Ongoing Incestuous Abuse During Adulthood

About the Course:

Substantial numbers of patients with Dissociative Identity Disorder at the time of presentation as adults report incestuous abuse continuing into the adult years and for many, the abuse is current and ongoing. Data relating to a series of 10 such incestuously abused women is presented. Such patients usually have been sexually abused from a very early age (typically from under age 3), with the manipulation of their sexual response a key component in conditioning an enduring sexualized attachment, at the same time shame and fear are used as key components in maintaining compliance and silence. Such women, when able to speak of it will describe the induction by their paternal abuser of orgasm at a very young age, typically around the age of six. Such women have high indices of self-harm and suicidality and are prone to place themselves in dangerous reenactment scenarios. The average duration of incestuous abuse for this group of women was 31 years and the average estimate of episodes of sexual abuse in their lives, 3,320. Most such women experience being “fused” to their father and do not feel that they have ownership of their own body. Generally their mother was reported as an active participant in the sexual abuse or at least as having done nothing to protect their daughter despite seeing obvious evidence of incest. The fathers, despite a propensity to use or threaten violence are generally outwardly productively employed, financially comfortable, stably married and half have had close involvement with a church. However, suicide and murder occur within the first or second degree relatives of these women at a high frequency. All ten had been sexually abused by various groupings of individuals connected to their fathers.

There have been ongoing reports of such cases in isolation for the past one and a half centuries and these reports are summarized in this presentation. The marked increase in the press reporting of such abuse in the wake of the documented abuses of Josef Fritzl, has allowed for the comparison of contemporary cases in the press to be compared with those encountered clinically and has confirmed many congruent similarities in both populations.

This form of extreme abuse has until recently not attracted any form of systematic scientific study and there has been little offered by way of published management guidelines.


Warwick Middleton, MB BS, FRANZCP, MD

Publication Date:



Warwick Middleton, MB BS, FRANZCP, MD (presenter)

About the Author:

Professor Middleton holds honorary appointments as Adjunct Professor, at the School of Public Health, La Trobe University, Melbourne, at the School of Behavioural, Cognitive & Social Sciences, University of New England, and at the Psychology Department, College of Science, University of Canterbury. He is Associate Professor, School of Medicine, University of Queensland. Professor Middleton has made substantial and ongoing contributions to the trauma and bereavement literature and was the primary architect in establishing Australia’s first inpatient/day hospital program for individuals with complex trauma/dissociative disorders in January 1997. He was the principal author of the first published series of individuals with DID to appear in the Australian scientific literature. He has had extensive involvement in teaching, including providing seminars and workshops as well as the supervision of health professionals. He chairs the Cannan Institute. Professor Middleton has been a member of ISSTD for well over two decades, is a Fellow of the Society and has been a long term member of the Editorial Board of the Journal of Trauma & Dissociation. He is currently an ISSTD Board member, Vice-Chair of the Scientific Committee, and Co-Chair of the Membership Committee. He was the recipient of the 2013 ISSTD Morton Prince Award for Scientific Achievement.

Recommended For:

This course is recommended for health care professionals, especially psychologists, counselors and social workers who seek knowledge about dissociative identity disorder as it relates to incestuous abuse in adults. It is appropriate for an intermediate level to advanced level of participants’ knowledge.

Course Objectives:

  1. Recognize the circumstances where ongoing incestuous abuse of the adult patient has happened and is likely to be continuing to happen.

  2. Explain where this form of abuse fits into the spectrum of severe trauma and why there has been so little focus on it in the scientific literature.

  3. Describe how management of such abused individuals requires addressing a strong attachment to abusers, substantial shame and a virtual life time of sexual conditioning.

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