Understanding PTSD After Sexual Assault

A person who has been sexually assaulted will generally experience high levels of distress immediately afterward. The trauma of being assaulted can lead to fear, anger, guilt, anxiety, and sadness. The stigma associated with sexual assault may cause embarrassment or shame for some people.

In addition, survivors of sexual assault have an increased likelihood of developing symptoms of post-traumatic stress disorder (PTSD). They might feel as though they are always in danger or need to always be on guard, and may distrust other people.

Such symptoms can continue for months or even years without treatment. This article discusses how sexual assault can lead to an increased risk of PTSD. It also covers the symptoms that people might experience and what they can do to get help.

What Is Sexual Assault?

The term "sexual assault" refers to a range of behaviors that involve unwanted, coercive, or forceful sexual contact or conduct. Sexual assault can include rape, attempted rape, and any form of unwanted sexual touching.

Sexual assault occurs with alarming frequency in the United States. Additionally, survivors of childhood sexual assault have an increased likelihood of being assaulted again in adulthood.

What Is PTSD?

Post-traumatic stress disorder (PTSD) is a mental health condition that causes a variety of troubling symptoms in the aftermath of a traumatic event like sexual assault.

PTSD is fairly common among people who have experienced sexual assault. In one study, nearly 75% of sexual assault survivors met the diagnostic criteria for PTSD one month after an assault, and nearly 48% still met the criteria one year after an assault.

Symptoms of PTSD may include re-experiencing the traumatic event, avoiding reminders of the trauma, startling easily, and having negative thoughts and beliefs.

Symptoms of PTSD After Sexual Assault

"Sexual assault is a devastating violation that undermines one’s feelings of safety and trust. It is common for sexual assault survivors to experience a host of symptoms in the immediate aftermath of their assault, including vivid flashbacks, nightmares, avoidance, feeling numb, guilty, or depressed, and being easily startled, jumpy, or irritable," says Michele Cascardi, PhD, a licensed clinical psychologist and psychology professor at William Paterson University.

Survivors of sexual assault can experience severe and chronic symptoms of PTSD, such as:

• Body aches
• Fatigue
• Flashbacks
• Headaches
• Insomnia
• Nightmares

Survivors' experience of PTSD might include:

• Avoidance, such as avoiding thoughts or feelings of the traumatic event (emotional avoidance); staying away from reminders of the trauma such as people, places, objects, or situations; and resisting conversations about what happened.
• Intrusive symptoms, such as repeated, unwanted memories of the event, recurrent nightmares, and flashbacks.
• Increased arousal, such as trouble falling or staying asleep, being easily startled or fearful, trouble concentrating, and hypervigilance to surroundings, and potential threats to safety.
• Changes in thoughts and feelings, such as ongoing, distorted beliefs about oneself or others; recurrent feelings of fear, horror, anger, guilt, shame, or hopelessness; loss of interest in once enjoyable activities; feeling detached from others or struggling to maintain close relationships; and difficulty experiencing positive feelings like joy or satisfaction.

Cascardi notes that while some of these symptoms can be a normal part of the healing process in the days and weeks after an assault, persistent symptoms that affect a person's quality of life and ability to function normally may indicate the development of PTSD.

Other Effects of Sexual Assault

Sexual assault can take a toll on physical, sexual, and behavioral health for months or even years after the event took place.

Physical Health

A sexual assault can bring on a number of chronic physical conditions, which are also common among people with PTSD. For example, women who have been raped have been found to be more likely to experience:

• Arthritis
• Chronic pelvic pain
• Digestive problems
• Intense premenstrual symptoms
• Non-epileptic seizures

Additionally, people who are survivors of rape or attempted rape are at an increased risk of contracting a sexually transmitted infection (STI), which can lead to additional physical and emotional health problems.

Sexual Health

Enjoying sexual contact can be difficult after experiencing sexual trauma. Someone who has survived a sexual assault may experience low sexual desire and reduced sexual behavior.

Some survivors experience pain, fear, or anxiety with sexual contact. Shame and guilt stemming from the trauma can also interfere with desire for and satisfaction from sex.

Survivors of childhood sexual assault are likely to have more severe sexual problems. Penetration during sexual assault will also increase the risk for future sexual problems.

Behavioral Health

There is no single behavioral reaction to sexual assault. Some survivors avoid sex after experiencing assault, while others engage in risky sexual behaviors such as not using protection or having a greater number of sexual partners.

Survivors may also turn to unhealthy behaviors like substance use and self-harm in an effort to cope with the intense unpleasant emotions that come from being assaulted.

These feelings may subside over time for some people. Others, however, will continue to experience some form of psychological distress for months or years.

Treatments for PTSD After Sexual Assault

For many who survive sexual assault, these symptoms will subside over time. However, for some, these symptoms may linger and even get worse. Fortunately, there are treatments available that have been found to help.

Psychotherapy

Psychotherapy has been proven effective in treating symptoms of PTSD following sexual assault. Cascardi notes that there is growing evidence for the effectiveness of cognitive processing therapy, prolonged-exposure therapy, and eye movement desensitization and reprocessing therapy.

• Cognitive processing therapy (CPT) helps people confront unpleasant memories and thoughts associated with the sexual assault. During CPT, a therapist will also guide them to correct any maladaptive, unrealistic, or problematic thoughts driving their PTSD symptoms.
• Prolonged-exposure therapy targets any learned behaviors people engage in or avoid in response to situations, thoughts, and memories associated with the sexual assault. The hope is that by confronting feared emotions, thoughts, and situations, they can learn that anxiety and fear will lessen on their own.
• Eye movement desensitization and reprocessing (EMDR) therapy can also help treat trauma related to sexual assault. This type of therapy uses rhythmic bilateral eye stimulation to help reduce the emotional effects of traumatic memories. While individual responses can vary, research has found that this approach can be effective in treating PTSD.

Mays explains that treatments for trauma can involve either a top-down or bottom-up approach. "A top-down approach focuses on the person’s thinking, beliefs, and behaviors and works to create change in those areas. Cognitive Behavioral Therapy is an effective example of this," she says. A bottom-up approach, such as EMDR, focuses on releasing the trauma a person holds in their body.

Support Groups

Joining an online or in-person support group provides the opportunity to connect with other survivors of sexual assault and get advice on overcoming the challenges associated with that trauma.

Support groups provide an excellent opportunity to develop supportive, trusting, and healthy relationships with other people with a shared experience. Your primary care physician or mental health professional is often the best place to start when searching for a local support group. 

Self-Help

In addition to talking to a therapist and/or joining a support group, there are some lifestyle changes and coping techniques you can do on your own to calm your body and mind and manage your symptoms.

• Spend time with supportive loved ones. Go for a walk, grab some morning coffee, or talk on the phone.
• Practice relaxation strategies. Find time for prayer, meditation, yoga, or progressive muscle relaxation.
• Go for a morning walk. Taking time to enjoy the outdoors, get some fresh air, and move your body can help regulate your mood and emotions.
• Keep a journal. A journal can offer a consistent place to write and process your feelings and experiences. 

How to Help a Loved One

"Healing sexual trauma is a process that takes time and that the person will go through many different emotions and experience the impact in different areas of their lives," Mays explains.

If your partner or another loved one is experiencing symptoms of PTSD after a sexual assault, there are things you can do to help.

• Listen: Let your loved one feel like they can confide in you, but don't pressure them to talk about their trauma. When they do decide to talk, focus on listening, being supportive, and validating what they are feeling.
• Avoid blame: Don't focus on the events themselves or ask "why" questions that imply blame. People who have experienced sexual assault often struggle with not being believed or with being shamed and blamed for their assault. 
• Don't pressure: Even if you feel like your loved one should take a certain action, whether it is talking to authorities or seeking treatment, focus on being supportive and respectful of how they want to handle the situation.
• Offer to help: If your loved one does want to talk to a healthcare provider or seek help from a mental help professional, look for ways that you can help. For example, you might offer to help them find a healthcare professional or go with them to their therapy appointments.

Having supportive relationships is important for people who have experienced trauma. Research has found that poor social relationships can impair PTSD recovery.

Summary

Sexual assault can lead to the onset of PTSD characterized by symptoms such as avoidance, flashbacks, and changes in thoughts and emotions. People may also experience other effects, including problems with physical, behavioral, and sexual health.

Recovering from sexual assault and PTSD is not something you should try to do alone. There are trained professionals to help and support you as you learn to manage the physical, mental, and behavioral effects of surviving sexual assault.