years go by, and i'm still here waiting
withering where some snowman was
mirror mirror where's the crystal palace
but i only can see myself
skating around the truth who i am
but i know, dad, the ice is getting thin....
Post Traumatic Stress Disorder in Survivors of Sexual Assault
PTSD was once thought to be a disorder suffered by war veterans who had been involved in heavy combat. Researchers now know that PTSD can result from many types of trauma, particularly those where the survivor feels that their life is threatened. It affects both females and males, and is common in survivors of sexual assault. PTSD in rape survivors is also sometimes referred to as Post Traumatic Rape Syndrome.
What is PTSD?
PTSD is a normal human emotional reaction to an abnormal situation. Everyone reacts differently to different situations and it doesn't have to be a life threatening experience for someone to develop PTSD.
Who is likely to suffer from PTSD?
PTSD affects hundreds of thousands of people who have been exposed to violent events such as rape, domestic violence, child abuse, war, accidents, natural disasters and political torture. Psychiatrists estimate that up to one to three percent of the population has clinically diagnosable PTSD...still more show some symptoms of the disorder.
Many survivors exposed to violations by people they must depend on or trust also show PTSD symptoms -- even if their experience was not directly life threatening. Betrayal by someone on whom you depend for survival (such as a child on a parent) may produce experiences similar to more obviously life-threatening traumas. Examples include physically or sexually abused children. This type of betrayal trauma is often accompanied by amnesia - for the survivor, forgetting may mean survival. In rape survivors, trauma typically includes elements of both betrayal and fear.
What are the symptoms of PTSD?
Characteristic symptoms of PTSD include re-experiencing the event (flashbacks), avoidance of things associated with the event (triggers), numbing of general responsiveness and increased arousal (hyper-arousal) not present before the event. Symptoms may appear soon after the trauma or fifty years later. Symptoms also sometimes resurface when the survivor is faced by further trauma or life stresses.
Sometimes these symptoms resolve within a few days or weeks, and not everyone who experiences a traumatic experience will develop PTSD. If symptoms persist for weeks or months, or when they are extreme, professional help may be necessary. On the other hand, if symptoms persist for several months without treatment, then the survivor may use avoidance to cope with the trauma -- and this strategy interferes with seeking professional help. Postponing needed intervention for a year or more, and allowing avoidance defenses to develop, could make treatment much harder.
Symptoms often present in Rape Trauma:
Intense fear, helplessness, or horror;
Repeated and distressing recollections of the event, including images, thoughts, or perceptions;
Inability to distinguish between past events and reality (flashbacks);
Distressing or frightening dreams about the event;
Avoidance of anything that may "trigger" a flashback including not talking about the attack
itself;
Denial - pretending it never happened or an inability to recall anything about the attack;
Feelings of numbness, detachment or "unrealness" about life in general;
Feelings of depression and isolation;
Change in sleep patterns;
Loss of appetite or a change in eating patterns;
Difficulty concentrating;
Avoidance of being touched and startling at sudden movements;
Difficulty in relationships with trust and intimacy;
Irritability and mood swings, outbursts of anger and crying;
Feelings of low self esteem and confidence which may include a feeling of being dirty or disgusting;
Self-blame, often accompanied by deep embarrassment or shame
Intrusive Symptoms - Flashbacks
Survivors with PTSD may have an episode where the traumatic event intrudes into their current life. This happens with sudden, vivid memories accompanied by painful emotions. Sometimes the trauma is re-experienced. This is called a flashback - a recollection that is so strong that the survivor thinks he or she is actually experiencing the trauma again or seeing it unfold before his or her eyes.
In traumatized children, this reliving of the trauma often occurs in the form of repetitive play. Re-experiencing can also occur in nightmares. In young children, distressing dreams of the traumatic event may evolve into generalized nightmares of monsters, of rescuing others or of threats to self or others.
At times, the flashback comes as a sudden, painful onslaught of emotions that seem to have no cause. These emotions are often of grief that brings tears, fear or anger. Survivors may have flashbacks repeatedly, much like memories or dreams about the traumatic event.
Avoidance Symptoms - Triggers
Another set of symptoms involves what is called avoidance. This affects the survivor's relationships with others because they often avoid close emotional ties with family, colleagues and friends. The survivor feels numb, has diminished emotions and can complete only routine, mechanical activities. When flashbacks occur, survivors may spend their energy on suppressing the flood of emotions.
Survivors may then become incapable of finding the necessary energy to respond to their environment: survivors who suffer PTSD frequently say they can't feel emotions, especially toward those to whom they are closest. As the avoidance continues, the person seems to be bored, cold or preoccupied. Family members often feel rebuffed by the survivor because they lack affection and act mechanically.
The survivor with PTSD may also avoid situations that remind them of the traumatic event because the symptoms may worsen. For example, a person who was raped while walking down a street at night might overreact to seeing a stranger approach them on the street. Over time, survivors can become so fearful of particular situations that their daily lives are ruled by their attempts to avoid them.
PTSD sufferers' inability to work out grief and anger over injury or loss during the traumatic event mean the trauma will continue to control their behavior without their being aware of it. Depression is a common product of this inability to resolve painful feelings.
Hyper-Arousal Symptoms
PTSD can cause survivors to act as if they are still threatened by the original trauma. Survivors with PTSD may become irritable, have trouble concentrating or remembering current information, and may develop insomnia. Because of their chronic hyper-arousal, many survivors with PTSD have poor work records, trouble with their bosses and poor relationships with their family and friends.
The persistence of a biological alarm reaction is expressed in exaggerated startle reactions. War veterans may revert to their war behavior, diving for cover when they hear a car backfire or a string of firecrackers exploding. At times, those with PTSD suffer panic attacks, whose symptoms include extreme fear resembling that which they felt during the trauma. They may feel sweaty, have trouble breathing and may notice their heart rate increasing. They may feel dizzy or nauseated. Many traumatized children and adults may have physical symptoms, such as stomachaches and headaches, in addition to symptoms of increased arousal.
Recovery Takes Time
Survivors recover in stages. They may start with one stage, go to another, and go back. Each person processes the event his or her own way. Here are some stages a survivor may go through:
1. Denial that the rape had any effect on their lives;
2. Fear it will happen again;
3. Feel sad because of a loss of their ability to trust in people, or places;
4. Anger at what happened;
5. Anxiety over the nightmares or flashbacks that may intrude on the life of the survivor;
6. Feel as if a part of themselves died during the rape attack
Treatment of PTSD
Psychiatrists and other therapists today have effective psychological and pharmacological treatments available for PTSD. These treatments can restore a sense of control and diminish the power of past events over current experience. The sooner survivors are treated, the more likely they are to recover from a traumatizing experience.
Psychiatrists help survivors with PTSD by helping them to accept that the trauma happened to them without being overwhelmed by memories of the trauma and without arranging their lives to avoid being reminded of it. It is important to re-establish a sense of safety and control in the survivor's life. This helps them to feel strong and secure enough to confront the reality of what has happened.
In people who have been badly traumatized, the support and safety provided by loved ones is critical. Friends and family should resist the urge to tell the traumatized person to "snap out of it," instead allowing time and space for intense grief and mourning. Being able to talk about what happened and getting help with feelings of guilt, self-blame, and rage about the trauma usually is very effective in helping people put the event behind them.
Sleeplessness and other symptoms of hyper-arousal may interfere with recovery and increase preoccupation with the traumatizing experience. Psychiatrists have several medications--including benzodiazepines and the new class of serotonin re-uptake blockers--that can help people to sleep and to cope with their hyper-arousal symptoms. These medications, as part of an integrated treatment plan, can help the traumatized person to avoid the development of long-term psychological problems.
In people whose trauma occurred years or even decades before, the professionals who treat them must pay close attention to the behaviors--often deeply entrenched--which the survivor has evolved to cope with their symptoms. Many people whose trauma happened long ago have suffered in silence with PTSD's symptoms without ever having been able to talk about the trauma or their nightmares, hyper-arousal, numbing, or irritability. During treatment, being able to talk about what has happened and making the connection between past trauma and current symptoms provides survivors with the increased sense of control they need to manage their current lives and have meaningful relationships.
Relationships are often difficult for survivors with PTSD. They often resolve conflicts by withdrawing emotionally or even by becoming physically violent. Therapy can help survivors to identify and avoid unhealthy relationships. This is vital to the healing process; only after the feeling of stability and safety is established can the process of uncovering the roots of the trauma begin.
To make progress in easing flashbacks and other painful thoughts and feelings, most survivors need to confront what has happened to them, and by repeating this confrontation, learn to accept the trauma as part of their past. Psychiatrists and other therapists use several techniques to help with this process.
One important form of therapy for those who struggle with post-traumatic stress disorder is cognitive/behavior therapy. This is a form of treatment that focuses on correcting the survivor's painful and intrusive patterns of behavior and thought by teaching him or her relaxation techniques, and examining (and challenging) his or her mental processes.
A therapist using behavior therapy to treat a person with PTSD might, for example, help a patient who is provoked into panic attacks by loud street noises by setting a schedule that gradually exposes the patient to such noises in a controlled setting until he or she becomes "desensitized" and thus is no longer so prone to terror. Using other successful techniques, patient and therapist explore the patient's environment to determine what might aggravate the PTSD symptoms and work to reduce sensitivity or to learn new coping skills.
Psychiatrists and other therapists also treat cases of PTSD by using psychodynamic psychotherapy. Post-traumatic stress disorder results, in part, from the difference between the individual's personal values or view of the world and the reality that he or she witnessed or lived during the traumatic event.
Psychodynamic psychotherapy, then, focuses on helping the individual examine personal values and how behavior and experience during the traumatic event violated them. The goal is resolution of the conscious and unconscious conflicts that were thus created. In addition, the individual works to build self-esteem and self-control, develops a good and reasonable sense of personal accountability and renews a sense of integrity and personal pride.
Whether survivors are treated by therapists who use cognitive/behavioral treatment or psychodynamic treatment, traumatized people need to identify the triggers for their memories of trauma, as well as identifying those situations in their lives in which they feel out of control and the conditions that need to exist for them to feel safe. Therapists can help survivors with PTSD to construct ways of coping with the hyper-arousal and painful flashbacks that come over them when they are around reminders of the trauma. The trusting relationship between patient and therapist is crucial in establishing this necessary feeling of safety. Medications can help in this process also.
Group therapy can be an important part of treatment for PTSD. Trauma often affects people's ability to form relationships--especially such traumas as rape or domestic violence. It can profoundly affect their basic assumption that the world is a safe and predictable place, leaving them feeling alienated and distrustful, or else anxiously clinging to those closest to them. Group therapy helps survivors with PTSD to regain trust and a sense of community, and to regain their ability to relate in healthy ways to other people in a controlled setting.
Most PTSD treatment is done on an outpatient basis. However, for people whose symptoms are making it impossible to function or for people who have developed additional symptoms as a result of their PTSD, inpatient treatment is sometimes necessary to create the vital atmosphere of safety in which they can examine their flashbacks, reenactments of the trauma, and self-destructive behavior. Inpatient treatment is also important for PTSD sufferers who have developed alcohol or other drug problems as a result of their attempts to "self medicate." Occasionally too, inpatient treatment can be very useful in helping a PTSD patient to get past a particularly painful period of their therapy.
The recognition of PTSD as a major health problem in this country is quite recent. Over the past 15 years, research has produced a major explosion of knowledge about the ways people deal with trauma--what places them at risk for development of long-term problems, and what helps them to cope. Psychiatrists and other therapists are working hard to disseminate this understanding, and an increasing number of mental health professionals are receiving specialized training to help them reach out to people with Post-traumatic Stress Disorder in their communities.
The information above was provided from a publication called "Rape: Victims of Crisis" by Ann Wolbert Burgess.
Some links for more information about PTSD:
David Baldwin's Trauma Information Pages: The most extensive site I've found about PTSD
Medications for Treatment of PTSD
Psychological Trauma and Substance Abuse in Women
Hidden Scars : Sexual and other abuse may alter the brain of the survivor
Anxiety Disorders: The Decade Of The Brain
Anxiety Disorders: Progress Promises New Insights and Treatments
Vietnam Veterans of Australia: Discusses symptoms and treatment of PTSD
Post-Traumatic Stress Disorder in the Workers' Compensation Setting
Post-Traumatic Stress Disorder: Symptoms and treatment of PTSD
Healing News: March Newsletter
Home
My Story If You Are Raped
Myths/Facts Loved Ones
PTSD
Rohypnol Quotes
Online Resources Speaking About Rape
Connections
Books Links
Lyrics The Controversial Book
Awards
Sign Guestbook
View Guestbook
Email Me