For example, one study found that, after controlling for history of psychiatric disturbance, adult survivors had lowered thresholds for pain (13). In addition to the psychologic distress that may potentiate survivors' symptoms, there is evidence that abuse may result in biophysical changes. Although some of these coping strategies may eventually lead to health problems, if symptoms are evaluated outside their original context, survivors may be misdiagnosed or mislabeled (5). These coping mechanisms are used for protection during the abuse or later to guard against feelings of overwhelming helplessness and terror. To appropriately treat and manage survivors of CSA, it is useful to understand that survivors' symptoms or behavioral sequelae often represent coping strategies employed in response to abnormal, traumatic events.
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