PTSD after a sexual trauma

Post-traumatic stress disorder, or PTSD, is most well-known for its prevalence in the veteran population, but close to 50 percent of PTSD in the United States is due to physical or sexual violence. Furthermore, about 30 percent of all PTSD cases in the United States can be attributed to sexual violence alone. This statistic is alarming, especially considering that one in three women and one in six men experience some form of sexual violence in their lifetimes. 

Sexual assault has many definitions, some legal and some medical, but the most widely accepted definition is sexual contact or behavior that occurs without explicit consent. This definition includes actual and attempted rape, sexual touching and force or coercion of a person into unwanted sexual acts. Sexual assault can be a one-time traumatic event, or it can be a part of continuing abuse stemming from domestic violence or human trafficking situations.

Feelings of trauma

The levels of trauma that result from sexual assaults are a little more difficult to define and conceptualize. “Trauma is really self-defined,” said Nancy Downing, PhD, RN, SANE-A, CP-SANE associate professor in the Forensic Nursing Program at the Texas A&M College of Nursing. “What is traumatic to one person may not necessarily be traumatic to another person.”

While physical injuries may occur in sexual assault, they are typically minor injuries that heal quickly. Unfortunately, psychological injuries are more common and can have long-term negative impacts on survivors’ functioning and quality of life. Approximately 94 percent of women experienced symptoms of PTSD after an assault.

“It is normal to have a very strong reaction to a traumatic episode. And its normal to have disruption to your day-to-day activities, especially within the first few days,” Downing said. “You may have trouble concentrating, eating, sleeping, but you need to give yourself time and permission to let yourself feel that way.”

She emphasizes those are normal reactions to be expected, but if day-to-day life is still impacted after two weeks, then she suggests speaking to a local sexual assault resource center or health care provider for assistance, if they have not already done so. Health care providers cannot diagnose PTSD until four weeks after the trauma, so these natural reactions can be normal. If they persist and if they continue to impact day-to-day function, then it is important to seek help, as early intervention could potentially reduce the severity of symptoms.

Symptoms of PTSD

The severity and type of symptoms can vary greatly among survivors of sexual assault and abuse, but there are a few common symptoms:

• Depression
• Anxiety
• Flashbacks or hyper-reactivity to stimulus like sounds or colors that reminds them of the trauma
• Intrusive symptoms like random thoughts which will drastically change their demeanor
• Avoidance of thoughts or things that remind the person of the trauma
• Hyper-sensitivity and easily triggered feelings
• Detrimental impact on their ability to function day-to-day

Families and loved ones may notice increased irritability, feelings of anger, feelings of numbness or substance abuse. Their loved ones may start to get into fights or have more angry outbursts. People also might also become less social, afraid to leave their homes and miss work or school. It is important to listen when they want to talk and steer them to get help.

PTSD progression and risk factors

“Most people who develop PTSD will have a spontaneous recovery, but about 10 percent will keep getting worse,” Downing said. “We do not know why this happens, but hormonal or genetic differences between people and the presence of past trauma, especially during childhood, tends to make people more likely to develop PTSD than others.”

The focus of Downing’s current research is to identify who might be at greater risk for PTSD development following sexual assault and potential interventions sexual assault nurse examiners (SANEs) can integrate into their care to prevent or reduce symptoms of PTSD.

The American Psychological Association reports that woman are twice as likely to develop PTSD, experience a longer duration of posttraumatic symptoms and display more sensitivity to stimuli that reminds them of the trauma.

Men and women who have experienced long term sexual abuse, like domestic violence or human trafficking, are also at high risk for PTSD.

“Most women that endure domestic partner violence often also endure sexual assault at some point,” said Nora Montalvo-Liendo, RN, PhD, FAAN, an assistant professor at the Texas A&M College of Nursing, who specializes in interpersonal and sexual violence among minority populations.

“Studies have shown women of color are more likely to experience abuse. These women frequently speak about PTSD symptoms like feelings of numbness, poor sleep patterns and hyper-arousal in regards to their environment,” said Montalvo-Liendo. “One of the biggest challenges for some women with PTSD symptomology is the ability to show maternal warmth to their children. It is important for people who experience sexual trauma to get the help they need, so it does not impact those around them.”

Things to do after an assault

If you have experienced a sexual assault, visit your health care provider or go to the emergency room for a health exam.

If you think you might report the assault to law enforcement, there are a few things you can do to preserve evidence for use in a future investigation. First, go to the hospital emergency room as soon as possible and find out which hospital in your community has sexual assault nurse examiners on staff.  If possible, do not change your clothes, wash, brush your teeth, eat or drink. Also, try not to use the restroom. If you need to change clothing, place all clothing you were wearing in a bag and bring it with you.

Where to seek care

A health care provider will offer to examine you for any unnoticed injuries, offer emergency contraception to prevent unplanned pregnancy, discuss risks of sexually transmitted infections and offer preventive treatments, talk about your mental well-being and provide you a medical certificate for time away from work or school.

With your consent, your health care provider can also collect evidence for use in an investigation in case you want to pursue legal actions in the future. You do not need to report the assault to the police to have a medical exam or have evidence collected, nor will you have to pay for the exam. SANEs can describe non-report and anonymous evidence kit options if you are unsure you want to report to law enforcement at the time of the exam, but still want evidence collected.

All emergency rooms are required by law to have nurses trained in basic evidence collection following sexual assault. Some hospitals have SANEs, who are nurses with additional extensive education to provide patient-centered, trauma-informed care following sexual assault. Many SANEs are also educated in providing care for patients experiencing domestic violence. Learn which hospitals in your community have SANEs on staff. Nurses trained in trauma-informed care take particular effort to work gently and slowly with their patients to help them feel comfortable. They also try to give the patient as much control as possible during the appointment to help them regain feelings of bodily autonomy. However, if the hospital does not have a SANE, you can ask to be transferred to a hospital that has SANEs. You also have the right to have a trained sexual assault advocate from a local sexual assault resource center support you through the medical visit. 

Seeking help

Most people do not seek mental health services following a sexual assault. Downing strongly encourages everyone to seek help whether or not they report the assault to law enforcement or believe they will develop PTSD. After a sexual trauma, people have a natural tendency to try to ignore what happened and move on with their lives, but seeking help can potentially reduce long-term impacts. She suggests speaking with a local sexual assault resource center, general care practitioner or any mental health practitioners trained in trauma.

If you or anyone you know experienced sexual trauma, contact your local health care provider or the Rape, Abuse and Incest National Network (RAINN) for assistance.