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Tag: complex post traumatic stress disorder

Revictimization: How Can This Keep Happening?

Moving from judgment to compassion.

Posted May 4, 2020 |  Reviewed by Lybi Ma

Jurien Huggins/Unsplash

Source: Jurien Huggins/Unsplash

I feel like I have “Abuse Me” written across my forehead! Why does this keep happening to me?

Over the years I’ve lost track of how many people have asked me that question.

The first time an individual is victimized, they often take on the responsibility for the abuse. This can be a way for a victim to reclaim control. It is reassuring to believe that changing habits, behaviors, or interactions will ensure that the abuse will not reoccur.

When someone is victimized a second or third time (or more), research shows they are even more likely to feel guilt and shame and to judge themselves harshly. Unfortunately, they are not alone. Family, friends, professionals, and the media often respond to revictimized people with far more judgment than compassion.

Saints, sinners, heroes, villains, the beautiful, the scarred, disciplined, undisciplined, strong, weak, and people of every other type have been victimized. Abuse, whether it is a single or a repeated event, is not elicited by victims; it is perpetrated against them by an offender.

A traumatizing abuse experience will often leave a victim in severe emotional and psychological distress, and sometimes in physical pain. The resulting symptoms, including those of post-traumatic stress disorder (PTSD), are attempts by the body, mind, and emotions to regain stability and to reduce this extreme distress. Ironically, defensive responses can place the victim at greater “risk for later interpersonal trauma.” (Jaffe et al. 2019) These trauma symptoms include: dissociation, alcohol and substance abuse, distorted perceptions, low self-esteem, risky behaviors, cognitive accommodation to on-going violence, learned helplessness or passivity in the face of danger, willingness to tolerate maltreatment in order to avoid abandonment, adaptation to socioeconomic stressors and discrimination(Briere, 2019) increased irritability and anger(Jaffe, et al. 2019)

Facts, provided by research, can serve as instruments of kindness.

Jaffe, et al. (2019) stated it succinctly: “The most consistent predictor of future trauma exposure is a history of prior trauma exposure.” A child who is abused is at a significantly higher risk of being revictimized in adolescence and/or adulthood. (Aakvaag, et al., 2019; Zamir, et al., 2018)

These facts, established by scientific research and supported nearly unanimously by experts across the fields of mental health and the social sciences, provide a strong rebuttal to knee-jerk reactions that place blame for revictimization on the innate characteristics of individual victims.

The field of psychology has gone through its own evolution in understanding revictimization. In 1920 Freud published Beyond the Pleasure Principle, in which he identified repetition compulsion as a repeating and reliving of painful experiences in lieu of holding them in memory(Zamir, et al. 2018) This theory, part of Freud’s developing understanding of human instinct, when applied more recently to revictimization, places the bulk of responsibility squarely on the psyche of the victim.

As the understanding of trauma and PTSD developed in the field, via both research and practice, new theories of revictimization developed based on the impact of an original trauma on a repeatedly abused person.

The facts establish that when a person is sexually assaulted multiple times or in several domestic violence relationships, the cause of that pattern is not some underlying masochism, a characterological failing, or any other personal flaw. All abuse, original and subsequent, is due to the actions of offenders. A victim’s vulnerability to revictimization is often directly related to the impact of inflicted trauma.

A central component to the theoretical models of revictimization, developed in the 1980s and 1990s, was the role of dissociation as a risk factor. (Zamir, et al., 2018)

Dissociation is a defense mechanism that protects the individual by breaking up consciousness to avoid being overwhelmed by an experience, memory, or sensation. This fragmenting can be as commonplace as distraction or daydreaming, or it can manifest more problematically as emotional detachment, numbing, or out-of-body experiences.

Disassociation may provide relief from distress, but when it develops into a behavioral pattern, outlasting the threat of the immediate abuse, it leaves the person increasingly vulnerable. They miss cues of danger and have a disrupted, discontinuous experience of themselves and their life.

Guilt and shame are two distinct, common remnants of having been victimized. While guilt involves the belief that one “should have thought, felt, or acted differently,” shame is a “painful emotion related to beliefs about threats to one’s social position, including devaluation and rejection.” (Aakvaag et al., 2018)

Guilt can increase the risk of revictimization by focusing our attention, in an exaggerated manner, on our own thoughts and feelings, leaving us vulnerable to missing external cues of danger.

Shame often leads to social withdrawal and isolation. (Aakvaag et al., 2018) Decreasing our connections to others increases our vulnerability because while we may be avoiding people likely to cause us harm, we are also losing access to those who would provide protection, support, an increased sense of personal worth, and the expectation of being well-treated.

Shame is strongly correlated with mental health problems in general and with many PTSD symptoms specifically. The Aakvaag et al. findings suggest that shame may be central to the causal link that earlier studies found between mental illness and revictimization.

Kindness and compassion demand that we consistently hold a conscious place for the role of the abuser in any dialogue with or about victims. Experience has taught me that when an abuser is forgotten, the victim is implicitly left to absorb responsibility for the abusive acts and the resulting conditions, thereby increasing the victim’s feelings of both guilt and shame. This pattern is all the more common when the offender is a loved one, providing further motivation for a victim (child or adult), to absorb responsibility for the actions and patterns of the other in an attempt to rescue a crucial, valued relationship.

Dave Lowe/Unsplash

Source: Dave Lowe/Unsplash

A person who has been victimized needs to heal from the injuries of abuse. Family, friends, support networks, medical, and mental health professionals should be united in promoting that healing for the purpose of restoring health and wellness. A secondary benefit of compassion is the reduction of trauma symptoms, hence a decrease in vulnerability to revictimization.

References

Jaffe, A. E., DiLillo, D., Gratz, K.L., Messman-Moore, T.L. (2019). Risk for revictimization following interpersonal and noninterpersonal trauma: Clarifying the role of posttraumatic stress symptoms and trauma-related cognitions. Journal of Traumatic Stress, 32, 42-55.

Briere, J. (2019). Treating Risky and Compulsive Behavior in Trauma Survivors. New York: The Guilford Press.

Aakvaag, H. F., Thoreson, S., Strom, I. F., Myhre, M., Hjemdal, O. K. (2019). Shame predicts revictimization in victims of childhood violence: A prospective study of a general Norwegian population sample. Psychological Trauma: Theory, Research, Practice and Policy, Vol 11, No. 1, 43-50.

Zamir, O., Szepsenwol, O., Englund, M. M., Simpson, J. A. (2018). The role of dissociation in revictimization across the lifespan: A 32-year prospective study. Child Abuse & Neglect, 79, 144-153.

Gay, P. (1988). Freud: A Life for Our Time. New York, NY: W. W. Norton & Company.Morereferences

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Recovering from Rape and Sexual Trauma

Recovering from Rape and Sexual Trauma

Recovering from sexual assault takes time, and the healing process can be painful. But you can regain your sense of control, rebuild your self-worth, and learn to heal.

The aftermath of rape and sexual trauma

Sexual violence is shockingly common in our society. According to the Centers for Disease Control and Prevention (CDC), nearly 1 in 5 women in the U.S. are raped or sexually assaulted at some point in their lives, often by someone they know and trust. In some Asian, African, and Middle Eastern countries, that figure is even higher. And sexual assault isn’t limited to women; many men and boys suffer rape and sexual trauma each year.

Regardless of age or gender, the impact of sexual violence goes far beyond any physical injuries. The trauma of being raped or sexually assaulted can be shattering, leaving you feeling scared, ashamed, and alone or plagued by nightmares, flashbacks, and other unpleasant memories. The world doesn’t feel like a safe place anymore. You no longer trust others. You don’t even trust yourself. You may question your judgment, your self-worth, and even your sanity. You may blame yourself for what happened or believe that you’re “dirty” or “damaged goods.” Relationships feel dangerous, intimacy impossible. And on top of that, like many rape survivors, you may struggle with PTSDanxiety, and depression.

It’s important to remember that what you’re experiencing is a normal reaction to trauma. Your feelings of helplessness, shame, defectiveness, and self-blame are symptoms, not reality. No matter how difficult it may seem, with these tips and techniques, you can come to terms with what happened, regain your sense of safety and trust, and learn to heal and move on with your life.

Myths and facts about rape and sexual assault

Dispelling the toxic, victim-blaming myths about sexual violence can help you start the healing process.

Myths and facts about rape and sexual assault
Myth: You can spot a rapist by the way he looks or acts.

 

Fact: There’s no surefire way to identify a rapist. Many appear completely normal, friendly, charming, and non-threatening.

Myth: If you didn’t fight back, you must not have thought it was that bad.

 

Fact: During a sexual assault, it’s extremely common to freeze. Your brain and body shuts down in shock, making it difficult to move, speak, or think.

Myth: People who are raped “ask for it” by the way they dress or act.

 

Fact: Rape is a crime of opportunity. Studies show that rapists choose victims based on their vulnerability, not on how sexy they appear or how flirtatious they are.

Myth: Date rape is often a misunderstanding.

 

Fact: Date rapists often defend themselves by claiming the assault was a drunken mistake or miscommunication. But research shows that the vast majority of date rapists are repeat offenders. These men target vulnerable people and often ply them with alcohol in order to rape them.

Myth: It’s not rape if you’ve had sex with the person before.

 

Fact: Just because you’ve previously consented to sex with someone doesn’t give them perpetual rights to your body. If your spouse, boyfriend, or lover forces sex against your will, it’s rape.

Recovering from rape or sexual trauma step 1: Open up about what happened to you

It can be extraordinarily difficult to admit that you were raped or sexually assaulted. There’s a stigma attached. It can make you feel dirty and weak. You may also be afraid of how others will react. Will they judge you? Look at you differently? It seems easier to downplay what happened or keep it a secret. But when you stay silent, you deny yourself help and reinforce your victimhood.

Reach out to someone you trust. It’s common to think that if you don’t talk about your rape, it didn’t really happen. But you can’t heal when you’re avoiding the truth. And hiding only adds to feelings of shame. As scary as it is to open up, it will set you free. However, it’s important to be selective about who you tell, especially at first. Your best bet is someone who will be supportive, empathetic, and calm. If you don’t have someone you trust, talk to a therapist or call a rape crisis hotline.

Challenge your sense of helplessness and isolation. Trauma leaves you feeling powerless and vulnerable. It’s important to remind yourself that you have strengths and coping skills that can get you through tough times. One of the best ways to reclaim your sense of power is by helping others: volunteer your time, give blood, reach out to a friend in need, or donate to your favorite charity.

Consider joining a support group for other rape or sexual abuse survivors. Support groups can help you feel less isolated and alone. They also provide invaluable information on how to cope with symptoms and work towards recovery. If you can’t find a support group in your area, look for an online group.

Step 2: Cope with feelings of guilt and shame

Even if you intellectually understand that you’re not to blame for the rape or sexual attack, you may still struggle with a sense of guilt or shame. These feelings can surface immediately following the assault or arise years after the attack. But as you acknowledge the truth of what happened, it will be easier to fully accept that you are not responsible. You did not bring the assault on yourself and you have nothing to be ashamed about.

Feelings of guilt and shame often stem from misconceptions such as:

You didn’t stop the assault from happening. After the fact, it’s easy to second guess what you did or didn’t do. But when you’re in the midst of an assault, your brain and body are in shock. You can’t think clearly. Many people say they feel “frozen.” Don’t judge yourself for this natural reaction to trauma. You did the best you could under extreme circumstances. If you could have stopped the assault, you would have.

You trusted someone you “shouldn’t” have. One of the most difficult things to deal with following an assault by someone you know is the violation of trust. It’s natural to start questioning yourself and wondering if you missed warning signs. Just remember that your attacker is the only one to blame. Don’t beat yourself up for assuming that your attacker was a decent human being. Your attacker is the one who should feel guilty and ashamed, not you.

You were drunk or not cautious enough. Regardless of the circumstances, the only one who is responsible for the assault is the perpetrator. You did not ask for it or deserve what happened to you. Assign responsibility where it belongs: on the rapist.

Step 3: Prepare for flashbacks and upsetting memories

When you go through something stressful, your body temporarily goes into “fight-or-flight” mode. When the threat has passed, your body calms down. But traumatic experiences such as rape can cause your nervous system to become stuck in a state of high alert. You’re hypersensitive to the smallest of stimuli. This is the case for many rape survivors.

Flashbacks, nightmares, and intrusive memories are extremely common, especially in the first few months following the assault. If your nervous system remains “stuck” in the long-term and you develop post-traumatic stress disorder (PTSD), they can last much longer.

To reduce the stress of flashbacks and upsetting memories:

Try to anticipate and prepare for triggers. Common triggers include anniversary dates; people or places associated with the rape; and certain sights, sounds, or smells. If you are aware of what triggers may cause an upsetting reaction, you’ll be in a better position to understand what’s happening and take steps to calm down.

Pay attention to your body’s danger signals. Your body and emotions give you clues when you’re starting to feel stressed and unsafe. These clues include feeling tense, holding your breath, racing thoughts, shortness of breath, hot flashes, dizziness, and nausea.

Take immediate steps to self-soothe. When you notice any of the above symptoms, it’s important to quickly act to calm yourself down before they spiral out of control. One of the quickest and most effective ways to calm anxiety and panic is to slow down your breathing.

Soothe panic with this simple breathing exercise

  • Sit or stand comfortably with your back straight. Put one hand on your chest and the other on your stomach.
  • Take a slow breath in through your nose, counting to four. The hand on your stomach should rise. The hand on your chest should move very little.
  • Hold your breath for a count of seven.
  • Exhale through your mouth to a count of eight, pushing out as much air as you can while contracting your abdominal muscles. The hand on your stomach should move in as you exhale, but your other hand should move very little.
  • Inhale again, repeating the cycle until you feel relaxed and centered.

Tips for dealing with flashbacks

It’s not always possible to prevent flashbacks. But if you find yourself losing touch with the present and feeling like the sexual assault is happening all over again, there are actions you can take.

Accept and reassure yourself that this is a flashback, not reality. The traumatic event is over and you survived. Here’s a simple script that can help: “I am feeling [panicked, frightened, overwhelmed, etc.] because I am remembering the rape/sexual assault, but as I look around I can see that the assault isn’t happening right now and I’m not actually in danger.”

Ground yourself in the present. Grounding techniques can help you direct your attention away from the flashback and back to your present environment. For example, try tapping or touching your arms or describing your actual environment and what you see when you look around—name the place where you are, the current date, and three things you see when you look around.

Step 4: Reconnect to your body and feelings

Since your nervous system is in a hypersensitive state following a rape or assault, you may start trying to numb yourself or avoid any associations with the trauma. But you can’t selectively numb your feelings. When you shut down the unpleasant sensations, you also shut down your self-awareness and capacity for joy. You end up disconnected both emotionally and physically—existing, but not fully living.

Signs that you’re avoiding and numbing in unhelpful ways:

Feeling physically shut down. You don’t feel bodily sensations like you used to (you might even have trouble differentiating between pleasure and pain).

Feeling separate from your body or surroundings (you may feel like you’re watching yourself or the situation you’re in, rather than participating in it).

Having trouble concentrating and remembering things.

Using stimulants, risky activities, or physical pain to feel alive and counteract the empty feeling inside of you.

Compulsively using drugs or alcohol.

Escaping through fantasies, daydreams, or excessive TV, video games, etc.

Feeling detached from the world, the people in your life, and the activities you used to enjoy.

To recover after rape, you need to reconnect to your body and feelings

It’s frightening to get back in touch with your body and feelings following a sexual trauma. In many ways, rape makes your body the enemy, something that’s been violated and contaminated—something you may hate or want to ignore. It’s also scary to face the intense feelings associated with the assault. But while the process of reconnecting may feel threatening, it’s not actually dangerous. Feelings, while powerful, are not reality. They won’t hurt you or drive you insane. The true danger to your physical and mental health comes from avoiding them.

Once you’re back in touch with your body and feelings, you will feel more safe, confident, and powerful. You can achieve this through the following techniques:

Rhythmic movement. Rhythm can be very healing. It helps us relax and regain a sense of control over our bodies. Anything that combines rhythm and movement will work: dancing, drumming, marching. You can even incorporate it into your walking or running routine by concentrating on the back and forth movements of your arms and legs.

Mindfulness meditation. You can practice mindfulness meditation anywhere, even while you are walking or eating. Simply focus on what you’re feeling in the present movement—including any bodily sensations and emotions. The goal is to observe without judgement.

Yoga, Tai Chi, and Qigong. These activities combine body awareness with relaxing, focused movement and can help relieve symptoms of PTSD and trauma.

Massage. After rape, you may feel uncomfortable with human touch. But touching and being touched is an important way we give and receive affection and comfort. You can begin to reopen yourself to human contact through massage therapy.

A powerful program for reconnecting to your feelings and physical sensations

HelpGuide’s free Emotional Intelligence Toolkit can help you recover after rape by reconnecting you to uncomfortable or frightening emotions without becoming overwhelmed. You can use the toolkit in conjunction with therapy, or on its own. Over time, it can make a huge difference in your ability to manage stress, balance your moods and emotions, and take back control of your life.

Step 5: Stay connected

It’s common to feel isolated and disconnected from others following a sexual assault. You may feel tempted to withdraw from social activities and your loved ones. But it’s important to stay connected to life and the people who care about you. Support from other people is vital to your recovery. But remember that support doesn’t mean that you always have to talk about or dwell on what happened. Having fun and laughing with people who care about you can be equally healing.

Participate in social activities, even if you don’t feel like it. Do “normal” things with other people, things that have nothing to do with the sexual trauma.

Reconnect with old friends. If you’ve retreated from relationships that were once important to you, make the effort to reconnect.

Make new friends. If you live alone or far from family and friends, try to reach out and make new friends. Take a class or join a club to meet people with similar interests, connect to an alumni association, or reach out to neighbors or work colleagues.

Step 6: Nurture yourself

Healing from sexual trauma is a gradual, ongoing process. It doesn’t happen overnight, nor do the memories of the trauma ever disappear completely. This can make life seem difficult at times. But there are many steps you can take to cope with the residual symptoms and reduce your anxiety and fear.

Take time to rest and restore your body’s balance. That means taking a break when you’re tired and avoiding the temptation to lose yourself by throwing yourself into activities. Avoid doing anything compulsively, including working. If you’re having trouble relaxing and letting down your guard, you may benefit from relaxation techniques such as meditation and yoga.

Be smart about media consumption. Avoid watching any program that could trigger bad memories or flashbacks. This includes obvious things such as news reports about sexual violence and sexually explicit TV shows and movies. But you may also want to temporarily avoid anything that’s over-stimulating, including social media.

Take care of yourself physically. It’s always important to eat rightexercise regularly, and get plenty of sleep—but even more so when you’re healing from trauma. Exercise in particular can soothe your traumatized nervous system, relieve stress, and help you feel more powerful and in control of your body.

Avoid alcohol and drugs. Avoid the temptation to self-medicate with alcohol or drugs. Substance use worsens many symptoms of trauma, including emotional numbing, social isolation, anger, and depression. It also interferes with treatment and can contribute to problems at home and in your relationships.

How to help someone recover from rape or sexual trauma

When a spouse, partner, sibling, or other loved one has been raped or sexually assaulted, it can generate painful emotions and take a heavy toll on your relationship. You may feel angry and frustrated, be desperate for your relationship to return to how it was before the assault, or even want to retaliate against your loved one’s attacker. But it’s your patience, understanding, and support that your loved one needs now, not more displays of aggression or violence.

Let your loved one know that you still love them and reassure them that the assault was not their fault. Nothing they did or didn’t do could make them culpable in any way.

Allow your loved one to open up at their own pace. Some victims of sexual assault find it very difficult to talk about what happened, others may need to talk about the assault over and over again. This can make you feel alternately frustrated or uncomfortable. But don’t try to force your loved one to open up or urge them to stop rehashing the past. Instead, let them know that you’re there to listen whenever they want to talk. If hearing about your loved one’s assault brings you discomfort, talking to another person can help put things in perspective.

Encourage your loved one to seek help, but don’t pressurize. Following the trauma of a rape or sexual assault, many people feel totally disempowered. You can help your loved one to regain a sense of control by not pushing or cajoling. Encourage them to reach out for help, but let them make the final decision. Take cues from your loved one as to how you can best provide support.

Show empathy and caution about physical intimacy. It’s common for someone who’s been sexually assaulted to shy away from physical touch, but at the same time it’s important they don’t feel those closest to them are emotionally withdrawing or that they’ve somehow been “tarnished” by the attack. As well as expressing affection verbally, seek permission to hold or touch your loved one. In the case of a spouse or sexual partner, understand that your loved one will likely need time to regain a sense of control over their life and body before desiring sexual intimacy.

Take care of yourself. The more calm, relaxed, and focused you are, the better you’ll be able to help your loved one. Manage your own stress and reach out to others for support.

Be patient. Healing from the trauma of rape or sexual assault takes time. Flashbacks, nightmares, debilitating fear, and other symptom of PTSD can persist long after any physical injuries have healed. To learn more, read Helping Someone with PTSD.

 

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Complex PTSD (CPTSD) in Teen Girls after Sexual Assault: Diagnosis and Treatment

Complex PTSD (CPTSD) in Teen Girls after Sexual Assault: Diagnosis and Treatment

Sexual Assault Can Affect Victims for Decades: What Type of Treatment Can Help?

Sexual assault is a crime that affects millions of people in the U.S.

The emotional and psychological consequences of sexual assault can cause severe, lifelong impairment. We’ll discuss these consequences and the details of the impairments below, but it’s important, first, for all members of the general public to understand that sexual assault can affect typical physical, psychological, and emotional development, degrade relationships, reduce cognitive function, and have a negative impact on academic performance, employment, decision-making, self-esteem, social functioning, and overall wellbeing.

We identify the event that leads to this broad host of impairments in the title of this article: sexual assault. The mental health disorder that develops as a result of sexual assault is called post-traumatic stress disorder (PTSD). In cases of sexual assault, many victims develop a variation of PTSD called complex post-traumatic stress disorder (CPTSD), which was defined and added to the International Classification of Diseases, 11th Revision (ICD-11), by the World Health Organization (WHO) in 2019, and came into effect for use by clinicians in January, 2022.

There’s another thing all members of the general public should understand about sexual assault before we offer clinical definitions, prevalence statistics, and additional data:

Adolescent girls have a higher risk of sexual assault than any other demographic group.

That’s why we write articles like this one. We work with adolescents every day of the year, and we see the consequences of sexual assault in adolescent girls with alarming frequency. We accept girls into our programs for depression, anxiety, behavioral issues, alcohol and drug addiction, and other mental health disorders. While every girl we meet does not have a history of sexual assault, the correlation between girls with mental health issues with severe impairment and girls who are victims of sexual assault is shocking: our goal is to inform anyone reading this article about how we – and they – can help girls who experience this crime recover and rebuild their lives in the face of extreme, painful, and recurring emotional consequences.

[NOTE: We understand sexual assault happens to boys and men, too. However, due to the overwhelmingly disproportionate prevalence of sexual assault among women, and teen girls in particular, we’ll use this time to focus on them.]

First, we’ll define sexual assault, share prevalence statistics, outline the devastating effects these conditions have on adolescent girls, then address PTSD and CPTSD in detail. We’ll talk about evidence-based treatments for PTSD and CPTSD in the last section of this article.

What is Sexual Assault?

The Rape, Abuse, and Incest National Network (RAINN) defines sexual assault as “sexual contact or behavior that occurs without explicit consent of the victim.” They identify several types of sexual assault:

  • Rape, i.e. forcible penetration of the victim’s body
  • Unwanted fondling or sexual touching
  • Forcing a victim to engage in sexual acts
  • Forced sexual acts include:
    • Being forced to give or receive oral sex
    • Being forced to penetrate the perpetrator’s body

Now let’s look at the latest statistics on the prevalence of sexual assault in the U.S. We’ll preface this with a figure from a study from 1998, which indicated that at that time, an estimated 17.7 million women had been victims of rape or attempted rape.

Women and Sexual Assault in the U.S.

  • 1 out of every 6 women report sexual assault in their lifetime
  • 66% of victims of sexual assault or rape are 12-17 years old
  • 34% of victims of sexual assault or rape are under age 12
  • 82% of victims of sexual assault under the age of 18 are female
  • Teen girls age 16-19 are 4 times more likely than the general population to experience rape, attempted rape, or sexual assault

We’ll add another general fact to this series of statistics:

In the U.S., on average, a sexual assault occurs every 68 seconds.

Now let’s look at where sexual assault happens and what victims were doing at the time of the assault.

Sexual Assault: Where Were the Victims and What Were They Doing?

  • Where they were:
    • 55% were at home or near home
    • 15% were in the open in a public place
    • 12% were at or near a relative’s home
    • 10% were in an enclosed space such as a parking garage
    • 8% were on school property
  • What they were doing:
    • 48% were sleeping or doing something else at home
    • 29% were out doing errands or going to work or school
    • 12% were working
    • 7% were at school
    • 5% were engaged in unidentified activities

We include these last two bullet lists to drive home a critical point and further dispel an old trope that persist to this day: in almost every case of rape or assault, female victims are not at a nightclub dressed in a miniskirt and tight top. In almost every case of rape or sexual assault, the victim is going about their life, minding their own business, and they become the victim of a crime. In other words, the perpetrator is responsible for the crime, not the victim.

Next, we’ll discuss the consequences of sexual assault.

The Long-Term Emotional Effects of Sexual Assault

As we discuss the long-term consequences of sexual assault and the impact it has on teen girls, let’s not forget the horror of the initial act: while every woman or girl has to deal with the fallout of the experience, it’s important to remember that the incident itself is most often terrifying, violent, and often sends victims into a state of emotional and physical shock.

With that said, let’s consider this next set of facts from tj Rape, Abuse, and Incest National Network (RAINN).

Sexual Assault, Women, and Teen Girls: Long-Term Effects

PTSD, Suicide, and Emotional Distress

  • 94% of female rape victims experience symptoms of post-traumatic stress disorder (PTSD) within two weeks of the rape
  • 30% of female rape victims report symptoms of PTSD persist for at least 9 months after the assault
  • 33% of female rape victims report thinking about suicide.
  • 13% of female rape victims attempt suicide.
  • 70% of rape/sexual assault victims experience moderate to severe distress

Work, School, and Relationships

  • 38% of rape victims report school problems
  • 37% report problems with family and friends
  • 84% of victims of rape by an intimate partner report:
    • Professional issues
    • Moderate to severe emotional distress
    • Increased problem at school
    • Increased problems at work
  • 79% of victims of rape by a family member, friend, or acquaintance report:
    • Professional issues
    • Moderate to severe emotional distress
    • Increased problem at school
    • Increased problems at work
  • 67% of victims of rape by a stranger report:
    • Professional issues
    • Moderate to severe emotional distress
    • Increased problem at school
    • Increased problems at work

Drugs and Alcohol

  • Victims of rape/sexual assault are more likely to use drugs than people who are not victims of rape/sexual assault. Compared to non-victims, they are:
    • 10 times more likely to use any type of drug
    • 6 times more likely to use cocaine
    • 4 times more likely to use marijuana

When we list the long-term consequences of sexual assault, what we really describe are the symptoms of PTSD and CPTSD. As you’ll see in the next section, the psychological, emotional, and social impairments/consequences associated with rape/sexual assault are virtually synonymous with PTSD/CPTSD symptoms.

PTSD and CPTSD: Clinical Definitions

An article called “Complex Post-Traumatic Stress Symptoms In Female Adolescents: The Role Of Emotion Dysregulation In Impairment And Trauma Exposure After An Acute Sexual Assault” published in 2020 addresses the issues central to this article. In the words of the study authors:

“This study aims to determine the frequency and structure of CPTSD, and the relationship of emotion dysregulation with impairment and additional trauma exposure among adolescents who have been sexually assaulted.”

The first thing the study authors do is recognize that sexual assault and rape are severely traumatic events that can disrupt self-organizational capacity and result in the appearance and experience of the core symptoms of PTSD, which include:

  • Re-experiencing traumatic memories
  • Cognitive avoidance of traumatic reminders
  • Behavioral avoidance of traumatic reminders
  • Persistent sense of threat, in the absence of actual threat

The second thing the study authors do is define the new diagnosis from the ICD-11 – which we discuss above – known as complex post-traumatic stress disorder (CPTSD). When the following three sets of symptoms appear in an individual when no trauma-related cues are present, they meet clinical criteria for CPTSD.

CPTSD: Symptom Profile

  1. Emotion dysregulation:
    • Heightened emotional reactivity
    • Under controlled anger
    • Irritability
    • Temper outbursts
  2. Negative self-concept
    • Beliefs about oneself as diminished
    • Defeated
    • Worthless
  3. Interpersonal problems
    • Persistent preoccupation or avoidance of social engagement
    • Difficulties in sustaining and managing relationships

As we mention above, those symptoms match the post-assault experience of a vast majority of victims or rape or sexual assault. Researchers concluded that CPTSD is a disorder that predominantly applies to victims of rape, but may also appear in victims of torture, prisoners of war, victims of childhood abuse, and/or victims of kidnapping, slavery, or forced prostitution.

It’s clear: CPTSD occurs in response to the most extreme forms of trauma we know about. Now let’s take a look at the results of the study.

Study Results: Prevalence of CPTSD in Teen Female Rape Victims

To measure the prevalence of CPTSD among teen female victims of sexual assault and/or rape, researchers recruited a total of 134 participants. Here’s the make-up of the study group:

  • All female rape/assault victims
  • Average age of 15.6 years old
  • 51% had received some type of psychiatric help before the study
  • 32% reported more than on rape/sexual assault
  • 92% of victims reported forced penetration
  • 63% were raped by a person they knew

At two time points – one immediately after the assault and one four months after the assault – researchers gathered data on the following three metrics:

  1. Presence of CPTSD
  2. Further exposure to trauma
  3. Level of impairment

Here’s what they found:

  • Complex PTSD diagnosis:
    • 59% met criteria for PTSD
    • 40% met criteria for CPTSD
  • Further exposure to trauma:
    • After four months:
      • 29% reported additional trauma
      • 9% reported additional sexual trauma
    • Impairment
      • 60% reported at least one symptom of self-organization in each of the three domains:
        • 87% emotion dysregulation
        • 75% negative self-concept
        • 75% interpersonal problems

With this data, the study authors confirm their hypothesis: the set of symptoms reported by teen female victims of sexual assault corresponds with both PTSD and CPTSD. In addition, the study authors indicate that:

“Emotion dysregulation was significantly associated with further exposure to general and to sexual trauma above and beyond core PTSD symptoms, negative self-concept and interpersonal problems.”

What that means is that the trauma of rape, particularly when compounded by additional sexual or general trauma, can exacerbate the symptoms of PTSD and meet the threshold for CPTSD. That information is important both for the families of the victims and the therapists who treat them: it can help families find the appropriate treatment team, and enable that treatment team to use therapeutic techniques proven to help people with PTSD and CPTSD.

That brings us to our final topic: what treatments are effective for PTSD and CPTSD?

Evidence-Based Support for Teen Female Rape Victims

In a paper published in August 2020 called “Systematic Review: Effectiveness Of Psychosocial Interventions On Wellbeing Outcomes For Adolescent Or Adult Victim/Survivors Of Recent Rape Or Sexual Assault,” researcher conducted a thorough review of the current best therapeutic practices for victims of rape or sexual assault.

In total, they found ten studies that analyzed the effectiveness of a wide range of therapeutic interventions. We’ll pull no punches here: the study authors were neither impressed with the strength of the evidence nor the design of the studies they reviewed. Despite spending significant time discussing the relative weaknesses of the studies, they did identify the following treatment interventions that improved symptoms in female rape victims:

  • Cognitive behavioral therapy (CBT)
  • Eye movement desensitization and reprocessing (EMDR)
  • Cognitive processing therapy (CPT)
  • Prolonged exposure therapy (PE)
  • Systematic Desensitization (SD)
  • Brief psychoeducation (PEI)
  • Psychological support (PS)

It’s important to note that in the context of this study, all of these interventions occurred in conjunction with CBT. Therefore, the study authors consider them all to CBT-based interventions, and determined they were effective in reducing the following symptoms:

  • General PTSD symptoms, including:
    • Avoiding memories
    • Avoiding triggers for memories
    • Constant sense of threat
  • Depression
  • Fear of subsequent rape/sexual assault
  • Sexual function

We’ll address that last bullet point, since it’s something we haven’t mentioned. In many cases, victims of rape or sexual assault experience impaired sexual function, which can manifest in various ways. This study indicates that all of the CBT-based interventions listed above can help reduce symptoms related to this phenomenon.

The Bottom Line: Treatment for Complex PTSD Can Help Reduce Symptoms

Adolescent girls who experience rape or sexual assault can develop PTSD or CPTSD, two mental health disorders that can cause severe, lifelong impairment. As we mention above, the symptoms of PTSD and CPTSD can disrupt almost all areas of life, including family, peer, and romantic relationships, academic achievement, work performance, psychological and emotional health, and overall wellbeing. The disruption can be moderate to severe, with severe impairment limiting function in all practical domains. In addition, anxiety, depression, and alcohol/drug use may also accompany the symptoms of rape-related PTSD or CPTSD.

Evidence in the second study we cite above shows that CBT-based interventions are effective in reducing symptom severity. The most effective approaches included:

  • B-CPT: Brief cognitive processing therapy
  • Prolonged exposure therapy (PE)
  • Brief psychoeducation (PEI)

Researchers indicate that multi-session treatments in these modalities that take place over time show the most success in symptom reduction. For families with teenage girls who have experienced rape or sexual assault, that’s valuable information. These girls are at risk of lifelong disruption, but with appropriate treatment and support, they can learn to manage the symptoms related to their experience, and live in the manner of their choosing, rather than a life dictated by the result of one – or several – traumatic experiences during adolescence.

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