PTSD is common for survivors of sexual assault. A study by Emily Dworkin and colleagues found 75% of victims experience PTSD symptoms one month after the event, 54% experience symptoms 3 months after, and 41% experience symptoms 12 months after the event. 36% of survivors experience lifetime PTSD. As such, for many people sexual assault can result in a disorder of nonrecovery.
Severity of symptoms for survivors who are diagnosed with PTSD is 52% one week after the event, 48% one month after, 41% two months after, 35% three months after, and 30% 12 months after the event.
The greatest amount of recovery from PTSD symptoms happens in the first three months after the event, at which point about half of all survivors still suffer from PTSD. In other words, about a third of all survivors shed their noticeable post traumatic symptoms after three months. Over the next nine months, symptoms can remain high, or reduce slowly but usually not dramatically. Thus, the first three months may be a critical time period for acknowledging the event and addressing treatment. Extending some form of therapy, whether formal or through self-help, is likely important in at least half the cases.
Post Traumatic Stress Syndrome is characterized by reexperiencing or reliving the event, avoidance behavior, negative changes to thoughts and emotions and hyperarousal, according to the DSM 5.
This study was the first to summarize the unique course of PTSD recovery among sexual assault survivors.
CSI’s take: Find a safe base and understand the attachment response
Trauma expert Bessel van der Kolk advises people who experience trauma to find safety with loved ones at home.
Research on child soldiers, children who were abducted and forced into military servitude (usually by warlords), show that recovery happened best when they were able to return home and to a loving and accepting environment. In those cases most children don’t experience PTSD. For returning children who are blamed, rejected, shunned and treated with disregard or contempt, PTSD is the norm.
A loving, gentle, understanding and nonjudgmental protector are elements of what attachment science teaches is optimal for romantic relationships and parent-child relationships (at any age). The attachment system is designed to teach children how to handle danger, and the self-protective patterns they develop tend to carry into adulthood. The attachment experience shapes how we perceive, respond to, and communicate about danger. For most people, danger is managed in part by defensively excluding unwanted information. The way information is excluded varies by a person’s pattern of self-protective attachment strategies.
Some attachment responses are to ignore dangerous experiences, avoid talking about them, blame oneself, and minimize negative affect. Excessive positive affect can hide negative experiences, but not resolve them. (The case of Victoria Climbié, physical not sexual assault, is an example.) False positive affect, exhibiting positiveness while experiencing pain, is an extreme form.
One approach implied by this attachment response may be to gently help people see that they are hiding their hurt which is causing them to avoid addressing the problem.
Another and opposite pattern of attachment responses are to increase aggression, talk about it but never resolve the problem, blame anyone and everyone, and exaggerate negative affect. (Affect is the intensity of emotion and/or the expression of emotions.)
An approach implied by pattern of self-protective strategies may be to help them focus their anger to the specific problem, or thing they are defensively excluding. Also, it may help them to focus on the true affect rather than the exaggerated affect.
Psychological follow-up questions from the study
Dworkin and her colleagues raise many questions. Do negative and unhelpful beliefs often formed after a traumatic event prevent or hinder a natural resolution of PTSD symptoms? Do commonly held societal myths about sexual assault hinder contribute to negative beliefs and also hinder recovery? Survivors often receive negative reactions when they disclose their experiences, and do these contribute to greater PTSD severity? Sexual assault tends to produce emotional reactions, such as anger, guilt and shame, so do these interfere with or inhibit other emotions which may help recovery. Their study didn’t contain sufficient data to identify what things might help with recovery, other than age. Younger people had more difficulty coping with sexual assault and took longer to recover.
DMM-attachment follow-up questions
When a DMM-attachment system perspective is added, other questions may appear.
- Shame is a sensitive emotion for some attachment patterns, but not for others. Oppositely, humiliation is a sensitive emotion for some, but not for others. For people sensitive to shame or humiliation:
- How does that impact their willingness to disclose sexual assault?
- How does it impact them if they disclose to someone who reacts not just negatively, but with shaming or humiliating comments?
- How can a professional adjust their approach to the survivor’s individual attachment-based needs?
- Does shame or humiliation make it harder for them access treatment?
- Avoiding negative affect (feelings) and self-blame are a major driving forces in some attachment patterns. Does this affect the choice for accessing treatment? If so, how can avoidance of negative affect be handled by professionals at all levels?
- Responsibility avoidance is a major driving force in some attachment patterns. Can this relate to experiencing subsequent traumas and thus to lifetime PTSD symptoms?
- A preference for conflict and unresolvable struggle is a driving force in some attachment patterns. How might this impact treatment?
- In many attachment patterns, achieving a coherent, comprehensive, correct, and relevant narrative about an experience can be difficult to achieve. A primary tenet of attachment theory and science is the defensive exclusion of information. How might this impact issues about acknowledging the experience, working through the grief process, accessing treatment, and the type of treatment?
- When a survivor doesn’t have a safe base to come home to, what can they do? How can professionals offer a safe base (or, be a transitional attachment figure)?
Study
Dworkin, Emily R., Anna E. Jaffe, Michele Bedard-Gilligan, and Skye Fitzpatrick. PTSD in the Year Following Sexual Assault: A Meta-Analysis of Prospective Studies. Trauma, Violence, & Abuse, (July 2021). https://doi.org/10.1177/15248380211032213.
Sage publishing: https://journals.sagepub.com/doi/abs/10.1177/15248380211032213
Abstract
Objective:
Sexual assault is associated with higher rates of posttraumatic stress disorder (PTSD) than other traumas, and the course of PTSD may differ by trauma type. However, the course of PTSD after sexual assault has not been summarized. The aim of this meta-analysis was to identify the prevalence and severity of PTSD and changes to the average rate of recovery in the 12 months following sexual assault.
Method:
Authors searched four databases for prospective studies published before April 2020 and sought relevant unpublished data. Eligible studies assessed PTSD in at least 10 survivors of sexual assault in at least two time points, starting within 3 months postassault. Random effects linear-linear piecewise models were used to identify changes in average recovery rate and produce model-implied estimates of monthly point prevalence and mean symptom severity.
Results:
Meta-analysis of 22 unique samples (N = 2,106) indicated that 74.58% (95% confidence interval [CI]: [67.21, 81.29]) and 41.49% (95% CI: [32.36, 50.92]) of individuals met diagnostic criteria for PTSD at the first and 12th month following sexual assault, respectively. PTSD symptom severity was 47.94% (95% CI: [41.27, 54.61]) and 29.91% (95% CI: [23.10, 36.73]) of scales’ maximum severity at the first and 12th month following sexual assault, respectively. Most symptom recovery occurred within the first 3 months following sexual assault, after which point the average rate of recovery slowed.
Conclusions:
Findings indicate that PTSD is common and severe following sexual assault, and the first 3 months postassault may be a critical period for natural recovery.