Rape-Trauma Syndrome

rape truama syndrome

About Dr. Wolbert’s RTS

Rape trauma syndrome (“RTS”) is described by psychiatrist Ann Wolbert Burgess and sociologist Lynda Lytle Holmstrom in 1974 (Burgress & Holmstrom) as “the acute phase and long-term reorganization process” that occurs as a result of forcible rape or attempted forcible rape. Dr. Burgess and Holmstrom interviewed and followed 146 patients admitted during a one-year period to the emergency ward of a city hospital with a presenting complaint of having been raped.

Based upon an analysis of the 92 adult women rape victims in the sample, they document the existence of an RTS and delineate its symptomatology as well as that of two variations; compounded reaction and silent reaction. Specific therapeutic techniques are required for each of these reactions.

Crisis intervention counseling is effective with typical rape trauma syndrome; additional professional help is needed in the case of a compounded reaction, and the silent rape reaction means that the clinician must be alert to indications of the possibility of rape having occurred even when the patient never mentions such an attack.

Strengths: RTS is the medical term given to the response that most survivors have to rape. It is very important to note that RTS is the natural response of a psychologically healthy person to the trauma of rape so these symptoms do not constitute a mental disorder or illness.

Weaknesses: “The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM‐5) does not define RTS as a disorder. Therefore, PTSD is more commonly considered as a possible diagnosis after a rape. Expert testimony about RTS is much less likely than other syndromes (e.g., battered woman syndrome) to be admitted in court proceedings, and admissibility is often split on the proposed use for the testimony itself.

In the overwhelming majority of instances of RTS use in criminal trials, it has been used by the prosecution to explain inconsistent or contradictory statements or actions completed by the victim, though it may also be used to educate a jury about incorrect assumptions about the causes and consequences of rape, testify that the victim’s psychological reactions are consistent with having been raped, or support a claim of damages.” (Patton, 2015).

Furthermore, RTS would be a better diagnosis because it is more specific to the symptoms that rape victims experience. For example, common symptoms seen in RTS, but not usually diagnosed in PTSD, including sexual dysfunction, long-term depression, fear, anxiety, social maladjustment, and humiliation (Frazier & Borgida, 1992; McGowan & Helms, 2003). -Pub Med

Visualizing Rape Trauma Syndrome

Rape Trauma Syndrome (RTS) is a way of describing post-traumatic stress symptoms that arise from sexual assault.  Disclaimer: Individuals are, well, individual.  There is no guarantee how someone will respond and the source paper on RTS actually described different ways that each stage might appear. Also, people may have defense mechanisms that prevent them from responding at all to rape trauma for weeks, months, even decades after the assault until one day after the individual is triggered or stable enough or for some unknown reason, they will appear.

Speaking of triggers, part of being a survivor means recognizing that we may move in and out of these stages at times in our lives.  Certain ages, dates, events, encounters can cause us to revisit a part of our recovery.  But we rebuild and move on.  Because as individuals, we’re hopefully always growing anyway.

The Stages of RTS

  • Acute Phase: This is usually the initial phase after an individual is raped, and usually takes place in the initial moments to weeks after the assault.  While outwardly it can appear many different ways, from crying to flat affect to uncontrollable laughter to anger, inwardly the theme is chaos.  The individual may be in shock, experiencing disorganized thoughts, and/or have difficulty concentrating. It may be hard to make decisions, and the individual may refuse to deal with it.  This is one reason many people delay reporting their assaults, though there are plenty of good reasons to not report even if someone is fully capable of making a rational decision.
  • Chronic Phase: If things were to move in a linear fashion, this phase would last the longest.  After the initial crisis wears off, it’s time for the body and mind to start piecing things back together. Someone may move to a new place, develop a strategy for avoiding their attacker or the location of the assault, or seek support from friends or professionals.  They may learn new coping strategies and/or process their assault.
  • Integration Phase: I like to call this one “the new normal.”  After the hard work of recovery has been done, survivors now work to create meaning from their experience.  This may include volunteering for their local rape crisis hotline, writing about their experience, or simply not having to think about it every day—not out of denial but from truly having moved on.  It could mean recognizing that certain songs may never be appealing again, but there is no longer an intense trauma response to the trigger.

The History

In the 1970s the sexual violence movement grew out of the feminist movement as a way for women to support other women who had been sexually assaulted. Ann Burgess, a psychiatric nurse and Lynda Holstrom, a sociologist, introduced RTS in 1974 after interviewing 92 adult female rape victims. For perspective, the first five rape crisis centers in the United States were founded in1972. Today the sexual violence movement recognizes that anyone of any age and gender can be assaulted and that treatment can appear in a number of evidence-based forms.

The Legacy

PTSD made its first appearance in the DSM in 1980.  It was developed in order to describe the symptoms of thousands of returning veterans of the Vietnam war with a list of exposures that expanded far beyond war experience. While many individuals who experience traumatic situations develop a fairly consistent set of symptoms, trauma experts note that men and women tend to experience different types of trauma, which do lead to different types of symptoms.  According to Bessel van der Kolk et al, men are more frequently traumatized by accidents, natural disasters, war, and assault.  Women, on the other hand, are more likely to be traumatized by sexual assault and childhood abuse. Even when men are assaulted, they are more likely to be assaulted by a stranger, whereas the vast majority of traumatized women are assaulted by someone they know, often a family member or intimate partner. People who experience trauma as children, or in repeated incidents of interpersonal violence are likely to have trauma symptoms that aren’t captured by classic PTSD symptoms.

Unfortunately, this has been classically dealt with by saddling individuals who have a history of complex trauma with several comorbid disorders.  By diagnosing people with “unrelated” disorders, not only have we delayed understanding the impact of exposure to repeated interpersonal trauma, but we increase the stigma felt by the individuals–usually women–by suggesting that they have additional mental health issues in addition to their trauma.  I have a number of clients who feel defensive about being diagnosed with bipolar disorder, borderline personality disorder, panic disorder, etc and insist that their symptoms stem from their trauma.  The description of rape trauma syndrome, with its inclusion of shame, guilt, difficulty with trust was an early descriptor that shed a light on the many dimensions of repeated or childhood violence. Esteemed trauma experts such as van der Kolk developed a description of complex trauma symptoms that include these elements as well as the more profound symptoms that accompanies more intimate types of violence.

– Sara Staggs, LICSW, MPH (a cache page from Psych Central)

Additional Information & References 

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