RAPE TRAUMA SYNDROME
A LEAFLET FOR PROFESSIONALS WORKING WITH RAPE SURVIVORS
Although there are few professionals whose primary role is working with rape survivors, many will at some time in their work come into contact with survivors of rape. This leaflet is designed to help Doctors, Nurses, Social Workers, Health Visitors, Solicitors and Police Officers. Further information is available from the Centre on the services we provide and on related issues such as Child Sexual Abuse.
Working with rape survivors can be upsetting especially for female professionals. The Centre can provide much needed confidential support at this time.
We suggest that this leaflet is read in conjunction with others in the series. Rape Trauma Syndrome is a useful tool in the working with survivors, however it is important that women are not "put into boxes". It is also vital that rape is recognized as a crime of power and violence. Rape is a social problem based on inequality between men and women in society.
Rape Trauma Syndrome
Crisis counselling has shown that survivors suffer a significant degree of physical and emotional trauma during the rape, immediately following the rape, and over a considerable time after the rape. They consistently describe certain symptoms over and over. The rape trauma syndrome is composed of three stages : The acute stage, the outer adjustment stage, and the renormalisation stage. The following is extracted from the work of Burgess and Holstrom, with modifications from our experience at the Rape Crisis & Sexual Abuse Centre.
1. The Acute Stage
Survivors vary as to the amount of time they 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. Behaviours which may be present in the acute stage are:
- Diminished alertness
- Numbness
- Dulled Sensory, affective and memory functions
- Disorganised thought content
- Paralysing anxiety
- Pronounced internal tremor
- Obsession to wash
- Hysteria and confusion
- Bewilderment
- Calmness and collectedness
- Acute sensitivity to the reaction of other people
- Not all survivors show their emotions outwardly. Some may appear calm and unaffected by the assault.
2. The Outward Adjustment Stage
Survivors in this stage seem to have resumed their normal lifestyle but there is internal turmoil which may manifest itself in any of the following behaviours
- Continuing anxiety
- Sense of helplessness
- Persistent fear and/or depression
- Mood swings from relatively happy to depression or anger
- Vivid dreams, recurrent nightmares, insomnia, wakefulness, flashbacks, loss of concentration
Physiological reactions such as tension, headaches, fatigue, general feelings of soreness or localised pain in the chest, throat, arm or leg. Specific symptoms may occur which relate to the area of the body which has been assaulted. Survivors of oral rape may have a variety of mouth and throat complaints, while survivors of vaginal or anal rape have different physical reactions.
Appetite disturbances such as nausea and vomiting, or an increase in appetite a result of ëcomfort eatingí. Rape survivors are also prone to developing anorexia and/or bulimia.
Denial. This involves the survivors blocking out thoughts of the assault from her mind or consciousness. She tries to block it out completely, to push it out of her mind, but the assault continues to haunt her.
The rape often upsets the womanís normal routine of living. Some are able to resume only a minimal level functioning. Others go work, school or college but are unable to be involved in more than business type activities. Still others may overcompensate and become very involved in work in order to complete the blocking process. Some may respond to the rape by staging at home, by only venturing out accompanied by a friend, or by being absent from work or dropping out of school or college.
Deterioration in social relationships which is exhibited by withdrawal from contact with friends and relatives.
Guilt is one of the major feelings in a survivor of rape. It may lead the woman into self destructive and/or self abusive behaviour including self mutilation and suicide attempts.
The incident may also alter their lifestyle in the following ways :
Their sense of personal security or safety is damaged.
They feel hesitant to enter new relationships, especially with men and may become distrustful of existing relationships with men.
Sexual relationships become disturbed. Many women 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.
Some now see the world as a more threatening place to live after the rape so they will place restrictions on their lives so that normal activities will be interrupted. For example, they may discontinue previously active involvements in societies, groups or clubs. Or, a mother who was a survivor of rape, may place unreasonable restrictions on the freedom of her children.
The woman may develop dependency on alcohol, cigarettes or drugs, both prescribed and illegal.
Phobias. A common psychological defence 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 going out at all, agoraphobia
- Specific fears related to the characteristics of the assailant, such as moustache, curly hair, the smell of alcohol or cigarettes, type of clothing or car
- Some survivors develop very suspicious, paranoid feelings about strangers
- Some feel a global fear of everyone
- Rage. The woman may feel fiercely angry about the rape, often without feeling that there is any way of positively channeling this rage. This may be exacerbated if she has, for example, reported the rape and the assailant has not been caught, or is not prosecuted or is given a very light sentence.
The Renormalisation Stage
In this stage, the woman integrates the event into her life so that the rape is no longer the central focus of her life. During this stage negative feelings such as guilt and shame become resolved and the woman no longer blames herself for the attack. For a time pain is evoked if the memory of the attack is revived. After more time passes, the pain loses its intensity. She is able to ëmove oní with her life without having the constant memories of the attack. It is unlikely that this stage will be reached without effective professional counselling.
A woman who has been raped needs reassurance that her feelings about it are normal and that it is possible to recover. Rape crisis counselling allows her to explore difficult and complex reactions, to understand their sources, and offers her the support she needs to ëmove oní.
The Effects of Rape
(While the Rape Trauma Syndrome deals specifically with the effects of rape, it is important to remember that all types of sexual assault cause trauma)
The effects of rape are varied and how a woman reacts to the attack depends upon her circumstances. Each woman has her own way of coping, and there is no right way or wrong way to react to sexual violence. How a woman copes may be complicated by the reactions of her family and friends, what her preconceptions about rape were, and the treatment she receives, for example, at the police station, and later, in court.
The fact that the crime of rape is more often defined in terms of presumptions about a womanís character than by the actual attack, has repercussions for women who have been attacked. Newspaper headlines refer to women who have been attacked.
Newspaper headlines refer to women in the roles according to us in a male dominated society: ëmother of twoí, ëyoung wifeí, ëgrandmotherí, ëvicarís daughterí. An attack which might be portrayed as vicious if it were perpetrated upon a young virgin is unlikely to be so portrayed if the survivor is a divorced woman who has had several lovers. Instead of angry headlines when a prostitute is raped we often find terms such as ëgood time girlí with the implication that this incident was sexual and exciting rather than violent and frightening. A rape is likely to be seen as more horrific if the woman is raped by a stranger in her own home than if she was out hitchhiking at night. While a degree of 'contributory negligence' for which the woman is blamed varies, it is rare for some such negligence not to be implied.
We all have to some extent absorbed these sexist attitudes, and since rapists often make the woman they are raping feel worthless and dirty, we are very likely to blame ourselves for the attack and to accept criticism of the way we conducted ourselves while it was going on. Women question themselves remorselessly in search of something in their behaviour, manner or dress which could explain why they were singled out for rape. The physical effects of rape may include pregnancy, sexually transmitted diseases, internal injury and other wounds.
While there is no ënormalí reaction to rape, the researchers Burgess and Holstrom have described typical phases of reaction which they have called the 'Rape Trauma Syndrome'. There is an urgent need for this syndrome to be recognised and understood.
Burgess & L. Holstrom (1974) 'Rape Trauma Syndrome', American Journal of Psychiatry. 121.9
WHAT WE DO
Counselling
We offer person centred counselling to women who have experienced rape, child sexual abuse, or any other form of sexual violence. This counselling is non-directive, non-judgemental, free and confidential. Counselling is available by telephone, face to face in the Centre, or in exceptional circumstances we will visit a woman at home.
Information
We provide information to women on practical matters such as sexually transmitted diseases, the morning after pill, the law surrounding sexual violence, criminal injuries compensation etcÖ Information on rape and sexual abuse is also available to professional and voluntary workers.
Support
We provide advice, information and support to partners, family and friends of women who have been sexually abused or raped. Due to the increase in men contacting the Centre we also offer telephone support to male survivors of rape and sexual abuse. We will also refer them on to organizations that offer additional and more specialized help.
Accompaniment
We will accompany women and girls to hospitals, clinics, police stations, courts or wherever else they have to attend as a result of sexual abuse or rape.
Advocacy
We will approach or speak to another voluntary or statutory agency on a womanís behalf at her behast.
Referral
If a woman is experiencing a specific problem that may need specialist help we will refer, with the womanís permission, to a voluntary or statutory body that may provide this help.
Self Help / Support Groups
We facilitate a wide range of groups such as groups for rape survivors, incest or child abuse survivors or groups for mothers of children who have been abused. These groups are set up periodically when there is a demand for them
Education
We facilitate talks or seminars for groups from the statutory and voluntary sector. These talks are on a wide range of issues surrounding sexual violence and itís effects. Large conferences on important issues are also organized where appropriate.
Publicity / Campaigning / Lobbying
The Rape Crisis & Sexual Abuse Centre recognizes how important public campaigning and lobbying is in changing public attitudes to the various issues surrounding sexual violence. We would also hope that by bringing such issues to the fore that we might influence government and legal thinking.
Research
We compile and monitor statistics that are made available to us in our work. These prove useful to us and other agencies when trying to find out more about the nature of the sexual crime. We also have a resource unit whereby information can be accessed by students, researchers, journalists and other interested parties.