Posttraumatic Stress Disorder: Rape Trauma

Posttraumatic Stress Disorder: Rape Trauma

By: Tiyah Roan

Esto es un párrafo listo para contener creatividad, experiencias e historias geniales.

Jocelyn Rowley

20 year old, Female

Jocelyn was a Sophomore at Midwestern University, where she was a good student up until she started experiencing problems with the following:

• Grades
• Studying
• No interest in her current friends or boyfriend
• Afraid of being alone
• Going to Sleep
• Nightmares

These symptoms made her want to see a therapist for the first time.

The Impact

Jocelyn had nightmares almost every night about unfamiliar men in dark clothing trying to harm her. This impacted her sleep schedule, because she was trying to stay awake to avoid the nightmares. During the day, she was extremely startled if someone walked up behind her and tapped her unexpectedly on the shoulder. Her reactions seemed extreme to her friends and they became offended. Anytime she was studying, especially if she was reading her English textbook, images of physical brutality would intrude on her thoughts and distract her. Overall, this impacted her ability to complete schoolwork and she had a great deal of difficulty concentrating.

First few therapy sessions:

The psychologist wanted to look for a specific stressful event that might have caused her symptoms. The symptoms had such a rapid onset, so she asked a number of questions about Jocelyn’s life just prior to entering therapy. Jocelyn reported that she had begun to feel more and more dissociated from herself. “She would catch a glimpse of herself in the mirror and think, “Is that me?” She would walk around in the winter weather with no gloves on and be relieved when her hands hurt from the cold, because “at least it’s an indication that I’m alive.”

After several sessions:

• Jocelyn mentioned she had been raped by the teaching assistant in her English literature course. This occurred 2 months before she entered therapy. Jocelyn stated, “Oh, well, that’s already taken care of. It didn’t really affect me much at all,” when she realized the therapist was interested in what happened. The therapist had to explain that serious trauma such as rape is not resolved quickly and rarely resolved by itself.

• Her therapist strongly advised her to contact the police, when she realized Jocelyn never reported the rape. Jocelyn refused, citing a number of reasons, ranging from feeling that no one would believe her (especially 2 months after the incident) to the fear of facing cross- examination and further humiliation.

*The therapist could not report the rape without Jocelyn’s consent, because the information she had obtained from Jocelyn was protected by confidentiality. (the ethical obligation not to reveal private communications, in this case, between psychologist and client). Rare exceptions to this ethical principle include:

• State laws require mental-health professionals to break confidentiality and report cases of child abuse.
• Psychologists are also required to report clients who are imminently dangerous to themselves or others.

*Over the next few sessions, Jocelyn gradually revealed the story of what happened to her.

The Teaching Assistant

*Trigger Warning

Jocelyn’s T.A for English had invited her to his house one night so that he could tutor her when she needed help writing an English paper. There were several male graduate students he shared a house with there when she arrived. Upon arrival he was busy working, then left her alone in his room to study her English textbook. When he returned, he approached her from behind while she was reading and grabbed her. He forced her onto his bed and then he raped her. Jocelyn was so terrified and stunned at what was happening to her that she said she had not struggled or fought physically back. However she did remember verbally, saying, “No!” and, “Don’t do this to me!” several times, but he ignored her earnest objections. She was afraid to yell louder, because she was the only female in the house and she didn’t know if they would help her or not. After he raped her, he proceeded to walk Jocelyn back to her dorm and warned her not to tell anyone. She agreed at the time, thinking that she would be able to erase the event and prevent it from having a negative effect on her life. Jocelyn just went to her dorm room, took an hour-long hot shower, in hopes of trying to scrub away the effects of what happened to her. While describing these events to the therapist, Jocelyn shook and her voice was breathy. She kept saying, “You believe me, don’t you?”

After that Night

Jocelyn believed at first she was able to keep it from affecting her life, but she couldn’t stop thinking about it. She started to feel guilt and stupid for even going to her teacher assistants house and that she had not anticipated him raping her. She wondered if there was anything she did that contributed to him doing this to her and was ashamed that she was not strong enough to have prevented the rape or its negative consequences. She asked herself: Had she dressed in some way or said something that indicated a sexual invitation to him? The only impact she initially believed the rape had on her was that she no longer attended discussion sections for her English course. Unfortunately, several other problems soon became evident as mentioned in previous slides. There was no further contact with her T.A., unless she saw him on campus. She would duck into a doorway to avoid him and she began to withdraw from relationships. This especially occurred with her boyfriend and in response he would try pressuring her sexually. However, she repeatedly rejected his physical advances and no longer had any interest in sex. The problems she was experiencing caused her to believe that she was losing control of her feelings, and she decided to seek professional help.

Interpersonal Relationship Problems

Jocelyn and her boyfriend had argued frequently in recent weeks of talking with her therapist. She expressed to the therapist that, “I just get so angry at him,” and she wasn't able to identify any specific problems in their relationship.

Her boyfriend complained that she was not emotionally invested in the relationship and accused her of cheating. She denied the accusations and felt abandoned, because she knew the way she was acting caused him to distance himself. She realized these problems were understandably causing her boyfriend to distance himself from her. Unfortunately, his reaction made Jocelyn feel abandoned.

Jocelyn was unsure if she could feel safe with anyone. She was afraid to walk alone to the library at night, but wouldn’t ask anyone to walk with her. Her academic problems intensified due to this fear, because it impacted her ability to study.

Jocelyn’s roommates noticed that she cried frequently and at unexpected times.They then started complaining that she was unusually sensitive to their teasing.

Social HIstory

Jocelyn was the oldest of three and grew up in a small midwestern town 100 miles away from the university.

Both of her parents were involved in the community and Jocelyn and her siblings' schools. They were successful in their professional occupations.

Jocelyn was mostly an A student, attended public schools and involved in several extracurricular activities. In high school, she was shy and considered “nerdy." This caused her to have some trouble making friends. When she went to college she was able to form a relatively large peer group.

Jocelyn’s parents were strict about dating and curfews. She had not been interested in attending large parties or drinking when she was in high school. However, her Junior and Senior year she did have a boyfriend. They started dating when they were both 16 years old and became sexually involved the next year. However, their relationship ended when they left their hometown to attend different colleges.

Jocelyn recalled that her high school boyfriend occasionally pressured her into having sex when she was not interested or thought it was too risky.

Continued...

• Although, to her therapist she denied having previously been a victim of sexual assault, except one incident she described did sound abusive according to the therapist.
• At the age of 13, Jocelyn went to a summer music camp to play the trombone, which is not usually played by a female.
• One day after rehearsal, the boys in her section ganged up on Jocelyn, teasing her that “girls can’t play trombones!” One of the boys began wrestling with her and placed a finger inside her shorts into her vagina. Jocelyn just remembered yelling at him, then he let her go, and all the boys ran away. Until she was raped, she had never viewed that event as being assaultive.

Conceptualization and Treatment

As Jocelyn began to work through her anxiety symptoms, other people’s reactions to the account of her rape caused her to have additional problems. These difficulties kept the focus of treatment away from her primary anxiety symptoms. After Jocelyn told her psychologist that she had been raped, she began to tell others in her life, including her boyfriend and her roommates.

How will they respond?

Boyfriends Response

Roommates Response

Jocelyn’s boyfriend had a self-centered and unfortunate reaction to what happened to her and their relationship ended quickly. In order to cope with his feelings, he confided in mutual friends of Jocelyn even after she asked him not to talk about the attack with anyone she knew.. Jocelyn felt like she had no control over her life due to her inability to stop the spread of gossip about her assault. She proceeded to still see her ex until they had a series of heated exchanges about a specific event. He grabbed Jocelyn from behind playfully, and he tightened his grip when she screamed and jumped in fright. This situation would normally seem trivial, but she felt triggered and like she couldn’t escape. After continued arguments about the incident, they decided not to see each other anymore.

“I never would have gone to a T.A.’s house,” or, “You’ve slept with more people than me; he must have sensed that,” or, “You didn’t look beat up; you must not have fought back hard enough.” They were frightened by what happened to her and tried to separate themselves from the possibility that it could happen to them. Her roommates accused her of lying or by pointing out any difference between them. Jocelyn’s lack of meaningful support from her friends caused her to withdraw more. Her anxiety increased and she became depressed.

Jocelyn eventually decided to tell her English professor that she had been sexually assaulted by her T.A.. She was outraged and recommended that she report the assault to the campus office. Jocely refused, because she wasn't ready to press legal charges or be in the same room as him ever again. Her professor assigned her a new T.A. so she could continue to go to discussions and asked if she would be ok with her reporting it to the dean and campus police. Jocelyn reluctantly agreed, if her professor promised to omit her name in any conversations.

Treatment

• Jocelyn's therapist allowed her to express her considerable anger and frustration about her situation and that she felt it was unfair.

-She had to deal with her fear of walking alone after dark, and trying to find someone to walk with her. Jocelyn felt it was ironic she wanted a friend to protect her from the violence of strangers, but someone she knew raped her. - In addition to her feelings of guilt, she felt guilty about the effect of her situation on her boyfriend and roommates. Was she responsible for making them fearful and resentful?

• In a session, the therapist pointed out that the intrusive images that Jocelyn was experiencing while reading her English textbook, could occur because she had been reading that textbook when her attacker grabbed her from behind. Jocelyn remained frustrated and depressed, but felt relieved that she wasn’t going crazy.
• Her nightmares had become increasingly severe and more related to her sexual assault. The dream started with Jocelyn in a crowded parking lot. A shadowy male in dark clothing would approach her and attack her after he told her he wanted to rape her. She remembered her limbs felt as if they were in thick glue and her struggles were ineffective after trying to fight off the attack. The other people in the parking lot stood watching, clapping and cheering for her assailant. Jocelyn would wake up in the middle of the room, crouched as if awaiting attack. These experiences terrified Jocelyn and her roommates.

Continued...

The therapist’s took on a cognitive-behavioral intervention focus for a treatment strategy with two main parts.

• The first part addressed the cognitive processes that prolong a maladaptive view of traumatic events, which begun as soon as Jocelyn entered therapy. This can include self-monitoring of activities, graded task assignments (such as going out alone), and modification of maladaptive thoughts regarding the event (such as guilt and self-blame).
• Prolonged exposure was the second part where the victim reexperiences the original trauma in a safe situation to slowly decrease the emotional intensity associated with memory of the event. In the therapy, Jocelyn was asked to relive the rape scene in her imagination. She was able to describe it aloud in the present tense. The therapist helped her repeat this sequence many times during each session. The sessions were recorded on audiotape, and the therapist required Jocelyn to listen to the tape at least once every day.

Continued...

• A sign of improvement came when Jocelyn was able to resume her studies. If she had failed it would be a sign for Jocelyn that the sexual assault permanently affected her life, and she struggled with not letting this happen. After 16 sessions (twice weekly for 8 weeks) therapy was terminated due to Jocelyn going home for the summer. The semester ended with her passing three of her four classes, including English. Jocelyn was encouraged to see a therapist in the summer, because she still suffered from occasional nightmares and other symptoms, but she was not ready to reveal to her parents what happened.
• The therapist called her once she returned to spring and Jocelyn ended up telling her parents about the sexual assault. She received more support than expected and continued her therapy with a new therapist. Jocelyn’s symptoms slowly diminished over time but she would have nightmares on rare occasions triggered by specific events. She no longer wanted to attend the university’s counseling service and wanted to concentrate on her studies.

10 years later

• Jocelyn completed college and then earned her master’s degree in library science. She enjoyed being a librarian at a small college in her hometown.
• Socially she experienced residual symptoms of posttraumatic stress disorder (PTSD) intermittently for several years. Her symptoms were not sufficiently frequent or severe, so she no longer met the formal diagnostic criteria for PTSD.
• Jocelyn still suffered from occasional nightmares depending on what she watched, so she tried to avoid movies or TV shows with sexual violence. This could be interpreted as avoiding stimuli associated with her rape trauma, which is a symptom of PTSD. This avoidance was also Jocelyn’s conscious decision not to support the segment of the entertainment industry that profits from depicting such scenes.
• Other examples of lingering mild PTSD symptoms that occasionally interfered with her career included hypervigilance and increased startle response. to situations that might present a threat to her own safety.
• The residual effects of the rape trauma could also be seen in the way that Jocelyn struggled to control her temper, which had become volatile and inappropriate when provoked. When provoked, the intensity of her subjective response was often out of proportion to the situation. This caused her to become unnecessarily timid about stating her opinions.

• Jocelyn’s relationships with men were also affected especially in her early 20s. She avoided intimate contact with men entirely and rejected any attempts. Her family and friends thought that her surviving the rape had “turned her into a lesbian” because of her lack of interest in men. This caused her to join a women’s poetry cooperative and a women’s music group of all sexual orientations. She found this community to be warm and supportive.
• When she decided to date again but avoided emotional intimacy. She pursued men who were inappropriate for her (such as someone who lived a thousand miles away, or someone who was already married).
• Jocelyn recognized her ongoing difficulties and went back to therapy with a local psychologist. At the time she had a new boyfriend where she felt something special and she wanted to work on issues involving intimacy, trust, and sexuality to progress their relationship.

• During this therapy, Jocelyn acknowledged that she had difficulty learning to trust him and needed gentle touch when engaging sexually. She would have irrational thoughts and abruptly interrupt sexual contact with her boyfriend. Her relationship was strained and he was confused. Jocelyn’s therapist utilized cognitive therapy to address these problems and try to eliminate the systematic biases in thinking that were responsible for Jocelyn’s maladaptive feelings and behavior.

Therapy

Her therapist utilized several strategies to treat Jocelyn’s distorted patterns of thinking and her biased conclusions as being testable hypotheses.

“Her distorted thoughts were either decatastrophized (developing what-if strategies to deal with feared consequences), reattributed (considering alternative causes of events), or redefined (changing the perspective of the problem so that the person feels some control over it). “

Therapy also included some elements of anger-management training (Novaco & Taylor, 2006). The therapist also helped her to rehearse assertive communication skills allowing Jocelyn to express herself clearly in situations that had previously led to the suppression of her true feelings or withdrawal.Jocelyn was able to improve her communication skills with others, have a more stable mood, develop a deeper, more meaningful relationship with her boyfriend and feel better about herself.

Shortly after therapy was completed, they got married!

DSM-Criteria

One frequent outcome of rape is posttraumatic stress disorder (PTSD). PTSD is included in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR; APA, 2000, pp. 467–468) under the general heading of Anxiety Disorders. PTSD is defined by the following criteria: 1. The person has been exposed to a traumatic event in which both of the following were present:

• The person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others.
• The person’s response involved intense fear, helplessness, or horror.

2.The traumatic event is persistently reexperienced in one (or more) of the following ways:

• Recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions
• Recurrent distressing dreams of the event
• Acting or feeling as if the traumatic event were recurring
• Intense psychological distress at exposure to cues that symbolize or resemble an aspect of the traumatic event
• Physiological reactivity on exposure to cues that symbolize or resemble an aspect of the traumatic event

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DSM-Criteria

3. Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by three (or more) of the following:

• Efforts to avoid thoughts, feelings, or conversation associated with the trauma
• Efforts to avoid activities, places, or people that arouse recollections of the trauma
• Inability to recall an important aspect of the trauma
• Markedly diminished interest or participation in significant activities
• Feeling of detachment or estrangement from others
• Restricted range of affect (such as being unable to have loving feelings)
• Sense of a foreshortened future (e.g., does not expect to have a career, marriage, children, or a normal life span)

4. Persistent symptoms of increased arousal (not present before the trauma), as indicated by two (or more) of the following:

• Difficulty falling asleep or staying asleep
• Irritability or outbursts of anger
• Difficulty concentrating
• Hypervigilance
• Exaggerated startle response

5. Duration of the disturbance is more than 1 month. 6. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

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Etiological Considerations

• Not all victims of trauma develop PTSD.

What determines whether or not a victim will develop PTSD following a traumatic event?

• There do not appear to be systematic differences in terms of demographic characteristics such as race, employment, education, and income. However, a common line of investigation is whether or not rape vic- tims who developed PTSD had a different pattern of adjustment that may have contributed to developing PTSD or premorbid personality characteristics
• There is some evidence suggests a relationship between depression prior to the crime, the level of stress associated with the crime (e.g., an attack with life threat, actual injury, or completed rape), and the probability of developing PTSD.
• Cognitive factors may also influence whether a rape victim will develop PTSD. A perceived life threat may be the best predictor of whether a person will develop PTSD (Basoglu & Paker, 1995). It is important to consider the person’s beliefs about how they can control future events. This indicator is important when viewed in light of the fact that many women who have been raped report that they expect to be rap
• Victims who suppress their feelings of anger may have an increased risk of developing PTSD after a rape (Foa & Riggs, 1995). Jocelyn’s ongoing problems with the experience of anger may have helped to prolong her other symptoms of PTSD, such as nightmares and hyperarousal.

Etiological Considerations

• Protective factors such as the person’s level of social support may help prevent or limit the development of PTSD and other psychological consequences of rape (Andrews, Brewin, & Rose, 2003; Keane, Fisher, Krinsley, & Niles, 1994). Having a social support network may not be enough, because withdrawal and avoidance is an inherent part of the disorder.
• Attitudes that society holds toward victims of sexual assault are also important in relation to social support (Ullman & Filipas, 2001). Myths about rape may decrease the amount of social support received by victims of these crimes.
• Jocelyn’s case also highlights another frequent consequence of rape trauma. Many victims develop sexual dysfunctions. Sexual difficulties may be an important consideration in planning treatment for some victims of sexual trauma.

Just the beginning

The most effective forms of treatment for PTSD involve the use of either cognitive-behavior therapy or antidepressant medication, alone or in combination (Foa, Keane, Friedman, & Cohen, 2009; Forbes et al., 2010) Jocelyn’s PTSD symptoms persisted for several years and she occasionally mourns the loss of her 20s. Despite the negative impacts of her sexual assault, Jocelyn was able to finish school, become close with her friends and family, have a successful career, and meet her lifelong partner.

Discussion

1. Discuss the issues surrounding Jocelyn’s reluctance to report her rape. Should her therapist have reported it to the police without her patient’s consent? Was there a better way for the English professor to handle the situation? 2. How did Jocelyn’s friends respond to her problems? Did they help the situation or make it worse? Is there anything that they could have done that would have been more beneficial to her?

Esto es un párrafo listo para contener creatividad, experiencias e historias geniales.

Thanks for listening!

Esto es un párrafo listo para contener creatividad, experiencias e historias geniales.

References

• Oltmanns T. F. (2012). Case studies in Abnormal Psychology, 9th Edition. Hoboken, NJ: John Wiley and Sons

• YouTube. (2019). YouTube. Retrieved February 11, 2023, from https://www.youtube.com/watch?v=osPSueUoqbw.