The Sex-Abuse Time-Line Diagrams
Richard A. Gardner*
ABSTRACT: When evaluating sexual abuse allegations it is extremely
important to differentiate between symptoms that arose prior to
disclosure and those that arose afterwards. Symptoms arising after
the disclosure and cessation of abuse can be caused by sexual abuse
therapy, multiple interrogations, and other aspects of the legal
process. Therefore, in a sex-abuse examination it is necessary to
inquire as to the timing of the development of any claimed
symptoms. Diagrams are presented to facilitate this inquiry.
Evaluators conducting sex-abuse examinations often fail to make a
differentiation between symptoms that arose prior to disclosure and
those that arose subsequently. Such a differentiation can be
extremely important when attempting to determine whether the accusation
is true or false. The effects of sex abuse can range from no
effects at all to psychosis and all points in between.
Furthermore, the symptoms that may result from sex abuse are so varied
that they do not fall into any specific category. Sometimes the
sex abuse is a traumatic experience and the victim may indeed exhibit
symptoms warranting a post-traumatic stress disorder (PTSD) diagnosis.
Some individuals who have been sexually abused do not develop PTSD
symptoms, but may develop sexual problems, e.g., sexual inhibition
problems, compulsive sexuality, and a wide variety of atypical forms of
sexual behavior (paraphilias). Interestingly, the same kinds of
symptoms may be seen in people subjected to a sexualized form of therapy
in which they are indoctrinated into the belief that they were sexually
abused when there is no good reason to believe that they were.
Such individuals may not only develop sexual symptoms, but symptoms that
might warrant a PTSD diagnosis.
For the patient who has been traumatically sexually abused, the PTSD
trauma is sexual. For the PTSD patient who was not sexually
abused, the trauma may be the "therapy," i.e., a treatment
that is much more educational and programming than a therapeutic
process. I refer to this as "therapy" trauma.
And there are patients especially children subjected to
interrogations by police, "validators," lawyers, prosecutors,
judges, juries, psychiatrists, psychologists, social workers, and
self-styled "therapists" who may also develop a wide
variety of symptoms derived from this trauma, symptoms that may warrant
a PTSD diagnosis, a sexual diagnosis, and/or a wide variety of other
diagnoses. I refer to this as legal process trauma, because
for these people the trauma is not sexual but the legal process.
In order to differentiate between predisclosure and postdisclosure
symptoms, the evaluator should trace carefully the evolution of the
sex-abuse accusation. Such inquiry should be conducted not only
with the alleged victim, but the accuser as well. For children,
this will usually involve the alleged child victim and the accusing
adult, most often a parent. When the accuser and the victim are
the same person, such as is seen in situations of belated sexual abuse
accusations, then only one person need be interviewed. In all
cases, however, when it is possible to interview the accuser and the
accused together, such interviews should be conducted. Obviously,
this is not always possible, especially in criminal cases when such
interviews are rarely permitted. In civil cases, however,
especially child-custody disputes, examiners should conduct such
interviews. After all, the two parties are generally still husband
and wife (or ex-husband and ex-wife).
The examiner does well in such an inquiry to begin by asking the
accuser a question such as, "I would like you to think back and
tell me exactly when was the first time that you thought that you (your
child) had been sexually abused." This question might be
followed by: "Exactly what happened then that made you think that
sexual abuse had taken place?" The presence of the accused
party at that point can often be helpful in such an inquiry.
Differences of opinion can be addressed simultaneously in order to
increase the likelihood that the examiner will get as valid a picture as
possible of what actually happened. Then, the examiner should
proceed with questions such as: "And what was the next thing that
happened?" Particular focus should be given to the day of the
alleged victim's disclosure and the nature of the interviews conducted.
The examiner should then delineate the various symptomatic effects of
the alleged abuse during the time frame of the abuse and
subsequently. Again, these should be traced in detail along a time
I have found that the diagrams presented in this article facilitate
this inquiry and are particularly useful when included in the examiner's
report. I refer to these as The Sex-Abuse Time-Line Diagrams.
Four diagrams have been prepared, each of which has its own special
purpose. Figures 1 and 2 are for the examiner.
They include the information for the examiner to consider during the
assessment process. Figures 3 and 4 include only the
Time-Line element in the figures and are to be presented to the patient
in the course of the inquiry. It would be injudicious to use Figures
1 and 2 for this purpose because they provide information
that might contaminate the interview.
Figure 1 is most useful in situations in which there has been
a time gap between the time of last possible exposure of the abused to
the alleged perpetrator and the time of disclosure. This is
commonly the case in situations in which an adult woman belatedly
accuses an elderly relative of having sexually abused her in
childhood. The time frame of the alleged abuses during childhood
would be represented by A-B. Point C represents the time in
therapy when she uncovered alleged memories of her abuse. Point D
represents the time when the examiner conducts the interview.
The graphics at the bottom of Figure 1 represent the
symptomatic effects of the aforementioned kinds of abuse. As can
be seen, depicted there is the gradual increase of symptoms over the A-B
time frame. With the discontinuation of the abuse at Point B, one
would expect a gradual diminution of the symptomatic effects of the sex
abuse. At Point C they would be less than at Point B and, if there
were no disclosures, interrogations, and "therapy," the
symptoms would decrease even further by Point D. If, however, at
Point C the patient is subjected to "therapy" and/or legal
process trauma, then symptoms would increase progressively by Point D.
The A-B time frame would be the period during which one would expect
to have seen symptoms of abuse. Under such circumstances, one
would expect to see residual symptomatology during the B-C time frame as
well, especially if the abuse was traumatic. When there has been
no actual sex abuse, then no symptomatic effects of sex-abuse trauma are
to be seen either in the A-B or the B-C time frame. Under such
circumstances we only see symptomatic effects during the C-D time frame
and this is depicted in the lowest symptomatic effects rendition in Figure
1. Although it is possible (but very improbable) that symptoms
arising in the C-D time frame might be the result of uncovered memories
of early childhood abuse, it is far more likely that such symptoms are
the result of the suggestions and even the indoctrinations of the
"therapist." Of course, this is only one of many factors
that one should consider when differentiating between a true and a false
accusation, but it is an important factor nonetheless.
The same diagram should prove useful in nursery school situations in
which there is a time gap between the child's last possible exposure to
the alleged perpetrator and the time of disclosure. A common
situation is one in which the child was attending the nursery school
during a particular school year, represented by time frame A-B.
Many weeks, months, and possibly even years later, word gets around that
one or more school personnel was sexually molesting children.
Investigations are conducted and at Point C children disclose their
alleged abuses during the A-B time frame. A series of
interrogations then ensue, some of which may be coercive and sexualized.
Symptoms arising during the C-D time frame, symptoms that are the
result of legal process trauma, are more likely to be the result
of the interrogations. Often, in such circumstances the children
are put into "therapy" at Point C and the symptoms one sees
are then the result of the combination of the legal process trauma
and the "therapy" trauma. Had the children indeed
been sexually molested during the A-B time frame, the period of
attendance at the school, then one would expect to see symptoms during
the A-B time frame and during the B-C time frame. At point C, the
initial evaluator might see residual symptoms of the sexual abuse at
that point. If the child was then protected from legal
process/"therapy" trauma, then one could predict that such
symptoms would have reduced themselves in frequency and duration, as
depicted by the broken line in the symptomatic effects diagram in Figure
1. Figure 1 is also applicable to other situations in
which there is a belated accusation, e.g., clergy, scoutmasters,
recreation workers, teachers, and even strangers.
Figure 2 is useful in situations in which the time of last
exposure to the alleged perpetrator (Point B) coincides very closely
with the time of disclosure (Point C). An example would be a
situation in which a mother actually observes her husband, the child's
stepfather, to be engaged in a sexual encounter with the child.
She immediately calls the police, obtains a restraining order, and the
stepfather is immediately required to live elsewhere. Another
example would be one in which a separated mother makes inquiries of her
daughter on her return home from a visit with the father. She
decides that the father's behavior during the course of bathing the
child suggests strongly that he was sexually abusing their
daughter. Immediately she calls the police and obtains a
restraining order, which brings about a cessation of visitation.
In both of these cases Figure 2 is applicable. In both
of these cases, as well, legal process/"therapy" trauma
can intensify symptoms and/or bring about symptoms that might not have
otherwise appeared. The upper symptomatic effects depictions at
the bottom of Figure 2 depict expected symptomatic effects had
there been bona fide sexual abuse. As seen there, one would expect
a gradual increase in symptoms over the A-B time frame. At Point
B, with the removal of the alleged perpetrator, one would then expect a
gradual diminution of symptomatic effects of the sex abuse. These
are represented by the broken line from Point B/C to Point D.
However, if the child is subjected to legal
process/"therapy" trauma, the reduction of symptoms does
not take place; rather, there is an escalation of symptoms. And
these are represented by the upper B/C-D line in the same graphic.
The lowest graphic depicts the situation when there has been no sexual
abuse. Then, there is a rapid appearance of symptoms at Point B/C
with further increase over time as the child is continually subjected to
legal process/"therapy" trauma.
These diagrams can also be useful when making inquiries involving
what I refer to as retrospective reinterpretation. This is
a phenomenon seen in false sex-abuse accusations in which behaviors
which, during the time frame of the abuse were considered to have other
causes are, subsequent to disclosure, reinterpreted in such a way that
they allegedly provide verification that sexual abuse was taking
place. The diagrams can also be useful for delineating what I
refer to as the pathologizing-the-normal-process by which
behaviors that were considered to be normal during the time frame of the
abuse are, in hindsight, also considered to be manifestations of sexual
As mentioned, Figure 3 and Figure 4 are designed for
use with parents. The information above the time line is identical
to Figures 1 and 2. The information below the time
line has been deleted in order to ensure that the interviewee is not
provided with any information that could contaminate the responses.
I have found it useful to include these diagrams as addenda in my
reports in that they provide clarifications that enhance the efficacy of
the report. Last, I have found the diagrams useful in the
courtroom especially in jury trials. An enlargement of the
diagrams can be made and the examiner and/or attorney can make reference
to them in the course of testimony. Readers who believe these
diagrams could prove useful to them have my permission to reproduce them
for their own personal use only.
|Sex-Abuse Time-Line Diagram No. 1
Richard A. Gardner, M.D.