Trauma From Sexual Violence And Coping PDF

Trauma from Sexual Violence and Coping Irfan Fayaz, Ph.D. Assistant Professor (Psychology) Jindal Institute of Behavioural Sciences  Some Major Topics to be covered….. 1. Introduction to Trauma and Sexual Violence 2. Psychological and Emotional Outcomes of Sexua...

Trauma from Sexual Violence and Coping Irfan Fayaz, Ph.D. Assistant Professor (Psychology) Jindal Institute of Behavioural Sciences  Some Major Topics to be covered….. 1. Introduction to Trauma and Sexual Violence 2. Psychological and Emotional Outcomes of Sexual Assaults 3. Societal Implications and Stigma 4. Posttraumatic Growth and Personal Transformation 5. Therapeutic Interventions and Community Resources 6. Legalities in Sexual Violence 7. Ethical Dilemmas in Research with Sexual Violence Survivors  Assessment Percentage breakdown of Grade: 1. 70% Internal Exam (Divided into 3-4 components) 15% for Presentations 20% Quiz 20% for Mid-term 10% for Class Participation. 5% Attendance ( 100-95=5); (90-94=4); (89-85=3); (84-80=2); (79-75=1) 30% End Semester Exam (Closed book and timed)  Disclaimer Please be advised: The following discussion includes sensitive content related to sexual violence Some wounds never show on the body that are deeper and more hurtful than anything that bleeds. (― Laurell K. Hamilton,)  Gender Gender “refers to the socially constructed roles and relationships, personality traits, attitudes, behaviors, values, relative power and influence that society ascribes to people based on their assigned sex. Gender is relational and refers not simply to women, men, or other gender groups, but to their relationship. Although notions of gender are deeply rooted in every culture, they are also changeable over time and have wide variations both within and between cultures” (International Organization for Migration ; 2015). Gender has 4 characteristics: 1. A social construct – Assigns the position of men and women in society 2. Asymmetrical – The assigned roles for women and men are not valued in the same way 3. Evolves in time, space, cultures,… 4. Institutionalized: not only within the family sphere, also society and political level.  GENDER VS. SEX Sex refers to the biological and physiological characteristics of males and females, such as reproductive organs, chromosomes, hormones, etc. Essentially, when we use the term sex, what we are commenting on is “male” vs. “female”. Sometimes, a person's genetically assigned sex does not line up with their gender identity. These individuals might refer to themselves as transgender, non-binary, or gender- nonconforming. Gender determines the roles, responsibilities, privileges, expectations and limitations of males and females in each culture. These perceptions and beliefs are influenced by social factors, such as history, tradition, religion and social norms. Gender applies to both males and females and is a neutral term, neither right nor wrong. WHAT ARE THE CRITERIA FOR HEALTHY CONSENT? 1. Mutual consent: explicit and informed consent, meaning both parties experience pleasure. 2. The notion of freedom implies the absence of any constraints. 3. Equality: the partners are equals and no major social distances exist between them. 4. Adequate age and development. 5. Adequate context. Based on self-respect. Adversity  Adversity Exposure  The “American Psychiatric Association” (APA) 2013, p. 271, defined exposure to adversity as “Exposure to actual or threatened situations that involve the risk of death, serious injury, or sexual violence”.  There is a high prevalence of adverse event exposure in the general population and according to Kilpatrick et al. (2013), it's estimated that a large majority of people, about 89.7%, experience adversity. However, only a relatively small fraction, around 8.3%, may have difficulty recovering from these experiences independently.  Unfavorable experiences may alter a person's perception of the world and oneself (Janoff-Bulman, 2010).  The existing literature provides different descriptions of an "adverse event". Adverse events are sudden, frequently unexpected occurrences that go beyond a person's ability to respond to the requirements of the incidents and interfere with other psychological requirements (Dunn et al., 2018; De Vries et al., 2008).  Adversity Exposure  Exposure to adverse events can comprise direct exposure to or being present when an accident, a “natural disaster, a physical or sexual assault, a war zone, conflict, or violence occurs”, as well as threats that have caused a family member or close friend to pass away or suffer serious harm (Mancini, 2019; Hostinar et al., 2023).  “The International Classification of Diseases” (ICD-11) tenth edition, in contrast, takes a different way in defining exposure to adversity, stating that "any events that results in widespread distress to practically anybody" (“World Health Organisation”, 2010, F43.1).  Acute and Chronic Adversity Definition: Acute adversity refers to intense, short-term events or experiences that cause significant distress or disruption. These events are typically unexpected and can have immediate, severe impacts on an individual’s mental, emotional, and physical well-being (Van Breda, 2018). Examples: Interpersonal violence: Experiences of abuse or assault, whether physical, emotional, or sexual. Accidents: Sudden incidents such as car crashes, falls, or other traumatic events that result in injury or shock. Natural disasters: Catastrophic events like earthquakes, floods, or hurricanes that cause widespread damage and disruption.  Acute and Chronic Adversity Definition: Chronic adversity encompasses ongoing, long-term conditions or situations that persist over an extended period. These adversities may not be as immediately intense as acute events but can lead to cumulative stress and long-term adverse effects on an individual’s health and well-being. Examples: Poverty: Persistent financial instability and lack of resources, leading to a continuous struggle to meet basic needs. Discrimination: Ongoing experiences of unfair treatment based on race, gender, sexual orientation, or other characteristics, leading to sustained psychological and social stress. Chronic illness: Long-term health conditions requiring ongoing management can lead to continuous physical and emotional strain.  Types of Adversities Violence and Abuse: Such as physical assault, sexual assault, domestic violence, childhood abuse, and neglect. Natural Disasters: Such as earthquakes, hurricanes, floods, and wildfires. Accidents and Injuries: Such as car accidents, severe injuries, or medical emergencies. Combat and War: Military combat, exposure to warfare, and other forms of violence in conflict zones. Loss and Bereavement: Sudden or unexpected death of a loved one, grief, and loss. Witnessing Traumatic Events: Being present during or witnessing accidents, violence, or disasters.  Sexual Violence as an Adversity Sexual violence is defined as any sexual act perpetrated against someone’s will (Leeb et al., 2008) and is a significant public health concern, partly due to the detrimental physical and psychological consequences victims of such violence typically experience.  Any sexual act that is carried out without a person’s consent. Sexual violence refers to any sexual act, attempt to obtain a sexual act, or other act directed against a person's sexuality using coercion, threats, physical force, manipulation, deception, or abuse of power.  It encompasses various behaviors and actions that violate an individual's bodily integrity, autonomy, and sexual rights. Sexual violence can occur in various contexts, including but not limited to interpersonal relationships, institutions, communities, and armed conflict. Session 2  Disclaimer Please be advised: The following discussion includes sensitive content related to sexual violence  SEXUAL AND GENDER- BASED VIOLENCE (SGBV) Sexual and gender-based violence (SGBV) is a human rights violation and refers to any act perpetrated against a people's will based on gender norms and unequal power relationships. SGBV can be physical, psychological, social, and economic. It includes intimate partner violence, sexual harassment and violence, harmful practices, sexual exploitation, and trafficking of human beings. Men and women, girls. LGBTQ+ and boys of any sexual orientation or gender identity, maybe the victim of such violence. Gender-based violence can occur in any context and affects both men and women of all ages. CONTRIBUTING FACTORS? RAPE CULTURE: The social context, which is characterized by colonial representations and the development of a pornographic culture that promotes mechanisms of dominance and submission, mainly affects young girls. SEXUALISATION: “Is to make a behavior or product sexual in nature or quality, even though it is neither.” A sexualized society consequently is a society “in which sexualization invades every aspect of our daily life and references to sexuality are omnipresent in public space: on TV, on the radio, online, in courses, in the objects we buy, the attitudes and behaviors of our peers, and so on”  SEXUAL VIOLENCE: IN WHICH CONTEXTS? SEXUAL VIOLENCE CAN TAKE ON VARIOUS FORMS: Interpersonal in the case of incest, sexual harassment, rape Collective in conflict and post-conflict situations, female genital mutilation (FGM), forced and early marriages, honor-related violence, or prostitution. IT CAN OCCUR IN DIFFERENT SITUATIONS in the private space in public spaces in daily life during the migration journey during armed conflicts, wars and post-conflict situations.  IT CAN OCCUR AT EVERY STAGE ON ONE’S LIFE: early childhood (sexual abuse, incest, rape...) childhood, 6-10 years (incest, child prostitution, rape...) adolescence (sexual harassment, forced marriage, prostitution, rape...) reproductive age (rape (within a marriage), honour-related crime, rape...) elderly women (forced marriage of a widow, rape...).  incest in childhood other people in sexual situations or, more generally, from watching other sexual mutilation people's private lives) sexual intimation obscene calls sexual harassment at work or on online grooming and exploitation the street for pornographic purposes HOW IS SEXUAL rape prostitution VIOLENCE EXPRESSED? sexual assault by one’s partner inappropriate touching SEXUAL VIOLENCE CAN Exhibitionism (Exhibitionism is getting sexual gratification from TAKE ON VARIOUS showing one's genitals or private FORMS, INCLUDING: areas to others. People who participate in exhibitionism enjoy being seen or fantasize about being sexually seen by others) Voyeurism (the activity of getting  Global Prevalence Prevalence According to the World Health Organization and (WHO), globally, about 1 in 3 women have experienced physical and/or sexual violence in Statistics of their lifetime, often by an intimate partner. Sexual Estimates suggest that approximately 15 million Violence adolescent girls aged 15 to 19 worldwide have experienced forced sex at some point in their lives.  Western Countries: United States, the Centers for Disease Control and Prevention (CDC) reports that nearly 1 in 5 women and 1 in 38 men have experienced completed or attempted rape during their lifetime. Canada Statistics Canada's General Social Survey on Victimization indicates that about 1 in 3 women and 1 in 8 men have experienced sexual assault since the age of 15. United Kingdom, the Crime Survey for England and Wales reveals that approximately 20% of women and 4% of men have experienced some form of sexual assault since the age of 16.  Indian Statistics:  In India, sexual violence against women and girls is a significant concern, with high-profile cases sparking national and international attention to the issue.  According to the National Crime Records Bureau (NCRB) of India, crimes against women, including rape and sexual assault, have been increasing in recent years.  However, underreporting remains a significant challenge.  The NCRB's latest available data indicates that in 2019, there were over 32,000 reported cases of rape in India. However, experts believe that the actual number of cases is much higher due to underreporting and social stigma.  In 2007, Ministry of Women and Child Welfare, supported by United Nations Children's Fund, save the children and Prayas conducted a study to understand the magnitude of child abuse in India, they found that 53.22% children faced one or more forms of sexual abuse; among them, the number of boys abused was 52.94% Child Sexual Abuse Child sexual abuse is the 5. sexual or digital (with fingers) involvement of a child in sexual penetration activity that he or she does not 6. pornography (forcing the child to fully comprehend, is unable to give view or use of the child in) informed consent to, or for which the child is not developmentally 7. child prostitution prepared, or else that violates the 8. exposure or “flashing” of body laws or social taboos of society parts to the child (Australian Psychological Society). 9. voyeurism (ogling of the child’s 1. sexual kissing body) 2. inappropriate touching or fondling 10. verbal pressure for sex of the child’s genitals, breasts, or buttocks 3. masturbation 4. oral-genital contact  Child Sexual Abuse in India Child sexual abuse in India is a prevalent and devastating issue, with a shocking 28.9% of children experiencing some form of sexual crime, and a devastating 92,105 calls reporting abuse and violence against children during the pandemic-induced lockdown. According to the NCRB data from 2020, approximately 28.9% of the entire child population experienced some form of sexual crime, yet only 65.6% of these crimes were reported. In India, an alarming statistic reveals that one in every two children has endured sexual abuse before turning 18, predominantly at the hands of family members or individuals known to them. Tragically, this issue has escalated further during the pandemic-induced lockdown. In the initial 11 days of the lockdown, CHILDLINE, an organization dedicated to helping distressed children and supported by the Ministry for Women and Child Development, received a staggering 3.07 lakh calls Shockingly, out of these, 92,105 calls were distressing reports of abuse and violence against children. Notably, during this period, CHILDLINE observed a significant 50 percent surge in the number of calls seeking assistance.  Sexual Violence Male-female Comparison One in every two children interviewed (53.22%) reported being a victim of one or more forms of sexual abuse, including severe and other forms. More than half (52.94%) of those who reported abuse were girls, while 47.06% were boys. 20.90% of children reported being subject to severe forms of sexual abuse that included sexual assault, making the child fondle private parts, making the child exhibit private body parts, and being photographed in the nude. Of these, a majority (57.3%) were boys. Half (50.7%) of the children were subjected to other forms of sexual abuse that included forcible kissing, sexual advances made during travel and marriages, and exposure to pornographic materials. Once again, half the victims (53.07%) were boys. Of all the children reporting sexual assault (penetration of the anus, vagina or oral sex), 54.4% were boys.  Sexual Violence in India According to the National Crime Records Bureau (NCRB), 31,677 rape cases were registered in India in 2021, which is an average of 86 cases per day. This is a rise from 2020, when 28,046 cases were registered. According to the NCRB, 63% of the 31,878 rape victims in 2021 were between the ages of 18 and 30. According to the NFHS, 8.5% of women in India report being victims of sexual violence at least once in their lifetime. Child sexual abuse is also a prevalent issue in India, with 28.9% of children experiencing some form of sexual crime. According to Mint, sexual crimes against women have increased by 70% in the last two decades. In 2018, Odisha had 49.4 cases per 100,000 women and girls, while Bihar had 1.8 cases per 100,00  Marital Rape A Harsh Reality Behind Closed Doors Sleeping With the Enemy: Modern Views of Marital Rape  From Case Study Educational Insights Understanding Marital Rape: Definition: Marital rape is a serious crime where one spouse forces the other into non-consensual sexual activity. Prevalence: Despite being illegal in many countries, marital rape remains widespread and underreported. Consequences: Physical: Injuries, chronic health issues, and gynecological problems. Mental: Trauma, PTSD, depression, anxiety, and suicidal thoughts. Social: Isolation, low self-esteem, and impact on children. Legal and Social Interventions: Importance of Reporting: Encouraging victims to report incidents and seek help. Support Systems: The role of shelters, counseling, legal aid, and community support in aiding victims. Education and Awareness: Raising awareness about marital rape and advocating for stronger legal protections and societal change. Marital rape is a grave violation of human rights that inflicts severe physical, psychological, and social harm on victims. Marital rape is the act of sexual intercourse with one’s spouse without their consent. Historically and for centuries, sexual intercourse within a marriage was regarded the male’s spousal right with their wife who was perceived as a possession. Currently, marital rape is more widely seen as an act of sexual violence. Rape is a heinous act which is performed with a girl or a boy, but what if the husband rapes his wife? Who will protect her? Marriage is supposed to be a bond between two individuals who are in love and care for each other and respect each other and not think another person as an object. Yes, marital rape exists, and a lot of petitions have been submitted, but it is not criminalized in the Indian constitution. Marital Rape Statistics 1. Between 14% and 25% of women are sexually assaulted by intimate partners (spouse or boyfriend) during their relationship. 2. Between 10 and 14% of married women will experience rape by their intimate partner. 3. According to one study, rape by a marital partner has been four times more common than by rapes by strangers. 4. 18% (almost one in five) of female marital rape survivors reported that their children witnessed the assault. 5. Marital and intimate partner rapes are under-reported–only 36% of all rape victims ever report the crime to police, and the percentage of married women who report a spousal rape is even lower.  Why does it happen? 1. The answers to this question may vary, but one aspect always remains: Rape isn’t your fault. 2. There’s nothing you did or didn’t do that justifies or explains spousal rape or sexual assault. 3. It’s all on the perpetrator. 4. “Rape is about dominance and power over someone,” Charna Cassell, a sex and trauma therapist in California, says. “While seemingly sexual in nature, it’s not about sex, even inside a relationship or a marriage. Rather, it’s about a partner believing they have the right to sex.” What separates sexual violence from other types of violence? Sexual violence differs significantly from other forms of violence in that, unlike other forms of violence, the feelings of shame and embarrassment, as well as the perceived stigma associated with being a victim of sexual violence. Session 3  Disclaimer Please be advised: The following discussion includes sensitive content related to sexual violence Consequences of Sexual Violence Psychological, Social, & Physical Consequences of Sexual Violence Psychological Consequences Trauma  Psychological Trauma 1. The term trauma has a Greek connotation, which means wound; precisely, it means psychological hurt caused by emotional distress leading to repression of memories, which may lead to behavioral problems (Krupnik, 2019; Nijenhuis, 2015). 2. Trauma refers to wound, shock, or physical hurt or psychological hurt by an event or events that are outside of a person's sphere of influence or control because of disturbing events (Champine et al., 2019; APA, 2013) 3. Psychological trauma is the reaction to unusual or surprising stressful experiences that could destroy the fundamental beliefs about self and the world around, thus making the person defenseless and susceptible makes an individual susceptible to different health-related issues (Sherin & Nemeroff, 2022; Perrotta, 2019).  “Trauma shatters the basic assumptions of an individual" refers to the idea that traumatic experiences can profoundly disrupt a person’s fundamental beliefs about themselves, others, and the world. Basic Assumptions: These are the core beliefs or mental frameworks that people use to understand their world. They might include beliefs like: 1. The world is a safe and predictable place. 2. Good things happen to good people. 3. I am in control of my life. 4. Other people can be trusted. Shattering of Assumptions: When someone experiences trauma, such as violence, abuse, or a life-threatening event, these basic assumptions can be challenged or destroyed. For example: 1. A person who believes the world is safe may start seeing it as dangerous and unpredictable. 2. Someone who thought they were in control may feel helpless or vulnerable. 3. Trust in others might be severely damaged if the trauma involves betrayal.  Psychological Trauma  Most of the people who experience trauma find it difficult to lead an everyday life (Nijenhuis et al., 2011; Mundy et al., 2022). It has been a challenge for clinical and social researchers to define trauma; thus, there is a discussion about the categorization of trauma, its nature, severity, and the experiences of individuals regarding stressful experiences (Kanzler & Ogbeide, 2020; Perrotta, 2019).  APA has defined “trauma” in DSM (V) as “Witnessing or directly experiencing life-threatening events or their aftermath can lead to distress, trauma, and behavioral changes (p.463)”. Thus, distressing life encounters make people susceptible and create psychological trauma, which hampers the ability of a person to adjust to day-to-day life events, thus making them feel vulnerable (Conversano et al., 2020). Signs of Trauma  Bodily Reactions to Trauma Theory Related to Trauma  Shattered Assumptions Theory of Trauma The Shattered Assumption Theory, proposed by Janoff-Bulman in 1989, is a framework used to understand the psychological impact of trauma on individuals' core beliefs about themselves, others, and the world. The theory suggests that traumatic events can shatter people’s fundamental assumptions about the world and their place in it. These assumptions typically include beliefs about personal invulnerability, the world's meaningfulness, and others' benevolence.  Shattered Assumptions Theory of Trauma Assumptive World: Individuals construct a set of beliefs and assumptions about the world and their existence within it. These assumptions help individuals make sense of their experiences and navigate the world with a sense of predictability, coherence, and safety. Assumptive World Violation: Traumatic events can challenge, disrupt, or completely shatter individuals' assumptive world. These violations occur when events contradict deeply held beliefs, leading to a profound sense of disorientation, vulnerability, and existential threat.  Shattered Assumptions Theory of Trauma Impact on Psychological Well-Being: The shattering of the assumptive world can have significant psychological consequences, including feelings of confusion, fear, helplessness, and loss of meaning or purpose. Individuals may struggle to reconcile the traumatic experience with their existing beliefs, leading to emotional distress and psychological symptoms such as depression, anxiety, and post-traumatic stress disorder (PTSD). Reconstruction and Coping: Following a traumatic event, individuals may engage in processes of reconstruction and coping to make sense of their experiences and restore a sense of coherence and meaning in their lives. This may involve reassessing and revising their assumptive world, integrating the traumatic experience into their personal narrative, seeking social support, and finding new sources of meaning and resilience. Disruption of Beliefs About Themselves Before Trauma: A person might believe they are strong, capable, and in control of their life. After Trauma: If someone experiences a traumatic event like an assault, they might begin to see themselves as weak, vulnerable, or powerless. They may struggle with feelings of shame, guilt, or self-blame, questioning their self-worth and abilities. Example: A person who was confident in their decision-making may, after a traumatic event, doubt their judgment and feel incapable of making safe or wise choices. Disruption of Beliefs About Others Before Trauma: A person might believe that people are generally kind, trustworthy, and that relationships are safe. After Trauma: If the trauma involved betrayal or harm by another person (such as abuse or betrayal by a trusted individual), they may start to see others as untrustworthy, dangerous, or malicious. This can lead to difficulties in forming or maintaining relationships. Example: Someone who was previously open and trusting might, after experiencing trauma, become suspicious of others, withdraw from relationships, or have difficulty trusting even those close to them.  Disruption of Beliefs About the World Before Trauma: A person might believe that the world is generally a safe, fair, and predictable place. After Trauma: Following a traumatic event (like a natural disaster or a violent attack), they may come to see the world as chaotic, unsafe, and full of danger. The sense that "bad things won’t happen to me" can be replaced by constant fear and hypervigilance. Example: A person who previously felt safe walking alone at night might, after experiencing an attack, feel that danger lurks everywhere, leading to ongoing fear and avoidance of certain places or situations. Betrayal Theory of Trauma  Betrayal Theory of Trauma Jennifer Freyd introduced the terms "betrayal trauma" and "betrayal trauma theory" in 1991. Betrayal trauma theory posits that there is a social utility in remaining unaware of abuse when the perpetrator is a caregiver (Freyd, 1994, 1996). The theory draws on studies of social contracts (e.g., Cosmides, 1989) to explain why and how humans are excellent at detecting betrayals; however, Freyd argues that under some circumstances, detecting betrayals may be counter-productive to survival. Specifically, in cases where a victim is dependent on a caregiver, survival may require that she/he remain unaware of the betrayal. In the case of childhood sexual abuse, a child who is aware that her/his parent is being abusive may withdraw from the relationship (e.g., emotionally or in terms of proximity). For a child who depends on a caregiver for basic survival, withdrawing may be at odds with ultimate survival goals, mainly when the caregiver responds to withdrawal by further reducing caregiving or increasing violence. In such cases, the child's survival would be better ensured by being blind to the betrayal and isolating the knowledge of the event, thus remaining engaged with the caregiver. The phrase "Betrayal Trauma theory" is generally used to refer to the prediction/theory about the cause of unawareness and amnesia: "Betrayal Trauma Theory: A theory that predicts that the degree to which a negative event represents a betrayal by a trusted needed other will influence how that event is processed and remembered." Jennifer Freyd said……. "I propose that the core issue is betrayal -- a betrayal of trust that produces conflict between external reality and a necessary system of social dependence. Of course, a particular event may simultaneously be a betrayal, trauma, or life threat. Rape is such an event. Perhaps most childhood traumas are such events." Betrayal trauma theory was introduced: "The psychic pain involved in detecting betrayal, as in detecting a cheater, is an evolved, adaptive motivator for changing social alliances. In general, it is not to our survival or reproductive advantage to go back for further interaction with those who have betrayed us. However, if the person who has betrayed us is someone we need to continue interacting with despite the betrayal, then it is not to our advantage to respond to the betrayal in the normal way. Instead, we essentially need to ignore the betrayal....If the betrayed person is a child and the betrayer is a parent, the child mustn’t stop behaving in a way that will inspire attachment. For the child to withdraw from a caregiver he is dependent on would further threaten his life, both physically and mentally. Thus, the trauma of child abuse by its very nature of it requires that information about the abuse be blocked from mental mechanisms that control attachment and attachment behavior. One does not need to posit any particular avoidance of psychic pain per se here -- instead, the control of social behavior is of functional significance. " What happens when you have to live with the person who betrayed you?  After betrayal, some people have a freeze response and Betrayal stay in denial in order to sustain a crucial bond. Women experience "betrayal Blindness Individuals use mechanisms to stay blindness" more than men, shifting to awareness and unawareness of their hurts. unaware of the betrayal. This in turn, Behavior blindness may causes betrayal blindness contribute to unexplained depression, anxiety, and health problems. How is Sexual Violence a Source of Trauma?  Sexual Violence as a Source of Trauma Betrayal of Trust: Sexual violence often involves a betrayal of trust, as perpetrators may be individuals known to the survivor, such as family members, intimate partners, friends, or acquaintances. This betrayal can shatter the survivor's sense of relationship safety and security. Example: Imagine a scenario where a young woman has a close friend she has known for years. She trusts him completely and sees him as someone she can rely on in any situation. One night, after they both attend a party, he offers to walk her home, as he has done many times before. But this time, he crosses boundaries and sexually assaults her. In this case: Before the Assault: The young woman believed her friend was trustworthy, safe, and had her best interests at heart. She felt secure in their friendship and relied on him as a part of her social support system. After the Assault: This friend’s betrayal shatters her sense of relationship safety. She might struggle with trusting not just him, but others as well. The betrayal might lead her to question her judgment about people, feel isolated, and experience deep emotional pain because someone she believed would protect her was the one who caused her harm. Sexual Violence as a Source of Trauma Loss of Control and Autonomy: Sexual violence involves the violation of bodily autonomy and control, as survivors are subjected to unwanted sexual acts or coercion against their will. This loss of control can lead to feelings of powerlessness, helplessness, and disempowerment. Fear and Threat of Harm: Survivors of sexual violence may experience intense fear and anxiety during the traumatic event, as perpetrators use threats, intimidation, or physical force to coerce or manipulate them into compliance. The fear of harm or retribution can persist long after the traumatic event has ended. Guilt, Shame, and Self-Blame: Survivors of sexual violence often experience feelings of guilt, shame, and self-blame, questioning whether they could have prevented the assault or blaming themselves for the perpetrator's actions. These feelings can erode self-esteem and contribute to self-destructive behaviors. Impact on Relationships: Sexual violence can have profound effects on survivors' relationships with others, including family members, friends, romantic partners, and colleagues. Survivors may struggle with trust, intimacy, communication, and social isolation as they navigate the aftermath of trauma. Invasion of Personal Boundaries: Sexual violence intrudes upon the survivor's personal boundaries and sense of bodily integrity, causing profound feelings of violation, shame, and humiliation. Survivors may struggle to regain a sense of safety and comfort in their own bodies. Psychological and Emotional Distress: Sexual violence can result in a range of psychological and emotional symptoms, including post- traumatic stress disorder (PTSD), depression, anxiety, flashbacks, nightmares, mood swings, and emotional numbness. Survivors may experience intense emotional pain, confusion, and self-blame. Cognitive Distortions and Intrusive Thoughts: Survivors may experience intrusive thoughts, memories, or flashbacks of the traumatic event, disrupting their daily functioning and causing distress. Cognitive distortions, such as negative beliefs about oneself or the world, may also emerge as a result of the trauma. Long-Term Effects and Complex Trauma: Sexual violence can have long-term effects on survivors' mental health, well-being, and overall quality of life. Many survivors experience complex trauma, characterized by a constellation of symptoms and difficulties that persist over time, including difficulties with emotion regulation, self- concept, and interpersonal relationships. Case Study Other Psychological outcomes  Reactive Attachment Disorder Reactive Attachment Disorder (RAD) is a complex and serious psychological condition that typically develops in infancy or early childhood as a result of significant disruptions in the child's early caregiving environment, such as neglect, abuse, frequent changes in caregivers, or inconsistent care. Attachment Difficulties: RAD is characterized by significant difficulties in forming and maintaining secure and healthy attachments with primary caregivers or adults responsible for the child's care. Symptoms: The symptoms of RAD can vary depending on the individual child and their experiences, but they often include: Avoidance of or resistance to comforting or affectionate gestures from caregivers. Withdrawal or emotional detachment from caregivers and others. Lack of responsiveness to social interactions and attempts to engage with others. Difficulty regulating emotions and behaviors, such as excessive anger, irritability, or defiance. Lack of interest in social interactions or relationships. Indiscriminate or excessive familiarity with strangers.  Reactive Attachment Disorder Impact on Development: RAD can have profound effects on a child's emotional, social, and psychological development. Without secure attachment relationships, children may struggle to develop a sense of trust, safety, and emotional security, which can impact their ability to form healthy relationships and navigate social interactions throughout their lives. Risk Factors: RAD typically arises in the context of early childhood adversity and disrupted attachment experiences. Risk factors for RAD include: Early experiences of neglect, abuse, or trauma. Frequent changes in caregivers or unstable caregiving environments. Institutionalization or placement in foster care or orphanages. Parental mental illness, substance abuse, or other significant stressors that interfere with caregiving abilities.  Posttraumatic Stress Disorder Posttraumatic Stress Disorder (PTSD) is a mental health condition that can develop after an individual experiences or witnesses a traumatic event that involves actual or threatened death, serious injury, or sexual violence. PTSD can occur in people of any age and is characterized by a range of symptoms that persist for an extended period after the traumatic event has ended. Symptoms: PTSD symptoms can be grouped into four main clusters: Intrusion Symptoms: Recurrent, involuntary, and distressing memories of the traumatic event, flashbacks, nightmares, or intense psychological distress when exposed to reminders of the trauma. Avoidance Symptoms: Efforts to avoid thoughts, feelings, conversations, places, people, or activities that are associated with the traumatic event, as well as feelings of detachment, numbness, or emotional blunting. Negative Alterations in Mood and Cognition: Persistent negative beliefs or expectations about oneself, others, or the world, distorted blame or guilt related to the traumatic event, persistent negative emotions (e.g., fear, horror, anger, guilt, or shame), and markedly diminished interest or participation in significant activities. Arousal and Reactivity Symptoms: Hypervigilance, exaggerated startle response, irritability, angry outbursts, difficulty concentrating, sleep disturbances, and reckless or self-destructive behavior.  Posttraumatic Stress Disorder Trauma Exposure: PTSD can result from exposure to a wide range of traumatic events, including combat exposure, sexual or physical assault, natural disasters, accidents, terrorist attacks, and life-threatening medical diagnoses. Risk Factors: Several factors may increase the risk of developing PTSD following a traumatic event, including:  Severity and duration of the trauma.  Previous experiences of trauma or adverse childhood experiences (ACEs).  Lack of social support or coping resources.  Pre-existing mental health conditions.  Genetic predisposition and neurobiological factors.  Impact on Functioning PTSD can significantly impair various areas of functioning, including work, school, relationships, and daily activities. Individuals with PTSD may experience difficulties in regulating emotions, maintaining interpersonal relationships, and engaging in self-care activities.  PTSD in children Posttraumatic Stress Disorder (PTSD) can affect children and adolescents who have experienced or witnessed traumatic events. PTSD in children manifests similarly to adults but may present with age-appropriate differences in symptom expression and coping mechanisms. Symptoms: Children with PTSD may exhibit symptoms from each of the four main clusters: Intrusion Symptoms: Children may experience distressing memories, nightmares, or flashbacks related to the traumatic event. They may also engage in reenactment of the trauma through play. Avoidance Symptoms: Children may avoid reminders of the trauma, including places, people, activities, or conversations associated with the event. Negative Alterations in Mood and Cognition: Children may display negative thoughts or beliefs about themselves or the world. They may experience persistent negative emotions, social withdrawal, or loss of interest in previously enjoyed activities. Arousal and Reactivity Symptoms: Children may demonstrate hypervigilance, irritability, difficulty concentrating, sleep disturbances, and exaggerated startle responses  PTSD in Children Age-Related Responses: Younger children may have difficulty verbalizing their feelings and experiences, instead exhibiting distress through changes in behavior, clinginess, regression in developmental milestones, or somatic complaints (e.g., stomachaches or headaches). Adolescents may display more verbal expressions of distress, as well as engage in risky behaviors or substance use as coping mechanisms. Impact on Development: PTSD can significantly impact a child's emotional, cognitive, and social development, affecting academic performance, peer relationships, and family dynamics. Untreated PTSD in children can lead to long-term emotional and behavioral difficulties. Complex Posttraumatic Stress Disorder (C-PTSD) Complex Posttraumatic Stress Disorder (C-PTSD) is a psychological condition that develops in response to prolonged, repeated trauma, particularly interpersonal trauma or abuse, occurring over an extended period during childhood or adulthood. C-PTSD is often associated with complex and multifaceted symptoms that go beyond those typically seen in traditional PTSD. Interpersonal Trauma: C-PTSD typically arises from exposure to chronic interpersonal trauma, such as childhood abuse (physical, emotional, or sexual), neglect, domestic violence, captivity, human trafficking, or prolonged exposure to traumatic stressors in dysfunctional relationships. Symptoms: In addition to the symptoms of traditional PTSD (intrusion, avoidance, negative alterations in mood and cognition, and arousal and reactivity), individuals with C-PTSD may also experience a range of other symptoms, including: Emotional Dysregulation: Difficulty regulating emotions, experiencing intense emotions (e.g., shame, guilt, anger, or sadness), and exhibiting emotional instability. Disturbances in Self-Identity: Feelings of worthlessness, shame, self-blame, or a distorted self-concept. Individuals may struggle with feelings of emptiness or a pervasive sense of being fundamentally flawed or damaged. Disturbances in Relationships: Difficulty establishing and maintaining healthy relationships, mistrust of others, fear of abandonment, and patterns of unstable or dysfunctional relationships. Negative Self-Perception: Negative beliefs about oneself, feelings of helplessness, powerlessness, or a sense of being irreparably damaged by the trauma. Dissociation: Episodes of dissociation, depersonalization, derealization, or dissociative amnesia as a way of coping with overwhelming emotions or traumatic memories.  Developmental Impact: C-PTSD can have profound effects on psychological development, interpersonal functioning, and overall well-being. Individuals with C-PTSD may struggle with self-esteem, trust, intimacy, and emotional regulation throughout their lives. Complexity and Comorbidity: C-PTSD is often characterized by its complexity and comorbidity with other mental health conditions, such as depression, anxiety disorders, substance abuse, personality disorders, and somatic symptoms.  Trauma-Related Depression Cyclical Nature: Depression and trauma often create a cyclical pattern, where symptoms of depression exacerbate the effects of trauma and vice versa. For example, individuals may withdraw from social support networks due to depressive symptoms, which can further isolate them and exacerbate feelings of loneliness or disconnection. This cycle can perpetuate a sense of hopelessness and reinforce negative beliefs about oneself and the world.  Trauma-Related Depression 1. Depression can often be a common response to trauma. When individuals experience traumatic events, they may be overwhelmed by intense emotions, feelings of helplessness, and a sense of loss of control. These experiences can disrupt their sense of safety, security, and well-being, contributing to the development of depressive symptoms. 2. Trauma-Related Depression: Depression that arises in response to trauma may be characterized by specific features related to the traumatic experience. For example, individuals may experience intrusive memories, nightmares, or flashbacks of the traumatic event, which contribute to feelings of distress and emotional dysregulation. Trauma-related depression may also be accompanied by symptoms of posttraumatic stress disorder (PTSD), such as hypervigilance, avoidance behaviors, and exaggerated startle responses.  Trauma-Related Depression 1. Depression can often be a common response to trauma. When individuals experience traumatic events, they may be overwhelmed by intense emotions, feelings of helplessness, and a sense of loss of control. These experiences can disrupt their sense of safety, security, and well-being, contributing to the development of depressive symptoms. 2. Trauma-Related Depression: Depression that arises in response to trauma may be characterized by specific features related to the traumatic experience. For example, individuals may experience intrusive memories, nightmares, or flashbacks of the traumatic event, which contribute to feelings of distress and emotional dysregulation. Trauma-related depression may also be accompanied by symptoms of posttraumatic stress disorder (PTSD), such as hypervigilance, avoidance behaviors, and exaggerated startle responses. Session 4 Other Emotional Grief and Loss in Responses to the Aftermath of Trauma. Sexual Assault.  Disclaimer Please be advised: The following discussion includes sensitive content related to sexual violence  Anxiety Issues Anxiety is a common response to trauma, 4. rapid breathing, or hyperventilation often stemming from the overwhelming 5. increased or heavy sweating stress and fear associated with traumatic experiences. 6. trembling or muscle twitching Anxiety is a feeling of fear, dread, and 7. weakness and lethargy uneasiness. It might cause you to sweat, 8. difficulty focusing or thinking clearly feel restless and tense, and have a rapid about anything other than the thing heartbeat. It can be a normal stress you’re worried about reaction. Some common symptoms of anxiety include: 9. insomnia 1. nervousness, restlessness, or being tense 10. digestive or gastrointestinal problems, such as gas, constipation, or diarrhea 2. feelings of danger, panic, or dread 11. a strong desire to avoid the things that 3. rapid heart rate trigger your anxiety  Panic Related Issues 1. People with panic disorder have frequent and unexpected panic attacks. These attacks are characterized by a sudden wave of fear or discomfort or a sense of losing control even when there is no clear danger or trigger. Not everyone who experiences a panic attack will develop panic disorder. 2. Panic attacks often include physical symptoms that might feel like a heart attack, such as trembling, tingling, or rapid heart rate. Panic attacks can occur at any time. Many people with panic disorder worry about the possibility of having another attack and may significantly change their life to avoid having another attack. Panic attacks can occur as frequently as several times a day or as rarely as a few times a year. 3. Panic disorder often begins in the late teens or early adulthood. Women are more likely than men to develop panic disorder.  Symptoms of Panic Disorder 1. Sudden and repeated panic attacks of overwhelming anxiety 10. Difficulty breathing and fear 11. Weakness or dizziness 2. A feeling of being out of control, or a fear of death or impending doom during a panic attack 12. Tingly or numb hands 3. An intense worry about when the next panic attack will 13. Chest pain happen 14. Stomach pain or nausea 4. A fear or avoidance of places where panic attacks have occurred in the past 5. Physical symptoms during a panic attack, such as: 6. Pounding or racing heart 7. Sweating 8. Chills 9. Trembling  Psychosomatic Problems Psychosomatic issues can indeed manifest as a response to trauma. Psychosomatic refers to physical symptoms or illnesses that are caused or exacerbated by psychological factors such as stress, anxiety, or trauma. Mind-Body Relationship: The mind and body are intricately connected, and psychological distress can manifest in physical symptoms or conditions. Traumatic experiences can activate the body's stress response system, leading to physiological changes that may contribute to the development or exacerbation of psychosomatic issues. Stress Response: Trauma triggers the body's stress response, releasing stress hormones such as cortisol and adrenaline. Prolonged or intense stress can dysregulate the body's physiological processes, compromising immune function, cardiovascular health, and other bodily systems, increasing susceptibility to psychosomatic symptoms.  Somatization: Somatization refers to the process by which psychological distress is expressed through physical symptoms or somatic complaints. Individuals may experience a wide range of psychosomatic symptoms, including headaches, stomachaches, muscle tension, fatigue, dizziness, chest pain, and gastrointestinal disturbances, among others. Chronic Pain Syndromes: Trauma-related stress and anxiety can contribute to the development or exacerbation of chronic pain syndromes, such as fibromyalgia, tension headaches, irritable bowel syndrome (IBS), and temporomandibular joint (TMJ) disorders. Chronic pain can significantly impact individuals' quality of life, functioning, and emotional well-being, further exacerbating psychological distress and trauma-related symptoms. Autoimmune Disorders: Emerging research suggests that trauma may increase the risk of autoimmune disorders, where the immune system attacks the body's own tissues, leading to inflammation and tissue damage. Trauma-induced dysregulation of the immune system may contribute to the development or worsening of conditions such as rheumatoid arthritis, lupus, multiple sclerosis, and inflammatory bowel disease. Physical Consequences  Injuries: Bruises; Cuts; Lacerations; Fractures; Scarring Studies found non-genital injury was found in 40% to 82% of patients, whereas genital-anal injury was documented in 6% to 87%. Physical Consequences Sexually Transmitted Infections (STIs): HIV/AIDS; Herpes; Chlamydia; Gonorrhea In 2020 there were are an estimated 374 million new infections in people 15–49 years with 1 of 4 curable STIs: chlamydia, gonorrhea, syphilis and trichomoniasis.  Unwanted Pregnancy: Forced pregnancy; Abortion; Miscarriage; Prenatal complications. 15% of married women aged 15—49 years had experienced sexual violence from their husbands or partner. The prevalence of unintended pregnancies among women aged 15—49 years has risen from 33% in 1992 to 38% in 2018. Sleep Disturbances: Insomnia; Nightmares; Sleep paralysis; Sleep apnea; Restless sleep Chronic Pain: Pelvic pain; Headaches; Back pain; Muscle tension; Fibromyalgia  Abortions, Miscarriage and Infertility Abortion, when performed safely by a qualified healthcare provider, typically does not lead to infertility. This applies to sexual assault survivors as well as others who undergo the procedure. Medical Abortion: When conducted in a sterile environment by a trained professional, whether through medication or surgical procedures, abortion is generally safe and does not affect future fertility. The risk of complications, including those that could affect fertility, is very low. Unsafe Abortion: If an abortion is performed in unsafe conditions— such as by an unqualified provider, in unsanitary conditions, or without proper medical supervision—the risk of complications increases significantly. These complications can include infections, uterine damage, or scarring, which may impact fertility.  Social Consequences  Stigmatization: Social Stigma: Survivors may face judgment, blame, or disbelief from others, leading to social isolation. Victim Blaming: Society may unjustly hold survivors responsible for the assault, exacerbating feelings of guilt and shame. Relationship Strain: Social Trust Issues: Survivors often struggle with trusting others, leading to difficulties in forming or maintaining relationships. Consequences Isolation from Friends/Family: Fear of judgment or disbelief may cause survivors to distance themselves from their support networks. Intimacy Challenges: Survivors might experience difficulties with physical and emotional intimacy, impacting romantic relationships. Social Withdrawal: Avoidance of Social Situations: Survivors may avoid social gatherings or public places out of fear or anxiety, leading to increased isolation. Loss of Social Skills: Prolonged isolation and trauma can result in a deterioration of social skills, making it difficult to reintegrate into social environments.  Workplace and Academic Consequences: Job Loss: The trauma of sexual violence can affect job performance, leading to potential job loss or demotion. Academic Decline: Survivors may find it challenging to focus on studies, resulting in poor academic performance or dropping out of school. Harassment and Retaliation: In some cases, survivors may face harassment or retaliation in the workplace or academic environment after reporting the assault. Social Community Impact: Loss of Community Support: Survivors may feel alienated from their Consequences community, particularly if the perpetrator is a well-known or respected figure. Displacement: Fear of encountering the perpetrator or dealing with social backlash may force survivors to relocate or change jobs. Impact on Family Dynamics: Family Conflict: The trauma can cause tension and conflict within families, particularly if the perpetrator is a family member. Intergenerational Trauma: The effects of the trauma can impact future generations, influencing family dynamics and relationships.  Disclaimer Please be advised: The following discussion includes sensitive content related to sexual violence Sexual Violence and Its Impact on Individual Sexuality  Changes in sexuality 1. Losing interest in sex/celibacy 2. Having more sexual partners Most of the survivors continue with 3. Engaging in sex work their normal sex life 4. Sex addiction 5. Feeling safer with women as intimate partners  Losing Interest in Sex/Celibacy For many, having a history of multiple sexual assaults resulted in a more negative attitude toward sex. For example, several survivors noted how they lost interest in sex after they were assaulted, with some still reflecting those sentiments even years after the assault: “I can’t say I like having sex till this day. I mean, I do, but if I don’t have sex, I’m okay—um, I learned how to satisfy myself, but I was like almost thirty before I learned how to enjoy it.” The decision to abstain from sex, while tied to the unwanted experience, was also influenced by other factors. Some survivors said they were influenced by religion or belief in God to remain celibate after their sexual assault or after years of engaging in risky sexual behavior “It was an experience because I had changed my religion and decided to follow the Lord and just didn’t want to have sex, didn’t want to.”  Having More Sexual Partners. While not all survivors wanted to stay away from sex completely, some survivors mentioned that their view of sex was altered due to the assault and this led them to engage in more sex rather than to abstain or lose interest. For some, having more sexual partners was due to their lack of experience with respectful, communicative partners; for others, it was tied to their feelings of self-blame and shame “So therefore I became promiscuous. It got to the point where I didn’t care about anything. Just had the attitude of just not caring. That’s the only thing men want you for anyways, so I just started being very promiscuous” Still others engaged in more sexual activity as a way to cope and feel in control of their recovery. Engaging in sexual behavior was seen as taking control of their sexuality and their bodily autonomy. “I acted out sexually, a lot, I think to feel more in control of my sexuality, of my body, like. And I guess I was promiscuous for about a year, while I was with my ex and he was a constant cheater. I didn’t feel bad about it, I took it as my sort of liberation at the time, I kind of viewed it as my empowerment.”  Engaging in Sex Work Three survivors disclosed their sex work histories in relation to their sexual assault histories. Women trade sex for money, drugs, shelter, or other things for varied reasons. Women connected their engagement in sex work to their drug use and their sexual abuse: “I was a drug addict. Performing sex, a lot of times I would throw up, I would be some disgusted, but the drugs said you got to have me.” “Went into sex working. For me, I think that was a way of trying to escape”  Increased Sexual Behavior (Addiction) Some engaged in increased sexual behavior after their assaults. Survivors sometimes tied this behavior to their definition of “addiction.” Two survivors talked about their experiences with engaging in frequent sexual behavior in the context of engaging in sex work (one in the previous section) and watching pornography, while for the others these experiences were tied to drug and alcohol addiction: “Even though I put the liquor down, I still have an alcoholic mind. That’s why when I was first sober, the first five years, I still behaved as if I was drinking. And in retrospect, every sexual encounter with men that really wasn’t into me but pretended to be, it was equivalent to taking a drink, to be honest with you.” Survivors disclosed feeling out of control or addicted to sex in some way.  Feeling Safer With Women As Intimate Partners survivors connected the gender of their intimate partners and being sexually assaulted. One survivor came out as a lesbian later in life and expressed being able to feel closer to women as romantic partners. However, even though she enjoyed being with women in romantic partnerships, she was sex avoidant in general and connected that to her trauma “I just wanted to feel that companionship with another woman because I enjoy women. I like women. I just don’t like having sex with women. I don’t like having sex at all” While sexuality and sexual orientation are complex and never simply just a choice, these survivors reported feeling safer and more connected to women and some of this safety and connection, according to the survivors, was related to being assaulted by men. Sexuality and sexual expression are fluid features of the human experience and do not exist completely separate from people’s broader life experiences Societal and Cultural Factors Contributing to Sexual Violence  Rape Culture: Normalization or trivialization of sexual violence in society through media, entertainment, and cultural narratives. Perpetuation of harmful gender stereotypes and attitudes that condone or excuse sexual aggression, dominance, and entitlement. Blaming and shaming of survivors, minimizing the severity of sexual assault, and shifting responsibility from perpetrators to victims.  Continue…………… Power Imbalances and Patriarchy: Social structures that perpetuate unequal power dynamics based on gender, race, class, and other intersecting identities. Patriarchal norms that reinforce male dominance and control over women's bodies, sexuality, and autonomy. Institutionalized sexism and misogyny that prioritize men's interests and needs while marginalizing and disempowering women and gender minorities Continue…………… Victim Blaming and Stigmatization: Cultural beliefs and attitudes that blame survivors for their own victimization, questioning their credibility, motives, and behavior. Stigmatization of survivors, fear of social judgment or retaliation, and reluctance to report sexual assault due to perceived shame or disbelief. Social norms that prioritize the reputation and interests of perpetrators over the well-being and rights of survivors. Continue…………… Lack of Comprehensive Sex Education: Inadequate or absence of comprehensive sex education programs in schools and communities. Limited knowledge and awareness about consent, boundaries, healthy relationships, and sexual autonomy. Misinformation, myths, and misconceptions about sexuality, sexual violence, and gender roles perpetuated by cultural taboos and social norms Continue…………… Normalization of Coercion and Sexual Coercion: Acceptance of coercive tactics, manipulation, and pressure to obtain sexual consent. Cultural scripts that romanticize persistence, conquest, and aggression in sexual relationships. Lack of clear communication and understanding about boundaries, consent, and mutual respect in intimate encounters. Continue…………… Structural and Systemic Failures: Inadequate legal frameworks, law enforcement responses, and judicial systems that fail to hold perpetrators of sexual assault accountable. Limited access to support services, resources, and trauma-informed care for survivors, particularly in marginalized and underserved communities. Institutional barriers that perpetuate inequality and injustice, including racism, classism, ableism, and heterosexism.