PTSD
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Summary
Sexual assault is a life threatening and harrowing event that not at all victims recover. Post traumatic stress disorder (PSTD is a lasting difficult disorder that comes after an exposure to a harsh helplessness. The most common reaction recognized following rape is anxiety. Many individuals suffer anxiety following rape. Some victims suffer anxiety up to sixteen years after the incident occurred. Similarly in studies carried out, about twenty three percent of victims were asymptomatic at one year post rape measures. Depression is also another reaction to rape. Some victims get more or less depressed right away following rape. These results are a matter of contention as some retrospective results are inconsistent with these results. Related to depression, suicidal thoughts and actions must be monitored in assault victims. In study of the victims seeking treatment, forty three percent had considered suicide and about seventeen actually tried to commit suicide.
Anger has over the years been reportedly seen in rape victims with PTSD. In general, rape victims were angrier than non-victims. Mild forms of dissociation are common, such as driving a familiar way but the individual does not pay attention to where he is heading. Most rape victims report a restricted life several months after the assault occurred. This problem in social functioning may be as a result of the victim’s fear of stranger, going out with new people and of people walking behind them. Some Rape victims experience sexual difficulties. Some of the victims questioned looking back, acknowledged at least experiencing one sexual dysfunction following the rape, with fear of sex and decreased arousal or desire as the most common problem noted.
Introduction
Sexual assault is a major, life threatening, traumatic event from which victims never fully recover. The most frequently observed disorder that develops as a result of sexual assault is post-traumatic stress disorder (PSTD). This is a lasting difficult disorder that comes after an exposure to a harsh helplessness.The victim experiences trauma, avoids stimuli associated with it, and develops a numbing or responsiveness and increased vigilance and arousal.
In the Diagnostic and Statistical Manual of Mental Disorders the revised edition, there are three criteria for the diagnosis of PTSD beyond criterion A, the stressor criterion. Criterion B describes re-experiencing phenomena: the flashbacks, nightmares, and intrusive recollections that emerge with reminders of the assault, but which appear to emerge even when no stimuli are apparent. Criterion C consists of avoidance behaviors: avoidance of recollections of the incident, numbing effect, and withdrawal from activities (the latter an overlapping symptom with depression) (Foa, 2009). Criterion D represents physiological over reactivity such as problems falling asleep, hyper vigilance, embellished startle responses, and strong physiological reactions in the presence of reminder stimuli. The avoidance and arousal symptoms are also observed in other anxiety disorders.
One of the old DSM-III criterion items for PTSD was the survivor guilt. Although many Vietnam veterans experience guilt over surviving when some of their friends were killed, this criterion is not relevant to most rape victims. However, most rape victims experience guilt over what they had to do to survive, or they felt guilty and shame over having been victimized. As a means of gaining control over the experience and feeling safe about the future, rape victims look to themselves for responsibility when questioning why the event occurred (Foa, 2009). Many of the victims for instance, stop going to parties, shopping, out on dates, and so on any more. Therefore, by doing so, they feel as if they are adequately protected against future attacks. In the first week following the attack, nearly ninety four percent of the victims have been found to meet symptomatic criteria for PTSD. Three months after the crime, forty seven percent of victims still met enough criteria for full diagnosis of PTSD. Most studies have found that the greatest amount of recovery occurs within the first three months post crime. After that there is very little additional of recovery. However, in the recent study, using weekly assessments, it was found that those women who developed PTSD showed no further recovery after one month post-crime, while those who recovered continued to show ready improvement over the three months of assessment.
Prior to the introduction of the PTSD diagnosis in the DSM-III, there was a two- phase reaction to rape, consisting of an acute phase and a reorganization phase; they termed this as trauma syndrome. The acute phase, characterized by disorganization lasting from several hours to several weeks, included both impact reaction such as shock and disbelief and somatic reactions such as physical trauma (Kendrick, 2007). The reorganization phase was depicted as long- term chronic disturbances such as nightmares and fears. Currently most researchers and authors agree that rape trauma syndrome is best characterized as PTSD.
Anxiety
The most continual reactions known following rape appear to be intense fears of rape- related situations and general diffuse anxiety, which have been noted up to sixteen years post-assault. In one study, about twenty three percent of victims were asymptomatic at one year post rape on fear measures (Foa, 2009). Similarly, in another study, although victims’ fearfulness declined somewhat overtime, they remained more fearful than non-victim controls one year post-assault. Again most fear reactions are currently discussed in terms of PTSD
Depression
Although depression is also a common reaction to rape, it appears to be less persistent than anxiety. Of thirty four victims, about sixteen were moderately depressed immediately following their rape. In larger sample of rape victims, about forty four percent of recent victims were diagnosed with major depression. However these symptoms declined significantly three months after the assault (Kendrick, 2007). When compared to non- victims, victims have been found to be significantly more depressed soon after assault, with difference decreasing three to four months late, and no differences between groups was noticed up to one year after the assault. However, some retrospective reports are inconsistent with these results. In interviews conducted fifteen up to thirty months post-assault, about forty one percent still reported episodes of depression they felt stemmed from the assault.
Of forty four victims seen at a clinic specializing in treatment of post rape PTSD and fear, about fifty nine percent were suffering from major depression. Rape victims reported significantly more depression than robbery victims for eighteen months post-victimization. Related to depression, suicidal thoughts and actions must be monitored in assault victims. In a study of rape victims seeking treatment, most victims had considered suicide and a couple of them actually attempted to kill themselves (Kendrick, 2007). In large random population survey, nineteen percent of rape victims reported making a suicide attempt, whereas forty four percent reported thinking about it. Clearly, suicidal ideation is present in significant proportion of victims and should be addressed.
Anger
Anger has been repeatedly observed in rape victims with PTSD. In a prospective study, about one hundred and sixteen rape and other crime victims were compared to a matched non-victimized control group on measures of anger and anger expression. Results indicated that in general, victims were angrier than those who are not victims. Certain assault variables, such as the use of a weapon and the victim’s response to the attack, predicted the attack response. The authors speculated that intense anger may interfere with the modification of the traumatic memory inhibiting fear responses that would lead to habituation, and by allowing the victim to avoid feelings of anxiety (Friedman, Keane, & Resick, 2010). That is, victims who are prone to experience anger than anxiety do not have the opportunity to confront fearful situations and thus to have that fear decrease; their anxiety-provoking cues and responses remain unchanged.
Dissociative Reactions
A dissociative reaction is a disturbance in the normally integrated functions of identity, consciousness or memory. Mild forms of dissociation are common, such as driving a familiar route and the individual realizes that he or she has not been paying attention to where they were driving. The most extreme form of dissociation recognized in the DSM-III-R is the multiple personality disorder (MPD), which is subsistence within the patient of two or more dissimilar personalities. A continuum of pathology lies between these two extremes. It is commonly held that dissociation in its more extreme forms is the result of trauma. As coping mechanism, dissociation psychologically removes the individual form from an extremely aversive event when physical escape appears impossible (Friedman, Keane, & Resick, 2010)
In a prospective study, rape victims and non-sexual assault victims with or without PTSD were compared for dissociation. Victims with PTSD scored significantly higher than victims without PTSD on measures of dissociation, intrusion, avoidance and assault related distress. Higher levels of dissociation were linked to greater levels of distress after the assault. At this time, the causal role of dissociation in PTSD is unclear. It is possible that tendency to dissociate predisposes traumatized individuals to develop PTSD by inhibiting the emotional processing of the traumatic material. On the other hand, individuals affected individuals may tend to dissociate as a coping response to intrusive images and fears (Kendrick, 2007).
Social Disorders
Even fifteen to thirty months after the assault, over half of the rape victims interviewed in a study reported a restricted social life, only going out with friends. Social and leisure modification was drastically worse for victims than for controls two months after the incident. In another study, but improved afterwards so that no differences were observed. By the end of the fourth months after the assault, most victims’ social adjustments had recovered except for work functioning, which continued to be problematic eight months post-assault. This problem in social functioning may be related to avoidance caused by victims’ fears of strangers, going out with new people, and of people walking behind them (Kendrick, 2007). Marital and family problems were reported more frequently in victims than non-victims in one study, but not in another. Greater threat to the victim during the assault was inversely related to poorer household adjustment. The authors speculated that victims may receive more support from their families.
Sexual Problems
Sexual difficulties following rape are common. One third of victims assessed retrospectively indicated decreased sexual satisfaction, even several years post-assault. At least one half of the victims questioned retrospectively reported at least one sexual dysfunction following the rape, with fear of sex and decreased arousal or desire as the most common problem noted (Wilson & Keane, 2004). Prospective studies have produced similar findings. Two weeks post-rape, nearly sixty percent of victims assessed, indicated less frequent sex since the assault. By the fourth week post-assault, nearly forty three percent reported a total avoidance of sex. Compared to non-victims, victims experienced significantly less sexual satisfactions.
Psychological Reactions
As it is for many anxiety disorders, increased arousal is one prominent characteristics of PTSD. The arousal cluster of symptoms in PTSD includes sleep disturbance, anger, and irritability and difficulty in concentrating, overstated startle response and hyper vigilance; in addition (Wilson & Keane, 2004). Physiological studies of the most of these symptoms of increased arousal in PTSD sufferers are scarce, despite the fact that at least two symptoms from the arousal cluster are required for a PTSD diagnosis, laboratory documentation is lacking for sleep disturbance, irritability, distractibility, and hyper vigilance, even though they are common symptoms of PTSD. Although overstated startle response has been studied, the results provide equivocal evidence for increased reactivity.
Conclusion
In conclusion, PTSD symptoms are numerous and varied. They may include general anxiety, depression, anger, dissociative reactions, social and sexual difficulties, and physiological changes and sensitivities among others, it is very important to keep in mind that the PTSD symptoms are complicated. However, very often when the PTSD is treated successfully, the other reactions dissipate as well.
References
Foa, E. B., & International Society for Traumatic Stress Studies. (2009). Effective treatments for PTSD: Practice guidelines from the International Society for Traumatic Stress Studies. New York: Guilford Press.
Friedman, M. J., Keane, T. M., & Resick, P. A. (2010). Handbook of PTSD: Science and practice. New York: Guilford Press.
Kendrick, Timothy. (2007). Ptsd: Pathways Through the Secret Door. Gardners Books.
Wilson, J. P., & Keane, T. M. (2004). Assessing psychological trauma and PTSD. New York: Guilford Press.
