Sandra*, a middle aged divorcee, telephone for counseling because she was having difficulty getting over a violent and traumatic rape experience. Three months earlier, she had been raped at knifepoint in her own home. Her assailant had gained entry to her house whilst she was asleep. He had raped her viciously for over an hour, tied her up and made off with a few valuable items. After the attack, Sandra was so scared to be alone that a close girlfriend has to move in with her. At night Sandra had terrible dreams about the rape and would often wake up screaming. Even during the day she couldn’t keep the memories of the rape out of her mind. She became overly anxious and had difficulty concentrating at her work. She was repelled by the thought of sex, although she was willing to be held and comforted by her boyfriend. She felt as if her emotions were numb and her future was bleak.
Sandra is displaying typical symptoms of a rape victim suffering from Post-Traumatic Stress Disorder (PTSD). PTSD is defined as those forms of psychological symptoms and dysfunction that begin after experiencing, witnessing or participating in an overwhelmingly traumatic and frightening event. PTSD is often a major contributor to the horror of the rape experience. The violence and terror that characterises every rape, renders rape victims unable to forget the experience.
Over recent years, the rape statistics in South Africa has escalated to shocking proportions. The latest figures indicate that a woman is raped every 37 seconds, and that one million rape cases are reported at police stations every year. For every rape case that is reported it is estimated that another thirty-five are not. Although no conclusive statistics are available regarding the incidence of PTSD in the South African population, surveys in America have shown that at least 31% of female rape victims suffer from PTSD.
The most common signs and symptoms of PTSD include recurrent intrusive memories or nightmares of the traumatic event, avoidance thoughts, situations and people associated with the trauma, decreased interest in usual activities and difficulty concentrating and falling asleep. Numbed emotions, especially towards people who were formerly close to the victims, increase feelings of detachment and isolation in the victim. In general, PTSD symptoms are more severe in traumatic experiences, which are initiated by an aggressor, as in the case of rape. In addition, rape victims often feel dirty all the time and tend to wash themselves constantly. The also lose self-confidence and fear being alone, lose trust in their relationships with other people and experience a deep sense of loss of control in their lives.
Once PTSD has been diagnosed, there is effective treatment that is available. Treatment generally involves “talk therapy” such as cognitive behavioural therapy, family therapy or brief psychotherapy. In some cases, a psychiatrist can also prescribe medication such as antidepressants or benzodiazepines. The therapist aims to help the victim recall the traumatic events in a safe environment and deal with negative emotions such as grief, guilt, anger, depression, anxiety and behavioural disturbances.
Sometimes it is useful for sufferers to work together with others who have undergone similar traumatic experiences. The Depression and Anxiety Support Group plays an important role in South African Mental Health by focusing on awareness campaigns, regional support groups and self-help techniques for people suffering from all forms of depression and anxiety disorders. The Support Group can be contacted on (011) 783-1474/6.
The prognosis for PTSD differs from individual to individual. A lot depends on the type and extent of the trauma a sufferer has undergone. Some sufferers can experience a speedy return to healthy functioning whilst others experience debilitating relapses. Some studies suggest that people with certain personality profiles or attitudes are more likely to develop PTSD symptoms. It has been found for example, that rape victims who had psychological problems before they were raped or were struggling with stressful life situations run a greater risk of developing lingering stress reactions after their traumatic events. Similarly, people who generally view life’s aversive events as beyond their control, develop more severe PTSD symptoms. Generally, however, an early diagnosis and an effective treatment course can go a long way in helping victims to overcome the impact of a traumatic rape experience.
People who are sustained by strong support systems are less likely to develop an extended disorder. Rape victims who feel loved, valued and accepted by a group of friends or relatives are more likely to recover successfully from their sexual assault. If someone close to you has been raped it is important that you believe what they tell you, do not blame them for what has happened and allow them to make their own decisions so that they still have a sense of control in their lives. Remember that some rape victims may block off their feelings and appear to be coping when underneath they really need someone to patiently listen and care for them.
Four steps in helping a rape victim overcome PTSD
Step 1: Explain the PTSD symptoms to the victim and that these horrible feelings and thoughts will go away with time.
Step 2: Let the victim know that feelings of guilt are normal and that they will also pass with time.
Step 3: Encourage the victim to talk about the rape as much as possible. Details are important – what did they think, feel and fear during the trauma? It is best for them to face their fears and feelings rather than avoid them.
Step 4: Supply the victim with a lot of support and security. Be patient with them bearing in mind that recovery from trauma is a process. Encourage the victim to take things slowly and gradually.
Comer, R.J. (1995) Abnormal Psychology: Second Edition. W.H. Freeman & Company: N.Y.
* Not her real name.