Rape trauma syndrome

Rape trauma syndrome (RTS) is the psychological trauma experienced by a rape victim that includes disruptions to normal physical, emotional, cognitive, and interpersonal behavior. The theory was first described by psychiatrist Ann Wolbert Burgess and sociologist Lynda Lytle Holmstrom in 1974.[1]

RTS is a cluster of psychological and physical signs, symptoms and reactions common to most rape victims immediately following and for months or years after a rape.[2] While most research into RTS has focused on female victims, sexually abused males (whether by male or female perpetrators) also exhibit RTS symptoms.[3][4] RTS paved the way for consideration of complex post-traumatic stress disorder, which can more accurately describe the consequences of serious, protracted trauma than posttraumatic stress disorder alone.[5] The symptoms of RTS and Post-Traumatic Stress Syndrome overlap. As might be expected, a person who has been raped will generally experience high levels of distress immediately afterward. These feelings may subside over time for some people; however, individually each syndrome can have long devastating effects on rape victims and some victims will continue to experience some form of psychological distress for months or years. It has also been found that rape survivors are at high risk for developing substance use disorders, major depression, generalized anxiety disorder, obsessive-compulsive disorder, and eating disorders.[6]

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.

Acute stage

The acute stage occurs in the days or weeks after a rape. Durations vary as to the amount of time the victim 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[7] there is no "typical" response amongst rape victims. However, the U.S. Rape Abuse and Incest National Network[8] (RAINN) asserts that, in most cases, a rape victim'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.[2]

Behaviors present in the acute stage can include:

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[10] 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[8] identifies five main coping strategies during the outward adjustment phase:

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

Lifestyle

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

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 parent who was a survivor of rape may place restrictions on the freedom of their 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,[4] including acute somatoform disorders (physical symptoms with no identifiable cause).[1] 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

Underground stage

Reorganization stage

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:

The renormalization stage

In this stage, the survivor begins to recognize his or her adjustment phase. 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) is particularly important. Male victims typically do not seek psychotherapy for a long time after the sexual assault—according to Lacey and Roberts,[19] 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[20] study of over 100 male rape victims found that the mean interval between assault and therapy was 16.4 years.

During renormalization, survivors integrate the sexual assault into their lives so that the rape is no longer the central focus of their lives; negative feelings such as guilt and shame become resolved, and survivors no longer blame themselves for the attack.

Legal issues

Prosecutors sometimes use RTS evidence to disabuse jurors of prejudicial misconceptions arising from a victim's ostensibly unusual post-rape behavior. The RTS testimony helps educate the jury about the psychological consequences surrounding rape and functions to dispel rape myths by explaining counterintuitive post-rape behavior.

Especially in cases in which prosecutors have introduced RTS testimony, defendants have also sometimes proffered RTS evidence, a practice that has been criticized as undermining core values embodied in rape shield laws, since it can involve subjecting victims to compelled psychological evaluations and searching cross-examination regarding past sexual history. Since social scientists have difficulty distinguishing symptoms attributable to rape-related PTSD from those induced by previous traumatic events, rape defendants sometimes argue that an alternative traumatic event, such as a previous rape, could be the source of the victim's symptoms.[21]

Criticism

A criticism of rape trauma syndrome as currently conceptualized is that it delegitimizes a person's reaction to rape by describing their coping mechanisms, including their rational attempts to struggle through, survive the pain of sexual assault, and to adapt to a violent world, as symptoms of disorder. People who installed locks and purchased security devices, took self-defense classes, carried mace, changed residence, and expressed anger at the criminal justice system, for example, were characterized as exhibiting pathological symptoms and "adjustment difficulties". According to this criticism, RTS removes a person's pain and anger from their social and political context, attributing a person's anguish, humiliation, anger, and despair after being raped to a disorder caused by the actions of the rapist, rather than to, say, insensitive treatment by the police, examining physicians, and the judicial system; or to family reactions permeated with rape mythology.

Another criticism is that the literature on RTS constructs rape survivors as passive, disordered victims, even though much of the behavior that serves as the basis for RTS could be considered the product of strength. Words like "fear" are replaced with words like "phobia," with its connotations of irrationality.[22]

Criticisms of the scientific validity of the RTS construct are that it is vague in important details; it is unclear what its boundary conditions are; it uses unclear terms that do not have a basis in psychological science; it fails to specify key quantitative relationships; it has not undergone subsequent scientific evaluation since the 1974 Burgess and Holstrom study; there are theoeretical allegiance effects; it has not achieved a consensus in the field; it is not falsifiable; it ignores possible mediators; it is not culturally sensitive; and it is not suitable for being used to infer that rape has or has not occurred. PTSD has been described as a superior model since unlike RTS, empirical examination of the PTSD model has been extensive, both conceptually and empirically.[23]

See also

References

  1. 1 2 Burgess, Ann Wolbert and Lynda Lytle Holmström (1974). "Rape Trauma Syndrome". Am J Psychiatry 131 (9): 981–986. doi:10.1176/appi.ajp.131.9.981. PMID 4415470.
  2. 1 2 Jonathan Sandoval (2002). Handbook of crisis counseling, intervention, and prevention in the schools. Psychology Press. pp. 1–. ISBN 978-0-8058-3615-8. Retrieved 1 October 2011.
  3. ↑ Philip M. Sarrel1 and William H. Masters (1982). "Sexual molestation of men by women". Archives of Sexual Behavior 11 (2): 117–31. doi:10.1007/BF01541979. PMID 7125884.
  4. 1 2 3 Tewksbury, Richard (2007). "Effects of Sexual Assaults on Men: Physical, Mental and Sexual Consequences". International Journal of Men's Health 6 (1): 22–35. doi:10.3149/jmh.0601.22.
  5. ↑ Bessel A. van der Kolk, Susan Roth, David Pelcovitz, Susanne Sunday, and Joseph Spinazzola (2005). "Disorders of Extreme Stress: The Empirical Foundation of a Complex Adaptation to Trauma" (PDF). Journal of Traumatic Stress 18 (5): 389–399. doi:10.1002/jts.20047. PMID 16281237.
  6. ↑ Brown, A.L.; Testa, M.; Messman-Moore, T.L. (2009). "Psychological consequences of sexual victimization resulting from force, incapacitation, or verbal coercion.". Violence Against Women 15 (8): 898–919. doi:10.1177/1077801209335491. PMID 19502576.
  7. ↑ Scarce, M. (1997). Male on male rape: The toll of stigma and Shame. New York: Insight Books.
  8. 1 2 Rape Trauma Syndrome. rainn.org
  9. ↑ Desirée Hansson What is Rape Trauma Syndrome?. Occasional Papers Series 1992. Institute of Criminology. University of Cape Town
  10. ↑ Burgess, AW; Holmstrom, LL (1976). "Coping behavior of the rape victim". Am J Psychiatry 133 (4): 413–8. doi:10.1176/ajp.133.4.413. PMID 1267040.
  11. ↑ King, M., Coxell, A. and Mezey, G. (2002). "Sexual molestation of males: Associations with psychological disturbance". British Journal of Psychiatry 181: 153–157. doi:10.1192/bjp.181.2.153. PMID 12151287.
  12. ↑ Groth, N., & Burgess, A. W. (1980). Male rape: Offenders and victims (1980). "Male rape: Offenders and victims". American Journal of Psychiatry 137 (7): 806–810. doi:10.1176/ajp.137.7.806. PMID 7386658.
  13. ↑ Choquet, M., Darves-Bornoz, J. M., Ledoux, S., Manfredi, R. and Hassler, C. (1997). "Selfreported health and behavioral problems among adolescent victims of rape in France: Results of a cross-sectional survey". Child Abuse and Neglect 21 (9): 823–832. doi:10.1016/S0145-2134(97)00044-6. PMID 9298260.
  14. ↑ Burnam, M. A.; et al. (1988). "Sexual assault and mental disorders in a community population. Journal of Consulting and Clinical Psychology" 56: 843–850.
  15. ↑ Choquet, M., Darves-Bornoz, J. M., Ledoux, S., Manfredi, R. and Hassler, C. (1997). "Self-reported health and behavioral problems among adolescent victims of rape in France: Results of a cross-sectional survey". Child Abuse and Neglect 21 (9): 823–832. doi:10.1016/S0145-2134(97)00044-6. PMID 9298260.
  16. ↑ Garnets, L. and Herek, G. (1990). "Violence and victimization of lesbians and gay men: Mental health consequences". Journal of Interpersonal Violence 5 (3): 366–383. doi:10.1177/088626090005003010.
  17. ↑ Struckman-Johnson, C. and Struckman-Johnson, D. (1994). "Men pressured and forced into sexual experience". Archives of Sexual Behavior 23 (1): 93–114. doi:10.1007/BF01541620. PMID 8135654.
  18. ↑ deVisser, R. O., Smith, A. M., Rissel, C. E., Richters, J. and Grulich, A. E. (2003). "Sex in Australia: Experiences of sexual coercion among a representative sample of adults". Australian and New Zealand Journal of Public Health 27 (2): 198–203. doi:10.1111/j.1467-842X.2003.tb00808.x. PMID 14696711.
  19. ↑ Lacey, H. G. and Roberts, R. (1991). "Sexual assault on men". International Journal of STD and AIDS 2 (4): 258–260. PMID 1911957.
  20. ↑ King, M. and Woollett, E. (1997). "Sexually assaulted males: 115 men consulting a counseling service". Archives of Sexual Behavior 26 (6): 579–588. doi:10.1023/A:1024520225196. PMID 9415795.
  21. ↑ Davis, Kathryn M. (1997–1998). "Rape, Resurrection, and the Quest for Truth: The Law and Science of Rape Trauma Syndrome in Constitutional Balance with the Rights of the Accused". Hastings L.J. 49: 1512.
  22. ↑ Stefan, Susan (1993–1994). "Protection Racket: Rape Trauma Syndrome, Psychiatric Labeling, and Law". Nw. U. L. Rev. 88: 1275.
  23. ↑ O'Donohuea, William; Carlsona, Gwendolyn C.; Benutoa, Lorraine T. and Bennetta, Natalie M. (10 July 2004). "Examining the Scientific Validity of Rape Trauma Syndrome". Psychiatry, Psychology and Law 21 (6): 858–876. doi:10.1080/13218719.2014.918067.

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