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Rape Trauma Syndrome:
The Journey to Healing Belongs to Everyone

© Amy Menna, Ph.D., LMHC, CAP

Some say rape is about power. It has been said that when a woman is raped, her power is taken away. Not only is this notion erroneous, but it is what keeps many woman silent. The immense power within a woman cannot be destroyed. It can be hidden under scars that feel like they will last a lifetime. However, the lasting effects of rape can be mitigated by uncovering the power that may feel like it was cleverly concealed. So many survivors believe that they are alone on a journey. Their story may be theirs...but the journey belongs to everyone.

The Story of Ella

Ella was raped at 17 when she was walking home from volleyball practice. The man who assaulted her was someone that she knew from school. He approached her asking her to help him lift something in to his van. He said that he would be able to give her a ride home afterwards. When they reached the van, he proceeded to rape her. When he was finished, he told her to get dressed and get in the front seat. He drove her right to her home without having to ask directions.

Ella never told anyone about the assault. She came home that day, went up to her room, and took a shower. After that, her mother asked her to come down to dinner. Knowing that her absence would be noticed, she sat at the dinner table pretending as if nothing happened. When asked if there was something wrong, she said that practice had been difficult. After dinner, she completed her homework and went to bed.

Ella attempted to put the assault out of her mind, never telling anyone. However, after the rape, she started having problems in school and became increasingly anxious. She started having more arguments with her parents as they were constantly frustrated by her unwillingness to get up to go to school. What her parents weren't aware of was that she slept very little throughout the night due to nightmares. Ella also began drinking more on weekends and was smoking marijuana at night just to be able to fall asleep. Her temper was extremely short which created problems with her friends. She began to isolate more and more.

At the request of her parents, Ella went to see a psychiatrist. She discussed the symptoms of depression and her inability to sleep. Never was she questioned about a history of sexual assault, nor would she volunteer the information. She was placed on a common antidepressant and sent on her way. Family therapy was recommended as the majority of problems seemed to surround her parents.

Soon she went away to college and her drinking increased significantly. She began dating a man who was verbally and physically abusive. At one point, she was referred by one of her professors to student services after coming to class intoxicated. She was reprimanded for poor judgment and placed on academic probation. This only created more discord with her parents. Fights with her boyfriend became more frequent and at one point she began to cut her arms "just to get a hold of herself." She started to think of suicide.

Her parents again intervened and sent her to a therapist. Again, she was not asked directly about a history of sexual assault. She explained her irritability and at times violent outbursts. She was diagnosed with Bipolar Disorder and sent to a psychiatrist who gave her medication. As many of her problems were external, Ella felt that the medication did not help therefore stopped taking it.

When Ella returned home for the summer, her parents immediately noticed a problem with her drinking. She was placed in a residential treatment facility for her addiction. The therapist asked directly whether or not Ella had been raped or sexually abused. For the first time, Ella told someone about what happened on the way home from school. Saying it out loud was her first step in her journey to healing. In doing so, she began identifying the underlying reasons why she made some of the choices she had made. Ella was able to recognize that on the day she was raped, she began fighting the world and never stopped. When she was raped, it made her feel scared, damaged, and like she had done something wrong. She had spent years wondering, "if I had only..." Ella realized that the way her life played out was a direct result of what she thought about herself.

Through trauma specific treatment, Ella was able to identify that issues surrounding safety and self-worth were at the heart of her troubles. She began making choices that would insure her safety such as putting up boundaries and not tolerating abuse. She began treating her body respectfully by discontinuing the use of alcohol and illicit drugs.

It was a constant struggle to change her way of thinking and feeling. She completed hours of exercises intended to increase her self-esteem. She created meaningful friendships with other women and started doing volunteer work for a women's shelter. At the end of the day she was filled with pride about her actions instead of disgust about herself. Ella had found the power of which she was searching for so many years.

The Truth About Rape

According to the Federal Bureau of Investigations Uniform Crime Report, Sexual Assault is the most under-reported crime in the United States. Survivors of sexual assault are often met with intrusive questions, accusations, and fear a losing battle of "he said - she said." Although women are the majority of the survivors, sexual assault does not discriminate. For many women, it has the single most significant influence on their life without them even knowing it.

The effects of rape reach far beyond the physical injuries incurred. What transpires is a journey where trust is lost and the bedrock of lives becomes quicksand. Rape survivors experience common symptoms of flashbacks, nightmares, anxiety, depression, and low self-esteem. Lack of services and under reporting leave the survivor alone in a journey along with scores of others who also feel isolated. So close to each other, yet so far away.

Rape Trauma Syndrome

Rape Trauma Syndrome (RTS) was identified by Ann Wolbert Burgess and Lynda Lytle Holmstrom in the mid-seventies after studying the typical patterns of rape survivors. RTS describes a process that rape survivors go through in response to the fear experienced during a sexual assault. Although each survivor has their own experience, there are common characteristics some survivors possess. These characteristics are the direct result of the profound fear inherent in sexual assault.

The response immediately after a rape varies with each individual. This immediate response is described as the Acute Phase. The Acute Phase can last anywhere from a few days to a few weeks after an assault. It is a response to a complete disruption of one's life and the horrific experience of being sexually assaulted. The Acute Phase produces as many responses as there are survivors. Some survivors may cry, others may laugh, and still others may be completely silent. As you saw with Ella, she went about her normal routine for the evening.

It is important to note that there is no "wrong" way to cope with the immediate after effects of sexual trauma. Each survivor is unique and will process the assault in different ways. The various responses to the initial assault fall into two categories; expressed and controlled. Survivors engaging in expressed responses are open with their emotions and are in an emotional state. Examples of expressed responses are crying, yelling, showing anger, or agitation. The second type of response is known as the controlled. Survivors engaging in this style of response contain their emotions and focus more on keeping their composure. These responses are a result of the survivor "regrouping" after the situation that has occurred. Again, neither response is superior to the other. They are both responses to trauma.

During the Acute Phase survivors may feel disbelief or in some way frozen. It has also been described as if survivors "left their body," forever being unable to reconnect with the woman or man who was raped. Survivors may feel humiliated, confused, dirty, ashamed, or in some way at fault for the assault; especially in the case where the assailant was an acquaintance. Physical concerns may arise during the acute phase as well. These concerns may be the direct result of the assault (i.e. bruising or soreness) or fear of the possible physical ramifications of the assault (i.e. pregnancy or STD's).

The Acute Phase can be described as the world turning upside down. Everything that was in place has fallen in disarray. The basic orientation to life has been lost by the survivor. This disturbance can result in nightmares, heightened anxiety, or a complete disconnection from one's emotions.

After the Acute Phase, comes the Reorganization Phase where the survivor attempts to reorganize her life. This phase invites a myriad of emotions such as fear, anxiety, denial, and most of all the loss of security. The shattering of security as well as trust is inherent in sexual assault. This loss of the fundamental need for security wreaks havoc on the survivor's life. The feeling of being unsafe looms over the survivor causing a heightened state of anxiety, difficulty with intimate relationships, and hypervigilence such as constantly checking one's surroundings.

The loss of trust coupled with feelings of being unsafe chip away at the personal relationships surrounding the survivor. Relationships suffer as a result of the survivor's isolating from their support system either physically or emotionally. The survivor may feel a general disconnection from peers as a result of the perceived unique experience. The shattering of trust can cause intimate relationships to be diluted as survivors may have a heightened suspicion of other's motives and feelings.

During the Reorganization Phase, the survivor attempts to reorganize his or her life and create the world that she or he once knew. Despite best efforts though, this phase is often riddled with feelings of guilt and shame. The survivor's attempt to get back to his or her routine is often plagued with feelings of anxiety and fear. She may attempt to return to normal social functioning (i.e. go out to social engagements), yet may find herself unable to do so. His or her attempts to re-establish in relationships may be hindered by lack of trust.

Long term reactions to sexual assault may also include the inability to find peace within this world. Sexual assault can change the individual forever as well as the world as they know it. The end result is a constant state of turmoil. At times, the survivor may not even recognize what is happening within. Sexual assault causes the body to be an unfriendly environment leading the survivor to at times feel dirty and ashamed. These feelings cause the individual to disconnect from their body entirely. Without a connection to their body, the survivor is unable to listen to internal states which assist her in navigating through the world. This contributes to a feeling inherent in many survivors, the feeling of being "lost."

Sexual Assault and the Body

The words "the scene of the crime" speak volumes in criminal investigations and movies. In the case of sexual assault, despite where the event occurred, the scene of the crime is the body itself. The body then becomes less of a vessel for the spirit, and more of an enemy always reminding them of what they long to forget. Resolution of the sexual assault requires the body to be empowered. Forming a loving relationship between survivors and their bodies will enhance their ability to care for themselves as well as live with less anger and fear.

During a traumatic experience, the body morphs into a different creature, one who of which better equipped to handle the situation. An assault at this level is then captured by this "creature within" who holds onto it to protect the individual from having to deal with such an emotional upheaval. Although its intentions are noble, it can only hold on to so long. Eventually, the memories and feelings start leaking out, causing the body to remember what the mind has forgotten.

The results are body-based symptoms which may not be recognized by the survivor as having a root in the assault. Survivors may have increased somatic complaints long after the original assault. These complaints may come in the form of gastrointestinal problems, migraines, or chronic pain. Sexual problems may also occur such as pain during intercourse.

Intrusive Symptoms

As stated above, the disconnection from one's body causes symptoms to leak into the survivor's life without his or her consent. These are known as intrusive symptoms. They are appropriately named as they intrude upon one's life. One symptom known to many survivors is a "flashback." This is when the survivor flashes back in to a memory of the assault. Survivors may feel as if they are seeing it or feeling it all over again. Intense fear surrounds these flashbacks as the survivor is not able to predict or control when they will occur.

Ella suffered from a common symptom of sleep disturbance. Survivors may have trouble falling asleep due to their racing thoughts or inability to calm their body. Some may attempt to put off sleep, knowing that nightmares are most likely going to wake them up in the middle of the night. This lack of rest only serves to compound the symptoms during the day.

Survivors may also experience extreme emotions that may not match the situation at hand. For example, some survivors may have more of a "quick temper" after the assault. Many are prone to depression or heightened anxiety. What was a "normal" worry is now an obsession that renders them fearful or impulsive. Feelings are internal cues that tell information about the world and what we are experiencing. For the survivor of sexual assault, feelings are more "flood gates" that tend to open with the slightest provocation.

Arousal Symptoms

Sexual assault can rob a survivor of their safety. This feeling of not being safe lasts long after the assault. It's this lingering feeling that causes a survivor to have what is called arousal symptoms. A common arousal symptom is known as an exaggerated startle response. If you have ever seen a scary movie, you can relate to being "on the edge of your seat." This feeling may be entertaining for a short time for some (hence the majority of the movies are action packed), but to sustain this state is both exhausting and damaging to the survivor.

A common arousal symptom seen in rape survivors is hypervigilence. When individuals feel safe, they are able to attune to what they choose to focus on. In the past, however, dangerous things happened "out of nowhere." In order to protect the body, the individual is hypervigilent to his or her surroundings, always attuned to what is going on in the background. This hypervigilence may be exhausting to the survivor as well as those around her. He or she may be accused of having a lack of attention or focus.

Avoidance Traits

Sexual assault creates an internal environment so scary that survivors may avoid any reminders of the event. Avoidance symptoms are behaviorsof which a survivor engages in to avoid reminders of the event. When referencing "reminders," though, one needs to recognize all that was connected with the assault. To illustrate, if one was raped in a park, they may avoid large open spaces. They may be triggered also by trees, the sound of birds, or a swing set that was near during the assault. Perhaps the assailant was wearing a certain cologne; in this case one may avoid smells including lotions, department stores, or other places where their senses may get triggered.

Emotions that may have been present during or after the assault may be avoided as well. For instance, survivors may avoid feelings of sadness or fear as they connect them to the assault. They may see them as signs of weakness and may correlate it with being vulnerable. Many survivors will avoid putting themselves in any vulnerable place even if it is showing emotion or letting go of a secret. A vulnerable position may lead to physical and emotional pain. Survivors will go to great lengths to ensure that the situation does not get recreated. Hence, survivors may work on escaping or avoiding both physically and emotionally vulnerable situations at all cost.

Avoidance issues can cripple a survivor emotionally as they have taken themselves out of important facets of life. Survivors of gang rape or date rape may avoid gatherings or large crowds. Intimate friends and partners are now no longer trusted. The survivor becomes more and more isolated from their peers as well as their own emotional experiences. Ella found the peer interaction to be too overwhelming and chose to retreat. Prolonged avoidance of dealing with the trauma of rape can lead a survivor to "hide out," causing them to work long hours, and/or become obsessed with isolated behaviors such as eating or exercising.

As the survivor attempts to avoid the difficult feelings associated with rape and its aftermath, many increase their use of mood altering substances. They may use alcohol or drugs to blanket the feelings of anxiety or fear. Many find mood altering substances initially comforting as they produce a feeling of safety. Others find that the only way for them to fall asleep through external means such as a substance. The flashbacks are then contained with drugs or alcohol. The amount needed to numb the pain or contain the memories increases until they become addicted. Many identify this as a problem and seek to lessen their drug and alcohol use. However, the less they use, the more symptoms of the sexual assault may come up. In these instances, the need for treatment of substance abuse as well as the assault is needed concurrently.

Negative Cognitions Associated with Rape Trauma

Although some survivors are able to connect their present feelings and symptoms to the original trauma, many survivors use present day problems to explain unhappiness. For example, they may not identify the deep rooted trust issues of which they may struggle. Instead, they believe that their present relationships are "not working out." A good look at an individual's life will reveal the true beliefs they have about themselves and the world. When one doesn't feel worthy, it leads them to construe situations to confirm their unworthiness.

In life, there are certain "rules" we use in society to create a safe and predictable world. For instance, the fact that the sky is blue has become a "rule" in our head ever since we first learned our colors. We then use this fact as a reference point to determine whether or not something is amiss in our world. We have also learned that a gray sky typically produces rain. In this case, our world becomes predictable. If the sky is blue, there is little chance of rain. If the sky is gray, we need to prepare for rain.

Additional "rules" and guidelines lay within the human mind. These rules are called "cognitions" or "beliefs." They are beliefs about oneself which are perceived to be true based on one's experience. Some common beliefs are that people are good, the world is relatively safe, sex is pleasurable, and we are in control of our environment. A sexual assault can change these beliefs at the core of the human being. These beliefs infiltrate the survivor's life without the conscience being aware. The beliefs then morph into the feelings that people are bad, the world is not safe, sex is something that hurts, and the environment is out of control. These beliefs about oneself and the body then polarize the survivor from their body or their world. However, rarely are survivors able to articulate that they feel their body is an enemy. Instead, they present with eating disorders, substance abuse, or self injurious behaviors.

Here are some common beliefs which may result from a sexual assault;

1. The world is not a safe place.

Typically, we are able to walk around in a relaxed state free from the feeling of impending doom. If this were not the case, we would walk this earth on a heightened state of alert. Our heart rates would be up, we would not be able to concentrate on the task at hand, and we would be very suspicious of those around us. This can be true of the survivor. Prior to the assault, they took comfort in a normal routine. Things were very predictable until the unpredictable happened.

Feeling as if the world is not safe creates a fearful environment. Walking around in a fearful state is what leads to the heightened anxiety. The sense of pending doom lingers and the survivor seeks safety in many ways. Safety in such a tumultuous world means either fighting your way through life or withdrawing all together. Relationships can be tainted with suspicion and intimacy is nearly lost.

If the assault was in the home, many people try to avoid the memories by moving. On the surface this may look like a solution. As triggers tend to be generalized, an individual may not feel safe in the home wherever it is. This related belief is that my home is not safe. In this instance, there is no refuge for the survivor until this belief is reversed.

2. I am less than.

The feeling that the individual is somehow tainted often follows a sexual assault. The fact that the body is the scene of the crime, feelings of shame become almost inescapable. This driving belief may lead to sexual problems and feelings of contempt for one's own body. Due to the contempt felt by the survivor, the body becomes a place that warrants harm instead of care. This can lead to self-injurious behavior such as cutting or burning. There is also no regard for the harmful effects alcohol or drugs have on the body.

Ella is a good example of someone who feels that she is somehow damaged or "less than." She experienced a great deal of abuse always believing that it was her fault. She engaged in sexual practices that she regretted. In this instance, she made a decision based on her boyfriend's wishes outweighing her own.

Subsequent sexual acting out can stem from this belief. After all, if someone feels as if they are dirty or bad, they will expect people to treat them as such. A good illustration of this may be a survivor who enters into relationships with abusive men. These men in turn treat the survivor as if she or he was less than thereby perpetuating beliefs about the self. Domestic violence can ensue as the survivor continues to believe that he or she is dirty or doesn't deserve love. Positive relationships that may develop are abandoned as they contradict what the survivor believes to be true.

Associated beliefs with this are; I am damaged goods, I am worthless, I am here for other's enjoyment, and I am dirty.

3. Sex is something painful.

Sexual assault is often accompanied by physical pain. Flashbacks during subsequent sexual activity perpetuated this belief. What once was a pleasant act to be shared between mutual partners may now be a dirty despicable act to be avoided. Partners are often unaware of the impact the assault has had on the survivors. At times they are unaware of the assault altogether. The feeling that one is engaged in an act that has harmed them in the past can lead the survivor to disassociate during intimacy. Attempts may be made to avoid any sexual activity all together.

4. People cannot be trusted.

Although it is true that some people in this world cannot or should not be trusted, a survivor often loses trust in all people. In many cases, the survivor was acquainted with the perpetrator. This contributes to the survivor feeling as if she somehow brought it upon herself. This belief, which is extremely erroneous, leads to feelings of over responsibility and shame.

Intimate relationships are adversely affected as suspicion lingers on the mind of the survivor. Support networks that were in place prior to the assault are not accessed as a result of this belief. Intimate relationships developed after the assault may be tattered with trust issues as well.

Treatment of Rape

Part of the healing process is to uncover one's true belief system. Often survivors identify verbally that the responsibility for the assault lies with the assailant. However, when you probe into the workings of their mind, you uncover lingering feelings as if they had somehow brought it on themselves. Eradicating these beliefs to the core then uncovers the strength beneath.

It is important that the survivor seek the treatment needed to resolve the underlying beliefs that result in the troublesome aspects of his or her life. It is a journey where the hidden power is uncovered. Through connecting with other survivors, women can share their stories and help each other identify where they found their power. As with any treasure hunt, the more people on your team, the better apt you are to find the gold.

A sexual assault can last from minutes to hours, but the lasting effects can go on for years. The act committed by another person may leave a mark on the survivor so deep that at times they may not even see it. The result is a cluster of symptoms that can only be resolved with awareness and empowerment.

The spirit is amazing in its resilience and starts to heal the moment it becomes injured. In becoming aware of the symptoms related to the assault, one can begin processing the events and come to a resolution. Survivors are empowered to overcome the beliefs instilled in them during the assault. Power is then uncovered showing strength that knows no limits. The spirit may have become clouded, but it is never broken.

Resources

http://www.rapevictimadvocates.org/
Rape Victims Advocate is an Illinois not-for-profit organization made up of many individuals with two primary goals: to assure that survivors of sexual assault are treated with dignity and compassion; and to affect changes in the way the legal system, medical institutions and society as a whole respond to survivors.

http://www.trauma-pages.com
These Trauma Pages focus primarily on emotional trauma and traumatic stress, including PTSD (Post-traumatic Stress Disorder) and dissociation, whether following individual traumatic experience(s) or a large-scale disaster.

http://www.nyscasa.org/local-programs-nyscasa.html
This is a link to local programs in your area provided by the New York State Coalition Against Sexual Assault.

http://www.ptsdinfo.org - Gateway to PTSD Information

http://www.giftfromwithin.org - PTSD Resources for Survivors & Caregivers

A request from Dr. Amy Menna:

Dear Colleagues and Friends,

If you would, please take a moment to read this email. I am embarking on a project to assist rape survivors. If you could pass this along or could assist in any way, please let me know.

"Reflections of Hope" is a project which ultimately hopes to empower survivors of rape. Through a compilation of letters and information from rape survivors to other survivors, healing can take place for those who suffer. I am looking for rape survivors to participate in this important mission to assist those who feel as if they are alone.

Any individual who has had an experience with rape can participate. It will entail writing a letter to other survivors and answering some questions (as few or as many as you wish). This information will then be published in a book for survivors. You do not need to be a writer, all is needed is a willingness to share your story with other survivors. Guidelines and further information will be given via email. There is no need to travel anywhere, and pseudonyms will be used to protect anonymity.

If you wish to participate or have questions, please send an email to Hopereflections@aol.com. You can visit the website at Survivorsofrape.com.

For those of you who wish to further the healing of survivors of rape, please email this to people you know who can then either participate or simply pass it on.

This project is being headed by Amy Menna, Ph.D. She has over 10 years of experience treating survivors of sexual assault and has published on the topic of Rape Trauma Syndrome, resiliency, and childhood sexual abuse. She resides in Tampa, Florida and teaches at a local university. If you would like to speak with her directly, feel free to call 813-766-8510. It is understood if you would like to verify this email. You may do so by calling her directly or visiting the website "survivorsofrape.com."

Amy Menna has a Ph.D. in Counselor Education and Supervision, is a Licensed Mental Health Counselor, and Certified Addictions Professional. She is in private practice and lives in Tampa, Florida. She is available by email at amymenna@aol.com.

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