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In lieu of the recent current events regarding the entertainment industry and sexual assault, some of us might be wondering, “Why are we hearing so much about this lately?” or “Why is this a big deal?” Admitting that you are confused about why this is, in fact, a big deal this is not necessarily synonymous with believing that unwanted sexual violence is okay or permissible. And it certainly does not imply that you support rape or hurting others. However, it might imply that you have participated in, normalized, or remained ignorant to a long-standing, harmful phenomenon in our society—rape culture. Put simply, rape culture is characterized as set of permission-giving beliefs and actions that objectify and harm other human beings based on societal norms about sexuality and gender.
Our society has socialized us to accept sexual assault, sexual violence, and sexual harassment as norms— assume that it happens to everyone (especially women)— believe that “boys will be boys”— expect people to get over it. The unfortunate reality is that these behaviors are not part of the normal human experience— sexual assault does not happen to everyone— this is not the standard in which we should hold our boys and men—and while some people successfully move past these experiences, some people do not. More often than not, the group of people identified as “not getting over it” may be experiencing Posttraumatic Stress Disorder (PTSD)—a psychiatric diagnosis with a set of symptoms that impair functioning and persist beyond one month.
It must be stated that development of PTSD is not a matter of mental toughness or weakness—it comes down to how one’s brain processes trauma. Comparable to medical illnesses, we all have our own psychological immune systems that are responsible for fighting off stressors and traumas. The psychological immune system is shaped from one’s biology in addition to environmental factors such as early childhood experiences, familial norms, and modeling. Thus, research indicates that some people are more susceptible to develop PTSD than others. Our society widely accepts PTSD as a problem facing veterans; however, studies indicate that up to 50% of female sexual assault victims develop a PTSD diagnosis and up to 94% of victims have posttraumatic symptoms during the two weeks following a sexual assault (also known as Acute Stress Disorder).
PTSD is most commonly associated with re-experiencing symptoms (i.e., nightmares or flashbacks) and hypervigilance. While those symptoms are key features of PTSD, specialists recognize that the disorder manifests in other ways that impair functioning. Many of these manifestations go unnoticed or get attributed to other variables in one’s life due to the lack of awareness within the public and health care system. Below are three common manifestations of PTSD in sexual assault victims that we should know about:
1. Changes in emotional functioning and the belief system. Sexual assault is a traumatic event that is often described as a very violating and frightening experience. It provokes a lot of confusion and heightened emotional states. Thus, it is quite normal for a person to be “shaken up” and even find themselves experiencing some depressive symptoms and anxiety in the days following a sexual assault. Many victims of sexual assault with PTSD may not have the verbiage to explain how they are feeling or even truly understand what they are feeling—they just know that they feel different than the way they felt before the assault. Likewise, friends and family may also describe their loved one as changed in some way or not his/her usual self. Such changes could present as anhedonia (i.e., lack of pleasure or interest in activities that were once enjoyed), persistent irritability, increased anger or aggression, depressed mood or chronic sadness, emotional numbness, hopelessness, and helplessness.
Many of these emotional changes relate to the posttraumatic world view and poor self-image that emerge after experiencing the powerlessness and horror of being sexually violated. It quite common for victims to believe that this assault was in some way their fault or that they could have and should have maintained more control over the situation. Beliefs of this type typically emerge because of others’ (and society’s) feedback about the assault or as a self-protective strategy to ensure that “it won’t happen again.” Similarly, irrational beliefs about safety often develop. These beliefs can range from believing that all people with commonalities to the perpetrator are dangerous and likely to inflict harm to believing that shopping malls and grocery stores are unsafe due to the high volume of people. PTSD sufferers also experience a decrease in self-confidence regarding their ability to cope with life stressors. These beliefs often manifest in avoidance….So. Much. Avoidance. PTSD lives and grows in avoidance—avoidance of thoughts or memories related to the assault, avoidance of people, places, and things that remind them of the assault or that now feel dangerous after the assault. Much of what PTSD suffers avoid is objectively safe and was not being avoided before the assault; this is changed aimed for in treatment.
2. Sexual promiscuity and reckless behavior. It is not uncommon for sexual assault victims to feel an intense state of confusion specifically about their sexuality, their sexual identity and sexual acts. Many victims will experience a complete aversion to anything sexual—this aversion is usually fear-based and commonly understood as a posttraumatic response by health care providers and lay people alike. What is less obvious as a posttraumatic response, however, is when the confusion and fear manifest into recklessness and promiscuity. There are a few reasons for this manifestation. One reason comes down to power and control. Sexual assault often leaves victims feeling powerless and completely out of control of their own body. Thus, many seek to regain power by using their body and their sexuality as a vehicle to make what happened to them “not a big deal.” If sex isn’t a big deal, then what happened isn’t a big deal, right? This is particularly relevant to instances wherein an assault is a person’s first sexual experience. This experience can (and often does) completely skew beliefs about the body and self-worth. Many victims form beliefs about worthlessness (e.g., “My body doesn’t deserve to be respected;” “I’m worthless anyway, so who cares;” or “It doesn’t matter what I want, my wants won’t be respected anyway, so why bother saying ‘No.’”).
Another reason for this manifestation can be understood as a “malfunctioning danger-meter.” Trauma distorts one’s beliefs about safety and danger, which inhibits many sexual assault survivors’ ability to accurately assess the degree of danger in people, places, activities, and situations. It is for this reason that sexual assault survivors are statistically more likely to be assaulted again after their first assault.
In cases of childhood sexual abuse, beliefs about self-worth, love, and affection become connected to fear, pain, and sexuality. Children’s brains are not at a developmental level to engage in high level critical thinking, so they are unable to comprehend ideas such as sexuality and consent. Children are also inherently vulnerable and powerless to many of their life circumstances. Both of these variables have profound implications for their mental health, sexual development, attachment, and behavior in adulthood.
3. Substance abuse and behavioral addictions. As one of the primary driving forces of PTSD is avoidance, it makes sense that PTSD is statistically correlated to substance
abuse and other behavioral addictions (i.e., gambling, eating disorders, cutting, etc.). The simplest way to understand this relationship is that these behaviors function as a numbing agent for the emotional pain and anxiety that many PTSD sufferers experience. Behavioral addictions such as disordered eating or gambling are also sometimes not quite numbing but distracting.
Because PTSD is often conceptualized as the byproduct of an unprocessed traumatic event, the brain will continue making (ineffective) attempts to processing it. This is why suffers often describe the memory and emotions as recurrent and often unescapable. Something such as alcohol will temporarily make the memory an emotional pain be escapable. This can become very reinforcing, making sufferers more likely to use the substance or behavior again when the memory pops up. In sum, the pattern of an addiction can sometimes function as a maintenance variable to PTSD and vice versa. Thus, it is very important for sexual assault survivors with PTSD to be very observant of their substance use patterns. Likewise, supports and loved ones should also be aware that substance abuse and addictions could be rooted in a traumatic event.
Some of the most important points to know about PTSD is that it is real and that it is often life-altering. Arguably of greater importance to know is that scientifically-proven treatment for PTSD exist. Your loved one with PTSD does not have to suffer with a traumatic experience for an indefinite amount of time. You do not have to suffer. Researchers and clinicians have identified a cognitive-behavioral treatment with an abundance of research support– Prolonged Exposure. This treatment model provides PTSD sufferers with relief by attacking the avoidance and fear related to the trauma head on. This process allows the traumatic experience to be processed and appropriately stored in memory.