PTSD in Sexual Assault Victims

PTSD in Sexual Assault Victims

According to the DSM-5, post-traumatic stress disorder (PTSD) occurs from an exposure to a traumatic event in which an individual experiences or witnesses death or threatened death, actual or serious injury, or actual or threatened sexual violation (Barlow, et al. 160). It can occur in anyone who [has] experienced or witnessed . . . a natural disaster, a serious accident, a terrorist act, war/combat, rape or other violent personal assault (Parekh). Currently, an estimated five percent of Americans (which is more than thirteen million people) have PTSD (Post Traumatic). In specific focus for the disorder, the estimated risk for developing PTSD for people who have experienced sexual assault is significantly large: forty-nine percent for rape victims and around twenty-four for other instances of sexual assault (Post Traumatic). PTSD as a result of sexual assault is quite common for victims.

When recognizing if one suffers from this disorder, it should be noted that PTSD has three main clusters of symptoms that victims will have: reexperiencing, avoidance, and hyper-arousal (Post Traumatic). Under these clusters are more specific symptoms of PTSD, including the following: nightmares and sleep disturbance, distress at exposure to similar stimuli, avoidance of talk of trauma, detachment, anger outbursts, startle response, hypervigilance, restricted affect, and regressive behavior, (Barlow, et al. 161) as well as many others. Instead of avoidance of talking about trauma, some victims might not actually be able to recall events at all due to dissociative amnesia, or because of injuries or drug usage at the time of the traumatic event (Barlow, et al. 163).

Symptoms may vary from person to person depending on the severity of the traumatic experience (or if there was more than one traumatic occurrence for the victim). Symptoms most common to victims of sexual assault are dissociation or re-living the physical trauma that they experienced through flashbacks or from similar scenarios or stimuli (Burgess), because of the direct and intense invasion of [their bodies], personal space, and safety' that has occurred (Burgess).

In addition to the primary symptoms of PTSD that people experience, victims of sexual assault may also commonly experience negative emotions such as depression, guilt, shame, and distrust (Burgess) following the sexual assault, which can evidently have a direct affect on one's daily life and habits by causing disinterest or fear in participating in daily activities. It is common for victims to develop a persistent and negative view about themselves, others, and the world, which also causes them to lose self-esteem or blame themselves for the traumatic experience (Barlow, et all 163). This can many times lead to social isolation by the victim from friends, family, or others (even therapists). Because of unfortunate symptoms like these, victims of sexual assault are actually between 1.4 and 3.6 times more likely to report a suicide attempt that nonvictims (Tomasula, et al).

Like the symptoms themselves vary, so can the duration of those symptoms. In all cases of PTSD, symptoms under the clusters do have to last for at least one month following an event to receive a PTSD diagnosis (Krystal). However, many symptoms can be existent even throughout a person's lifetime after that initial month. Symptoms can reappear as stressful stimuli (more commonly known as triggers) introduced to a person, or if they experience another traumatic event similar to the original one.

When seeking diagnosis, a person must be clearly experiencing the clusters of main PTSD symptoms (reexperiencing, avoidance, and hyper-arousal) for at least one month, as mentioned above (Krystal). For many victims who suffer from PTSD, assessment of the disorder is commonly difficult; many people, due to the avoidance section of the symptom cluster, will find it hard to recognize they have a problem, especially if the symptoms appear after a length of time following the traumatic event (Diagnosing PTSD). Other issues that arise include that many victims believe they can handle the disorder on their own without professional help, are embarrassed or ashamed of what happened, or simply don't know where to look for aid (Diagnosing PTSD).

For actual assessment of the disorder, medical professionals will first take a complete medical and personal history (Diagnosing PTSD) for the patient and then look for specific signs including the exact event that was experienced/learned about/witnessed (for example, rape), the number of and intensity of the symptoms that the patient is experiencing (like nightmares or startle responses), how he or she is coping with those symptoms (if he or she is experiencing avoidance, etc), and the duration of the symptoms (Diagnosing PTSD).

For victims of sexual assault, some medical professionals (if the victims are children) will often look for reenactment of the traumatic experience through play (Diagnosing PTSD), because many children are not able to communicate their traumatic experiences in the same ways that adults can. Screening for PTSD in victims can sometimes be completed through online surveys (which are today popular and convenient and test for many different mental disorders); some people may prefer taking a survey on their own, or some may like the idea of a medical professional providing a written one to them (this would obviously be more accurate and recommended). Physical examinations are often completed on patients who are seeking help, to check for other medical issues that could be contributing to or causing symptoms (Tull and Gans).

Psychological examinations are usually recommended; this allows victims to openly discuss their experiences (if they so choose) with a professional and tell them about the specific event they experienced that has caused certain symptoms (Tull and Gans). The information from psychological examinations, surveys, and physical examinations (not always are all of them necessary or completed) is then gathered to give the potential PTSD diagnosis for the patient, depending on how intense or clear the results are.

The first appearances of PTSD were seen around the 1980s within the DSM-3; the very first terms used to address the symptoms of the disorder were commonly heard of as shell-shock, soldier's heart, or war neurosis and closely followed the disaster of the Vietnam War (Crocq and Crocq). However, epics like the tale of Gilgamesh propose that the first case of chronic mental symptoms caused by sudden fright in the battlefield [were] reported in the account of the battle of Marathon by Herodotus, written in 440 bc (Crocq and Crocq).

Far before symptoms were being recognized as potentially eligible for being an actual disorder, many of these now-defined symptoms were merely thought to be part of human fundamental experience (Crocq and Crocq). In the late 1700s, Nosographie Philosophique (1798) described the case of a philosopher who became apprehensive, depressed, being withdrawn, and having an overall personality change after a near-death experience, and in 1884 those who experienced severe railway accidents (and experienced similar symptoms) made way for the first mention of the term traumatic neurosis (Crocq and Crocq). In World War I, the observed mental distress of soldiers was repeatedly described in literary works; the aftermath of this and the Vietnam War brought high rates of suicide or alcoholism amongst veterans and sparked the need for psychiatric assessment and treatment, which led to PTSD finally being added to the DSM-3 in 1980 (Crocq and Crocq).

For victims of sexual assault, more detail has been recently added to the DSM-5 for PTSD: As to the specific definition of an intensely stressful event, DSM-5 retains the prior description of threatened death, serious injury' and adds sexual violence.' Whereas the test in DSM-IV-TR limits the description of sexual trauma to sexual assault,' DSM-5 presents a wide-ranging set of examples of sexual violence (Levin, et al). While statistics are difficult to find about when sexual assault was considered for PTSD before being added to the DSM-5, this quotation reveals that sexual assault is becoming more common when talking about which types of traumatic events cause the disorder.
Treatment of PTSD can vary; the main treatments for the disorder include psychotherapy, medication, or both (Treatment for), but it depends on the victim's preference or accessibility to these treatments. For psychotherapy, a victim may refer to Cognitive Behavioral Therapy (CBT) for trauma-focused therapy that has weekly meetings to identify, understand, and change thinking and behavior patterns (Treatment for).

Forms CBT are Cognitive Processing Therapy (CPT), Prolonged Exposure (PE), Eye Movement Desensitization and Reprocessing (EDMR), and Stress Inoculation Training (SIT) (Treatment for). Other therapies for PTSD besides CBT include Present Centered Therapy (PCT), which is non-trauma focused and orients around current problems instead of directly processing traumatic experiences (Treatment for). So, either a victim chooses therapy that directly addresses the traumatic event he or she experienced, or he or she can choose a therapy to avert his or her focus from the traumatic event to the present. Again, the therapy chosen can depend on many outside factors or the type of traumatic experience. And like mentioned before, many people often do not even seek treatment (because they are ashamed or confused at where they should look for it).

Common medications used to treat PTSD are selective serotonin reuptake inhibitors (SSRIs) (Treatment for). Sertraline and Paroxetine are the only medications currently approved by the FDA for PTSD, but Fluoxetine and antidepressants such as Venlafaxine are often provided to victims as well (Medications for). Some medications, such as Topiramate, are in the anti-epileptic category of medications and [are] thought to modulate glutamate neurotransmission . . . but the side-effects are greater than they are for SSRI antidepressants, so there is insufficient evidence for the recommendation of such medications (Medications for). Victims of sexual assault commonly use these medications as a way of relieving anxiety experienced from PTSD symptoms. However, if not taken properly, many victims are also unfortunately susceptible to drug abuse problems.

Some special populations for those with PTSD who have been sexually assaulted include victims from domestic violence, university students, and those who are intellectually disabled. Domestic violence is problematic because often times people do not know what is going on in someone else's relationship or the victim is scared to come forward (due to stalking, death threats, etc). For university students, parties, access to alcohol, or dorm room security can be significant contributing factors that correspond to sexual assault cases. For those with intellectual disability, sometimes consent is difficult or impossible to give. High rates of sexual violence in the country suggest that people with intellectual disabilities (ID) are likely to be sexually victimized, (Shabalala and Jasson) often for this fact that consent cannot be given.
Eighty-one percent of women and ten percent of men have experienced some form of sexual assault in relationships have reported experiencing PTSD symptoms or some form of impaired daily functioning (Statistics).

Women in college are three times more likely than all women to get sexually assaulted and around five percent of undergraduate males experience sexual assault (Campus Sexual Violence). Even if not reported at universities, PTSD symptoms are still highly likely to be seen in victims of sexual assault. For people with intellectual disabilities, one study in 2011 that tested fifty-four people with intellectual disability (twenty-seven who were sexually assaulted and twenty-seven who weren't) for symptoms of PTSD showed that those who were intellectually disabled had intense PTSD symptoms from all three clusters (Shabalala and Jasson).

In summary, PTSD, with its clusters of many intense symptoms, is incredibly common for trauma victims who experience some form of sexual assault in their lifetime. Although there are many negative symptoms that result from this disorder that can persist for long periods of time, there are also many positive forms of therapy or medications available for victims as treatment if they so choose to take that path. The history of PTSD symptoms has been mentioned and recorded even before the first DSM was published, and it is clear that psychologists have worked hard at improving the specifics of what can cause PTSD in victims of sexual violence (which will lead to easier assessment and diagnosis in the future). As this improvement continues, treatments will also update and be able to aid those with PTSD from sexual assault, whether university students, victims of domestic violence, those with disabilities, or people from other populations.

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