Rape+Trauma+Syndrome

Jennifer Kordas

** Rape Trauma Syndrome **

**Background** Rape trauma syndrome (RTS) is recognized as a form of post traumatic stress disorder (PTSD). Specifically, it is defined as “the stress response pattern of a victim following forced, non-consenting sexual activity" (Keogh, 2006). This disorder was first identified in the 1970’s by Ann Wolbert Burgess, a psychiatric nurse, and Lynda Lytle Holmstrom, a sociologist (Burgess, 1983). Symptoms of RTS do not usually occur immediately and include recurrent and intrusive recollections of the rape, nightmares, numbing of general responses, feelings of detachment and estrangement, difficulty sleeping, outbursts of anger, and an exaggerated startled response (Keogh, 2006). RTS is both an acute and long-term emotional reorganization process and may last for months or years after the rape has occurred (Roger Williams University, 2011).

**Diagnosis** Keogh (2006) explains that RTS can be diagnosed through a series of tests and analysis of certain stress responses. In order to be diagnosed four criteria must be met:
 * 1) The event that causes the stress must be of significant magnitude to evoke distinguishable symptoms in almost everyone
 * 2) The trauma must be re-experienced (flashbacks)
 * 3) Reduced involvement with the environment around the victim, or numbing of responsiveness to the environment (withdrawal)
 * 4) Two of the following six symptoms must be present for at least one month following the rape: exaggerated, startle response of hyper-alertness; disturbance in sleep patterns; impairment of memory and/or level of concentration; avoidance of activities that arouse recollection; increased symptoms that symbolize or resemble the event; and guilt about surviving or about behavior during the rape

According to the Counseling Center at Roger Williams University (2011), rape trauma syndrome follows four stages: acute/impact reaction phase, outward adjustment phase, depressed phase, and an integration and resolution phase. Each phase is characterized by unique emotional and physical concern that most survivors experience. The phases usually overlap with each other.

**Phase 1: Acute/Impact Reaction** This first phase of RTS occurs within the first several days after the rape. The victim may express anger in a variety of ways, such as fear, crying, smiling, restlessness, and tenseness. The victim may also control their feelings and hide them beneath a calm, composed attitude. Physically, the victim may be sore from the physical attack, have muscle tension, an inability to sleep, or be edgy and jumpy. There may also be some genital problems such as discharge, itchiness, burning during urination, chronic infections, and rectal bleeding/pain. Additionally, it is common to have gastrointestinal irritability in this phase, which includes stomach pain, reduced or increase appetite, and nausea. The emotional reactions a rape victim may feel during this stage can range from fear, shock, and anger to shame, self-blame, confusion, and a sense of guilt (Rape Victims Advocates, 2011).

**Phase 2: Outward Adjustment** The 2nd phase of RTS can last from weeks to months following the rape. Long-term emotional reactions include intense fear, anxiety, denial, and a sense of lost security. There may also be some lingering physical symptoms during this stage, such as burning during urination, itching, genital discharge, tension headaches, and nausea caused from medication (Roger Williams University, 2011).

**Phase 3: Depression** This phase can last anywhere from a few days to many months. The victim may feel a loss of self-esteem, obsessive memories, and a feeling that they cannot control their life and environment (Roger Williams University, 2011).

**Phase 4: Integration and Resolution** The final phase of RTS lasts months to years. In the long-term, victims will feel a lack of trust in sexual partners, or be anxious and depressed when reminded of the incident or rape in general (Rape Victims Advocates, 2011).

**Prevention and Treatment** Some research shows that early intervention methods may prevent or lessen the effects of RTS on a rape victim, at least in the short-term. In a study conducted by Foa, Hearst-Ikeda, and Perry (1995), it was found that imaginal and in vivo exposure were effective on women who received this treatment within one month of the sexual assault. However, no significant differences were found after 5 months. A more recent study done by Foa, Zoellner, and Feeny (2006) discover ed that cognitive-behavioral therapy (CBT) within 4 weeks of the rape contributed to reduction in RTS symptoms and an overall lower level of anxiety, even at the 9-month mark.

Rresearch also shows that pharmacological interventions may be beneficial as well. After a traumatic event, epinephrine and oth er stress hormones are released in the body. These hormones assist in memory consolidation and learning. Therefore, it is hypothesized that B-adrenergic anatagonists, like propranolol, can alleviate these effects (Kilpatrick, Amstadter, Resnick, & Ruggiero, 2007).

A recommended treatment for RTS and PTSD is provided by Foa and colleagues, as well as the International Society of Traumatic Stress Studies (2000). Four psychosocial intervention techniques are recommended for adults: exposure therapy, cognitive therapy, anxiety management training, and psychoeducation. These techniques are usually part of a multicomponent treatment program and are rarely used alone.

Usually the psychosocial methods are combined with some type of pharmacological treatment. Sertraline and paroxetine are currently the only two drugs that have received FDA approval for treatment of PTSD and RTS, they are also widely endorsed by experts as the most desirable treatm ent (Kilpatrick, Amstadter, Resnick, & Ruggiero, 2007). On average, the use of these medicines resulted in a minimum of a 30% reduction in PTSD and RTS symptoms.

Although these promising forms of invention and treatment for PTSD and RTS exist, the treatment response rate is not 100%. Further research on treatments is needed in this field.

**References**

Burgess, A.W. (1983). Rape trauma syndrome//. Behavioral Sciences & the Law, 1(3//), 97-113.

//Breaking the silence// [image]. Retrieved from http://www.cristyli.com

//Depression// [image]. Retrieved from http://www.familycrisiscenterofeasttexas.com

Foa E.B., Hearst-Ikeda D., Perry K.J. (1995). Evaluation of a brief cognitive-behavioral program for the prevention of chronic PTSD in recent assault victims. //J Consult Clin Psychol.;63//:948-955.

Foa E.B., Keane T.M., Friedman M.J. (200). Effective Treatments for PTSD: Practice Guidelines From the International Society for Traumatic Stress Studies. New York: Guilford Press.

Foa E.B., Zoellner L.A., Feeny N.C. (2006). An evaluation of three brief programs for facilitating recovery after assault //. J Trauma Stress.19 // :29-43.

Keogh, A. (2006). Rape trauma syndrome- time to open the floodgates? // Journal of Forensic and Legal Medicine 14(4) //, 221-224.

Killpatrick, D.G., Amstadter, A.B., Resnick, H.S., & Ruggiero, K.J. (2007). Rape-related PTSD: issues and interventions. // Psychiatric Times 24(7), 50 //.

// Rape trauma syndrome //. (2011). Rape Victims Advocates, Chicago, IL. Retrieved from http://www.rapevictimadvocates.org/trauma.asp

// Sexual assault. // (2011). Counseling Center, Roger Williams University, Bristol, RI. Retrieved from http://www.rwu.edu/studentlife/studentservices/counselingcenter/sexualassault/rapetrauma.htm