Rape Trauma Syndrome

Rape Trauma Syndrome

Rape Trauma Syndrome is a form of psychological and Post Traumatic Stress Disorder that is experienced by an individual that has been sexually assaulted. Although most research into RTS has been focused on female victims, males who are sexually abused (whether by male or female perpetrators) have also exhibited RTS symptoms. There is a model for recovery that each survivor goes through at his or her own speed or intensity. The time an individual takes to recover varies greatly on each case because it depends on each survivor’s personal experience as well as any events that may have followed it. The syndrome is classified by three characteristic phases which may continue over an extensive period of time.

Phase one: The Acute Phase

Immediately following a sexual assault, survivors may experience a wide range of emotional reactions that result from being faced with a shocking, and in some cases, potentially life-threatening situation. Most commonly, survivors go into a state of emotional and physical shock immediately after a sexual assault. The symptoms that may be experienced while in this state include:

·         Constant anxiety

·         Fear

·         Hypervigilence (being on edge and easily startled)

·         Feeling scattered and unable to focus

·         Nightmares

·         Disturbed sleeping (difficulty falling asleep or staying asleep)

·         Disturbed eating (increase or decrease in eating, nausea, vomiting)

·         Body shakes

In addition to being in a state of shock, survivors in this phase are often overwhelmed by their feelings of guilt, shame, and self-blame regarding the sexual assault. It is these feelings that often deter survivors from reaching out for support from others. Not all survivors’ emotional reactions to a sexual assault are expressed in the same way. Most often their reactions are manifested in one of the two following ways:

1. Expressive – obvious outward expression such as crying, shaking, tenseness or restlessness. (i.e. Demonstrations of anger, fear and/or anxiety)

            2. Controlled – appearing quite calm and rational about the situation, and/or asking or        hiding their feelings.

During the first few weeks following the assault the survivor may experience acute physical symptoms, for example, soreness and/or bruising on various parts of the body. These symptoms may be specific to where on the body the sexual assault took place, such as vaginal discharge, burning sensations, pain, itchiness, irritation of the mouth or throat, or rectal pain or bleeding. In the period immediately following the assault, survivors may have many practical problems to deal with such as:

                        • Informing family and friends (who to tell and how to tell them)

            • Medical examinations (whether or not to have one, and/or where to go)

            • Concern of STIs, AIDS, and/or (for females) pregnancy

            • Decision about pressing charges or not

 Phase two: Outward Adjustment

In the next phase toward recovery it is common for survivors to attempt to forget about the sexual assault and to return some normality to their life. While they may seem to have forgotten about the incident and gone on with their life, there is usually a high level of denial and repression of feelings regarding the incident. Some survivors may express this denial by acting as though the sexual assault has no affect on them anymore, and others may frame the sexual assault as “just a bad sexual experience.” Most survivors will not want to talk about the sexual assault during this phase, and will be actively avoiding any potential triggers or reminders of the sexual assault. For this reason, many people begin making some life changes such as moving, changing schools/job, traveling, changing friends, etc. while others keep busy to avoid thinking about it by working or partying hard. In this phase there is a sense of “getting on with life and forgetting about the sexual assault.” This phase of denying and repressing feelings serves both an important and functional role; it is an essential part of the healing process.

Phase three: Long-Term Reorganization

Long-term reorganization is the phase where the survivor is no longer able to repress the assault or forget about it and healing begins to take place. It begins when something triggers the survivor to think about the sexual assault again (this usually comes in the form of a flashback). The beginning of this phase can be very frustrating, as many feel that they have already dealt with this, and yet now they cannot seem to stop thinking about it again.

In this phase it is common to feel overwhelmed by the return of frequent flashbacks, nightmares, anxiety, and feelings of hopelessness. For some survivors this is a time when they may think about suicide. Fortunately, it is in this phase that the survivor is able to work to heal from the sexual assault and integrate it into their life; this phase provides the opportunity for survivors to regain a sense of safety, control and trust. Long-term adjustment to sexual assault depends on several factors. Some influencing factors include the degree of support received from friends and family, previous self-concept, treatment by professionals following the assault, involvement with the criminal justice system, and their relationship to the perpetrator.

The three phases of Rape Trauma Syndrome provide survivors and their supporters with a better understanding of the stages survivors commonly experience when recovering from a sexual assault. Each survivor will move through the phases at their own pace and each will find their own unique path to healing and recovery.

Recovery:

Recovery from sexual assault involves a complicated and multifaceted healing process. Some issues that a survivor may deal with during her or his recovery include: safety, trust, sexual intimacy, defining the experience, minimizing and denial, and disclosure. Recovering or healing from a sexual assault does not mean never thinking about the sexual assault again or not having strong feelings about it. Recovery is a process by which survivors learns to integrate the experience into the rest of their lives, make deep and lasting changes, reconnect to themselves and those around them, and work toward a better world.

Treatment:

Rape trauma syndrome does not have to occur immediately after the assault. If the victim seeks professional help immediately after the rape, she will be less likely to suffer from symptoms of rape trauma syndrome. She may contact some center of service for sexual assault victims or other institution concerned with crisis intervention. These centers give the victims immediate support, information and they attempt to equip the victim with coping skills needed to deal with the crisis. Early crisis intervention may decrease the probability of onset of rape trauma syndrome. If the symptoms occur and last for more than one month, the patient is diagnosed with the rape trauma syndrome. In this case, the victim should engage in some type of therapy.

Behavioral Therapy Techniques:

·         In flooding, the patient is trained in progressive relaxation and then a rapid exposure to a feared object is introduced. (Zimbardo, 1985). Flooding is not the best way to deal with patient suffering from rape trauma syndrome, because it is too narrow and in its original form, it would be too aversive to the client. Also, it does not offer what the victim needs most: support. However, rapid exposure in imagery might be used to reduce anxiety that is aroused by nightmares and flashbacks. (Matlin, 1989). Although this technique may work with some patients, it should be used with caution, because there may simply be patients who could not take it.

·         Systematic desensitization is often employed to treat patients with fear and anxiety. Frank in 1988 conducted study comparing SD with cognitive-behavior therapy in treatment of rape victims. Both techniques seemed to be very successful. The victim is first taught progressive muscle relaxation, using Jacobson’s method. In case of rape victims, the instruction should not be “allow your thought to ramble”, since they would probably ramble to the scenes of the assault. Rather, they may be instructed to focus on a specific pleasant, happy scene. Then, the target complaint is broken into specific scenes, which are arranged in hierarchy. The patient engages in relaxation and imagines as vividly as possible the scenes, proceeding from the least threatening to the most threatening one.

·         Eye movement desensitization is a procedure in which the patient elicits sequences of large-magnitude, rhythmic saccadic eye movements while holding in mind the most salient aspect of traumatic memory. This results in a lasting reduction of anxiety, the cognitive assessment of the memory is changed and the frequency of flashbacks, intrusive thoughts and sleep disturbances decreases. This procedure seems to be very effective in only one session, as Shapiro (1989) claims. It does not require a hierarchical approach as systematic desensitization does, and it does not produce in the patient as high anxiety levels as flooding does

Cognitive-behavior therapy is a combination of techniques and principles of both cognitive and behavioral therapies. Cognitive therapies attempt to change irrational or faulty beliefs, expectations, appraisals and attributions. The rape victim can benefit greatly from cognitive therapy, especially in dealing with self-blame, anxiety attacks and some aspects of sleep disturbances. (Rosenhan et al., 1989). A victim who feels guilty and blames them self probably has some problems with attributions and appraisals. Anxiety attacks signify some distortion of expectations and appraisals. The therapist may explain how and why fear and anxiety develop following the rape, why the victim tries to attribute the blame to herself, and why her automatic thoughts are inappropriate. The therapist, together with the patient, tries to find other solutions, other ways to cope with her anxiety attacks. The patient may learn new coping skills to deal with her problems.

Coping imagery may be used to reduce severity of anxiety attacks and sleep disturbances. It is very useful to combine imagery with deep muscle relaxation. Calming imagery may be substituted for scenes in which the patient relives the trauma. Also, assertiveness imagery may be used with a client who feels vulnerable in many life situations. (Rosenhan et al., 1989) The victim would imagine as vividly as she can herself as an assertive person in a situation that she fears. This helps her to get used to such thoughts and the image becomes less threatening.

To deal with anger and anxiety attacks, the therapist may use assertiveness training. (Rosenhan et al., 1989) Resick (1988) describes assertion training used in group therapy for rape victims. Resick et al. included an educational phase, in which the patients learned about the development of anxiety and fear in relation to rape. It was explained how assertive responses are used to counter fear and reduce avoidance. The reason is that assertive responses are incompatible with fear. Assertion training may be beneficial in dealing with interpersonal issues. In the Resick study, victims were trained to change non-assertive cognitions and faulty thinking patterns. Several sessions focused on covert and behavioral rehearsal of assertive responses.

http://www.uofaweb.ualberta.ca/sac/nav01.cfm?nav01=23611&

http://www.womensweb.ca/violence/rape/trauma.php

http://en.wikipedia.org/wiki/Rape_trauma_syndrome

http://artcbt.com/WebRTS.doc