foster father on suspicion of serious sexual abuse of children, including death, child trafficking and serious bodily injury has been determined violation. From the prosecutors' documents, there were some descriptions of sexual abuse on the part of the applicant.

contrast to the descriptions given were missing years of sexual abuse by the biological father.

Tatzeugen could not be named and the applicant also stated that could be approached by the offender under any circumstances.

from the enlisted records of the number of inpatient psychiatric hospital home stays, since 1984, in the time following the end of the specified in the application of sexual abuse by mid-1991 showed no evidence of sexual abuse by father and foster father. The most recently by a university hospital's diagnosis was "paranoid-hallucinatory psychosis from schizophrenic group.

Since mid-1991 the applicant began outpatient psychotherapy. From a treatment report of the treating psychotherapist from the year 1995, it was the first time, an indication that the patient from the time 3 - 13 Age by her father had been sexually abused.

found in a further therapy report, released in 1997, stating that "additional severe trauma were reminded by the foster father, who subjected them to extreme sadistic se-sexually abuse rituals, and forced into prostitution". The therapist went on to the fact that sexual abuse is not through the foster-father at the beginning of therapy known been, but was recalled in the course of therapy by the patient was. At the same time the therapist is different from the previous diagnosis new diagnostic set "dissociative identity disorder (multiple personality), together with the note that the patient in 12 different alters have split.

Finally, the therapist added as possible in their new report from the year 1998, the representation of meaning that the patient had reported more trauma by ritual abuse in which she had become a witness of agonizing torture of another child.

the descriptions of the therapist were generally held on the Information on the se-sexually abuse also refer to any further information on individual offense.

In summary, it is clear that had been given with regard to statement creation and development in the years 1984-1991, despite numerous psychiatric and psychotherapeutic shear treatment of the applicant does not indicate the sexual allegedly to 1984, many years of ongoing abuse. Until the start of outpatient psychotherapy since mid-1991 came with the memory of the patient to a highly sexual abuse. In the course of further over several years of therapy, were expanding descriptions of sexual abuse with the Ten-trend increasingly extreme offense.

(continued in No. 7)

third The clinical picture of "dissociative identity disorder" and the discussion about the causes

The "dissociative identity disorder" (including multiple personality disorder) is in the classification system of ICD-10 listed in F44.81 and therefore internationally acknowledged as a disease.

of the crucial features of the disease include memory problems, Trancezu-stands, nagging inner voices and obvious evidence of acts or the latest exhibit behavior, to which one does not remember can. The dissociation was raised as a form of reaction and processing of traumatic experiences dar. This is the mechanism of dissociation in several parts of the personality as a kind of protective function in order to remain viable in difficult-most traumatic experiences.

It is estimated that about 80 per cent of the country affected by a dissociative identity disorder are women. At a dissociative identity disorder sufferers would describe in up to 90 per cent of cases of sexual and physical abuse. Documented but are also descriptions of emotional cruelty, extreme neglect, poverty or witnessing a violent death first

found after the recent experience of the author from the processing of cases, be-confirmed that the therapists who deal primarily with the diagnosis and treatment of dis-social tive identity disorder, have been deemed to severe trauma in frühkindli-chen Age . Regularly been traumatized by sexual abuse from the third consumption Age, but also from 1 Age indicated.

It must not go unnoticed that regularly by others are serious doubts as to the cause of dissociative identity disorder as a designated sexual abuse have been logged. Thus, some authors noted was that the possibility of seeing "false memories" because of the psychotherapy (so-called False Memory Syndrome) should be seriously considered second Here it is assumed that by (unintended) effects suggestive memories can be distorted or even created new memories that do not correspond to reality, that is wrong. Here are "false memories" experienced by the patient as real memories 3rd

It has also been damage in the U.S., where processes of patients who had received incorrect treatment in psychotherapy memories of extreme sexual abuse of customs, but this not correspond with the facts. The patients have been awarded in some cases, high damages 4th Even in Germany there are for a film broadcast by the ARD report (title: Multiple personalities - madness of the therapist?) From 08.27.2003 a first case in which denies a patient who remembered to have suffered violence experiences in therapy. She has brought an action against their therapists.

How controversial is the debate now is, can be also an information mationsblatt of the Association to raise awareness of dissociation as a survival pattern DIVERSITY eV, see Bremen. There has been stated that 'almost 99 per cent of all People with a dissociative identity disorder as young children have been traumatized by life-threatening and chronic, by gender violence. For this purpose, without reference to American and Dutch studies have been referred.

4th Claims based on the OEG, proof and evidence

According to § 1 para 1 OEG condition for the granting of supply, that the applicant honorable Member as a result of intentional, unlawful assault has suffered an injury to health. The afflicted in the cases of dissociative identity disorder sexual abuse recited violence is one such assault dar. But the violent sexual abuse (eg sexual contacts) is within the scope of § 1 OEG 5th Applicants should follow the temporal scope of the OEG in principle (just application of § 1 para 1 OEG) between acts of 05/23/1949 to 15/05/1976 (application of the hardship provision of § 10 a OEG) and actions from 05/16/1976 to differ.

needed is more that the violent attack, which is in such cases as sexual abuse is proven. According to the established case law of the Federal Social Court, this means that the physical attack with near certainty MUST BE ESTABLISHED 6th

not only in the cases of recollected sexual abuse, but in all cases without criminal court procedure, the full evidence of the applicants as a high hurdle, this is certainly the case when the sexual abuse is denied or the person had died and Tatzeugen missing. What is more, that the sexual abuse in cases of late remembering back many decades, is such that the evidence already set so tight restrictions.

Can not the sexual abuse be found as evidence, is the application of evidence in-honorable Member. For this case, § 6 section 3 OEG in connection with § 15 of the Act provides to the administrative procedures of the war victims (VFG-KOV) presented a Beweiserleich-sion, unless documentation exists to procure or not, or have been lost through no fault of the applicant . Under that provision, the contract details are honorable Member of arrival, based on that of injury-related facts-be drag to place the decision is based, as far as they appear credible in the circumstances of the case. The assessment must extend to whether the applicant by the honorable Member information given to the alleged sexual abuse to describe logical and consistent and in alignment with the known external Circumstances be regarded as credible.

The need to apply the burden of proof provision found in almost all cases, Len. It was therefore necessary to the facts - educate as much as possible - with the restrictions because of the far-off events.

This happened regularly in that the applicant was asked to describe their added-sent to sexual abuse specifically and to identify the perpetrator or perpetrators. In addition, all documents relating to hospital and the reports of psychotherapeutic treatments and a health insurance information on any treatment been called upon.

were obtained from the evaluation questions, so as the case conducted a personal interview of the applicant or a further survey in the written-out process has been.

As the investigation of the facts relevant hearings of siblings also have shown as witnesses. This allowed the applicant to be honorable Member confirmed or refuted in this way factual claims. Likewise, hearings of accused fathers have been able to give information to the accusations.

surrendered after evaluating the arguments of the applicant, the medical records of the information contained therein often References to external facts and the hearing or be-founded doubts about the information provided, they are either not credible in the sense of § 15-KOV VfG be evaluated was. This led directly to the rejection of the request.

can
course, but also for the evaluation of all documents result in a situation in which to obtain a meaningful psychological report on the credible-speed of the information the applicant is required. The requirements that must be made with such a report has shown the Supreme Court in a landmark ruling 7th It is advisable in case of a report commissioned studies selected on the basis of their competence by the prosecutor or criminal courts can be used.

In the cases handled by the author, it was not normally required to obtain a meaningful psychological report, because already on the evaluation of documents and statements was a sound decision possible.

to report in this context is the fact that in one case by an attorney requesting an advisory opinion was requested, in which the applicant was unable to provide information to make the alleged sexual abuse. Alongside, a consultant has been appointed as a psychotherapist working in the field of dissociative Identitätsstö requirements. The claim of the lawyer was in two Ways to reject. First, the question arose how a verifier has no information on Schadenssachver containing the credibility to judge. Second, the therapist does not have the expertise required to create a meaningful psychological report.

5th Processing Standards

Given the characteristics that have been shown in the processing of cases with a dissociative identity disorder should be observed in handling some of the standards-who.

For clarification should be considered an example of an application, which by a lawyer, represented claimant contends that he had been sexually abused since childhood by a criminal group. For details of the sexual abuse she could not comment. The purpose was to question the therapist. Because she was very frightened and afraid of reprisals, she would not name the perpetrators. Moreover, they make their Aussageverweige-insurance law against close relatives use.

The administrative staff who are confronted with such a request the first time, will at first rightly ask, how to deal with this application concerning the investigation of the facts is.

First one must bear in mind that it is the applicants is to mentally ill persons in part. You yourself are in the representation by a lawyer often unable to understand the speeds with an application process under the OEG related necessity, or even view. This and the existing idea with them that the reports of the treating psychotherapist sufficient in connection with the diagnosis of "dissociative identity disorder" to the satisfaction of sexual abuse ma-Chen, the observed resistance to measures to explain the evidence by the authority.

recommend against this background that the applicant already directly An after-supporting position on the proposed clarification of the facts and the applicable rules of evidence comprehensively put into the picture. This is all about making the applicant shows that the Authority is required under existing regulations, to take evidence, and it also determines the manner in which this happens (§ § 20, 21 SGB X).

This is not just for the sake of openness and clarity, but also because displayed, because some applicants or their lawyers have tried to circumvent the orderly Beweiserhe to-ambient. It has been stated that certain evidence measures are not required (eg the hearing of the accused Father), because the existing anxiety problems to a massive decline in health or the lead applicant is at risk of suicide. So seriously take these notes on the one hand, even so, it is not acceptable on the other hand, that the result is deemed necessary education measure is suppressed. The government has therefore not come help but persistently point out the rules to be observed by it.

Before family members, accused by the applicant whether or not accused wrote to-be, the applicant should be informed and also questioned whether levied by their reservations. If the agreement refused to make initial contact, the applicant is for the case that the survey of members for Unum is held-accessibility to note this and to the resulting negative consequences for the decision.

In no case should the inquiry be conducted in order to put forward health hazard against the will of the applicant.

family members and accused persons to be heard on the facts are, they are entitled to be informed of the right to refuse testimony (§ 21 para 3 SGB X).

6th Problems and abnormalities in the Processing

The processing of cases with a dissociative identity disorder has shown that all were predominantly serious doubts as to the presented sexual abuse. These doubts have arisen as follows:

• In some cases a balance between factual allegations of the applicant to be made as credible be classified details of siblings with the same issue, the allegations of the applicant were subsequently to be wrong to look (for example, claimed was one applicant that she by her father since early child-safety almost every night from the bed and sexually abused was brought. Two elderly and because of the whole hearing results as credible genu sisters were put forward that the applicant has from an early age slept with in her room and made them all the time no observations were, to support the allegations of her sister.)

• In some cases, the data of the applicants that they over time had occasion several hospitalizations made to be extremely contradictory dictory identified (eg has been put forward in the survey of the history that no sexual contact has passed and no pregnancy has been submitted. According to the later "Remembering" in psychotherapy, it was (time them against the first entry) ben constantly sexual abuse and given a pregnancy, which was ended with an abortion. The well-known for this time framework conditions could also appear as the claim entirely unlikely.).

• In some cases, have resulted solely from the testimony of formation and evolution considerable doubt (eg, the applicant for 7 years with repeated because of the disturbed mother / daughter -. Relationship treated therapeutically After the meetings of a support group for "incest survivor" participated, had complained it the first time a sexual abuse by her father. After a change of therapists widened the description of the sexual abuse of the time. Finally, it was argued that the applicant had been sexually abused in a satanic cult.)

by the author so far 14 of these cases have been completed. 10 applications are rejected and a case has been accepted. In 3 cases, the application has been withdrawn.

Even if this number still represents no significant statistical value, then the machining but found that certain recurring patterns in the presentations by the applicant and agency run by therapists and become visible first estimates are possible.

Such was not to be overlooked that the "recollection" of sexual abuse often only after many years, sometimes decades later, was created in the course of psychotherapy the treatment. More striking was that several different psychotherapists in-NEN cases in the same almost word description of extreme sexual abuse reported. Thus found is often the first indication of sexual abuse by the father. In the course of therapy, a sexual abuse has been named by the brothers. Time later was then stated that the patient "ritualized sexual abuse of customs and ill-treatment was by a criminal group in a satanic cult "exposed eighth

The attending psychotherapists are, as shown in their reports led to therapy, deal with the damage not critical in the treatment of memories of the widening sexual abuse. A comparison with the real circumstances and conditions in the family of the patient was - wherever possible - rather than in any case. In some cases it was obvious because of the selected formulations, that the basis of the clinical picture obtained a diagnosis of "dissociative identity disorder" on the trauma of early childhood sexual Abuse had been left closed. It was found in several cases, from Ren therapy reports claiming that the sexual abuse "from 1 with the safety Of age must have begun. " It is obvious that this is neither the patients nor the therapists were able to know.

In this context, therefore, must be made aware that it is inadmissible under the prevailing school of thought is to close a mental disorder to a particular cause as the trigger of the disease back 9 If it worked in the cases nevertheless substantial evidence to such conclusions were, this could be explained by the fact that the therapist with a diagnosis of "dissociative identity disorder" to a great extent (up to 90 per cent of cases), early childhood trauma of sexual abuse he wait.

While obvious in a number of cases was that the "recollection" was produced in the course of therapy, showed in some cases a different origin of the memory of sexual abuse. It was seen that some patients had been informed of the existing literature on the problem of multiple personalities or self-help groups in term papers and came across during their studies on the topic of sexual abuse Len. However, were In these cases, then later in therapy on the floor of first vague "memory images" and so-called "body memories" other memories of sexual abuse.

can in processing the application cases of the OEG facts noted by the said high rejection rate at which certainly includes the request withdrawals added GE expects-will be substantial doubt about the during a therapy has been or expanding "recollections" to early childhood sexual abuse advent-men. For the handling of cases, this means that classified by the psychotherapist-introduced ideas about the cause of dissociative identity disorder without further teres may be accepted. Rather, it is necessary to fully elucidate the facts and make a careful assessment of the educational results.

7th An example (part 2)

basis of the statement of the applicant that could be approached by the offender in no case was the investigation of the facts from the outset limited. It is therefore all hospital records and treatment reports and the files were called in the prosecutor's office and evaluated.

given to sexual abuse by the father of 3 to 13 Age was found in the voluminous documentation, not a single indication. In contrast there were at indicated sexual abuse by the foster father of 14 to 16 Years (1982 - 1984) documents in the case of the prosecution, which have been made in the context of criminal interrogation of the applicant. Thereafter, the foster father of the applicant as part of a criminal group in a solitary house in an extremely sadistic manner was sexually abused. A foster father discovered the pregnancy when the applicant was terminated by him with kicks to the abdomen.

The exact evaluation of all documentation to the defendant in numerous to external events such as inter alia, included dates of school changes and times of a school visit and the care of the grandmother and the time of death, revealed the following:

In consultation with their parents (father and stepmother), the applicant because of problems at home during the was autumn 1985 in the household of a teacher measures absorbed. The husband of a teacher who had studied medicine. In the budget there were several underage daughters. Around the turn of 1985/86, the applicant has left the household of the foster family to care for her ailing grandmother to her death the middle of 1986.

Thereafter, the stay in the foster family about one quarter. This also taking into account the uncertainties short stay in the foster family raised the question as to how the system outlined by the therapist, sprawling, and claiming to be from 1982 - 1984, two continuous years of sexual abuse should have gone through the foster-father and other perpetrators CARRIED. The data were both in the time period and the years-resangaben not consistent.

The
here on the basis of their own data resulting conflict should be resolved by a hearing of the foster parents, but this was not the agreement of the applicant. They withdrew their request.

It is not surprising ensure that in such a contradictory facts and the prosecutor investigation has been terminated because of lack of suspicion.

This case also indicates that the revealed with the help of the therapist, "I Remember changes" do not agree to two years of extreme sexual abuse by the foster father in a criminal group can. The documents it was found that there was the part of the therapist not only superficial plausibility of the resulting information in therapy.

contrast revealed in the documents a number of clues for a different decision-stehungsursache for psychiatric illness.

8th Conclusion

from the processing of cases with a dissociative identity disorder gained experi-ence have given rise to elaborate on two aspects.

This is even the legal side of compensation. This is in view of the provisions of § 10 a OEG judge with their temporal scope of 05/23/1949 to 05/15/1976 The view of the cases is presented in which due to the late "recollection" was in the period from 1949 to sexually abused his 10th As expected, there was the evidence in the most recent alleged abuse cases as extremely difficult. For the administration so that the problem is connected to a decision still must take on far past events that can not always make happy.

It is the fact that should be reconsidered for the presumption applicable standard of proof of "good possibility" 11 for cases of this kind in the application of burden of proof provision of § 15 VfG-KOV. It should be pointed out that this burden of proof was originally established in the war victims in order not to leave uncared for in the case of destruction of evidence by the events of war, the war affected victims. Here but there were regular opportunities to match the information from the applicant with an accessible source material. In addition, the type of injury was often result in a unique way to return to the effects of war. All of this was raised in the after OEG significantly different from cases under examination dar. So it is not possible in mental illness, to close on certain causes.

This leads to two suggestions. Should be considered whether it would not make sense to establish a satis-capacity for the filing of claims under the OEG. With such an exclusion period from would-in the most recent cases without timely criminal court Prosecution of acts regularly as evidence into account.

The second suggestion relates to the standard of proof in the case of the burden of proof, which also continues to be necessary. Here would be to consider whether the standard of proof should be tightened so that the damaging event occurred at least with "probability" must.

The second aspect has to do with the fact that the handling of cases of serious doubts about the alleged side psychotherapeutic context of a dissociative Identitätsstö-tion with infantile sexual abuse is justified. It is therefore critical to the actions of the therapists be noted, however, affected mainly on the consequences for women alerted.

The investigations have produced a number of cases because the facts are important indications of the existence of so-called "false memories" of sexual abuse. This would be the therapist, dealing primarily with the diagnosis and treatment of dissociative identity disorder, take note. For them, the question arises as to whether the goal of therapy is useful to start from a situation also wrong.

to draw your attention is also on the consequences for patients and their family To field. 'False memories' cause according to the findings in the cases it handles not only to a non-provoking appalling living biography, but also regularly destroy the family unit. There remain unjustly accused back parents and siblings, who are stunned by the allegations against and in conflict herewith also quite emotional disorders may develop. On the side of the patient also beat high cost of treatment and often premature incapacity to beech, which would also occur with a different original causes for mental illness can result.

the end to be in this context it tells of the fate of a father who was convicted in 2003 by the Landgericht Hannover because of "recollected" sexual abuse of his daughter to 8 years in prison, although the Public Prosecutor had requested acquittal. The Federal Court reversed the decision and referred it to a new trial and decision to a different chamber of the District Court. The father had by then already more than half a year in prison behind him. After receiving a further report was now the father acquitted 12th

The presiding judge of the first hearing was quoted by saying that "no one type of abuse can think of. "

Apart from the fact that such reasoning to a wrong conclusion Ver-out, nobody has come up with such abuse. Handled in the cases described extreme abuses are in fact described in the literature since the 90's 13th

comments

first Guest article by Dr. Ursula "Multiple personality; This is not me - Survival in other rer identity "in the magazine" Brain & Mind "Dossier No 1 / 2004 p. 14 ff

second Paper by Simmons' Diagnostic, forensic and ethical aspects of treatment-induced sexual abuse problem psychotherapy experiences "in" The Nerve Doctor "issue 11/1999, p. 1009 ff also article by Stoffels and Ernst Remembrance and pseudo-doerinnerung; About the longing , trauma victims to be "in" Der Nervenarzt "issue 05/2002, p. 445 ff Renate Next Volbert" Evaluation of statements in trauma ", 1 Published 2004, p. 105 ff, Verlag Hans Huber. Who is more deeply with the problems would like to address, which in particular the book by Renate Volbert is recommended.

third Tower of Loftus' False Memories "in" Scientific American "magazine 01/1998, p. 62 ff

4th Stoffels see under No. 2, p. 449 and then report "Flora's stories" in "Der Spiegel" magazine 44/1998 p. 230 ff

5th Judgement of the BSG 10/18/1995 - 9 RVg 4 / 93 -

6th Judgement of the BSG of 22.06.1998 - 9/9a RVg 3 / 87 - 7, with further references (BSGE 63 S. 270 ff)

BGH of 30.07.1999 - 1 StR 618/98 -

8th Michael Huber, "Multiple Personalities, survivors of extreme violence", first edition 1995, Fischer - Verlag. One explanation for the almost verbatim descriptions could result from that contained in the book appropriate descriptions and the therapist's own after entering in the treatment of patients of recommended changes, the book did. Likewise, led from the case records, that female persons are informed by-the book had.

9th On this issue in one case an expert opinion has been obtained in which this had been considers-represented solution.

10th In 13 of 14 cases began to put forward sexual abuse prior to 05/16/1976, of which 2 cases already in the 40's years. In 6 cases, it ended in the period prior to 16.05.1976.

11th Judgement of the BSG 02/03/1999 - B 9 R 33 / 97 V - with further references

12th Hannover Allgemeine Zeitung, 3.4.2003 and from 9.9.2004

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