A little more on RTS (Rape Trauma Syndrome)

I find that knowing what reactions are normal in rape victims helps me understand that the feelings I have are normal and that I am not alone. I already posted another article on RTS that I compiled from a few websites, but this one helped me understand a little more and, for me, anything helps. I hope that someone reading this can be helped, even in the least.

Rape Trauma Syndrome (RTS) is a form of Post-Traumatic Stress Disorder (PTSD) that often affects rape survivors.

Not all rape survivors will experience RTS. Different women respond to the trauma of rape in different ways. Some women will experience severe RTS, while others have few symptoms or none at all. ALL rape survivors need to be believed, taken seriously and supported, regardless of whether they experience RTS or not.

Experiencing some or all of the symptoms of RTS does not mean you’re crazy. The symptoms of RTS can be very powerful and distressing. As a survivor, it may feel as if you’re going crazy, but that is a normal reaction. If you are supporting a friend or family member who has been raped, you may find the survivor’s behaviors puzzling or upsetting. HOWEVER, the symptoms of RTS are a NORMAL reaction to a traumatic experience, and they will fade over time with proper care and support.

A survivor’s individual response to rape, and the degree of RTS they experience depends on many factors:

  • If the victim knew and trusted the rapist
  • If family and friends are supportive and patient, or blaming and unhelpful
  • Treatment by the police and justice system, should the victim choose to report the attack
  • Age and previous life experiences
  • Cultural and religious background
  • The degree of violence used by the rapist
  • Injuries, illnesses or disabilities resulting from the rape
  • Whether the rape brings up memories of past traumas
  • The victim’s emotional state prior to the rape
  • The victim’s practical and material resources

Remember: Every rape situation is unique and it is very important to treat each rape survivor as an individual.

It is next to impossible to completely forget about a rape. Many survivors lose or suppress memories of all or part of the rape, but it is not forgotten; however, the memories will almost certainly resurface later, and the survivor will need to face them.

If the victim is very young, or experiences the rape as especially traumatic, they may block the memory of the rape even as it is occurring. They may not consciously recognize that they has been raped or may not experience any symptoms until months or years later, usually when another life event, such as a first sexual relationship or another trauma, triggers the memories. Once the memories return the survivor will never forget what happened, but will learn to live with the trauma. Recovery takes time. Survivors must allow themselves to remember the rape and feel whatever feelings it will bring, even though this is often very difficult and painful. They need to work through the experience, and integrate it into their lives so they can move on.

Physical Symptoms of RTS

  • Shock: usually an immediate response. May include: numbness, chills, faintness, confusion, disorientation, trembling, nausea and vomiting
  • Sleep problems: unable to sleep, sleeping more than usual, or other changes in sleeping pattern
  • Eating problems: no appetite and subsequent weight loss, or compulsive eating and subsequent weight gain
  • No energy or too much energy
  • Physical illness: the stress may weaken the immune system and making them more vulnerable to illness. The rapist may have infected the survivor with an STD, or other illness. A general feeling of “unwellness” is normal
  • Physical pain: this may be as a result of injuries inflicted by the rapist, or a physical reaction to emotional pain
  • Cardiovascular problems: heart palpitations, breathlessness, tightness or pain in the chest, high blood pressure
  • Gastrointestinal problems: loss of appetite, nausea, diarrhea, constipation, dryness in mouth, butterflies in stomach, feelings of emptiness in stomach, etc.
  • Exaggerated startle response: over-reacting to sudden noise or movement
  • Over-sensitivity to noise

Cognitive Symptoms of RTS

“As if” feelings or flashbacks: re-experiencing sensations that were felt during the rape, or actually reliving parts of the experience in memory or dreams.

  • Intrusive thoughts: sudden or forceful “intrusive” memories of aspects of the rape. Constantly thinking about the attack.
  • Memory loss: the survivor may be unable to remember the rape or parts of it; this is usually temporary, although it can last for many years
  • Poor concentration
  • Increased alertness
  • Speech problems: stuttering, stammering or other difficulty talking
  • Indecisiveness
  • Difficulty problem solving
  • Nightmares
  • Violent fantasies
  • Revenge fantasies

Behavioral Symptoms of RTS

  • Crying
  • Avoiding reminders of the rape
  • Pretending that it never happened
  • Neglecting themselves or other people
  • Increased washing or bathing
  • Self-blame
  • Fear of being alone
  • Not socializing or socializing more than before the rape
  • Relationship problems: the survivor may be irritable, argumentative or easily upset; they may withdraw from people they felt close to before the rape or form sudden new connections; they may grow overly dependent on others or become too independent.

Survivors may experience sexual problems after the rape. They may not want sexual contact of any kind, or may no longer enjoy it – this may be exacerbated if their partners blames them or are impatient with their recovery; alternatively, they might become more sexually active than before.

Survivors may make drastic changes in home, work, school or relationships; this can be an important part of helping them feel safe and in control again.

  •     Substance abuse
  •     Emotional Symptoms of RTS
  •     Denial
  •     Numbness or lack of emotion
  •     Rapid, inexplicable mood changes
  •     Shame
  •     Guilt
  •     Feeling dirty
  •     Anger or desire for revenge
  •     Fear
  •     Nervousness and worry
  •     Being easily upset
  •     Powerlessness and loss of control
  •     Grief and loss
  •     Feeling “different” from other people
  •     Loss of Self-esteem
  •     Losing interest in life
  •     Depression
  •     Suicidal feelings

RTS symptoms change over time.  In the first days after the rape, survivors usually experiences shock. They may be visibly upset, or may appear calm and reluctant to talk. Once the shock has passed there may behave as if nothing has happened. This is called denial or apparent adjustment and helps the survivor block painful memories and feelings that they may not yet be strong enough to deal with. This phase can last for weeks or months or even years, but is almost always followed by a long phase of active healing, during which the survivor will probably experience other RTS symptoms. With care, attention and time, the symptoms will decrease and finally disappear completely.

Many rape survivors who experience symptoms of RTS, may find it helpful to talk to a counselor trained in working with rape victims. A counselor can help them deal with the strongest symptoms, or to work through memory loss. Other survivors may find that the rape brings up other underlying problems, and in these cases, more help may be needed. If you would like to find a capable counselor, contact UASA or another women’s help group.

For more information contact United Against Sexual Assault (UASA). We offer a 24/7crisis line for victims and also offer training, education and information about rape and other forms of violence against women, teens and children.

http://uasasonoma.org/services/rts.html

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Understanding what Rape Trauma Syndrome (RTS) is

I have found that one way to help understand what you feel after being raped is to understand what RTS is. Rape Trauma Syndrome affects many victims, whether it happened last week or seven years ago (as in my case). When I searched online, I found a few different articles that tried to explain what RTS is. All seemed to have a lot of different, but valuable material. So I merged all three websites information into one to help me (and others in my position) understand what it is they are going through. You are not alone.

Rape Trauma Syndrome (RTS) is a form of psychological trauma experienced by a rape victim that consist of disruptions to normal physical, emotional, cognitive, behavioral, and interpersonal characteristics. The theory was first described by psychiatrist Ann Wolbert Burgess and sociologist Lynda Lytle Holmstrom in 1974.

RTS describes a cluster of psychological and physical signs, symptoms and reactions common to most rape victims, during, immediately following, and for months or years after a rape. While most research into RTS has focused on female victims, males who are sexually abused (whether by male or female perpetrators) have also exhibited RTS symptoms. RTS also paved the way for consideration of Complex Post Traumatic Stress Disorder, which can more accurately describe the consequences of serious, protracted trauma than Post Traumatic Stress Disorder alone. The symptoms of RTS and Post-Traumatic Stress Syndrome overlap; however, individually each syndrome can have long devastating effects on rape victims.

The severity of sexual violence is not determined by the aggressor, but by a survivor’s reaction to the event. Symptoms the rape survivor experiences that are both mental (emotional) and physical. The rape survivor will experience symptoms of physically reliving the rape, fear of seeing the assailant, fear of another attack, sleep disturbances, nightmares, fear, suspiciousness, anxiety, major depression, and impairment in social functions.

Common stages of RTS: RTS identifies three stages of psychological trauma a rape survivor goes through: the acute stage, the outer adjustment stage, and the renormalization stage.

IMPACT STAGE

The impact stage is the initial stage most survivors experience. The survivor may appear dazed, in a state of un-reality and struggling to comprehend the rape. There is a wide range of symptoms that rape survivors express during this time: from calm and controlling to hysterical and crying. Often the survivor will make comments like, “I can’t believe this happened to me” or some other shock-type of statement which disclaims the actuality of the traumatic event. The victim is realizing that their lifestyle has been completely disrupted. The most common reactions of this stage are:

Shock: The person appears to be on automatic pilot and may act as like they normally do. If this response does not work, then crisis sets in.

Denial: The person may refuse or avoid talking about the incident, or even try not to think about it. The person wants to forget what happened. This is usually a short-lived response.

Rationalization: Involves a lot of talking and repeating the same things over and over, often may appear to be void of emotions. It is usually a verbal processing of thoughts. A person might ask a lot of, “What if…” and “Why didn’t I…” questions.

During these first few days, the survivor may be concerned with decisions regarding medical care, police involvement, physical security, etc. He/She will probably be concerned with how significant others will respond to the assault. The survivor may still feel a loss of control. Sometimes signs of depression will serve to mask other feelings.

ACUTE STAGE

The acute stage occurs in the days or weeks after a rape. Durations vary as to the amount of time a survivor may remain in the acute stage. The immediate symptoms may last a few days to a few weeks and may overlap with the outward adjustment stage.

According to Scarse there is no “typical” response amongst rape victims. However, the U.S. Rape Abuse and Incest National Network (RAINN) asserts that, in most cases, a rape survivor’s acute stage can be classified as one of three responses: expressed (“He or she may appear agitated or hysterical, [and] may suffer from crying spells or anxiety attacks”); controlled (“the survivor appears to be without emotion and acts as if ‘nothing happened’ and ‘everything is fine'”); or shock/disbelief (“the survivor reacts with a strong sense of disorientation. They may have difficulty concentrating, making decisions, or doing everyday tasks. They may also have poor recall of the assault”). Not all rape survivors show their emotions outwardly. Some may appear calm and unaffected by the assault.

Physical: Fatigue, soreness, pain, etc. Some are real and some are psychosomatic. Sleep pattern disturbances are common. The survivor usually has trouble sleeping or restless nights when they wake and cannot go back to sleep. Some will have nightmares and wake up screaming, etc. Eating pattern disturbances can include decreases appetite, nausea and vomiting or stomach pains. Symptoms specific to the attack could be the mouth and throat irritation caused by oral sex, vaginal discharge, bleeding, pain, swelling, etc., caused by anal sex.

Emotional: Primary symptoms include fear of death, injury, mutilation, etc. The survivor feels a combination of “thankful to be alive” and “fear of death” which is related to a loss of control. Shame, guilt, and anger are also symptoms that may be occurring.

Thoughts-Cognitive: Survivors will often try to suppress thoughts of the attack. Often when this approach is used the survivor suffers from flashbacks and nightmares. Most go through a rationalization process throughout the duration of syndrome- “What if..”, “If I had only…”, and “Why did this happen to me?”

Behaviors present in the acute stage can include:

  • Diminished alertness.
  • Numbness.
  • Dulled sensory, affective and memory functions.
  • Disorganized thought content.
  • Vomiting.
  • Nausea.
  • Paralyzing anxiety.
  • Pronounced internal tremor.
  • Obsession to wash or clean themselves.
  • Hysteria, confusion and crying.
  • Bewilderment.
  • Acute sensitivity to the reaction of other people.

The outward adjustment stage

Survivors in this stage seem to have resumed their normal lifestyle. However, they simultaneously suffer profound internal turmoil, which may manifest in a variety of ways as the survivor copes with the long-term trauma of a rape. In a 1976 paper, Burgess and Holmstrom note that all but 1 of their 92 subjects exhibited maladaptive coping mechanisms after a rape. The outward adjustment stage may last from several months to many years after a rape.

RAINN identifies five main coping strategies during the outward adjustment phase:

  • minimization (pretending ‘everything is fine’)
  • dramatization (cannot stop talking about the assault)
  • suppression (refuses to discuss the rape)
  • explanation (analyzes what happened)
  • flight (moves to a new home or city, alters appearance)

Other coping mechanisms that may appear during the outward adjustment phase include:

  • poor health in general.
  • continuing anxiety
  • sense of helplessness
  • hypervigilance
  • inability to maintain previously close relationships
  • experiencing a general response of nervousness known as the “startle response”
  • persistent fear and or depression at much higher rates than the general population.
  • mood swings from relatively happy to depression or anger
  • extreme anger and hostility (more typical of male or masculine victims than female or feminine victims)
  • sleep disturbances such as vivid dreams and recurring nightmares
  • insomnia, wakefulness, night terrors
  • flashbacks
  • dissociation (feeling like one is not attached to one’s body)
  • panic attacks
  • reliance on coping mechanisms, some of which may be beneficial (e.g., philosophy and family support), and others that may ultimately be counterproductive (e.g., self harm, drug, oralcohol abuse)

Lifestyle – Survivors in this stage can have their lifestyle affected in some of the following ways:

  • Their sense of personal security or safety is damaged.
  • They feel hesitant to enter new relationships.
  • Questioning their sexual identity or sexual orientation (more typical of men raped by other men).
  • Sexual relationships become disturbed. Many survivors have reported that they were unable to re-establish normal sexual relations and often shied away from sexual contact for some time after the rape. Some report inhibited sexual response and flashbacks to the rape during intercourse. Conversely, some rape survivors become hyper-sexual or promiscuous following sexual attacks, sometimes as a way to reassert a measure of control over their sexual relations.

Some rape survivors now see the world as a more threatening place to live after the rape so they will place restrictions on their lives so that normal activities will be interrupted. For example, they may discontinue previously active involvements in societies, groups or clubs, or a mother who was a survivor of rape may place restrictions on the freedom of her children.

Physiological responses

Whether or not they were injured during a sexual assault, rape survivors exhibit higher rates of poor health in the months and years after an assault, including acute somatoform disorders (physical symptoms with no identifiable cause). Physiological reactions such as tension headaches, fatigue, general feelings of soreness or localized pain in the chest, throat, arms or legs. Specific symptoms may occur that relate to the area of the body assaulted. Survivors of oral rape may have a variety of mouth and throat complaints, while survivors of vaginal or anal rape have physical reactions related to these areas.

Nature of the assault

  • The nature of the act, the relationship with the offender, the type and amount of force used, and the circumstances of the assault all influence the impact of an assault on the victim.
  • When the assault is committed by a stranger, fear seems to be the most difficult emotion to manage for many people.(Feelings of vulnerability arise).
  • More commonly, assaults are committed by someone the victim knows and trusts. May be heightened feelings of self-blame and guilt.

Underground stage

  • Victims attempt to return to their lives as if nothing happened.
  • May block thoughts of the assault from their minds and may not want to talk about the incident or any of the related issues. (They don’t want to think about it).
  • Victims may have difficulty in concentrating and some depression.
  • Dissociation and trying to get back to their lives before the assault.
  • The underground stage may last for years and the victim seems as though that they are “over it”, despite the fact the emotional issues are not resolved.

Reorganization stage

  • May return to emotional turmoil
  • It can be extremely frightening to people in this stage to once again find themselves in the same emotional pain.
  • Fears and phobias may develop. They may be related specificity to the assailant or the circumstances or the attack or they may be much more generalized.
  • Appetite disturbances such as nausea and vomiting. Rape survivors are also prone to developing anorexia nervosa and/or bulimia.
  • Nightmares, night terrors feel like they plague the victim.
  • Violent fantasies of revenge may also arise.

Phobias – A common psychological defense that is seen in rape survivors is the development of fears and phobias specific to the circumstances of the rape, for example:

  • A fear of being in crowds.
  • A fear of being left alone anywhere.
  • A fear of men.
  • A fear of breasts.
  • A fear of going out at all, agoraphobia.
  • A fear of being touched, hapnophobia.
  • Specific fears related to certain characteristics of the assailant, e.g. mustache, curly hair, the smell of alcohol or cigarettes, type of clothing or car.
  • Some survivors develop very suspicious, paranoid feelings about strangers.
  • Some feel a pervasive fear of most or all other people.

RENORMALIZATION STAGE

In this stage, the survivor begins to recognize their adjustment phase. Particularly important is recognizing the impact of the rape for survivors who were in denial, and recognizing the secondary damage of any counterproductive coping tactics (e.g., recognizing that one’s drug abuse began to help cope with the aftermath of a rape). Typical of male victims is a long interval between the sexual assault and the victim’s seeking psychotherapy—according to Lacey and Roberts, less than half of male victims sought therapy within six months and the average interval between assault and therapy was 2.5 years; King and Woollett’s study of over 100 male rape victims found that the mean interval between assault and therapy was 16.4 years.

During renormalization, the survivor integrates the sexual assault into their life so that the rape is no longer the central focus of their life. During this stage negative feelings such as guiltand shame become resolved and the survivor no longer blames themselves for the attack.

Typical statements of victims experiencing RTS

  • I’m going crazy.
  • I can’t remember what I wanted to do next.
  • I want to drink all the time, I just want to forget about it.
  • I can’t get to work on time or meet simple deadlines.
  • I’m having nightmares and flashbacks all the time.
  • I can’t eat or sleep.
  • All I want to do is eat.
  • I’ll never trust anyone again.
  • All I want to do is sleep.
  • Everything is just fine. Everyone is making such a big deal about this.

COMMON FEELINGS EXPERIENCED BY SURVIVORS

• The following are not the only emotions experienced by survivors. This is a list of a few of the most common.

NIGHTMARES: Nightmares are much more prevalent following the first few weeks following the assault or during times when the survivor is dealing with a lot of trauma. During the healing process, the survivor spends so many waking hours thinking about the assault that it can become overwhelming. These thoughts can even carry over into the survivors sleeping hours, becoming nightmares. When the survivor goes to bed, the brain is still working, trying to sort out the day’s thoughts. As a survivor sleeps, the thoughts continue. Those thoughts form into dreams. Before you know it, the survivor is dreaming about the assault.

ANGER: It is easy to see why the survivor is angry. His/Her power and control was taken away and the survivor is left to deal with the aftermath. In many cases, the survivor’s sense of security is stripped away, leaving the survivor feeling vulnerable. The survivor didn’t ask to have this done to them and now they are having work through all the issues surrounding the assault. The anger many be directed toward himself/herself, the rapist, therapist, family, friends, co-workers, etc.

SHOCK: A feeling of numbness might occur with the survivor. Many survivors state that they are on “automatic pilot”. This generally happens during the first few days following the assault.

DENIAL: Disbelief and denial by the survivor often occurs even when there is evidence to support the contrary: violence, forceful isolation, restraint, verbal threats, etc. Many survivors recall denying to themselves that they were being raped. Following the assault, some will make statements like, “That did not just happen to me.”

SELF-BLAME: Many survivors feel betrayed by their own judgment. This can especially be true in cases of acquaintance rape. In cases of acquaintance rape, men/women that the survivor knew, men/women to whom they have trusted, men/women who they will most likely continue to see around, have turned on them in a terrible way. The feelings of self-blame begin as the survivor recognizes his/her inability to make the acquaintance rapist stop. Immediately after the rape, self-blame causes many survivors to try and shut the episode out of their minds. Also, self-blame is one of the reasons why survivors do not report the assault to authorities, in fear that others will blame them just as they blame themselves.

NOT FIGHTING BACK: After being raped, many survivors are angry with themselves for not fighting back harder, even though, at the time of the rape, most report feeling afraid for their lives. In retrospect, they think of ways they could have fought off the attack, screamed for help, or escaped. They often replay the assault in their minds, trying to come up with a different ending.

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