Trauma & PTSD

What is Trauma?

If you are a survivor of sexual violence, you have likely heard the term trauma. Trauma always begins with a distressing event or series of events, typically involving feelings of intense fear, helplessness, or horror. In general terms, this could refer to a wide range of examples—a car crash, the death of a parent, combat—the list of possibilities is almost infinite. But for survivors of sexual violence, the traumatic event will likely be a single violent event like a rape or assault, a repeated series of individual violent events, or a repeated pattern of abuse or sexual violence.

Trauma refers to the lasting emotional and physical responses that follow a traumatic event. Nearly every trauma survivor experiences a range of physiological and emotional effects during and immediately after a traumatic event. This reaction is called fight, flight, or freeze, and refers to the stress responses, triggered by hormones, that the human body and brain automatically activate in order to survive in dangerous and life-threatening circumstances. During fight, flight, or freeze, your heart rate and breathing speed up, you may become pale, flushed or clammy, your pain response is diminished, your pupils may dilate to let in more light, and you may tremble or feel on edge. All of these responses increase the human ability to survive a traumatic event. 

When we talk about trauma, we are not talking about these in-the-moment responses, but rather the lasting physical and emotional after-effects of traumatic events. The effects of fight, flight, or freeze often persist beyond the period in which they increase survival. Even a single incident of violence can have devastating effects on a survivor. Survivors often have trouble feeling safe, regulating their emotions, and maintaining relationships with friends, partners, and family. They can experience intense feelings of shame, powerlessness, and terror. These reactions can interfere in even the most basic functions and necessities of daily life, like sleeping, eating, going to school, and leaving the house.

What is PTSD?

For most trauma survivors, the distress and symptoms of trauma dissipate relatively quickly. After the acute crisis is over, they return to a normal state of arousal, emotional regulation, and general physical and mental health. For some survivors, though, symptoms persist and even intensify over time. Researchers believe that PTSD results from the improper processing of memory. The physical and emotional reactions of fight, flight, or freeze are connected to those memories, so that every time a memory is triggered, the whole range of responses is activated. While it is normal to have intense reactions to trauma in the short term, longer term and enduring symptoms may indicate PTSD. PTSD is common and normal for survivors, and nothing to be ashamed of.  While it is challenging and painful to live with, PTSD is just your brain and body trying to cope with trauma.

To be diagnosed with PTSD, you need to experience all of the following. Although you are unable to receive a Post Traumatic Stress Disorder Diagnosis if you don’t experience all of these symptoms, a good mental health professional will be able to treat the trauma reactions and you are having. Please remember that not being able to receive a PTSD diagnosis does not mean that your experience and trauma are less severe than for individuals who do have it. This is just a clear way of being able to determine the type of support and psychiatric care needed by some people.

Here are the symptoms that you need to have in order to be diagnosed with PTSD.

  • At least one re-experiencing symptom, such as nightmares or flashbacks. These may be accompanied by the physical effects of a traumatic event and may feel like a reliving of the event. They may be triggered by outside reminders of the trauma, or by the survivor’s own thoughts and emotions.
  • At least one avoidance symptom, such as staying away from people or places that are reminders of the trauma. This can also be consciously avoiding thinking about the event.
  • At least two arousal or reactivity symptoms, such as angry outbursts, feeling on edge, or having trouble sleeping. 
  • At least two cognition or mood symptoms, which might include shame, guilt, or lack of interest or enjoyment in life.

PTSD can have devastating effects on survivors. Living in a heightened state of arousal and fear over time damages both physical and mental health, and can derail education and work, and harm relationships. People suffering from PTSD may develop stress related illnesses and experience increasing social isolation. PTSD will not likely go away on its own. If you are suffering from PTSD, it is important to seek help.

What is Complex PTSD?

While any traumatic event can result in PTSD, Complex PTSD is a response to prolonged and repeated trauma. Among survivors of sexual violence, children experiencing long term sexual abuse or adult victims of prolonged domestic sexual violence are particularly likely to develop Complex PTSD. Long-term trauma, especially experienced during childhood, affects the brain itself, leading to structural changes in areas of the brain related to alarm, memory, and thinking, as well as functional changes to the brain.

Symptoms and challenges of Complex PTSD include:

  • Behavioral symptoms, such as aggression, alcohol and drug abuse, self-destructive behavior, and dangerous sexual behavior.
  • Emotional symptoms, such as panic, rage, depression, suicidal thoughts, persistent sadness and hopelessness, or loss of faith.
  • Cognitive symptoms, including both reliving and forgetting the traumatic event, feeling separate from your body or thoughts, or having unclear thinking. 
  • Interpersonal symptoms, including, for example, isolation, distrust, or chaotic and damaged personal relationships. 
  • Distorted perceptions of the perpetrator, such as becoming preoccupied with the relationship or with revenge, or viewing the perpetrator as having total power.
  • Altered and distorted sense of self, for example feelings of helplessness, of shame, or of being completely different from others.
  • Somatization, meaning the development of multiple physical symptoms that don’t have their source in identifiable medical conditions. The presence of stress hormones over prolonged time can lead to lowered immunity and chronic health conditions.

What is Stockholm Syndrome, and What Does it have to do with Sexual Violence?

Stockholm syndrome involves a victim developing an emotional bond with an abuser. The name Stockholm syndrome originated with a bank robbery in Sweden, where the hostages developed sympathy for their attacker. The connection between victim and abuser is now referred to as a trauma bond and is particularly common among victims of childhood sexual abuse. Trauma bonds occur when abuse is punctuated by brief kindnesses, and where the victim feels dependent on the abuser for survival. Childhood sexual abuse is genearlly committed by adults who should be caretakers of the victims, and, in the case of parents, children may literally depend on them for survival. Survivors experiencing PTSD with Stockholm may feel sorry for their abuser, and even defensive or protective of the abuser if an outsider tries to intervene. They may blame themselves rather than their abuser. These feelings and reactions may continue even after the abusive situation has ended.

What is Trauma Informed Therapy?

Some types of therapy address the particular needs of trauma survivors. Trauma is complex, and therapy that does not take that into account may fail to offer survivors the help that they truly need. Counselors and therapists who are knowledgeable about trauma have a full understanding of how social, biological, and environmental factors play a role in the lives of their clients following trauma. It is a good idea for survivors of sexual violence to ask a potential therapist directly if they are able to provide trauma informed therapy.

What other Disorders and Challenges Commonly affect Survivors of Sexual Violence?

Comorbidities are disorders that occur at the same time, in the same person, and that are connected to one another. PTSD has a number of common comorbidities. Even survivors who do not exhibit PTSD symptoms, however, can struggle with these other difficulties. The trauma of sexual violence is connected to a wide range of symptoms and disorders. Here are some of the most common ones. 

Depression is more than normal everyday sadness. It is a serious disorder that affects how an individual thinks and feels. People experiencing depression may have feelings of hopelessness, despair, and intense sadness. Depression impairs daily functioning and can cause individuals to feel unable to partake in their daily activities. It can involve difficulties sleeping, suicidal thoughts, loss of energy, change of appetite.

Experiencing anxiety every now and then is normal, but anxiety disorders are much more distressing and impairing than everyday worries. Anxiety disorders include social anxiety disorder, generalized anxiety disorder, specific phobias, and panic disorders. Anxiety disorders can be debilitating, interfering in somebody’s ability to function and manifesting in physical as well as emotional symptoms.

DID, sometimes referred to as multiple personality disorder, describes a disorder where an individual develops multiple personalities, each with their own behaviors and personalities, that exist within the single individual. The different personalities control the individual’s actions at different times, which can lead to memory loss and hallucinations. DID, which is extremely rare, generally occurs as a result of trauma.

BPD is a disorder that involves patterns of varying mood, behavior, and self image. People suffering from BPD tend to see things as black and white, and often struggle with intense anger, sadness and anxiety, which leads them to have a pattern of intense and unstable relationships with others. They may struggle with self harm, impulsive, and self-destructive behavior as well as suicidal thoughts and actions. BPD has complex roots, but trauma is thought to be one of the causes.

Self-harm refers to deliberate acts of physical harm inflicted on oneself. Acts of self-harm include cutting, extreme scratching, skin carving, burning, punching, biting, or head-banging. Self-harm is strongly related to trauma, and particularly to childhood sexual abuse. People with PTSD are the most likely to engage in self-harm. Self-harm can be a way to gain control over one’s own body, a way to numb other forms of pain, a grounding behavior to bring survivors out of dissociative episodes into the present moment, or a way of punishing the self as a way to cope with shame and guilt.

Eating disorders are serious and often fatal illnesses that are manifested as extreme disturbances in eating behaviors, thoughts about food, weight ,and body image. Trauma and PTSD have been found to increase the risk for developing eating disorders, and eating disorders are strongly associated with sexual violence. Survivors may experience complex body-related trauma, including feelings of shame, disconnection (or the desire to be disconnected) from their bodies, and loss of control over the body. Eating disorders, for survivors, are often attempts to cope with these traumas, but ultimately hinder healing. It is critical that those suffering from eating disorders receive treatment, as eating disorders are the most fatal mental illness. Eating disorder treatment is multifaceted, including individual and family therapy, medical monitoring and care, and nutritional education and intervention.

Eating disorders include the following:

  • Anorexia
  • Bulimia
  • Binge Eating 
  • Avoidant Restrictive Food Intake Disorder (ARFID)

For more information about eating disorders, and where to get help, click here.