Sexual Trauma

Sexualized violence, a serious global problem, crosses all social boundaries and affects people of all ages, sexual orientations, genders, gender identities, abilities and relationship statuses. Whether in the form of childhood sexual abuse, incest, sexual exploitation, domestic violence, sexual assault, sexual harassment, stalking, cyber harassment, voyeurism or trafficking, it is always an act aggression and violence that degrades, humiliates and takes power away from those victimized. Sexualized violence is endemic and it is an epidemic.

Although anyone is at risk, oppression and the inequalities in society that result from systematic racism, sexism, homophobia, transphobia, ableism and other marginalizing characteristics, create further vulnerabilities for certain types of violence. For example women and girls are particularly vulnerable to being victimized by sexual violence.

The Impact of Sexual Trauma

Objectification is at the core of what it is to be traumatized in this way. Most often perpetrated by someone known and even trusted, the experience shatters a person’s sense of safety and trust in others and in their own judgments, altering the perceptions of themselves and the world around them.

The probability of having negative consequences is much higher with sexual abuse compared with most other traumatic events leaving those affected at risk for a wide range of medical, psychological, behavioral, and sexual disorders.

• Chen and colleagues (2010) found that a history of sexual abuse in childhood or adulthood was associated with more than three times the risk for an anxiety disorder compared with individuals who had no such history; more than twice the risk for depression, an eating disorder, or PTSD; and more than four times the risk for suicide attempts^[5].
• Of adults who receive mental health services, it’s thought that as many as 50% of women and 25% of men have experienced childhood sexual abuse^[6].

The sexual nature of this violence further complicates the trauma and individuals will often experience additional traumatic effects such as self-blame, shame and self-hatred. The consequences of trauma are frequently isolating in themselves but the shame that comes with sexual trauma not only leaves people feeling very alone, often they are alone, in their trauma and in their search for resolution.

Barriers

Rape Culture (societal attitudes, beliefs and misconceptions)

a complex set of beliefs that encourage male sexual aggression and supports violence against women. It is a society where violence is seen as sexy and sexuality as violent. In a rape culture, women perceive a continuum of threatened violence that ranges from sexual remarks to sexual touching to rape itself. A rape culture condones physical and emotional terrorism against women as the norm… In a rape culture both men and women assume that sexual violence is a fact of life, inevitable… However… much of what we accept as inevitable is in fact the expression of values and attitudes that can change.

~Emilie Buchwald, Transforming a Rape Culture

We live in a culture where sexualized violence is minimized, normalized, ridiculed and even romanticized.  Victims of this crime are blamed for instigating it or “asking for it” by the way they dress, how much they had to drink, where they went or with whom. No other crime blames the victim to this magnitude. These victim blaming attitudes are pervasive and promote negative beliefs, myths and misconceptions about sexual violence including what it is, how it happens, to whom and by whom.  As a result, disclosures can be met with disbelief, blame, judgement or even threats and as a result there is an incredible amount of silence and stigma surrounding this issue.

Lack of Awareness on Trauma Responses

It’s not always easy to fully understand the short and long-term impacts of this particular kind of trauma- not simple for survivors themselves, nor for others. In addition to the myriad of myths and misconceptions about what sexual violence is and how it happens, people impacted by trauma may behave and respond quite differently from what others might expect. Focusing on the victim’s behaviour (or to what has been referred to as “counter-intuitive victim responses”) and the general lack of understanding of how the brain is impacted by trauma gets in the way of understanding, believing and supporting survivors.

Recall of the event rarely occurs in a linear, step-by-step recounting of what transpired ideal for police statements and court testimonies. Recollection is often much more fragmented and confused. Traumatized victims may also appear to be lacking in emotion, which may seem at odds with the experiences they are describing and lead to mistaken impressions. They may not scream, fight or run. In fact, experiencing a freeze response (link) is most common. They may minimize or even deny the incident happened at all. They may choose to stay with or see the perpetrator again. This kind of response can be an effort to regain some sort of normalcy, routine and sense of control soon after the sexual assault. 

Rape Culture and the perpetuation of rape myths:

Impact the prevalence of sexual violence by removing responsibility from perpetrators and silencing its victims

• Although it is estimated that one in three girls and one in six boys are sexually abused in North America, the exact number is hard to determine because many cases are not reported to authorities. Sexual violence support services across North America would say that these numbers are grossly underreported.

Influence the development of PTSD

• The prevalence of PTSD in assault survivors is drastically higher than the national prevalence of the disorder. The US National Comorbidity Survey Report estimates the lifetime prevalence of PTSD among North Americans to be 7.8%. The lifetime prevalence of PTSD for women who have been sexually assaulted is 50%.
• Trauma is impacted by the level of support someone receives, whether that support is real or perceived. If the survivor of sexual assault believes that others have failed to react in a positive and supportive manner, there is a greater risk of PTSD.
• Ullman and Filipas (2001) determined that negative social reactions and responses  were associated with more severe PTSD symptoms.^[10]

Determine whether someone chooses to disclose their experience and seek help

• How we respond to disclosures significantly impacts the healing journey and can determine whether a person continues to seek support or whether they are shamed, silenced and further isolated.

Impact the quality of care they receive when they do seek help

• Survivors of sexualized trauma are more likely to experience secondary victimization when seeking help from medical, social and criminal justice systems.
• Secondary Trauma occurs when professionals exhibit and use victim-blaming behaviours^[11]. Contact with many services especially those which do not specialize in sexual assault traumatization, can increase survivors’ psychological and physical distress.^[12]

What can service providers do?

Sexual violence profoundly disempowers and disconnects those who have experienced it, leaving people feeling afraid, powerless, helpless, and out of control. What is helpful is to consciously do the opposite; to help give back power and control, to establish a sense of safety, to foster a sense of reconnection, and to help grow to a sense of trust in others and in themselves.

Be Trauma Informed

Awareness:

• Understanding the breadth and scope of sexual violence including the impact and important aspects of recovery. 
• Recognizing the historical, political, societal and cultural context in which sexual violence takes place.
• Being aware of how our beliefs and values have been shaped by the context in which we live. 
• Challenging our own personal values, their origins and being open to new information.

Listen and Believe

Disclosures that are met with belief and validation help create a sense of safety and can help to alleviate some of the fear of judgment from others.

• “I believe you”

Reminders that they had no control over what happened to them and that the perpetrator is fully responsible can begin to lessen the sense of blame and responsibility survivors often carry.

• “This is not your fault”
• “You are not responsible for other people’s choices and behaviours”
• “They made a conscious choice to hurt you and there was nothing you could have done to change that”

Empower

Offering real choices with an emphasis on providing information from a variety of viewpoints so that people can make an informed choice, while respecting their rights to do so, encourages people to take responsibility for their lives and empowers them to actively participate in their own care and ultimately their own healing.

• “Have you thought about whether or not you would like to involve the police? Your options include: involving the police, not involving the police or completing a Third Party Report. The decision is up to you. Would you like some information about these options?”

Offer Information

Explaining what we are doing and why while providing all relevant information along the way can help to return a certain sense of control.

• Explaining what your role is, what you will be doing and why
• “We can stop or take a break at any time. You just let me know”

Provide space

Sexualized violence is the ultimate form of physical and emotional violation leaving people feeling hyper sensitive to any touch or physical proximity. It is very important that we are mindful of people’s personal space and that we ask for permission if we need to touch them or even sit beside them.

• “Is it ok if I sit next to you? “
• “How can I be helpful?”  “What can I do?”

The yoga studio I go to provides little round tokens for members to take and place in front of their mats if they would like physical adjustments during their practice. This gives the yoga instructor a visual cue of who they have permission to approach and physically adjust (touch) during the class.

Yoga Student, Winnipeg

Childhood Sexual Abuse

Childhood sexual abuse can occur over a period of time, is perpetrated by a trusted adult, and is a deep, dark secret the person may have hidden for a very long time. In cases where the perpetrator is a parent or family member, which is most often the case with childhood sexual abuse of girls in particular, this further complicates the trauma.  The very person who is biologically supposed to comfort and protect you is harming you instead, creating tremendous conflict. This can result in a child blaming themselves for the abuse in order to protect their relationship with the attachment figure.

Research has shown that there are serious consequences of adverse childhood environments on brain development and that childhood sexual abuse can have lifelong consequences for mental health. The ACE Study shows that certain childhood experiences (including sexual abuse) are also linked to many physical and psychological problems, and increase the risk of things like alcoholism, depression, poor academic achievement,^[13] Post Traumatic Stress Disorder, somatic complaints and suicide^[14]. A relatively new study found that childhood sexual abuse is linked to observable structural changes in the brain including the reduction of gray matter responsible for information processing and compromised cognitive control. ^[15]

The trauma and fears resulting from childhood sexual abuse can be carried into adult life, as can the behaviours the person who experiences sexual abuse used to survive. Many individuals who experienced child abuse define themselves by these abusive experiences, and still live from day to day as if they are just surviving and are living in fear of further harm.

Men Affected by Sexual Abuse

There is heavy societal and cultural pressure on men to be viewed as strong, unemotional, tough, and totally in control. Maintaining this image of masculinity is strongly reinforced, even at the risk of neglecting one’s own emotional needs. For men who have experienced sexual abuse, getting help is difficult and often avoided for fear of appearing weak or vulnerable. They are less likely to report sexual abuse, to identify experiences they have had as abusive, and to seek support or formal treatment for these experiences.^[16] As a result, the prevalence of these crimes is skewed and often leads to the false conclusion that male sexual victimization is rare.

It is important to differentiate the effects of sexual abuse on men especially since they are more likely to be overlooked. Men have learned to bottle emotions, and disconnect from relationships which may require a different therapeutic approach. Men who have been sexually assaulted may have concerns about their masculinity as well as their sexual orientation. They may be more developmentally prone to shame because of the gender strain of not being able to sustain the cultural expectations of men in the wake of interpersonal trauma. As a result, they can struggle intensely with self-blame and often present with more externalizing symptoms of anger, substance use, and impulsive self-destructive behavior than women.

The myths in our society about men being victims of abuse hold a lot of power and may create obstacles for men to talk about their experiences and be recognized as victims of sexual abuse. When they do, they are much less likely to be taken seriously and much less likely to receive treatment. Male survivors of childhood sexual abuse are also often viewed as less vulnerable than women, and mental health professionals may be less likely to ask men or recognize sexual abuse^[17]. If service providers believe in these myths, this will prevent them from providing knowledgeable and sensitive services to men who experienced sexual abuse.

---

[1] Government of Ontario

[2] Childhood Sexual Abuse: A Mental Health Issue

[3] Accessibility and Disability for Indigenous Women, Girls, and Gender Diverse People

[4] Smith, S., Stewart, D., Peled, M. et al. (2009). A Picture of Health: Highlights from the 2008 BC Adolescent Health Survey. Vancouver, BC: McCreary Centre Society.

[5] Trauma-Informed Care in Behavioral Health Services

[6] Cavanagh, M, Read, J. and New, B. (2004). Sexual abuse inquiry and response: A New Zealand training programme. New Zealand Journal of Psychology, 33(3), 137-144.

[7] Gutierres, S.E. & Van Puymbroeck, C. (2006). Childhood and adult violence in the lives of women who misuse substances. Aggression and Violent Behaviour, 11, 497-513.

[8] Dube, S.R., Miller, J.W., Brown, D.W., Giles, W.H., Felitti, V.J., Dong, M., & Anda, R.F. (2006). Adverse childhood experiences and the association with ever using alcohol and initiating alcohol use during adolescence. Journal of Adolescent Health, 38, 444.e1-444.e10.

[9] Waldrop, A.E., Santa Ana, E.J., Saladin, M.E., McRae, A.L., & Brady, K.T. (2007). Differences in early onset alcohol use and heavy drinking among persons with childhood and adulthood trauma. American Journal of Addictions, 16, 439-442.

[10] Ullman, Sarah E, Filipas, Henrietta H. Predictors of PTSD Symptom Severity and Social Reactions in Sexual Assault Victims. Journal of Trauma Stress 2001 Apr; 14(2): 369–389.

[11] Campbell R, Barnes HE, Ahrens CE, Wasco SM, Zaragoza-Diesfeld Y, Sefl T. Community Services for Rape Survivors Enhancing Psychological Well-Being or Increasing Trauma? Journal of Consulting and Clinical Psychology. 1999;67(6):847-858

[12] Campbell R, Wasco SM, Ahrens CE, Sefl T, Barnes HE. Preventing the “Second Rape”: Rape Survivors’ Experiences with Community Services Providers. Journal of interpersonal violence. 2001;16(12):1239–1259

[13] Child abuse ‘has serious consequences for brain development’

[14] Childhood Sexual Abuse and Brain Development: A Discussion of Associated Structural Changes and Negative Psychological Outcomes

[15] Child abuse ‘has serious consequences for brain development’

[16] Sorsoli L, Grossman FK, Kia-Keating M. “I keep that hush-hush”: male survivors of sexual abuse and the challenges of disclosure. J Couns Psychol. 2008;55:333-345.

   Artime TM, McCallum EB, Peterson ZD. Men’s acknowledgment of their sexual victimization experiences. Psychol Men Masc. 2014;15:313-323.

   Monk-Turner E, Light D. Male sexual assault and rape: who seeks counseling? Sex Abuse. 2010;22:255-265.

[17] Fisher, A., Goodwin, R. and Patton, M. (2009, March). Men & Healing: Theory, Research, and Practice in Working with Male Survivors of Childhood Sexual Abuse: A Guidebook. Ottawa, ON: The Men’s Project