How to cope with PTSD following sexual assault
I've recently learned that approximately half of all women who have been sexually assaulted develop post traumatic stress disorder. Check out what you can do to begin recovery if you're one of them.
The US National Comorbidity Survey Report estimates that the lifetime prevalence of PTSD among North Americans is 7.8%. The lifetime prevalence of this disorder for women who have been sexually assaulted is 50%.1 According to the Rape, Abuse and Incest National Network (RAINN), 94% of women who are raped experience PTSD in the two weeks following the attack, and 30% will within nine months. Charlene Hills, a licensed clinical social worker, states that survivors who believed their lives were in danger during the assault are more likely to develop the disorder. Although the fight or flight response may have kicked in, neither were effective when the women were overpowered.2 Hills cites the following common PTSD symptoms in sexual assault survivors:
agitation, irritability, or hypervigilance
nightmares or flashbacks
mistrust of others or emotional detachment
loss of interest in pleasurable activities
self-destructive behaviors (such as eating disorders or cutting)
social isolation or loneliness
Possible long-term effects include:
chronic pain or worsening of physical health problems
risk of developing an autoimmune disease
depression or anxiety disorder
loss of occupational or educational functioning
substance abuse or addiction
suicidal thoughts or behaviors
Reading these lists plunged me back into my friend’s pool when I was seven years old. Her stepfather rammed his finger into my vagina twice while we floated around her pool. Within months of that incident, my brother (four years older) started sexually abusing me and persisted for about three years. Shortly before my thirteenth birthday, I was raped (statutory) by one of my brother’s classmates. Approximately a dozen years after that final assault I disclosed all those experiences to a therapist in my initial counseling session.
Having been a licensed psychologist for 34 years, I realize that I never met diagnostic criteria for PTSD, yet I suffered numerous symptoms. I have always been hypervigilant to my surroundings, anxious about potential safety threats, and easily startled. Although I haven’t had nightmares, I’ve often had trouble falling asleep and my husband said that my body is tense even while sleeping. For much of my life I have been plagued by guilt, shame, and intense anger. I was diagnosed with an autoimmune disease at age 54.
Matthew Tull, PhD, cited the Center for Disease Control’s claim that one in three women and one in four men will experience sexual violence at some point in their lives.3 My work in the field of child sexual assault prevention indicates that one in four girls and one in six boys in the US will experience unwanted sexual contact prior to their 18th birthday. Tull says that such survivors have an increased likelihood of developing intrusive thoughts and memories, may feel like they are always in danger, and need to be on guard. They may have mixed feelings about consensual intimacy or decreased desire for or satisfaction from sex. In this realm, I have been fortunate. Even though I have felt haunted by the trauma of child assault, I’m grateful to have a healthy attitude about sex. (If interested, check out my blog about intimacy after assault.)
In Dr. Tull’s article in verywellmind (a Cleveland Clinic online mental health resource), he indicates that many sexual assault survivors avoid exposure to situations that remind them of their assault: television programs, movies, newspaper articles, and conversations on the subject. During my career as a social worker and school psychologist, I occasionally worked with clients who grappled with sexual abuse. I sometimes struggled to remain objective and to leave the issue at work. It was impossible for me to read the newspaper or watch the evening news without becoming overwrought or obsessing on assault scenarios. As a result, I began a media boycott in 1989 which continues today. I sleep much better and expend emotional energy in more positive pursuits.
Thankfully, I never detached from others and haven’t had difficulty experiencing joy or satisfaction as some survivors do. And I have never felt hopeless. I attribute this good outcome to my vocational training, the excellent therapists with whom I’ve worked, an incest survivor’s group, and eleven years of Al-Anon meetings.
Sexual assault is the most frequent cause of PTSD in women1 and close to 50% of PTSD in the US is due to physical or sexual violence, according to Mary Leigh Meyer.4 Unfortunately most people don’t seek mental health services following sexual assault. “It is normal to have a very strong reaction to a traumatic episode…trouble concentrating, eating, sleeping, but you need to give yourself time and permission to .. feel that way,” says Nancy Downing, PhD, RN, associate professor of Forensic Nursing at Texas A & M. She speculates that hormonal or genetic differences, past trauma, and especially childhood trauma, make people more susceptible to this disorder than others. Downing states that most individuals who develop PTSD will have a spontaneous recovery, but about 10% will keep getting worse. She urges all survivors to speak with a sexual assault resource center or a mental health practitioner trained in trauma.
PA Frazier writes that “Events perceived as uncontrollable are much more distressing than controllable events.” After sexual assault, survivors often assign blame to themselves or someone who might have been able to protect them. Such a focus on the past tends to result in poorer outcomes than an emphasis on managing the present and the impact of the assault. “Control over the recovery process results in lowered distress levels.”5 Survivors in counseling will be more apt to maximize their healing with a therapist who emphasizes coping strategies in the present.
THE PATH TO RECOVERY
The following are recommendations of the aforementioned authors or ones I have found effective.
Cognitive processing therapy, a cognitive-behavioral treatment focused on helping people who are “stuck” in their thoughts about trauma.6 Developed by Dr. Patricia Resick and a team of psychologists, this method requires the client to write about the traumatic event in detail, then read it aloud in and outside the treatment setting. The therapist helps to identify and address errors in thinking by having the client gather evidence for and against those thoughts.
Exposure therapy, which targets learned behaviors that people engage in (most often avoidance of thoughts and memories that are viewed as frightening or anxiety-provoking), the goal of which is to reduce fear and anxiety and to increase the quality of the client’s life.
Group therapy (for incest, child sexual assault, or rape survivors) offers opportunities to share experiences with others in a safe and empathic environment.
Self-care and the use of coping techniques to decrease PTSD symptoms:
breathing slowly when feeling frightened
carrying a comforting object that reminds you of the present
telling yourself that you are safe
keeping a journal about events that trigger flashbacks
using “grounding” strategies (describing your surroundings, what you hear, see, or smell) that keep you in the present
National Center for Post Traumatic Stress Disorder. Epidemiological Facts PTSD – A National Center for PTSD Fact Sheet. Retrieved April 1, 2005 from http://www.ncptsd.va.gove/facts/general/fs_epidimiological.html; 2005.
Methodist Hospital Community Counseling Program. Understanding PTSD in Sexual Assault Survivors. June 26, 2020.
Centers for Disease Control and Prevention. Preventing Sexual Violence. Updated February 5, 2021.
VitalRecord, a news publication of Texas A & M Health. PTSD After A Sexual Trauma. January 29, 2019.
Frazier PA. Perceived Control and Distress Following Sexual Assault: A Longitudinal Test of a New Model. Journal of Personality and Social Psychology. 2003;84(6): 1257-1269. [PubMed] [Google Scholar]
Barlow, David H. Clinical Handbook of Psychological Disorders. Fourth Edition: A Step-by-Step Treatment Manual. New York. 2014.
