| Dealing
with the after effects of rape is a nightmare. The physical
hurts can often soon be mended, but it's the inner pain
that people can't see that takes longest. It's also the
hardest to deal with because it's not like healing after
surgery, there is no set time limit. The emotional scars
can stay with us a lifetime.
What is PTSD?
PTSD is a reaction to being exposed to an event which
is outside the range of normal human experience. Sometimes
it is referred to as post traumatic rape syndrome too.
It is a normal human emotional reaction to an
abnormal situation. Everyone reacts differently
to different situations and it doesn't have to be a life
threatening experience for someone to respond in this
way. It just has to be perceived by the victim as a traumatic
event. It is a psychological phenomenon. It is an emotional
condition, from which it is possible to make a full and
complete recovery.
PTSD affects hundreds of thousands of people who have
been exposed to violent events such as rape, domestic
violence, child abuse, war, accidents, natural disasters
and political torture. It is normal to be affected by
trauma. There is help, and it is ok to ask for help. PTSD
is not rare. It is not unusual. It is not weak to have
PTSD.
Traumatic experiences bring to the fore survival skills
which are valuable and useful at the time of the trauma,
but which usually become less valuable, less useful and
less effective with time. Sometimes survivors become stuck
in problem behaviors when their pain is not acknowledged,
heard, respected, or understood. Denial plays a great
part here (it didn't happen, or it shouldn't affect you).
Put-downs, dismissal of the pain, mis-diagnosis and other
forms of secondary wounding keep survivors stuck.
Symptoms may come on soon after the trauma or fifty
years later. That is what is meant by the post in PTSD.
It is normal too for symptoms to come up again when faced
by further trauma and in very stressful times. It is normal
to be affected by trauma.
Society has it's own way of dealing with trauma which
can both be belittling or denying. For a survivor to be
told that what happened to them wasn't that bad, or was
no big deal or continually being told it was time that
they were over it, or just try and forget it ever happened
cause secondary wounding in trauma survivors. It reinforces
the mistrust of everyone and everything that trauma evokes
in all survivors who no longer can believe that the universe
is fair or just.
This ability to do whatever it takes to survive is instinctive.
We all have it, and in traumatic enough situations, it
will come out or we die. Extreme situations which trigger
this reaction again and again may cause survivors to do
things in order to survive which can be hard to look back
on later.
Similarly shutting down feelings in order to do whatever
it takes to survive, or do your job and help others survive,
is a reality based survival skill. Numbness is the answer.
It is effective. It will help you live.
Unfortunately when survivors numb their fear, despair
and anger, all their feelings, even good ones, are numbed.
Numbness is comfortable. Thinking about what they have
been through is so painful survivors wind up avoiding
thinking about, feeling, or doing anything that reminds
them of the trauma. For example, if they feel the trauma
was their fault they may spend the rest of their life
having to be right so they won't ever be at fault again.
If they were happy when the trauma hit, they may avoid
happiness forever.
Criteria for diagnosis of PTSD
- These are simple guidelines that may help you to
work out if you are suffering from post traumatic stress
disorder. I will go into more detail later.
- The survivor must have experienced or confronted with
an event that involved actual or threatened injury,
or a threat to their physical integrity. i.e. rape.
- The survivor must show symptoms of intense fear,
helplessness or horror.
- The survivor must experience distressing recollections
of the event. i.e. flashbacks.
- The survivor persistently avoids things that remind
them of the event. i.e. triggers.
- The survivor must be show significant distress or
impairment by the event, either in their social occupational
or other important areas of functioning.
- Persistent symptoms of increased arousal (not present
before the trauma) as indicated by at least two of the
following: difficulty falling or staying asleep; irritability
or outbursts of anger; difficulty concentrating; hyper
vigilance; exaggerated startle response.
- Symptoms must last at least one month.
Symptoms often present in Rape
Trauma
- Intense fear, helplessness, or horror.
- Repeated and distressing recollections of the event,
including images, thoughts, or perceptions. Unable to
distinguish between past events and reality. Such incidents
are often called "flashbacks".
- Distressing and or frightening dreams about the event.
- Associating various words, happenings, or "triggers"
to the actual event which then causes a "flashback".
- Avoidance of anything that may "trigger"
a flashback including not talking about the attack itself.
- Pretending it never happened and an inability to
recall anything about the attack, "denial".
- A feeling of numbness, detachment or "unrealness"
about everything.
- A lack of emotion or inability to feel love or care
about anything.
- A feeling of depression and isolation.
- A change in sleep patterns. More often or not the
ability to sleep or stay asleep for any length of time.
- A lack of concentration.
- Avoidance of being touched, and shying away from loved
ones. Sudden movements may startle.
- A lack of trust in anyone, even close family or partners.
- More irritable than usual. Outbursts of anger and
crying. Mood swings.
- A feeling of low self esteem and confidence.
- A feeling of being dirty, or disgusting.
- Deep embarrassment or shame. Sometimes self blame
for events.
- Bitterness and morbid hatred of the perpetrator,
with a preoccupation of how to harm or humiliate them.
- Loss of appetite or a change in eating patterns.
Intrusive Symptoms: Flashbacks
Intrusive symptoms can be described as those where the
traumatic event "intrudes" into everyday life,
and is re-experienced. These symptoms are often referred
to as Flashbacks. The event is so real and so vivid it
feels like the person is actually experiencing the trauma
all over again. It is happening right in front of their
eyes, and they can't tell what is reality and what is
memory.
These flashbacks can range in severity from mild and
brief to long and strong. They can involve both sensory
perceptions and motor re-enactment too. During a flashback
you may experience vivid images, strong smells, or noises.
Some may even involve actually acting out a traumatic
experience. Many times trauma survivors don't recognize
that they are having a flashback nor remember afterwards
what happened. It is not unusual for someone to faint
or dissociate during a flashback and be unable to recall
any part of the experience, even when a witness describes
their behavior to them.
Sometimes after a flashback trauma survivors are aware
of what triggered especially if someone else observes
the behavior and recounts it to them, or if it is a recurring
situation.
Sometimes these flashbacks occur as nightmares or bad
dreams too. There is some evidence to suggest that traumatic
nightmares occur in the earlier, lighter stage of sleep
than other dreams, and are more easily recalled upon waking.
Traumatic dreams may however contain accurate and inaccurate,
literal and symbolic, information and should always be
interpreted with caution.
Sometimes there is no actual reliving of the trauma
itself, but instead survivors experience a sudden painful
emotional breakdown. These can involve crying, anger or
fear for no apparent reason, and can occur repeatedly
like flashbacks. Sometimes a flashback can involve just
having feelings that are far more intense than a situation
calls for but would have been appropriate in the original
traumatic situation.
The important thing to remember about flashback experiences,
especially those related to abuse and rape survivors,
is that they can make you feel as afraid, as helpless,
and as out of control as you were during the actual trauma,
even if you don't consciously remember it. Others have
the experience of losing their sense of where the flashback
stops and reality begins.
Avoidance Symptoms: triggers
Symptoms of avoidance can be described as an emotional
numbness or coldness towards people who are close to us.
Survivors shut people out, or push them away. This in
turn affects their relationships with those who are often
the ones who are trying hardest to help. When survivors
are coping with flashbacks it takes a lot of energy to
try and suppress the flood of emotions that threaten to
overwhelm them. They find that they have no real emotion
left for anyone else, and often feel emotionless or numb
towards everyone else. Inability to recall important aspects
of the trauma is another of the ways avoidance and numbing
may work. This means the person cannot remember exactly
what happened. Many trauma survivors forget in order to
survive.
Survivors may also have learned to dissociate, to literally
not be there, to survive. They automatically "switch
off" during a stressful situation because it is too
painful to deal with.
Numbness makes it hard for survivors to take care of
themselves. Feelings are there to tell us how to do that.
If you can't tell what you feel, you can't choose healthy
behaviors for yourself.
Another symptom is avoidance of situations or activities
that may trigger reminders of the traumatic event. These
are commonly referred to as "triggers" Other
symptoms may worsen when a situation or activity occurs
that reminds them of the original trauma. Often the survivor
is unable to identity a trigger without help from someone
who knows about their traumatic experience.
Triggers can be people, places, sounds, images, feelings,
smells, tastes, films, animals, the tone of someone's
voice, body positions or sensations, weather conditions,
time factors, or any combination of things that even remotely
resemble traumatic experiences. They can be as subtle,
complex and obscure as clues in a good detective novel.
Survivors can become so scared of particular situations
that their daily lives are ruled by their attempts to
avoid them. PTSD sufferers' inability to work out grief
and anger during the traumatic event means that the trauma
will continue to control their behavior without their
being aware of it. Depression is a common product of this
inability to resolve painful feelings.
Hyperarousal Symptoms
The survivor part of us is not able to listen to "reason".
It is going to be constantly looking for danger from now
on whether or not others think it is reasonable. Real
physiological changes occur in the brains of survivors
which make them quick to react. In order to live through
the trauma, survivors may develop the capacity to go from
being completely fine into a killing rage in seconds.
That defensive mechanism helps them live.
Some survivors may stop sleeping soundly. Sleep can
get you killed, so they won't take the risk. Survivors
may be uncannily able to read the moods of those around
them because the moods of their abusers defined their
lives. Sometimes they also become hyper vigilant, searching
for physical danger everywhere they are and all of the
time.
Due to hyper vigilance and lack of sleep, it is hard
for survivors to concentrate on everyday things. They
may do poorly in school and in their everyday lives that
leads them to believe they are stupid or inept when actually
they have a symptom of PTSD.
Survivors often react faster and more completely to
sudden noises or movements. These are lifesaving skills
that the survivor feels they need while they are still
at risk. These are reality based, effective survival skills.
They keep you alive. They don't go away by themselves.
Recovery
Recovery is a slow process which doesn't come easily
or without pain. The survivor must be heard, feel they
are understood, believed and find the ability to reconnect
to a community. Recovery takes time. The survivor sets
the pace. Recovery is not a race, and can't be given a
set time limit. Recovery doesn't erase the trauma as if
it had never happened, it just makes it easier to deal
with.
Further trauma will always affect survivors. PTSD symptoms
may come back during times of further stress, but the
negative effects can be minimized as the survivor learns
what they are and feels able to take care of themselves..
True healing is knowing it is okay to ask for help again.
Recovery is about learning better ways of coping with
trauma and letting go of fear, even fear of change. Slow
growth is good growth.
You can't rush survivors and we must not dismiss their
pain. Instead of comparing pain, survivors and survivor
groups are encouraged to respect each other's pain and
to focus on what they have in common and to share recovery.
Each person's unique experience and pain is respected.
PTSD symptoms, numbing, hyper vigilance and flashbacks,
are strong hints that you need to get help! They helped
you survive, but they do not go away by themselves. People
have to alter their lives to control them. They can become
both ineffective and a source of constant pain.
It takes time to get better. Getting better is the reward
for taking the time to recover. Getting better, however,
is a slow process. The state of almost constant physiological
arousal which many trauma survivors live in makes it difficult
for them to take in the kind of information needed to
heal. This is part of the brain chemistry of survivors.
It is not resistance or stubbornness on their part. People
can talk about changing but all survivors may see is their
lips moving. The words and concepts make no sense. They
are incapable of taking what is being said on board because
they are too busy taking in information for their survival.
Things like who is in the room, where are they sitting,
where is the door, which is the quickest way out, do they
look hostile or friendly, how are they reacting to me?
Until they start to feel safe a survivor won't be able
to react to anything or anyone. They have to feel safe
and feel as though there is an element of trust there.
When they have been treated with respect, not discounted,
not pushed to hurry up and recover, which are secondary
wounding experiences and make PTSD worse, they will feel
safe and know it because they will be able to hear and
understand what the therapist or group is saying in a
new way.
When they can hear, survivors can begin to work on safety
issues. They can begin to understand and protect themselves
from triggers. They can learn to handle emotions such
as anger and fear. Survivors can develop the capacity
to respond rather than react, like having a pause button
instead of an on-off switch.
Searching for the right help is important. You need to
be comfortable enough with the therapist or group. On
the other hand searching for the perfect group or a therapist
who will never make a mistake can put off recovery for
life. The therapist or group is not going to fix you.
They will however provide you with information and a variety
of coping skills, but it is you who does the work and
heals.
There are many forms of therapy available to survivors.
Two of the most common used are cognitive/behavior therapy
and psychodynamic psychotherapy. Cognative/behaviour therapy
involves focusing on ways of correcting the survivor’s
painful and often intrusive patterns of behavior and thoughts.
This is achieved through teaching them relaxation techniques
and examining their mental process. This can involve exposing
the survivor to certain triggers in a controlled environment
until they are "desensitized" to the trigger
and is no longer afraid of the situation.
Psychodynamic psychotherapy tends to focus on helping
the survivor to look closely at the way behavior and experience
during their traumatic experience violated them. Often
the way a survivor differentiated between their individual
personal values and the reality of what they experienced
during the traumatic event can result in PTSD. This therapy
aims to resolve the conscious and unconscious conflicts
that evolved from the trauma. They also work on building
self confidence and esteem, self control and an all round
renewed pride in themselves and their abilities.
Each person heals in their own way, there are no hard
and fast rules, just as there is no pill that can cure
PTSD. Yes drugs can be used to help with the side effects
of PTSD, like helping sleeplessness or hyper arousal.
Unfortunately there is no simple clear cut solution for
such a complex phenomenon. I firmly believe that survivors
have to confront what has happened to them, and by repeating
this confrontation, learn to accept the trauma as part
of their past. There is no magic wand. However counseling
and therapy can help to find an easier path through the
trauma and set you on the path to healing.
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