Kanyanya M. I., M.Mmed (Psych.)Hotel La Mada, Nairobi

JUNE 14,2013

Kenyatta National Hospital

Sexual violence- a serious human rights and public health issue,

A problem in Kenya and the world over. Affects both males and females of all ages

(1, 2). Children at greatest risk. The prevalence; approx. 12–35% (women)

and 4–9% (men). About 2/3 of survivors develop long-term

effects (3).

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include a variety of adult psychiatric conditions; MDD, borderline PD, somatoform disorders, substance use disorders, PTSD, dissociative disorder, and eating disorders (2).

Other long-term effects include self-destructive behavior, anxiety, feelings of isolation and stigma, poor self-esteem, a tendency toward revictimization, and sexual maladjustment (4).

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NAME: MM SEX: MALE AGE: 20YRS RESIDENCE: DONHOLM, NBI. MARITAL STATUS: SINGLE EDUCATION: F4

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Patient staggered in and requested not to sit in a chair but to lie on the examination couch. Lay in prone position, a position he maintained throughout the interview.

Avoided eye contact. Complained of;- Feeling sad and angry- Bitterness towards women

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Feeling worthless Emptiness Feeling hopeless and suicidal Social withdrawal Self blame Poor sleep Poor appetite

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Sad, withdrawn and angry since childhood when he was sexually assaulted on diverse occasions by a female cousin and two house-helps and a cousin.

low self-esteem. poor at making and keeping friends. girlfriend studying in SA; poor relationship poor sleep and nightmares.

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Withdrawn - bedroom. often blames himself for his condition. dreams a lot about his own death, lost 8kg over the past two months. bitter towards women and forces them in to

sex just to hurt their feelings. watches pornography, in an effort to sooth

himself, only to get more frustrated.

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Suicidal attempts- innumerable times, (with medication pills). Planning to use charcoal stove.

inform his mother of the abuse but mother would be angry with him and assault him physically and one time threatened to throw him in to the toilet.

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2nd of 4 siblings. The elder sister is educated to masters degree level and is independent while his only brother and immediate follower dropped out of school in F2 and disappeared from home 4 months ago. Nobody knows where he is. His younger sister is in F2.

The father is an engineer. He takes alcohol and is often violent towards the mother. Mother is a primary school teacher.

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The patient does not take psychoactive substances. Educated to F4 (2011) and scored B+ and has been admitted to study Petroleum Engineering in China from September 2013.

In primary school he used to be teased because he was bigger and older than his classmates; this made him to sit KCPE in class seven, scoring 387/500. In high school was bullied.

No positive forensic history.

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wasted afebrile, not pale v/s normal systems essentially normal Sad Persecutory auditory hallucinations. Paranoid Suicidal ideation

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Axis 1: MDD with parasuicidal behavior. Axis 2:? Borderline PD. Axis 3: 0 Axis 4: childhood sexual abuse, poor social

support, dysfunctional family, lack of friends due to poor inter-personal relationships.

Axis 5: GAF 41-50

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Baseline blood work up Corroborative history Supportive counseling Trauma Focused CBT Family therapy Group therapy Antidepressants (Antipsychotics). (Referrals: social worker, police)

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Long term GBV effects Be supportive Multi-disciplinary approach *Loss to follow up.

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1. National Guidelines on Management of Sexual Violence in Kenya, 2nd Edition (2009), xi.

2. Putnam, F.W. (2003). Ten-year research update review: Child sexual abuse. Journal of the American Academy of Child and Adolescent Psychiatry, 42 (3), 271.

3. N von Fraunhofer (2006). Working with the victims: adult survivors of child sexual abuse,

4. Browne, Angela; Finkelhor, David. Impact of child sexual abuse: A review of the research. Psychological Bulletin, Vol 99(1), Jan 1986, 66.

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