No person exposed to severe trauma is immune to suffering and the signs of that suffering are referred to as symptoms. When these symptoms can be grouped as a pattern over time, they are referred to as a syndrome. Once the pattern becomes entrenched or unlikely to change, and affect a person’s functioning in a permanent way it is referred to as a disorder and is regarded as a mental illness.
Rape Trauma Syndrome (RTS) is the medical term given to the response that survivors have to rape. It is very important to note that RTS is the natural response of a psychologically healthy person to the trauma of rape so these symptoms do not constitute a mental disorder or illness.
The most powerful factor in determining psychological suffering or damage is the character of the traumatic event itself. Individual personality characteristics count for little in the face of overwhelming events. Physical harm or injuries are also not as great a factor since individuals with little or no physical harm may yet be severely affected by their exposure to a traumatic situation. Before looking at the effects of rape it is therefore important to first examine the character of the trauma that is rape.
Not only is there the element of surprise, the threat of death and the threat of injury, there is also the violation of the person that is synonymous with rape. This violation is physical, emotional and moral and associated with the closest human intimacy of sexual contact. The intention of the rapist is to profane this most private aspect of the person and render his victim utterly helpless. The character of the event is thus connected to the perpetrator’s apparent need to terrorise, dominate and humiliate the victim. The victim is therefore most likely to see his actions as motivated by deliberate malice, a malice impossible for her to understand. Rape by its very nature is intentionally designed to produce psychological trauma. It is form of organised social violence comparable only to the combat of war, being but the private expression of the same force. We get nowhere in our understanding of Rape Trauma Syndrome if we think of rape as simply being unwanted sex. Where combat veterans suffer Post Traumatic Stress Disorder, rape survivors experience similar symptoms on a physical, behavioural and psychological level.
PHYSICAL SYMPTOMS OF RAPE TRAUMA SYNDROME
Physical symptoms are those things which manifest in or upon the survivor’s body that are evident to her and under physical examination by a nurse or doctor. Some of these are only present immediately after the rape while others only appear at a later stage.
- Immediately after a rape, survivors often experience shock. They are likely to feel cold, faint, become mentally confused (disorientated), tremble, feel nauseous and sometimes vomit.
- Gynaecological problems. Irregular, heavier and/or painful periods. Vaginal discharges, bladder infections. Sexually transmitted diseases.
- Bleeding and/or infections from tears or cuts in the vagina or rectum.
- A soreness of the body. There may also be bruising, grazes, cuts or other injuries.
- 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. This may be difficulty in sleeping or feeling exhausted and needing to sleep more than usual.
- Eating disturbances. This may be not eating or eating less or needing to eat more than usual.
BEHAVIOURAL SYMPTOMS OF RAPE TRAUMA SYNDROME
Behavioural symptoms are those things the survivor does, expresses or feels that are generally visible to others. This includes observable reactions, patterns of behaviour, lifestyle changes and changes in relationships.
- Crying more than usual.
- Difficulty concentrating.
- Being restless, agitated and unable to relax or feeling listless and unmotivated.
- Not wanting to socialise or see anybody or socialising more than usual, so as to fill up every minute of the day.
- Not wanting to be alone.
- Stuttering or stammering.
- Avoiding anything that reminds the survivor of the rape.
- Being more easily frightened or startled than usual.
- Being very alert and watchful.
- Becoming easily upset by small things.
- Relationship problems, with family, friends, lovers and spouses. Irritability, withdrawal and dependence are factors which effect this.
- Fear of sex, loss of interest in sex or loss of sexual pleasure.
- Changes in lifestyle such as moving house, changing jobs, not functioning at work or at school or changes to her appearance.
- Drop in school, occupational or work performance.
- Increased substance abuse.
- Increased washing or bathing.
- Behaving as if the rape didn’t occur, trying to live life as it was before the rape, this is called denial.
- Suicide attempts and other self-destructive behaviour such as substance abuse or self mutilation.
PSYCHOLOGICAL SYMPTOMS OF RAPE TRAUMA SYNDROME
Psychological symptoms are much less visible and can in fact be completely hidden to others so survivors need to offer this information or be carefully and sensitively questioned in order to elicit them. They generally refer to inner thoughts, ideas and emotions.
- Increased fear and anxiety.
- Self-blame and guilt.
- Helplessness, no longer feeling in control of her life.
- Humiliation and shame.
- Lowering of her self esteem
- Feeling dirty or contaminated by the rape
- Feeling alone and that no one understands.
- Losing hope in the future.
- Emotional numbness.
- Loss of memory.
- Constantly thinking about the rape.
- Having flashbacks to the rape, feeling like it is happening again.
- Becoming suicidal.
There are many influences on the manner in which each individual survivor of sexual violence copes and on the length of time the symptoms may be present. These factors include:
- Support systems
- The relationship with the offender
- The degree of the violence used
- Social and cultural influences
- Previous experience with stress
- Ability to cope with stress
- Attitude of those immediately contacted after the assault
- The age and developmental stage of the survivor (adolescent survivors are more vulnerable)
It is important that we recognise that survivors will not respond in the same ways, as comparing two case histories can show. While most survivors will experience these symptoms, some survivors may only experience a few of these symptoms while others may experience none at all. We must be careful not to judge whether someone has been raped by the number of symptoms that they display. Because most survivors are afraid to tell anyone that they have been raped it is often not easy to observe their reaction, or recognise them without the survivor’s own account – and this she is unlikely to give easily.
It has been observed through clinical studies that almost all rape survivors suffer severe and long lasting emotional trauma. The most significant factors that cause this appear to be a combination of the following features of the assault experience.
It is sudden
It is perceived as life threatening
Its apparent purpose is to violate the survivor’s physical integrity and/or render her helpless.
The survivor is forced to participate in the crime.
The survivor cannot prevent the assault or control the assailant, her normal coping strategies have failed. Thus she becomes a victim of someone else’s aggression.
The trauma is usually compounded by the myths, prejudice and stigma associated with rape. Survivors who have internalised these myths have to fight feelings of guilt and shame. The burden can be overwhelming especially if the people they come into contact with reinforce those myths and prejudices.
This is why it is essential that all legal, medical and police procedures must not cause further trauma to survivors who must be given all possible support to overcome and survive the ordeal. Courts are now beginning to use evidence of this kind in the trial stage of a court case as well as at the sentencing stage where the effect that the rape has had on the victim’s life is taken into consideration when sentencing the perpetrator. However it is plain to see that there are distinct psychological clues, left in the survivor’s mind, that add up to evidence of trauma of a very particular character that we know as the crime of rape.