The trauma inflicted by sexual assault can leave you feeling fear, anger, guilt, anxiety, and sadness. On top of this, the event may leave you embarrassed or ashamed.

94% of sexual assault victims experience post-traumatic stress disorder (PTSD) symptoms within two weeks of their encounter. Up to half will experience negative long-term effects. ¹

The most common PTSD symptoms are known as flashbacks (reimaginings of the traumatic event). These flashbacks are usually caused by a trigger (a reminder of the event). ² For example, you may experience a flashback by hearing about a sexual assault case on the news.

Flashbacks can make your life unstable and lead to other mental illnesses, such as depression. However, help is available. Throughout this blog, the role of PTSD in sexual assault victims.

Why Do Sexual Assault Survivors Experience PTSD?

According to the McGill Journal of Medicine, PTSD in “assault survivors is drastically higher than the national prevalence of the disorder.” ³

Sexual assault is more than just a violation of the body. It’s a disturbance of personal space and one’s understanding of safety. But how does PTSD develop after a sexual assault experience?

According to Akiami McCoy, LCSW, LCSW-C, a psychotherapist, “The brain does not perform well for a victim during a sexual assault.” During the encounter, your brain’s response is “flight or flight.” She continues, “Unfortunately, most victims are overpowered and can do neither. They may instead disassociate themselves from the act, and that’s where the mind escapes the body until the assault is over.“

In a 2015 study, it was found that victims who dissociated during a sexual assault were very likely to develop PTSD. ⁴ On top of this, if you’re already struggling with a mental illness (i.e. anxiety), you’re at an even higher risk of developing PTSD.

PTSD Symptoms

Since the symptoms of PTSD are so versatile, they’re separated into four categories:

• Avoidance
• Changes in emotional and physical reaction
• Intrusive memories
• Negative changes in mood and thought

To better understand PTSD, we’re reviewing each category separately. However, it’s important to note that children ages six and under may experience other symptoms, including:

• Re-enacting the incident through play
• Terrifying dreams of the incident

Avoidance

Avoidance symptoms include: ⁵

• Attempting to steer clear of conversations and thoughts about the incident
• Avoiding places, people, and/or activities associated with the incident

Changes in Emotional and Physical Reaction

Sometimes referred to as arousal symptoms, these include: ⁶

• Aggressive behavior or angry outbursts
• Becoming easily startled or frightened
• Constantly being on guard for harm
• Difficulty concentrating
• Insomnia
• Irritability
• Overwhelming guilt or shame
• Self-destructive behavior

Intrusive Memories

Symptoms of intrusive memories include: ⁷

• Experiencing flashbacks of the incident
• Intense emotional anguish or physical reaction to something that brings up the memory of the incident
• Reoccurring and undesired distressing memories of the event
• Terrifying dreams or nightmares of the incident

Negative Changes in Mood and Thought

These symptoms include: ⁸

• Difficulty experiencing positive emotions
• Emotional numbness
• Feelings of hopelessness (especially in terms of the future)
• Lack of interest in activities and people which were once of interest
• Separation from family and friends
• Trouble maintaining close relationships

How Do These Symptoms Play a Role in Daily Life?

Kandee Lewis, the executive director of the Positive Results Corporation, says, “The way a person thinks, walks, talks, and engages is divided into ‘before assault’ and ‘after assault,’ and they are never the same. There will be a day that that person feels like themselves, the ‘before’ self.”

After an assault, you may not feel daily life as normal. ⁹ Even the smallest of incidences (such as a movie scene or a door knock) can trigger a flashback. As a result, these reactions abstract you from what’s actually happening.

As McCoy puts it, “During a crisis, the brain is working to encode the violent event in order to store it as a memory. Unfortunately, encoding does not happen the way it would normally after the event is over. The victim may only be able to recall what they set their mind on until the act was over. That may be a picture on the wall, the trash on the floor, the spot on the ceiling…”

Sexual Assault and Relationships

Michael J. Salas, owner and founder of Vantage Point Counseling Services in Dallas, says, “Living with PTSD typically includes recognizing that the traumatic experience has changed you. It is true that you don’t completely lose yourself, but many things will shift as a result… opinions, perspectives, and even personality.”

These changes all work together when you enter into a relationship. If you have trouble finding a partner, it’s understandable. Sexual assault makes it difficult to trust anyone and can strongly influence your sexuality. ¹⁰

Sala teaches victims to recognize the first moment they felt safe following their assault. Many argue they never had that realization. As a result, survivors who attempt to explore their own sexuality may never feel safe doing so.

“A lot of survivors have difficulty feeling sexual pleasure or describe feeling numb or unable to really be present when they’re with a partner,” Mallonee explains. “Even supportive partners don’t always understand, or may feel hurt that sex with them could be triggering.”

If you are a partner of someone who has survived sexual assault, here are some tips to make your partner feel more secure:

1.) Learn About Trauma and PTSD

Before you try to help a sexual assault survivor, you must understand how PTSD changes the brain. Keep in mind that learning about PTSD isn’t just about research. It’s about having open discussions with your partner to better comprehend their position.

2.) Don’t Force the Story Out, Let the Survivor Tell It When They Comfortable

Opening up about an experience is difficult for any survivor. Part of this has to do with trust issues. However, the most difficult aspect of opening up is reliving unwanted memories.

Survivors will open up and discuss the incident with you (or other problems that surfaced afterward) on their own time. It’s not up to you to decide when a partner is ready to tell you.

A survivor once said, “I don’t give someone all the details at once. I need to see that they can be patient early on, and not because it’s a manipulation, but they are genuinely trying to be understanding of something that is out of both of our control.”

3.) Always Communicate

All relationships survive on communication. When it comes to PTSD relationships, the survivor must be able to process their trauma.

Kelly O’Brien, a survivor, notes, “The thing that makes me most comfortable as a survivor is having open communication with my partner at all times, but especially during bad days and during sex. We both make it a habit to check in with each other often and talk about everything too. Whether it is just how we are feeling that day or our past, we are open and make sure we are each up to talking about it at the time.”

4.) Make Sure Consent is a Priority

Understand that your partner needs to consent to anything, from sex to little choices (i.e. what to eat for dinner).

Survivor Alaina Leary points out, “What makes me feel most comfortable is being with a partner who prioritizes consent not just in our sexual and romantic aspects but in every small way, from my ability to make my own choices about my body (how I look, what I wear) and my identity, to what we are each responsible for in our lives.”

When it comes to trauma, survivors must have a sense of control over themselves. “I need to feel like I can throw the brakes on something or that I will be heard if I say I’m uncomfortable,” one survivor informs.

5.) Respect the Needs of Your Partner

To handle triggers, survivors have specific needs most people don’t. Sometimes, these needs are small. As a survivor and licensed clinical social worker Cynthia Stocker notes, if a survivor “comes home, and wants the curtains to be closed, don’t have an argument about that. Allow [them] to have the curtains closed.”

Often, you’ll find these needs putting a halt to certain actions (especially in the bedroom). You mustn’t take these things personally. As Stocker explains, “If a survivor says, ‘I don’t want to have oral sex. That isn’t something I’m comfortable with.’ Whether it’s giving or receiving, understand that that isn’t about you. It’s not personal.”

6.) Go With the Flow of Your Relationship

Survivors must recover at their own pace. Therefore, so should your relationship with them. “Understand that time for a survivor is going to look very different than it is for you,” Stocker informs. “Understand that their recovery is fluid, and can change from day to day and just accept that. What’s true one day may not be true the next, and has a lot to do with where they’re at in their process.”

7.) Don’t Be Afraid to Celebrate Recovery

“If you are recovering from trauma, and you are a survivor, we have to notice the small changes we make every day,” says Stocker. “If you are able to make one small change, celebrate that. And as you celebrate every small change that you make, you will make larger changes. But if you don’t notice the small changes, it’s impossible to make bigger ones.”

Sexual Assault Treatment

When it comes to PTSD treatment, medical professionals will recommend two routes: psychotherapy and medication. ¹¹ Since PTSD affects everyone differently, treatment is seldom the same. There is no treatment option where “one size fits all.”

If you have suicidal thoughts due to PTSD, you must get help immediately. In cases of emergency, go to your local emergency room or call 911. In all other cases, you can reach out to the 988 Suicide & Crisis Lifeline.

Medication

Antidepressants are common for sexual assault survivors as they can help ease symptoms of: ¹²

• Anger
• Numbness
• Sadness
• Worry

Other medications may help with specific symptoms. For example, Prazosin may ease PTSD sleep problems, such as insomnia and nightmares. ¹³ However, Prazosin currently isn’t approved by the Food and Drug Administration (FDA).

Psychotherapy

Psychotherapy, also known as “talk therapy,” is a treatment used for a variety of mental illnesses, including anxiety and depression. The purpose of this therapy is to understand the root of your PTSD, identify your triggers, and look into treatment solutions. ¹⁴ The most common psychotherapies include:

• Family therapy
• Group therapy
• Individual counseling
• Job-related therapy

Your healthcare provider will likely recommend cognitive behavioral therapy (CBT). The two most common CBTs used for PTSD are:

• Cognitive Restructuring helps you understand the memory your trauma stems from. Sometimes, trauma can be remembered as worse than it is. The goal is to help you remember more realistically. ¹⁵

• Exposure Therapy directly exposes you to your fears. From there, you’ll learn how to control the anxiety that follows. This is done safely and provides you with the time to adjust. You may be asked to write, imagine, or visit the location where this happened. ¹⁶

National Sexual Assault Hotline

If you need to talk to someone immediately, you can reach out to the 24/7 National Sexual Assault Hotline at 1-800-656-4673 or visit their website for an online chat.

References

¹ Chivers-Wilson KA. Sexual assault and posttraumatic stress disorder: a review of the biological, psychological and sociological factors and treatments. Mcgill J Med. 2006 Jul;9(2):111-8. PMID: 18523613; PMCID: PMC2323517.

² Jones E, Vermaas RH, McCartney H, Beech C, Palmer I, Hyams K, Wessely S. Flashbacks and post-traumatic stress disorder: the genesis of a 20th-century diagnosis. Br J Psychiatry. 2003 Feb;182:158-63. doi: 10.1192/bjp.182.2.158. PMID: 12562745.

³ Chivers-Wilson KA. Sexual assault and posttraumatic stress disorder: a review of the biological, psychological and sociological factors and treatments. Mcgill J Med. 2006 Jul;9(2):111-8. PMID: 18523613; PMCID: PMC2323517.

⁴ Nöthling J, Lammers K, Martin L, Seedat S. Traumatic dissociation as a predictor of posttraumatic stress disorder in South African female rape survivors. Medicine (Baltimore). 2015 Apr;94(16):e744. doi: 10.1097/MD.0000000000000744. PMID: 25906104; PMCID: PMC4602697.

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⁹ Moscarello R. Psychological management of victims of sexual assault. Can J Psychiatry. 1990 Feb;35(1):25-30. doi: 10.1177/070674379003500104. PMID: 2180547.

¹⁰ Ullman SE, Filipas HH. Predictors of PTSD symptom severity and social reactions in sexual assault victims. J Trauma Stress. 2001 Apr;14(2):369-89. doi: 10.1023/A:1011125220522. PMID: 11469163; PMCID: PMC3583013.

¹¹ Martin A, Naunton M, Kosari S, Peterson G, Thomas J, Christenson JK. Treatment Guidelines for PTSD: A Systematic Review. J Clin Med. 2021 Sep 15;10(18):4175. doi: 10.3390/jcm10184175. PMID: 34575284; PMCID: PMC8471692.

¹² Williams T, Phillips NJ, Stein DJ, Ipser JC. Pharmacotherapy for post traumatic stress disorder (PTSD). Cochrane Database Syst Rev. 2022 Mar 2;3(3):CD002795. doi: 10.1002/14651858.CD002795.pub3. PMID: 35234292; PMCID: PMC8889888.

¹³ Koola MM, Varghese SP, Fawcett JA. High-dose prazosin for the treatment of post-traumatic stress disorder. Ther Adv Psychopharmacol. 2014 Feb;4(1):43-7. doi: 10.1177/2045125313500982. PMID: 24490030; PMCID: PMC3896131.

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