Rape trauma syndrome

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Rape trauma syndrome (RTS) is the psychological trauma experienced by a rape survivor that includes disruptions to normal physical, emotional, cognitive, and interpersonal behavior. The theory was first described by nurse Ann Wolbert Burgess and sociologist Lynda Lytle Holmstrom in 1974. [1]

Contents

RTS is a cluster of psychological and physical signs, symptoms and reactions common to most rape victims immediately following a rape, but which can also occur for months or years afterwards. [2] While most research into RTS has focused on female victims, sexually abused males (whether by male or female perpetrators) also exhibit RTS symptoms. [3] [4] RTS paved the way for consideration of complex post-traumatic stress disorder, which can more accurately describe the consequences of protracted trauma than post-traumatic stress disorder alone. [5] The symptoms of RTS and post-traumatic stress syndrome overlap. As might be expected, a person who has been raped will generally experience high levels of distress immediately afterward. These feelings may subside over time for some people; however, individually each syndrome can have long devastating effects on rape victims and some victims will continue to experience some form of psychological distress for months or years. It has also been found that rape survivors are at high risk for developing substance use disorders, major depression, generalized anxiety disorder, obsessive-compulsive disorder, and other disorders. [6]

Common stages

RTS identifies three stages of psychological trauma a rape survivor goes through: the acute stage, the outer adjustment stage, and the renormalization stage.

Acute stage

The acute stage occurs in the days or weeks after a rape. Durations vary as to the amount of time the victim may remain in the acute stage. The immediate symptoms may last a few days to a few weeks and may overlap with the outward adjustment stage.

According to Scarse, [7] there is no "typical" response amongst rape victims. However, the U.S. Rape Abuse and Incest National Network [8] (RAINN) asserts that, in most cases, a rape victim's acute stage can be classified as one of three responses: expressed ("He or she may appear agitated or hysterical, [and] may suffer from crying spells or anxiety attacks"); controlled ("the survivor appears to be without emotion and acts as if 'nothing happened' and 'everything is fine'"); or shock/disbelief ("the survivor reacts with a strong sense of disorientation. They may have difficulty concentrating, making decisions, or doing everyday tasks. They may also have poor recall of the assault"). Not all rape survivors show their emotions outwardly. Some may appear calm and unaffected by the assault. [2]

Behaviors present in the acute stage can include:

Outward adjustment stage

Survivors in this stage seem to have resumed their normal lifestyle. However, they simultaneously suffer profound internal turmoil, which may manifest in a variety of ways as the survivor copes with the long-term trauma of a rape. In a 1976 paper, Burgess and Holmstrom [10] note that all but 1 of their 92 subjects exhibited maladaptive coping mechanisms after a rape. The outward adjustment stage may last from several months to many years after a rape.

RAINN [8] identifies five main coping strategies during the outward adjustment phase:

Other coping mechanisms that may appear during the outward adjustment phase include:

Lifestyle

Survivors in this stage can have their lifestyle affected in some of the following ways:

  • Their sense of personal security or safety is damaged.
  • They feel hesitant to enter new relationships.
  • Questioning their sexual identity or sexual orientation (more typical of men raped by other men or women raped by other women. [16] [17] ).
  • Sexual relationships become disturbed. [18] Many survivors have reported that they were unable to re-establish normal sexual relations and often shied away from sexual contact for some time after the rape. Some report inhibited sexual response and flashbacks to the rape during intercourse. Conversely, some rape survivors become hyper-sexual or promiscuous following sexual attacks, sometimes as a way to reassert a measure of control over their sexual relations.

Some rape survivors may see the world as a more threatening place to live in, so they will place restrictions on their lives, interrupting their normal activity. For example, they may discontinue previously active involvements in societies, groups or clubs, or a parent who was a survivor of rape may place restrictions on the freedom of their children.

Physiological responses

Whether or not they were injured during a sexual assault, survivors exhibit higher rates of poor health in the months and years after an assault, [4] including acute somatoform disorders (physical symptoms with no identifiable cause). [1] Physiological reactions such as tension headaches, fatigue, general feelings of soreness or localized pain in the chest, throat, arms or legs. Specific symptoms may occur that relate to the area of the body assaulted. Survivors of oral rape may have a variety of mouth and throat complaints, while survivors of vaginal or anal rape have physical reactions related to these areas.

Nature of the assault

  • The nature of the act, the relationship with the offender, the type and amount of force used, and the circumstances of the assault all influence the impact of an assault on the survivor.
  • When the assault is committed by a stranger, fear seems to be the most difficult emotion to manage for many people. (Feelings of vulnerability arise.)
  • More commonly, assaults are committed by someone the survivor knows and trusts. May be heightened feelings of self-blame and guilt.

Underground stage

Reorganization stage

Phobias

A common psychological defense that is seen in rape survivors is the development of fears and phobias specific to the circumstances of the rape, for example:

  • A fear of being in crowds.
  • A fear of being left alone anywhere.
  • A fear of men or women. (androphobia or gynophobia)
  • A fear of going out at all, agoraphobia.
  • A fear of being touched, hapnophobia.
  • Specific fears related to certain characteristics of the assailant, e.g. side-burns, straight hair, the smell of alcohol or cigarettes, type of clothing or car.
  • Some survivors develop very suspicious, paranoid feelings about strangers.
  • Some feel a pervasive fear of most or all other people.

Renormalization stage

In this stage, the survivor begins to recognize their adjustment phase. Recognizing the impact of the rape for survivors who were in denial, and recognizing the secondary damage of any counterproductive coping tactics (e.g., recognizing that one's drug abuse began to help cope with the aftermath of a rape) is particularly important. Male survivors typically do not seek psychotherapy for a long time after the sexual assault—according to Lacey and Roberts, [19] less than half of male survivors sought therapy within six months and the average interval between assault and therapy was 2.5 years; King and Woollett's [20] study of over 100 male rape survivors found that the mean interval between assault and therapy was 16.4 years.

During renormalization, survivors integrate the sexual assault into their lives so that the rape is no longer the central focus of their lives; negative feelings such as guilt and shame become resolved, and survivors no longer blame themselves for the attack.

Prosecutors sometimes use RTS evidence to disabuse jurors of prejudicial misconceptions arising from a victim's ostensibly unusual post-rape behavior. The RTS testimony helps educate the jury about the psychological consequences surrounding rape and functions to dispel rape myths by explaining counterintuitive post-rape behavior.

Especially in cases in which prosecutors have introduced RTS testimony, defendants have also sometimes proffered RTS evidence, a practice that has been criticized as undermining core values embodied in rape shield laws, since it can involve subjecting victims to compelled psychological evaluations and searching cross-examination regarding past sexual history. Since social scientists have difficulty distinguishing symptoms attributable to rape-related PTSD from those induced by previous traumatic events, rape defendants sometimes argue that an alternative traumatic event, such as a previous rape, could be the source of the victim's symptoms. [21]

Criticism

A criticism of rape trauma syndrome as currently conceptualized is that it delegitimizes a person's reaction to rape by describing their coping mechanisms, including their rational attempts to struggle through, survive the pain of sexual assault, and to adapt to a violent world, as symptoms of disorder. People who installed locks and purchased security devices, took self-defense classes, carried mace, changed residence, and expressed anger at the criminal justice system, for example, were characterized as exhibiting pathological symptoms and "adjustment difficulties". According to this criticism, RTS removes a person's pain and anger from their social and political context, attributing a person's anguish, humiliation, anger, and despair after being raped to a disorder caused by the actions of the rapist, rather than to, say, insensitive treatment by the police, examining physicians, and the judicial system; or to family reactions permeated with rape mythology.[ citation needed ]

Another criticism is that the literature on RTS constructs rape survivors as passive, disordered victims, even though much of the behavior that serves as the basis for RTS could be considered the product of strength. Words like "fear" are replaced with words like "phobia", with its connotations of irrationality. [22]

Criticisms of the scientific validity of the RTS construct are that it is vague in important details; it is unclear what its boundary conditions are; it uses unclear terms that do not have a basis in psychological science; it fails to specify key quantitative relationships; it has not undergone subsequent scientific evaluation since the 1974 Burgess and Holstrom study; there are theoretical allegiance effects; it has not achieved a consensus in the field; it is not falsifiable; it ignores possible mediators; it is not culturally sensitive; and it is not suitable for being used to infer that rape has or has not occurred. PTSD has been described as a superior model since unlike RTS, empirical examination of the PTSD model has been extensive, both conceptually and empirically. [23]

See also

Related Research Articles

Neurosis is a term mainly used today by followers of Freudian thinking to describe mental disorders caused by past anxiety, often that has been repressed. In recent history, the term has been used to refer to anxiety-related conditions more generally.

Post-traumatic stress disorder (PTSD) is a mental and behavioral disorder that develops from experiencing a traumatic event, such as sexual assault, warfare, traffic collisions, child abuse, domestic violence, or other threats on a person's life or well-being. Symptoms may include disturbing thoughts, feelings, or dreams related to the events, mental or physical distress to trauma-related cues, attempts to avoid trauma-related cues, alterations in the way a person thinks and feels, and an increase in the fight-or-flight response. These symptoms last for more than a month after the event. Young children are less likely to show distress, but instead may express their memories through play. A person with PTSD is at a higher risk of suicide and intentional self-harm.

Dissociation is a concept that has been developed over time and which concerns a wide array of experiences, ranging from a mild emotional detachment from the immediate surroundings, to a more severe disconnection from physical and emotional experiences. The major characteristic of all dissociative phenomena involves a detachment from reality, rather than a loss of reality as in psychosis.

Psychological trauma is an emotional response caused by severe distressing events that are outside the normal range of human experiences, such as experiencing violence, rape, or a terrorist attack. The event must be understood by the affected person as directly threatening the affected person or their loved ones with death, severe bodily injury, or sexual violence; indirect exposure, such as from watching television news, may be extremely distressing and can produce an involuntary and possibly overwhelming physiological stress response, but does not produce trauma per se.

Adjustment disorder is a maladaptive response to a psychosocial stressor. It is classified as a mental disorder. The maladaptive response usually involves otherwise normal emotional and behavioral reactions that manifest more intensely than usual, causing marked distress, preoccupation with the stressor and its consequences, and functional impairment.

Acute stress disorder is a psychological response to a terrifying, traumatic or surprising experience. It may bring about delayed stress reactions if not correctly addressed. Acute stress may present in reactions which include but are not limited to: intrusive or dissociative symptoms, and reactivity symptoms such as avoidance or arousal. Reactions may be exhibited for days or weeks after the traumatic event.

Complex post-traumatic stress disorder (CPTSD) is a stress-related mental disorder generally occurring in response to complex traumas, i.e. commonly prolonged or repetitive exposures to a series of traumatic events, within which individuals perceive little or no chance to escape.

Gender is correlated with the prevalence of certain mental disorders, including depression, anxiety and somatic complaints. For example, women are more likely to be diagnosed with major depression, while men are more likely to be diagnosed with substance abuse and antisocial personality disorder. There are no marked gender differences in the diagnosis rates of disorders like schizophrenia and bipolar disorder. Men are at risk to suffer from post-traumatic stress disorder (PTSD) due to past violent experiences such as accidents, wars and witnessing death, and women are diagnosed with PTSD at higher rates due to experiences with sexual assault, rape and child sexual abuse. Nonbinary or genderqueer identification describes people who do not identify as either male or female. People who identify as nonbinary or gender queer show increased risk for depression, anxiety and post-traumatic stress disorder. People who identify as transgender demonstrate increased risk for depression, anxiety, and post-traumatic stress disorder.

Rape is a traumatic experience that affects the victim in a physical, psychological, and sociological way. Even though the effects and aftermath of rape differ among victims, individuals tend to suffer from similar issues found within these three categories. Long-term reactions may involve the development of coping mechanisms that will either benefit the victim, such as social support, or inhibit their recovery. Seeking support and professional resources may assist the victim in numerous ways.

<span class="mw-page-title-main">Rape</span> Type of sexual assault usually involving sexual intercourse without consent

Rape is a type of sexual assault involving sexual intercourse or other forms of sexual penetration carried out against a person without their consent. The act may be carried out by physical force, coercion, abuse of authority, or against a person who is incapable of giving valid consent, such as one who is unconscious, incapacitated, has an intellectual disability, or is below the legal age of consent. The term rape is sometimes used interchangeably with the term sexual assault.

Stress-related disorders constitute a category of mental disorders. They are maladaptive, biological and psychological responses to short- or long-term exposures to physical or emotional stressors. The National Institute of Environmental Health Sciences categorizes Obsessive-Compulsive Disorder (OCD) and Post-Traumatic Stress Disorder (PTSD) as stress-related disorders. However, the World Health Organization's ICD-11 excludes OCD but categories PTSD, Complex Post-Traumatic Stress Disorder (CPTSD), adjustment disorder as stress-related disorders.

Traumatic stress is a common term for reactive anxiety and depression, although it is not a medical term and is not included in the Diagnostic and Statistical Manual of Mental Disorders (DSM). The experience of traumatic stress include subtypes of anxiety, depression and disturbance of conduct along with combinations of these symptoms. This may result from events that are less threatening and distressing than those that lead to post-traumatic stress disorder. The fifth edition of the DSM describes in a section titled "Trauma and Stress-Related Disorders" disinhibited social engagement disorder, reactive attachment disorder, acute stress disorder, adjustment disorder, and post-traumatic stress disorder.

<span class="mw-page-title-main">Military sexual trauma</span> U.S. legal term for sexual assault or harassment during military service

As defined by the United States Department of Veterans Affairs, military sexual trauma (MST) are experiences of sexual assault, or repeated threatening sexual harassment that occurred while a person was in the United States Armed Forces.

Memory and trauma is the deleterious effects that physical or psychological trauma has on memory.

Victimization refers to a person being made into a victim by someone else and can take on psychological as well as physical forms, both of which are damaging to victims. Forms of victimization include bullying or peer victimization, physical abuse, sexual abuse, verbal abuse, robbery, and assault. Some of these forms of victimization are commonly associated with certain populations, but they can happen to others as well. For example, bullying or peer victimization is most commonly studied in children and adolescents but also takes place between adults. Although anyone may be victimized, particular groups may be more susceptible to certain types of victimization and as a result to the symptoms and consequences that follow. Individuals respond to victimization in a wide variety of ways, so noticeable symptoms of victimization will vary from person to person. These symptoms may take on several different forms, be associated with specific forms of victimization, and be moderated by individual characteristics of the victim and/or experiences after victimization.

PTSD or post-traumatic stress disorder, is a psychiatric disorder characterised by intrusive thoughts and memories, dreams or flashbacks of the event; avoidance of people, places and activities that remind the individual of the event; ongoing negative beliefs about oneself or the world, mood changes and persistent feelings of anger, guilt or fear; alterations in arousal such as increased irritability, angry outbursts, being hypervigilant, or having difficulty with concentration and sleep.

Childbirth-related post-traumatic stress disorder is a psychological disorder that can develop in women who have recently given birth. This disorder can also affect men or partners who have observed a difficult birth. Its symptoms are not distinct from post-traumatic stress disorder (PTSD). It may also be called post-traumatic stress disorder following childbirth (PTSD-FC).

The term functional somatic syndrome (FSS) refers to a group of chronic diagnoses with no identifiable organic cause. This term was coined by Hemanth Samkumar. It encompasses disorders such as chronic fatigue syndrome, fibromyalgia, chronic widespread pain, temporomandibular disorder, irritable bowel syndrome, lower back pain, tension headache, atypical face pain, non-cardiac chest pain, insomnia, palpitation, dyspepsia and dizziness. General overlap exists between this term, somatization and somatoform.

Cannabis use and trauma is the contribution that trauma plays in promoting the use and potential abuse of cannabis. Conversely, cannabis use has been associated with the intensity of trauma and PTSD symptoms. While evidence of efficacious use of cannabis is growing in novelty, it is not currently recommended.

Sexual trauma therapy is medical and psychological interventions provided to survivors of sexual violence aiming to treat their physical injuries and cope with mental trauma caused by the event. Examples of sexual violence include any acts of unwanted sexual actions like sexual harassment, groping, rape, and circulation of sexual content without consent.

References

  1. 1 2 Burgess, Ann Wolbert; Lynda Lytle Holmström (1974). "Rape Trauma Syndrome". Am J Psychiatry. 131 (9): 981–986. doi:10.1176/ajp.131.9.981. PMID   4415470.
  2. 1 2 Jonathan Sandoval (2002). Handbook of crisis counseling, intervention, and prevention in the schools. Psychology Press. pp. 1–. ISBN   978-0-8058-3615-8 . Retrieved 1 October 2011.
  3. ↑ Philip M. Sarrel1 and William H. Masters (1982). "Sexual molestation of men by women". Archives of Sexual Behavior. 11 (2): 117–31. doi:10.1007/BF01541979. PMID   7125884. S2CID   35328701.{{cite journal}}: CS1 maint: numeric names: authors list (link)
  4. 1 2 3 Tewksbury, Richard (2007). "Effects of Sexual Assaults on Men: Physical, Mental and Sexual Consequences". International Journal of Men's Health. 6 (1): 22–35. doi:10.3149/jmh.0601.22.
  5. ↑ Bessel A. van der Kolk, Susan Roth, David Pelcovitz, Susanne Sunday, and Joseph Spinazzola (2005). "Disorders of Extreme Stress: The Empirical Foundation of a Complex Adaptation to Trauma" (PDF). Journal of Traumatic Stress. 18 (5): 389–399. doi:10.1002/jts.20047. PMID   16281237.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  6. ↑ Brown, A.L.; Testa, M.; Messman-Moore, T.L. (2009). "Psychological consequences of sexual victimization resulting from force, incapacitation, or verbal coercion". Violence Against Women. 15 (8): 898–919. doi:10.1177/1077801209335491. PMC   2761643 . PMID   19502576.
  7. ↑ Scarce, M. (1997). Male on male rape: The toll of stigma and Shame. New York: Insight Books.
  8. 1 2 Rape Trauma Syndrome. rainn.org
  9. ↑ Desirée Hansson What is Rape Trauma Syndrome?. Occasional Papers Series 1992. Institute of Criminology. University of Cape Town
  10. ↑ Burgess, AW; Holmstrom, LL (1976). "Coping behavior of the rape victim". Am J Psychiatry. 133 (4): 413–8. doi:10.1176/ajp.133.4.413. PMID   1267040.
  11. ↑ King, M., Coxell, A. and Mezey, G. (2002). "Sexual molestation of males: Associations with psychological disturbance". British Journal of Psychiatry. 181 (2): 153–157. doi: 10.1192/bjp.181.2.153 . PMID   12151287.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  12. ↑ Groth, N., & Burgess, A. W. (1980). Male rape: Offenders and victims (1980). "Male rape: Offenders and victims". American Journal of Psychiatry. 137 (7): 806–810. doi:10.1176/ajp.137.7.806. PMID   7386658.{{cite journal}}: CS1 maint: multiple names: authors list (link) CS1 maint: numeric names: authors list (link)
  13. ↑ Choquet, M., Darves-Bornoz, J. M., Ledoux, S., Manfredi, R. and Hassler, C. (1997). "Selfreported health and behavioral problems among adolescent victims of rape in France: Results of a cross-sectional survey". Child Abuse and Neglect. 21 (9): 823–832. doi:10.1016/S0145-2134(97)00044-6. PMID   9298260.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  14. ↑ Burnam, M. A.; et al. (1988). "Sexual assault and mental disorders in a community population". Journal of Consulting and Clinical Psychology. 56 (6): 843–850. doi:10.1037/0022-006x.56.6.843. PMID   3264558.
  15. ↑ Choquet, M., Darves-Bornoz, J. M., Ledoux, S., Manfredi, R. and Hassler, C. (1997). "Self-reported health and behavioral problems among adolescent victims of rape in France: Results of a cross-sectional survey". Child Abuse and Neglect. 21 (9): 823–832. doi:10.1016/S0145-2134(97)00044-6. PMID   9298260.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  16. ↑ Garnets, L.; Herek, G. (1990). "Violence and victimization of lesbians and gay men: Mental health consequences". Journal of Interpersonal Violence. 5 (3): 366–383. doi:10.1177/088626090005003010. S2CID   145629850.
  17. ↑ Struckman-Johnson, C.; Struckman-Johnson, D. (1994). "Men pressured and forced into sexual experience". Archives of Sexual Behavior. 23 (1): 93–114. doi:10.1007/BF01541620. PMID   8135654. S2CID   35473428.
  18. ↑ deVisser, R. O., Smith, A. M., Rissel, C. E., Richters, J. and Grulich, A. E. (2003). "Sex in Australia: Experiences of sexual coercion among a representative sample of adults". Australian and New Zealand Journal of Public Health. 27 (2): 198–203. doi:10.1111/j.1467-842X.2003.tb00808.x. PMID   14696711.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  19. ↑ Lacey, H. G.; Roberts, R. (1991). "Sexual assault on men". International Journal of STD and AIDS. 2 (4): 258–260. doi:10.1177/095646249100200406. PMID   1911957. S2CID   76081619.
  20. ↑ King, M.; Woollett, E. (1997). "Sexually assaulted males: 115 men consulting a counseling service". Archives of Sexual Behavior. 26 (6): 579–588. doi:10.1023/A:1024520225196. PMID   9415795. S2CID   23808869.
  21. ↑ Davis, Kathryn M. (1997–1998). "Rape, Resurrection, and the Quest for Truth: The Law and Science of Rape Trauma Syndrome in Constitutional Balance with the Rights of the Accused". Hastings L.J. 49: 1512.
  22. ↑ Stefan, Susan (1993–1994). "Protection Racket: Rape Trauma Syndrome, Psychiatric Labeling, and Law". Nw. U. L. Rev. 88: 1275.
  23. ↑ O'Donohuea, William; Carlsona, Gwendolyn C.; Benutoa, Lorraine T.; Bennetta, Natalie M. (10 July 2004). "Examining the Scientific Validity of Rape Trauma Syndrome". Psychiatry, Psychology and Law. 21 (6): 858–876. doi:10.1080/13218719.2014.918067. S2CID   143593118.
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