In 1972-73, Ann Wolbert Burgess and Lynda Lytle Holstrom interviewed over 600 survivors of sexual assault and identified the "Rape Trauma Syndrome".Researches has shown that most women who have been sexually assaulted go through these stages.
More specifically, RTS is a response to the profound fear of death that almost all survivors experience during the assault.
Rape Trauma Syndrome by Ann Wolbert Burgess & Lynda Lytle Holmstrom
Victims suffer a significant degree of physical and emotional trauma during the rape, mediately following the rape, and over a considerable time period after the rape. Victims consistently describe certain symptoms. We define the cluster of symptoms that are documented here as the rape trauma syndrome.
This syndrome has two stages: the immediate or acute phase, in which the victim's lifestyle is completely disrupted by the rape crisis, and the long-term process, in which the victim must reorganize this disrupted lifestyle. The syndrome includes physical, emotional, and behavioral stress reactions which result from the person being faced with a life-threatening event.
The acute phase: disorganization
Immediate Impact Reaction: A prevailing myth about rape victims is that they are hysterical and tearful following a rape. We did not find this to be necessarily true. On the contrary, victims described and indicated to us an extremely wide range of emotions in the immediate hours following the rape. The physical and emotional impact of the incident can be so intense that the victim feels shock and disbelief. Two main styles of emotion were shown by the victims within the first few hours after the rape: expressed and controlled. In the expressed style. the victim demonstrated such feelings as anger, fear and anxiety. They were restless during the interview, becoming tense when certain questions were asked, crying or sobbing when describing specific acts of the assailant, smiling in an anxious manner when certain issues were stated. In the controlled style, the feelings of the victim were masked or hidden, and a calm, composed or subdued affect could be noted.
Physical Reaction: Rape is forced sexual violence. Therefore, it is not surprising that victims describe a wide gamut of physical reactions. Many described a general feeling of soreness all over their bodies. Others specified the body area that had been the focus of the assailant's force, such as throat, chest, arms or legs.
Sleep Pattern Disturbances: In the acute phase, victims have considerable difficulty with disorganized sleep patterns, complaining that they cannot fall asleep, or if they do, they wake up during the night and cannot return to sleep. Those who have been attacked while sleeping in their own beds may awake each night at that time again. It is not uncommon for victims to scream out in their sleep.
Eating Pattern Disturbances: A marked decrease in appetite following the rape is generally noticed by victims. They may complain of stomach pains or describe loss of appetite or the food not tasting right. Frequently victims feel nauseated just thinking of the assault. It is important to determine whether these symptoms are related to the emotional reaction to the rape or are a reaction to an antipregnancy medication.
Symptoms Specific to Focus of Attack: Victims also report physical symptoms specific to the area of the body that had been the focus of the attack. Those forced to have oral sex may describe irritation of the mouth and throat. Those forced to have vaginal sex may complain of vaginal discharge, itching, a burning sensation upon urination, and generalized pain. Those forced to have anal sex may report rectal pain and bleeding.
Emotional Reactions: Prevailing stereotypes of rape are that the main reactions of women are to feel ashamed and guilty. We did not find these to be the primary reactions in the majority of victims. To the contrary, the primary feeling expressed was that of fear-fear of physical injury, mutilation and death. It is this main feeling of fear that explains why victims develop the range of symptoms we call the "rape trauma syndrome." Their symptoms are an acute stress reaction to the threat of being killed. Most victims feel they had a close encounter with death and are lucky to be alive. Victims express other feelings in conjunction with the feeling of fear of dying. These feelings range from humiliation, degradation, guilt, shame and embarrassment, to selfblame, anger and revenge. Because of the wide range of feelings experienced during the immediate phase, victims are prone to mood swings.
Many victims realize their feelings are out of proportion to the situation they are in. They will report feeling angry with someone and later realize the anger was unfounded in that situation. Women become quite upset over their behavior which, in turn, produces more distress for them. Victims also report feeling irritated with people during the first few weeks when they symptoms, are acute. They become cautious of all people.
Thoughts. The victim continually tries to block the thoughts of the assault from her mind. She says she is trying to blot it from her mind, to push it from her mind, but the thought of the assault continually haunts her. There is a strong desire for the victims to try and think of how she could undo what has happened. She reports going over in her mind how she might have escaped from the ass"ant, how she might have handled the situation differently. However, she usually ends up saying that she would have beaten or killed if she did not do what the assailant demanded. Victims vary as to the amount of time they remain in the acute phase. The immediate symptoms may last a few days to a few weeks. More often than not, the acute symptoms overlap with they symptoms of the long-term process.
The long-term process: reorganization:
The rape represents a disruption in the life style of the victim, not only during the immediate days and weeks following the incident, but well beyond that to many weeks and months. Various factors seem to influence how the victim copes with the crisis, such as her personality style, the people available to her who respond to her distress in a serious and concerned manner, and the way in which she is treated by the people with whom she comes into contact after the rape. The victim had to cope with the following symptoms during the long-term reorganization process.
Changes in lifestyle: The rape upsets the victim's normal routine of living. In some cases, not just one but many aspects of the victim's life were changed. Many victims are able to resume only a minimal level of functioning even after the acute phase ends. These women go to work or school but are unable to be involved in more than business-type activities. Other victims respond to the rape by staying home, only venturing out of the house accompanied by a friend, or by being absent from or stopping work or school. A common response was to turn to family members not normally seen on a daily basis. Often this meant a trip home to some other city and a brief stay with parents in their home. In most of these cases the victim told her parents what happened. Occasionally the parents were contacted for support, although the victim did not explain why she was suddenly interested in talking to them or being with them. There is often a strong need to get away. Moving was another response that changed victim's lifestyles. Many changed residence specifically because of the rape. Another change victims may make in their lifestyle is to change their telephone number. Many request an unlisted number. She may do this as a precautionary measure, or after receiving threatening calls. Victims fear that the assailant may gain access to them through the telephone. They may also be hypersensitive to obscene phone calls which may or may not be from the assailant.
Dreams and Nightmares: Dreams and nightmares are a major symptom with the rape victim and occur both during the acute phase and the long-term process. Victims report two types of nightmares. One type is when the victim dreams of being in a similar situation to the rape and is trying to get out of it, but fails. These dreams are similar to the actual rape itself. The second type of dream occurs as time progresses. The dream material changes and often the victim will report mastery in the drama. However, the dream content is still of violence and this is disturbing to the victim. Often they will see themselves committing acts of violence such as killing and stabbing people. Therefore, the power gained in this second type of dream may represent mastery but the victim has to deal with this violent image of herself.
Phobias: A common psychological defense is the development of fears and phobias specific to the circumstances of the rape. Phobic reactions to a wide variety of circumstances may develop. One such circumstance is being in crowds. Another is fear of being alone after the rape. She may develop specific fears related to characteristics of the assailant. Other victims describe a suspicious, paranoid feeling. Some victims feel a global fear of everyone.
Many victims report a fear of sex after the rape. The normal sexual style of the victim becomes disrupted after a rape. The rape is especially upsetting if the victim has never had any sexual experience before the rape, since she has no other experience to compare to it and no way to know whether sex will always be so unpleasant. For a victim who had been sexually active, fear increases when her partner confronts her with resuming their sexual pattern.
Compounded reaction to rape: We also saw people in our sample who described a past or current difficulty with a psychiatric condition, a physical Condition, or behavior patterns which created difficulty for them living in this society. These victims were frequently known to other therapists, physicians, or agencies. These victims needed more than crisis counseling. This group developed additional symptoms, such as: increased physical problems; depression; increased drinking or drug use; suicidal behavior; and psychotic behavior. It appears that under the stress of rape, the victim will regress according to her vulnerability. Such vulnerable positions are portrayed with a history of previous psychiatric symptoms, a poor access to a social supportive network, or with simultaneous problems such as family, financial or academic, as well as recurring problems such as alcoholism. A careful study of such background data helps the counselor to deal with the situation. At the very least, this background information will prepare the counselor to refer the victim for psychotherapy or to enlist the aid of a previous therapist with the victim's permission.
Silent reaction to rape: The silent reaction to rape can occur in the victim who has not reported the rape to anyone, who has not dealt with feelings and reactions to the incident, and who, because of this silence, has become further burdened psychologically. We became aware of such a syndrome as a result of listening to the life history data reported by the victims we saw. A number of them stated that they had been raped or sexually molested as children or adolescents, as well as when adult women. Some victims never told anyone and kept the burden within themselves. The current rape reactivated their emotional reaction to the prior experience. The victim talked as vividly about the previous assault as the present one, indicating that the incident had never been adequately settled or integrated. Counselors who suspect that the client has a history of being raped should be sure to include questions relevant to the possibility of the victim's having been subjected to an earlier rape or attempted rape or other molestation. The most effective treatment when a silent reaction to rape has been determined is to encourage victims to discuss their feelings. They may need to go over the incident in detail: describing the circumstances; their perception of the assailant; conversations around the attack; the use of threats; their emotional reactions; who they did or did not tell; and their feelings, thoughts and actions since the earlier incident. It is important to learn why victims felt that there was no one they could tell about the incident.
Summary: Rape trauma syndrome is the acute or immediate phase of disorganization and the long-term process of reorganization that occurs as a result of attempted or actual rape. The acute phase includes: (1) the immediate impact reaction (either expressed or controlled); (2) physical reactions; (3) emotional reactions to a life-threatening situation. The long-term process includes: (1) changes in lifestyle; (2) dreams and nightmares; and (3) phobic reactions. There are two variations to the rape trauma syndrome. In the compounded reaction to rape, the victim experiences not only these symptoms, but also a reactivation of symptoms of a previously existing condition. In the silent reaction various symptoms occur but without the victim ever mentioning that a rape has occurred. Crisis counseling is effective with victims developing typical rape trauma syndrome. Additional professional help may be needed for victims with compounded reactions. Counselors should be alert to certain clues that indicate the possibilities of rape even when the person never mentions such an attack.
-Excerpted from Ann Wolbert Burgess and Lynda - Lytle Holmstrom, Rape: Victims of Crisis, (Bowie, Md.: Robert J. Braky Co., 1974), pp. 37-50.
*Dr. Ann Wolbert Burgess is an internationally recognized pioneer in the assessment and treatment of victims of trauma and abuse. She has received numerous honors including the Sigma Theta Tau International Audrey Hepburn Award, the American Nursesí Association Hildegard Peplau Award, and the Sigma Theta Tau International Episteme Laureate Award.
*Lynda Lytle Holmstrom is a Professor Dept. of Sociology, Boston College
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