CONTENTS

About This Course

Table of Contents

1. Introduction to the Issues
2. Understanding Alcohol Abuse
3. Understanding Violence Against Women
4. Alcohol and Domestic Violence
5. Alcohol, Sexual Assault, and Rape
6. Prevention and Early Intervention
7. Screening and Assessment
8. Diagnosis and Treatment
9. Legal and Ethical Issues

Supplements
Fact Sheets
Videos
Resources

Silence Hurts
Alcohol Abuse and Violence Against Women

The Aftermath of Rape: Victim Responses

Survivors of sexual assault often experience traumatic stress, a complex mix of mental, physical, and emotional responses. They include fear, anger, pain, shock, and the shutdown of many physical systems. Symptoms include:

• Chronic headaches
• Fatigue
• Sleep disturbances
• Recurrent nausea
• Nightmares
• Decreased appetite
• Eating disorders
• Menstrual pain
• Suicide attempts

Sexual assault more than doubles the odds that the victim may resort to substance abuse after the attack.⁵⁰ The most fundamental assumptions of trust, personal safety, and bodily integrity have been destroyed for rape victims. They must face not only the possibility of pregnancy but also the fear that they could be infected with HIV.

Post-Traumatic Stress Disorder

Many victims also develop lasting symptoms of post-traumatic stress disorder (PTSD). First identified in war veterans, PTSD causes:

• Chronic numbing of physical and emotional responses
• Denial of reality
• Guilt and self-blame
• Nightmares
• Flashbacks

PTSD often lasts for years. Survivors of sexual assault may also experience depression, anxiety, and explosive anger. They may show a general inability to maintain relationships or to cope with everyday problems.⁵¹

Because people react to stress in different ways, it is not possible to predict exactly how the victim will feel after a sexual assault. It is helpful, however, to learn and recognize some of the most common responses of sexual assault victims.⁵²

• Shock and disbelief. She may say: "I feel numb, or "I can't believe this happened to me." She may be withdrawn and distant from other people. She may want to forget what happened and avoid people or situations that remind her of the assault.
• Remembering what happened and what it felt like. She may say: "Sometimes, I can't stop thinking about it." "It comes back out of nowhere. I feel like it's happening all over again." She may have flashbacks and nightmares about the attack. When she thinks about the assault, she may re-experience feelings of fear or powerlessness.
• Intense emotions. She may say: "I feel very sad, like I lost a part of me." "I have this intense anger that I never felt before." Intense emotions after a sexual assault are normal. Some people may also feel anxious or depressed.
• Physical symptoms. She may say: "I've had trouble trying to fall asleep at night." Some victims experience headaches and stomachaches and may find it difficult to concentrate on routine activities. She may also experience changes in her sexuality, such as a loss of interest in sex or an avoidance of sexual situations.
• Self-blame and shame. She may say: "I felt like it was my fault. I trusted him." Because of misconceptions about rape, some victims blame themselves, doubt their own judgments, or wonder if they were responsible for the assault. The reactions of others, often based on myths about rape, sometimes reinforce feelings of guilt and shame. Some victims describe feeling dirty, devalued, and humiliated as a result of a sexual assault.

It is important to remember that every individual responds to trauma in her own way. The use of physical force, display of a weapon, and injury to the victim can increase a rape victim's chances of having PTSD symptoms. The severity of the attack will influence the stress response to a rape. If the victim had to go to the hospital for her injuries or undergo any medical procedures, she may be more likely to experience ongoing stress reactions than victims who did not require medical interventions.⁵³