International Journal of Cultic Studies ■ Vol.10, 2019 41
Ritual Abuse and Developmental Trauma:
Application of the Triphasic Model of Trauma Treatment in the Case of
“Sarah”
By Cortny Stark
The University of New Mexico, Rio Rancho, NM
Abstract
Clients who have experienced ritual abuse (RA)
in childhood present to therapy with a variety of
complex symptoms. The case of “Sarah”
provides clinicians with an example of the
presenting problems experienced by adult
survivors of childhood cultic abuse. This case
conceptualization utilizes developmental trauma
disorder (DTD van der Kolk, 2009) as an
organizing framework for understanding the
client’s symptoms and psychological distress.
Sarah’s treatment and related counseling
interventions follow Herman’s (2015/1992)
triphasic model of trauma recovery, while
referencing the fragmentation of trauma memory
(van der Kolk, 1996) as a foundation for trauma
processing. I also discuss the role of alternative
internal identities, or “alters,” in the recovery
process.
Keywords: Ritual abuse, developmental trauma
disorder, triphasic model of trauma recovery,
trauma treatment
Theoretical and Research Basis for
Treatment
In this article, I review the background and
foundations for counseling treatment of client
“Sarah” while she was receiving mental health
services at a college resource center. Sarah’s
experience with adverse childhood events,
specifically cult-perpetrated ritual abuse of a
sadistic nature, explains the origins of her
symptoms and psychological distress. I use
developmental trauma disorder (DTD) as a
framework for understanding the complex nature
of her symptoms and fragmented identity.
Adverse Childhood Events and Ritual Abuse
Exposure to traumatic events and adverse
experiences in childhood increases the
likelihood that individuals will experience
additional exposure or victimization in
adolescence, and adulthood (Herman,
2015/1992). Children who experience traumatic
events are more likely to experience adverse
physical and mental health symptoms across
their lifespan. Upon entering adulthood, these
children are at greater risk of developing liver
disease, chronic obstructive pulmonary disease,
autoimmune disease, somatization (negative
somatic symptoms with no biomedical cause),
depression, suicide attempts, and efforts to self-
medicate through the use of substances (Felitti &
Anda, 2010). Ritual abuse is a distinct form of
child abuse that not only predisposes individuals
to an increased likelihood of developing the
aforementioned difficulties but it is also
correlated with an increased risk of dissociative
symptoms and disorders (Noblitt &Perskin,
2000). This form of abuse is frequently
associated with destructive cults of various
ideological backgrounds, organized crime
groups, or both (Noblitt &Noblitt, 2008).
The ritual abuse of a child is a unique form of
trauma that aims to break down the child’s
integrity of self and create dissociative states,
with the ultimate aim of contributing to the
individual’s (or when the abuse occurs within a
group, the group’s) perceived sense of power
(Noblitt &Perskin, 2000). Ritual abuse consists
of maltreatment that is perpetrated “in a
ceremonial or circumscribed manner and where
the abuse causes traumagenic dissociation and/or
establishes or reinforces control over dissociated
states” (Noblitt &Noblitt, 2008, p. 25). This
form of abuse often includes the use of
programming, a method that includes extreme
physical, emotional and/or psychological pain to

42 International Journal of Cultic Studies ■ Vol. 10, 2019
induce dissociative states and create new
internal, or “alter,” identities (Miller, 2012).
Abuse of children within cultic settings may
also follow a nonritualized course, with children
subjected to sexual, physical, and/or
psychological abuse that is not directly related to
ritualized programming. Although nonritualized
abuse may be perpetrated as a means of
asserting control through violence, such abuse is
not associated with prescribed rituals or
ceremonies. In my clinical experience, not all
cults practice ritual abuse, nor due all groups
who may be classified as cults necessarily
engage in ritual abuse of its members. For those
groups who engage in abuse of their members
(and/or members’ children), the level of sadism
exercised in ritual versus nonritualized abuse is
individualized and inconsistent thus, the “level
of sadism” of ritual abuse cannot be generally
stated. The case of “Sarah,” described in the
following text, illustrates that severely sadistic
abuse can occur as an isolated event or isolated
events with individual cult members or persons
not explicitly affiliated with the cult.
The instances of abuse I discuss in this
manuscript include both ritualized and
nonritualized sadistic abuse, and also incest.
Sadistic abuse is defined as “extreme adverse
experiences” wherein the perpetrator derives
pleasure from the suffering of the victim(s), and
it includes “acts of torture, overcontrol, and
terrorization, ...ritual involvements, and
malevolent emotional abuse” (Goodwin, 1993,
p. 181). The sadistic nature of the traumatic
content I describe in this manuscript may be
disturbing for some readers, particularly those
individuals who have survived abuse or
violence. I encourage readers to use discretion
should the material shared here elicit a strong
negative response.
The organized and systemic nature of ritualized
trauma includes multiple experiences of torture,
threats of death to self and loved ones, and
exposure to gruesome scenes. Children
subjected to ritual abuse are often brought into
the abuse by a trusted loved one or caregiver and
are subjected to repeated exposure throughout
childhood. This repeated victimization affects
development of emotional regulation and
interpersonal skills (Cloitre et al., 2009), and it
impairs the individual’s ability to master
developmental milestones. Dr. Bessel van der
Kolk (2005) labeled the disruption of victims’
lifespan development and resulting
symptomology as developmental trauma
disorder.
Developmental Trauma Disorder: Framework
for Presenting Problem
DTD accounts for the complex nature of
traumatic stress when the client has experienced
ongoing trauma at the hands of caregivers that
extends over multiple developmental periods
(Bremness &Polzin, 2014). Van der Kolk and
colleagues (2009) proposed the addition of DTD
to the fifth edition of the Diagnostic and
Statistical Manual of Mental Disorders (DSM-
5), but they were unsuccessful. The DSM-5
maintains posttraumatic stress disorder (PTSD)
as the only diagnosis that explains the
symptomology attributed to traumatic
experience. Although DTD is not officially
acknowledged as a diagnosis by the American
Psychiatric Association (APA), the symptoms
outlined in DTD consist of consensus criteria
developed by the National Child Traumatic
Stress Network (NCTSN). These criteria were
derived from numerous longitudinal studies that
utilized diagnostic interviews to explore the
experience of children who have been exposed
to complex trauma to include ritual and cult
abuse (Bremness &Polzin, 2014).
DTD provides practitioners with a
comprehensive outline for understanding the
spectrum of symptoms and altered perception
experienced by survivors of ritual abuse.
Individuals with DTD experienced multiple
traumatic exposures that incited “intense affects
such as rage, betrayal, fear resignation, defeat
and shame,” and caused the child/adult survivor
to engage in “efforts to ward off the recurrence
of those emotions” these efforts included
avoiding experiences that preceded the trauma
or “engaging in behaviors that convey a
subjective sense of control in the face of
potential threats” (van der Kolk et al., 2009, p.
10). Survivors with DTD experience somatic
problems, from headaches and stomach aches to