RAPE TRAUMA SYNDROME
Although every survivor you encounter will be unique, many will have one thing in common: Rape Trauma Syndrome (RTS). Identified by Ann Wolbert Burgess and Lynda Lytle Holmstrom, RTS is a cluster of emotional responses to the extreme stress experienced by the survivor during the sexual assault. More specifically, RTS is a response to the profound fear of death that almost all survivors experience during an assault. RTS occurs in two phases:
The Acute (Initial) Phase, which usually lasts anywhere from a few days to a few weeks after the attack.
The Reorganization Phase, which usually lasts anywhere from a few weeks to several days after the attack.
Often, the end of the Acute Phase will overlap the beginning of the Reorganization Phase. Each phase is characterized by particular emotional and physical concerns that most survivors experience.
The Acute Phase
During this phase, the survivor experiences a complete disruption of their life, responding to the fear of death they experienced. Survivors may display any of a number of contrasting emotional responses. A survivor may cry, shout, swear, laugh nervously, be silent, discuss the weather, or sit calmly. Responses may vary depending on any one of a number of external and experiential circumstances. No response is inappropriate! However, responses fall into one of two main styles:
If a survivor uses the Expressed style, they openly display their emotions. They may be agitated and restless, talk a lot, cry, swear, shout, and laugh. Any emotion is appropriate--because every person has his or her own unique way of responding to events in their life.
If a survivor uses the Controlled style, they contain their emotions. Most of the survivor's energy is directed toward maintaining composure. They may sit calmly, respond to questions in a detached, logical way, and downplay their fear, sadness, anger, and anxiety.
Both of these styles of emotional response reflect different ways of dealing with a crisis. A person may also exhibit characteristics of both styles.
In general, the survivor's initial response to the assault will be shock and disbelief. Many survivors may appear numb. Far from being inappropriate, this response provides an emotional "time-out" during which the survivor can acknowledge and begin to process the myriad components of the experience. A survivor who was assaulted by an acquaintance may have a particularly difficult time overcoming shock and disbelief. The experience of an acquaintance rape can also make a person question the trustworthiness of others in their life. If the assault was particularly terrifying or brutal, the survivor may experience an extreme shock response and completely block out the assault.
Following the shock and disbelief most survivors initially experience, they may experience a variety of emotions or mood swings. Survivors may feel angry, afraid, lucky to be alive, humiliated, dirty, sad, confused, vengeful, degraded. All of these responses, as well as the many that are not listed, are normal. In short, whatever a survivor is feeling is valid because they are feeling it. It is how they express their reaction to the rape crisis.
Physical concerns of the Acute Phase
Usually, the survivor will report a general soreness and aches throughout their body. Survivors will also report pain in the specific areas of the body that were targeted during the assault. These specific pains may be the result of actual physical trauma, or may be a psychosomatic response. Both reasons are equally valid and real.
The survivor will often notice disruptions in their usual sleeping and eating patterns. They may not be able to eat or sleep, or may eat more than usual and be unable to stay awake. Survivors may report nightmares in which they relive the assault. These may evolve into dreams in which the survivor takes the violent role in some way, in effect reclaiming the control lost during the assault. Although both types of dreams may upset a person, they are part of the healing process. Sexual assault is such a traumatic event that the survivor may dream about it in some way throughout their life.
The Reorganization Phase
During this phase of RTS, the survivor reorganizes herself/himself and their life after the sexual assault. Basically, they learn to cope again. Several factors influence the survivor's ability to reorganize their life after the sexual assault:
Personality. What coping mechanisms does a person already possess? How successfully have they coped with stress and trauma in the past?
Support System. Does she/he have a strong system of friends and family for emotional support? Does the survivor truly feel they can go to them for support? Is a survivor treated with empathy?
Existing Life Problems. Does this person have a drinking or drug problem? Are they experiencing a divorce or other break-up? Do they have emotional or psychological problems? Even if the survivor had these life problems under control prior to the assault, the trauma of the assault may reactivate them.
Prior Sexual Victimization. Was the survivor assaulted previously, especially within the last two years? If so, recovery may be much more difficult.
Emotional Concerns of the Reorganization Phase
The concerns the survivor has may fall into any of four groups:
1. Social Concerns
The survivor may experience some difficulty returning to pre-assault social patterns. She/he may feel an increased distrust toward others in general and, with male rapists involved, an increased suspicion of men in particular. A survivor may have a shorter temper, or easily break into tears. Some reactions may be the result of a specific component of the assault. For example, if the survivor was assaulted while alone, she/he may want to be with other people constantly. If a survivor was gang-assaulted, she/he may withdraw socially and rely on a few significant others for companionship and support. The survivor's social patterns after the assault may depend less upon the conditions of the assault and more upon the survivor's personality. Many survivors feel a strong need to "get away." A survivor may visit parents. They may move, especially if assaulted at home. Survivors may change jobs or leave school. All these actions are "normal" in that they represent what the survivor needs to do in order to regain control over their life.
2. Psychological Concerns
Denial of the effects of the assault, or of the assault itself, is a common reaction during the reorganization phase. Denial may be a component of the survivor's recovery, since it gives a person space to catch their breath before beginning the stressful task of processing and resolving the trauma. Denial that lasts longer than a few hours or days, however, is detrimental to recovery.
Depression, guilt, and a general loss of self-esteem are all common psychological reactions. These symptoms suggest that a survivor has turned their anger inward, and that they have unresolved fears. Remind a survivor that they are in no way responsible for the assault and that nothing they did could ever justify the violence they have experienced. Encourage survivors to direct these negative feelings toward the assailant and away from his or herself.
The survivor may experience fearful reactions to stimuli that remind them of the assault or the assailant. Phobic reactions are extreme manifestations of anxiety. For example, if the survivor was assaulted outdoors, they may be afraid to leave the house. If the assailant had alcohol on his breath, this odor may remind a survivor of the assault and bring on nausea. Survivors may experience a general paranoia, or panic attacks.
3. Sexual Concerns
The assault may disrupt the sexual life of the survivor because sex, which usually involves pleasure, was instead used as a weapon to humiliate, control and punish. It will probably take some time for the survivor to disassociate the sexual assault from consensual sex. Acts the assailant forced a survivor to do that they were not used to doing will probably cause particular difficulty. Survivors may experience physical pain during sex, have difficulty relaxing, or be generally indifferent to sex. At the other extreme, some survivors may desire sex all the time. Most likely, a person's behavior will fall between these two extremes.
If the survivor was a virgin at the time of the assault, she/he may have a heightened fear of a first consensual sexual encounter.
The survivor may be concerned about their partner's reaction to them. Survivors may wonder if a partner will feel differently toward them. Because of the range of stresses the survivor experiences after an assault, consensual sexual relationships and other friendships can be placed under heavy strain. Current statistics indicate that about half of all survivors lose their love relationships within a year of sexual assault.
4. Physical Concerns
The survivor may report continuing gynecological/genital problems. If a survivor was physically beaten, the survivor may continue to experience pain. Sexually transmitted diseases are a further concern, as well as pregnancy. Nightmares may also continue. If they continue in a manner that makes a person lose sleep or fills their waking hours, they might want to consider counseling.
A person with RTS and/or Post Traumatic Stress Disorder (PTSD) may experience flashbacks during the acute or recovery phase. A flashback is when a person is exposed to some stimuli which triggers an involuntary reaction and can often set off a temporary crisis. Any of the physical senses can trigger a flashback; sight, sound, taste, feel or smell. As little as one and as many as all five of a person's senses may be heightened or irritated in a flashback. Each flashback is unique and is a normal part of recovery for many survivors.
During a flashback, a person may often feel as if they are reliving the trauma that affected them and can exhibit symptoms as if they are currently being attacked. For example, a survivor may feel aches and pains, irritation in the area where they were injured or other symptoms as if they had just been raped. Survivors may also exhibit other behaviors as if they were currently being attacked such as screaming, running, hiding, fighting, shutting down or being completely quite.
Interjecting current stimuli or removing irritating stimuli may help a person during a flashback. If the smell of roses is making someone flashback, remove roses, rose scented perfumes, etc. from their environment. Or if a persons flashback makes them feel as if they are in a wooded, swampy area, mention the floor, carpet, ceiling, sofa, etc. to them. This type of activity should be verbal and it may not be productive to touch a survivor who is having a flashback.