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What is Rape Trauma Syndrome?

By:Desirée Hansson (in collaboration with the Lawyers for Human Rights)uct.ac.za


INTRODUCTION

Many people experience physical, psychological and behavioural problems after suffering a serious trauma like losing someone they love or being disabled in a car accident. These problems have been called Post Traumatic Stress Disorder. This condition is a normal reaction to abnormal stress. People who have not previously had a mental illness or psychological problems can suffer Post Traumatic Stress Disorder.

Different kinds of traumas can produce different reactions. Take rape for example: Rape is not just unwanted sex, it is a highly traumatic experience and like other serious traumas, it has negative effects on those who survive it. Rape is usually experienced as life threatening and as an extreme violation of a person. It is not surprising then, that many rape survivors suffer from a particular kind of Post Traumatic Stress Disorder, known as Rape Trauma Syndrome:

PHYSICAL SYMPTOMS OF RAPE TRAUMA SYNDROME
Immediately after a rape, survivors often experience shock: they are likely to feel cold, faint, become mentally confused (disoriented), tremble, feel nauseous and sometimes vomit.
 
•   Pregnancy.
•   Gynaecological problems like: irregular, heavier and/or painful periods, vaginal discharges, bladder infections, sexually transmitted diseases like syphilis, gonorrhoea and/or AIDS.
•   Bleeding and/or infections from tears or cuts in the vagina or rectum, depending on what happened during the rape.
•   A soreness of the body. There may also be bruising, grazes, cuts etc, depending on the kind of force used during a rape.
•   Nausea and/or vomiting.
•   Throat irritations and/or soreness due to forced oral sex.
•   Tension headaches.
•   Pain in the lower back and/or in the stomach.

Sleep disturbances like: difficulty falling asleep, waking up during the night, being woken by nightmares about the rape, getting less sleep than usual; or on the other hand feeling exhausted and needing to sleep more than usual.

Eating disturbances such as: not feeling like eating, eating less than usual and so losing weight; or on the other hand eating more than usual and so putting on weight.

BEHAVIOURAL SYMPTOMS OF RAPE TRAUMA SYNDROME
•   Crying more than usual.
•   Difficulty concentrating.
•   Being restless, agitated and unable to relax; or on the other hand just sitting around and moving very little.
•   Not wanting to go out and/or socialise; or on the other hand socialising more than usual.
•   Not wanting to be left alone.
•   Stuttering or stammering more than usual.
•   Trying to avoid anything that reminds the survivor of the rape. So for example, someone who was raped at a party may stop going to parties. Many rape survivors don't want to talk about what happened, because it makes them remember the rape.
•   Being more easily frightened or startled than usual. Rape survivors often get very scared when someone walks up behind them without warning.
•   Being very alert and watchful.
•   Getting very upset by minor things that didn't worry them before the rape.
•   Losing interest in things that used to be of interest to them before the rape.
•   Problems in relationships with people like family, friends, lovers and spouses. Rape survivors may become irritable and so may quarrel with others more easily; or they may withdraw from people with whom they had been close before the rape. They may also become very dependent on others, or on the other hand overly independent.
•   Sexual problems like a fear of sex, a loss of interest in sex or a loss of sexual pleasure.
•   Changes in work or school such as: dropping out of school, truanting from school, changing jobs, or stopping work altogether.
•   Moving house.
•   Increased use of substances like alcohol, cigarettes and/or drugs. A person who didn't use a substance before the rape may start to use it after a rape.
•   Increased washing and/or bathing, because of a feeling of being dirty from the rape.
•   Acting as if the rape never happened. It is quite common for rape survivors to try and carry on with their lives as if nothing has happened, because they don't want to face their feelings about the rape. This is called denial.


PSYCHOLOGICAL SYMPTOMS OF RAPE TRAUMA SYNDROME
•   Intrusive thoughts about the rape that upset the rape survivor.
Intrusive thoughts and feelings about being dirty from (contaminated by) the rape. These feelings often make rape survivors wash or bath more frequently. These thoughts are known as obsessional thoughts.

•   Flashbacks - the sudden feeling that the rape is happening again, which makes the survivor very frightened and upset.
•   Nightmares about the rape.
•   Being very upset by anything that reminds the survivor of the rape.

Becoming extremely afraid of certain things that remind the survivor of the rape. Such extreme fears are called phobias. Rape survivors often develop extreme fears of men, of strangers, of being alone, of leaving their homes, of going to school or to work, and of sex. These phobias are called traumatophobias, because they are caused by a trauma.

•   A loss of memory for all or part of the rape, which is called psychogenic amnesia.
Being unable to feel certain feelings like happiness, or feeling very 'flat'. On the other hand, rape survivors can feel emotionally confused and have mood swings (quick changes of mood).

•   Feeling that they will not live for very long and/or feeling very negative about their future prospects.
•   Feeling depressed and/or sad, and sometimes having thoughts of suicide.
•   Feeling irritable and angry.
•   Feeling more fearful and anxious than usual. Rape survivors are often very afraid that their assailant/s will return, that they may be pregnant or have been infected with a disease from the rape.
•   Feelings of humiliation and shame.
•   Feeling different and/or distant from other people.
•   Feelings of guilt and self-blame about the rape. Rape survivors often feel that they were somehow responsible for being raped.
•   Feelings of helplessness and powerlessness.
•   A loss of self respect and self confidence. Many rape survivors feel that the rape has made them worth less than other people.

Human beings respond to trauma in different ways. Although many rape survivors suffer from the symptoms of Rape Trauma Syndrome, not all survivors respond to rape in the same way - some rape survivors may have none of these symptoms and others may suffer only a few. Therefore, if a person experiences many of the symptoms of Rape Trauma Syndrome, it is highly likely that s/he has been raped; but if a person claims to have been raped, yet experiences none of these symptoms, or only a few, it is not a sign that s/he has not actually been raped. Because most rape survivors are afraid to tell anyone that they have been raped, any person who claims to have been raped, should be treated as if they have been raped.

It is important to treat each rape survivor as an individual and to try and understand what the rape means to that particular person. A person's religion, culture, class, race and gender may affect how they feel about being raped. The impact of a rape may be worse if the victim is physically or mentally handicapped, if they were raped by more than one person, or on more than one occasion; and/or if they were raped by someone they knew. Coping with being rape may also be more difficult if family, friends and colleagues are not supportive and/or blame the survivor.

Rape survivors seem to experience different symptoms of Rape Trauma Syndrome over time. In the first couple of days immediately after a rape, a survivor usually experiences a state of shock. After this shock has passed, some survivors try to act as if nothing has happened. This is their way of trying to block out the rape, because they feel that they won't be able to cope if they let themselves remember what happened to them. So, they may look as if they have not been affected by the rape. This has been called the stage of denial or pseudo-adjustment.

However, if a rape survivor is going to recover well from the impact of a rape, s/he must let her/himself remember the rape and feel whatever s/he is feeling inside. When s/he does start remembering and feeling, s/he will also start suffering from symptoms, but these usually improve gradually over time. It often helps a survivor to have counselling if s/he is experiencing symptoms that upset her/him.

The effects of rape are long term. Rape survivors never forget being raped, but many learn how to deal with the memory. Studies have shown that the symptoms suffered by a rape survivor three months after a rape usually continue over the next three to four years, although they do seem to improve over time. Rape survivors who have strong self-esteem before being raped, those who have good relationships with people and those who have few major changes in their fives in the year, before a rape; seem to recover more quickly from the effects of rape.

Rape Trauma Syndrome has been introduced in court cases overseas in a number of ways: to corroborate a victim's claim that s/he did not consent to having sex; to explain a rape survivor's poor memory about a rape; and to help the court decide on a sentence for a rapist. The negative effects of rape are not yet widely known or recognised in South Africa. Many of our courts are still operating under the false impression that rape is merely unwanted sex and therefore, that it does not damage rape survivors especially in the long term. Rape Trauma Syndrome is only now being introduced as evidence in South African courts.


Rape trauma syndrome
Rape Trauma Syndrome is a form of post traumatic stress disorder experienced by a rape victim. The term is used to characterize a group of signs, symptoms and reactions of a rape victim.

Research has shown that rape victims suffer a significant degree of psychological trauma during, immediately following, and for a considerable time after they have been raped. This theory was first described by psychiatrist Ann Wolbert Burgess and sociologist Lynda Lytle Holmstrom in 1974.

The Rape Trauma Syndrome describes three psychological stages a rape victim goes through: the acute stage, the outer adjustment stage, and the renormalization stage.

Acute Stage
Victims vary as to the amount of time they 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. Behaviors which may be present in the acute stage are:
Diminished alertness.
Numbness.
Dulled sensory, affective and memory functions.
Disorganized thought content.
Vomiting.
Nausea.
Paralyzing anxiety.
Pronounced internal tremor.
Obsession to wash.
Hysteria, confusion and crying.
Bewilderment.
Acute sensitivity to the reaction of other people.
Not all survivors show their emotions outwardly. Some may appear calm and unaffected by the assault

The Outward Adjustment Stage
Victims in this stage seem to have resumed their normal lifestyle but there is internal turmoil which may manifest itself in any of the following behaviors:

Continuing anxiety.
Sense of helplessness.
Persistent fear and or depression.
Mood swings from relatively happy to depression or anger.
Sleep disturbances such as vivid dreams, recurrent nightmares.
insomnia, wakefulness, night terrors.
flashbacks.
dissociation (feeling like one is not attached to one's body).
panic attacks.
Reliance on coping mechanisms e.g. self harm, substances, religion, family.

Lifestyle
Victims 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.
Sexual relationships become disturbed. Many victims 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 women become hyper-sexual following sexual attacks, sometimes as a gesture that they have power and choice over their sexual relations
Some 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 unreasonable restrictions on the freedom of her children.

During this stage the victim may develop dependency on alcohol, cigarettes or drugs, both prescribed and illegal.


Physiological Responses
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 which relate to the area of the body which has been assaulted. Survivors of oral rape may have a variety of mouth and throat complaints, while survivors of vaginal or anal rape have different physical reactions.

Eating disorders
Appetite disturbances such as nausea and vomiting. Rape survivors are also prone to developing anorexia and/or bulimia.

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 going out at all, agoraphobia.
Specific fears related to the characteristics of the assailant, such as 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 global fear of everyone.

The Renormalization Stage
In this stage, the victim integrates the event into their life so that the rape is no longer the central focus of their life. During this stage negative feelings such as guilt and shame become resolved and the victim no longer blames themselves for the attack.

Further reading
Burgess, Holstrom (1978). Rape Trauma Syndrome. Boston, Mass: American Psychiatric Association. 

See also
Talking about rape [77KB PDF]
New guidelines on rape inquiries
A new approach to distress
Rape victims told alcohol consumption may cost them compensation
Men believe they can get away with rape, claims Cameron
Rape, myth and the law
Feminist fantasy
Anxiety

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