The prevalence of PTSD in sexual assault survivors

Today (10^th October) marks World Mental Health Day. 1 in 4 people in the UK will experience a mental health issue every year. Whilst there are many mental health issues no one person’s experience is the same. It is common for survivors of sexual assault to experience a mental health issue after the incident, with 94% of survivors experiencing symptoms of Post-traumatic stress disorder (PTSD) in the first 2 weeks following an assault, and 50% experience symptoms long term. It is estimated that nearly 500,000 adults are sexually assaulted each year. That’s approximately 470,000 adults in the UK who will experience PTSD type symptoms this year as a result of sexual violence. The actual numbers are probably much higher due to the fact that crimes of this nature are rarely reported or disclosed and these statistics don’t even consider the 1 in 20 children who experience sexual assault as only adults are surveyed.

When we think of PTSD we often think of soldiers and refugees who have experienced atrocities associated with war, partly because the condition was first recognised in soldiers and referred to as ‘shell-shock’. However, since then it is widely understood that PTSD can occur following exposure to any traumatic event which may be subjective to each individual. Many survivors will experience an ‘acute stress reaction’ (‘psychological shock’) following a traumatic event. However, it is only if these symptoms persist for longer than 4 weeks that a formal diagnosis of PTSD can be given. It is also important to note that those caring for someone with PTSD ought to care for themselves too. Sometimes hearing about someone else’s trauma can cause PTSD symptoms. This is known as ‘secondary trauma’ and can be equally difficult to deal with.

PTSD is a type of severe anxiety disorder with both physical and psychological symptoms which may include; reliving parts of what happened through flashbacks, nightmares, and intrusive thoughts; a feeling of alertness known as hypervigilance (constantly being in a state of fight or flight) such as panicking when reminded of the trauma, being easily upset, angry, or aggressive, disturbed or lack of sleep, difficulty concentrating, participating in destructive behaviour and recklessness, sweating, nausea, and shaking. Other symptoms may include avoiding feelings or memories which may include feeling numb, using drugs or alcohol, or having difficulties remembering what happened. Other symptoms may be experienced such as self-blame, feelings of distrust, feeling unsafe, and overwhelming feelings of anger, sadness, shame, and guilt.

These symptoms can lead to feeling constantly on edge which is exhausting over time. This can directly impact a person’s ability to function in everyday life and may cause issues with personal care, holding down a job, maintaining relationships, memory, making decisions, libido, and being able to enjoy things that were enjoyed prior to the traumatic event. Some individuals may have additional risk factors for developing PTSD which can also exacerbate the condition. Being repeatedly exposed to trauma, being physically injured, having low self-esteem, having little or no support from friends, family, and professionals, dealing with additional stress at the time, and previously experiencing anxiety or depression may increase the likelihood of developing PTSD as a result of sexual violence.

Sometimes due to traumatic and painful experiences our mind protects itself by burying or even forgetting the events. These memories are stored until they are triggered which brings them to the forefront of our minds. These are known as ‘flashbacks’ and is the symptom of PTSD most often portrayed in popular culture. It is where a person re-experiences the event that manifests itself visually, auditory or sensory. They can be intense or subtle and may occur at any time whether asleep or awake for seemingly no reason. Flashbacks are typically bought on by a ‘trigger’ which is something that may act as a reminder of the traumatic experience. Common triggers are; seeing the perpetrator or someone that looks like them, hearing the perpetrators voice or seeing mannerisms that may remind the survivor of them, specific smells e.g. aftershave, alcohol, songs or pieces of music, physical touching, or even feelings, such as feeling sad, angry etc. Flashbacks can be frightening and confusing. During a flashback it is common to feel numb, nauseous, dissociate, or experience a panic attack. It is worth noting that during a period of therapy or counselling, flashbacks may increase. This is common as part of the counselling process is to bring up thoughts and feelings relating to the experience in order to be able to work through them.

The effects of PTSD can in turn lead to the development of other disorders. A 1997 study by Breslau et al. found that women who experienced PTSD were 2 times more likely to develop depression and 3 times more likely to develop alcohol related problems in the future. This highlights the importance of treatment and support for victims of trauma. It is estimated that 80% of sufferers of PTSD will have an additional co-occurring condition, the most common being major depressive disorder (MDD) and substance abuse disorders. The self-medication hypothesis attempts to explain this high co-occurrence. It refers to the motivation to relieve pain and distress associated with disorders such as PTSD. This often leads to people self-medicating with substances such as drugs or alcohol to try and alleviate their symptoms. However, this may then leave them with a substance abuse disorder. There is still not an explicit explanation and more research is needed in this area.

There are a few misconceptions about PTSD. Firstly, that it is a male condition reserved for war veterans. This is simply untrue and can affect anyone who has experienced anything that to them constitutes a traumatic experience. In fact, women are more likely to suffer from PTSD than men, with 1 in 10 women experiencing the condition during their lifetime compared to 1 in 25 men. However, this gender difference may be due to the events which cause PTSD. Women typically cite sexual assault and child sexual abuse as the event which triggered their PTSD. Men typically cite accidents, physical assaults, combat, and natural disasters. Seeing as in the UK 35% of women experience sexual assault compared to 14% of men, it is easy to see why these numbers may be higher for women. Additionally, because of cultural factors men are less likely to seek help for mental health issues than women which may also influence the statistics.

The portrayal of PTSD we typically see is dramaticised in the media and often focuses on myths and stereotypes. It is a myth that PTSD sufferers are more violent. In a study where this was tested it was found that any increase in aggression compared to the general population was due to confounding factors e.g. substance abuse, rather than the PTSD itself. Even without considering those factors most PTSD sufferers aren’t violent with less than 8% participating in violent behaviour.

Additionally, not everyone who experiences trauma will develop PTSD. They may experience acute stress after the incident and some symptoms of PTSD but with time most people tend to recover. This doesn’t mean that those who develop PTSD are weaker than those who do not or that those who develop PTSD have suffered any more. As with any mental health condition there is a biological basis with neurological and physiological symptoms. No one can simply get better by ‘trying to get over it’. Professional treatment is the only way to really treat PTSD. Seeking help is not an admission of defeat and is in fact a brave thing to do. A survivor may feel as if they are a burden, however it is important to note that there are people who care and want to help. It can be difficult to ask for help but it is the first step towards recovery. There are many different treatment options including; cognitive behavioural therapy, prolonged exposure therapy, pharmacological treatments such as anti-depressants for co-occurring mood disorders.  In the same way a person’s experience with PTSD is unique so is a person’s treatment plan. It is possible to live a normal life whilst dealing with PTSD.

These myths perpetuate the stigma surrounding PTSD and mental health issues in general. It is so important to learn about these conditions, so we can understand other people and be there for them should they ever need it, rather than say the wrong thing and make them feel misunderstood or helpless. Misinformation about disorders can potentially be dangerous if it prevents a person from seeking help. Despite attitudes towards mental health changing in recent years with the general populous becoming more accepting of mental health sufferers there is still societal stigma. This stigma means that a lot of people do not feel comfortable disclosing their diagnosis or discussing how they are feeling openly with friends or family. When a relatively unknown condition such as PTSD is coupled with the trauma of sexual assault- a person needs a space where they feel safe, heard, respected and free from any judgement.

At the Gemini Project we want you to know that you are not alone. These feelings that you may be experiencing are normal and with time things do get easier. We can help ourselves through general self-care, we can ask for support from friends, and seek help from professionals. It is important to note that how we may feel isn’t a permanent state of mind. This pain is temporary, and we can get through it. After all, there is a reason we are called survivors.

For more information on PTSD visit: https://www.mind.org.uk/information-support/types-of-mental-health-problems/post-traumatic-stress-disorder-ptsd/about-ptsd/#.W70PlGhKi00

If you need to talk to someone immediately regarding sexual assault visit: https://rapecrisis.org.uk/

If you’re feeling low and need to talk to someone visit: samaritans.org