Many ritually abusive cults deliberately divide the personality system down the middle of the head, making sure that there is no communication between the two sides. “Left side” parts might be instructed to speak to no one other than the perpetrators.

— Alison Miller

Research on organized abuse emphases the diversity of organized abuse cases, and the ways in which serious forms of child maltreatment cluster in the lives of children subject to organized victimization (e.g. Bobby 1996b, ITII 1997, Kelly and Regan 2000). Most attempts to examine organized abuse have been undertaken by therapists and social workers who have focused primarily on the role of psychological processes in the organized victimization of children and adults. Dissociation, amnesia and attachment, in particular, have been identified as important factors that compel victims to obey their abusers whilst inhibiting them from disclosing their abuse or seeking help (see Epstein et al. 2011, Sachs and Dalton 2008). Therapists and social workers have surmised that these psychological effects are purposively induced by perpetrators of organized abuse through the use of sadistic and ritualistic abuse. In this literature, perpetrators are characterized either as dissociated automatons mindlessly perpetuating the abuse that they, too, were subjected to as children, or else as cruel and manipulative criminals with expert foreknowledge of the psychological consequences of their abuses. The therapist is positioned in this discourse at the very heart of the solution to organized abuse, wielding their expertise in a struggle against the coercive strategies of the perpetrators. Whilst it cannot be denied that abusive groups undertake calculated strategies designed to terrorize children into silence and obedience, the emphasis of this literature on psychological factors in explaining organized abuse has overlooked the social contexts of such abuse and the significance of abuse and violence as social practices.

— Michael Salter

Ritually abusive groups also convince children that something evil has been put inside them. For example, a child is made to believe he or she has a "black heart" - seeing the abuser holding an animal heart and then feeling severe chest pain while it is supposedly inserted. In "brain transplants", the brain of an abuser or of a despised animal such as a rate is supposedly put into a child. Children are told that they are demons or monsters or aliens, or internal copies of an abuser whose "seed" has been implanted by rape. Ch29, p324

— Alison Miller

The fact that most perpetrators of organized abuse are men, and that their most intensive and sadistic abuses are visited upon girls and women, has gone largely unnoticed, as have the patterns of gendered inequity that characterize the families and institutional settings in which organized abuse takes place. Organized abuse survivors share a number of challenges in common with other survivors of abuse and trauma, including health and justice systems that have been slow to recognize and respond to violence against children and women. However, this connection is rarely made in the literature on organized abuse, with some authors hinting darkly at the nefarious influence of abusive groups. Fraser (1997: xiv) provides a note of caution here, explaining that whilst it is relatively easy to ‘comment on the naïveté of those grappling with this issue ... it is very difficult to actually face a new and urgent phenomenon and deal with it, but not fully understand it, while managing distressed and confused patients and their families’.

— Michael Salter