A 35-year-old woman, with a second year of high school education, married, an 8-year-old daughter and a 1-year and 2-month-old son.
He attended the primary care clinic for angustious and depressive symptoms of eight years of evolution, without treatment and started after the birth of his elder daughter.
The symptoms had worsened in the last year, after the birth of her second child.
Together with the foregoing he hit her daughter, and therefore the husband suggested to consult her.
She was referred to the Psychiatry Unit for the research made by the general practitioner of the history of child sexual abuse, which until that date the patient had silenced.
Background.
He was hit during his childhood by a father, who abused sexual care without penetration from 10 to 15 years old, when he left school and became an alcoholic from another city to work.
In the first house where he worked, he was violated by the son of the council.
This traumatic experience silenced her for fear, shame and guilt.
Later, he presented anguish, nightmares and intrusive images of the rape that resolved spontaneously a month, with the abandonment of the workplace.
These symptoms reactivated one year later, when the victim was accidentally perceived on the street and again resolved spontaneously with the return of the patient to her place of origin.
She married and started her sexual life without problems.
During her first pregnancy she began to present anguish related to the idea of having a daughter, to whom the same could happen as her, that is, being raped.
Anxiety increased when it was born, and anhedonia, intolerance, irritation and emotional lability were added in the puerperium, symptoms for which she did not consult.
When she resumed her sexual life after childbirth, at an opportunity when her husband was under the influence of alcohol, olfactory images and perceptions reappeared when the father sexually abused her.
The patient again felt her father's odor near her.
Before this episode she had blurred memories of the abuse suffered in her childhood.
After this incident, images of child abuse appeared egodisorderly every time she had sexual relations.
In addition, symptoms of hypervigilance and avoidance behaviors related to sexual life appeared, resulting in secondary frigidity with serious problems in the couple relationship.
The rape and sexual dysfunction had not been unveiled by the patient.
An example of the above is found in her medical record, in a consultation to gynecology without previous trauma to her marriage for a breast fibroadenoma, the physician who attended her in this opportunity reported no sexual history.
Location and treatment.
The patient experienced great relief when the general practitioner asked him about the history of sexual abuse.
One of the aspects that had most distressed her during her life was the fear that other people, including her husband, knew of her sexual traumatic history, as it was imagined that it would be rejected and that it would not be relieved.
With the specialty team he talked about his other traumatic background.
After the third intervention, the patient reported her trauma to her husband, who not only noticed her but also gave her support.
After the abuse, the patient improved substantially, with remission of symptoms, sexual dysfunction and her daughter.
He attended a total of five controls in the Psychiatry Unit where his improvement was verified.
During this time she was treated with fluoxetine 20 mg/day and meleril 25 mg/day.
At six months, the mental health team found that the patient was asymptomatic, working and without partner conflicts.
