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Abstract
Victims of rape routinely are acknowledged to need counseling but not psychotherapy; if psychotherapy is provided, the major focus is on preexisting psychopathology. The author examines these assumptions and presents a different formulation based solely on an in-depth examination of the many levels of the trauma. Case material reveals the typical symptoms, conflicts, and defenses found in rape victims. The author makes recommendations for psychotherapeutic technique, especially in regard to difficulties in forming a therapeutic alliance.
... The victim comes to therapy feeling as if she is "going crazy" and fears that the therapist will confirm it. She blames herself for this disastrous state of affairs (Rose, 1986). ...
... One way to understand the ensuing psychological damage is that the internal self and object representations and adaptive techniques for understanding and dealing effectively with the feelings, thoughts, fantasies, and impulses arising from the stressor-rape, are therefore not developed or adequate. The victim thus experiences her internalized object relations as having been shattered (Rose, 1986;Titchener, 1986). With this devastation, the victim experiences her early supportive environment and the maternal introject as no longer available to her. ...
... It results in withholding of crucial material and in the rupture of the developing alliance. Any references to it need to be explored, particularly if mistrust is manifest in the transference (Lindy et al., 1986;Rose, 1986;Spiegel, 1984). One patient, a victim of an acquaintance rape, began her psychotherapy with an agitated but distant recital of her experiences. ...
Describes a model that is derived from the author's experience in providing individual psychodynamic psychotherapy and consultation to rape victims. Technical problems that occur in the psychodynamic psychotherapy of rape victims are discussed. They include the formation of a therapeutic alliance, the identification and interpretation of defenses, the victim's conflict over aggression, preexisting psychodynamics, countertransference reactions, and contact with societal institutions. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
... Frankenthal (1969) noted that prisoners endure their situation by detaching themselves from their immediate surroundings and reliving better times, an observation echoed by Frank (1973). Rose (1986) reported that depersonalization, including out-of-body experiences, and other dissociative forms are commonly reported by rape victims (but no statistical data was provided). ...
... The extensive literature on so-called "near-death experiences" also contains many reports of perceptual alterations in connection with actual or perceived threat to one's life, including out-of-body experiences and other changes in the phenomenal self (Noyes & Kletti, 1977), which have also been anecdotally reported in connection to such other traumatic events as rape (e.g., Rose, 1986). ...
We present proposed changes to the dissociative disorders section of the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders and review the concept of pathological and nonpathological dissociation, including empirical findings on the relations between trauma and dissociative phenomenology and between dissociation and hypnosis. The most important proposals include the creation of two new diagnostic entities, brief reactive dissociative disorder and transient dissociative disturbance, and the readoption of the criterion of amnesia for a multiple personality disorder diagnosis. We conclude that further work on dissociative processes will provide an important link between clinical and experimental approaches to human cognition, emotion, and personality.
... Ces questions troublent Jonathan et paraissent tellement envahissantes que les trois objectifs d'une psychothérapie tels que précédemment discutés s'appliquent dans son cas. À la suite d'auteurs tels que Rose (1986) et Everstine-Sullivan et Everstine (1989, il y a lieu de penser que le bouleversement vécu par Jonathan est si important que seule une démarche psychothérapique psychanalytique individuelle qui viserait à le libérer du joug des conflits inconscients qui l'habitent apparaît indiquée. En effet, ni des approches de groupe ni des approches axées sur des comportements ou des cognitions précises centrées sur le trauma de la victimisation ne sauraient le soulager. ...
... Comme le soulignent Baril (1983), Rose (1986) ainsi que Everstine-Sullivan et Everstine En ce sens, lorsque une psychothérapie s'impose, il importe que le traitement proposé corresponde le plus étroitement possible aux besoins individuels reconnus suite à l'évaluation. ...
... However, two authors discuss the use of psychodynamic psychotherapy for rape and incest survivors which does not blame the survivor for the assault (Rose, 1986;Schuker, 1979). Schuker regards rape reaction as resulting from "narcissistic injury," and suggests that therapy be focused on helping the survivor become angry at the rapist and less blaming of herself, hi addition, the survivor is encouraged to grieve the loss of the former self-image, which may have included a sense of invulnerability and safety. ...
... Schuker regards rape reaction as resulting from "narcissistic injury," and suggests that therapy be focused on helping the survivor become angry at the rapist and less blaming of herself, hi addition, the survivor is encouraged to grieve the loss of the former self-image, which may have included a sense of invulnerability and safety. Rose (1986) discusses psychodynamic considerations in several case studies and provides recommendations for the psychodynamic treatment of survivors. Making a suggestion reminiscent of stress-oriented therapy with veterans, Rose recommends that interpretations during therapy focus on aspects of the survivor's experience of the rape, and emphasizes that traditional transference interpretations should be used primarily to provide additional information for the reconstruction of the trauma. ...
Reviews the treatment literature discussing trauma-focused interventions for Vietnam veterans and rape and incest survivors. Some assumptions about the coping process that the authors believe underlie the diverse approaches that currently exist are examined. Specifically, the treatment approaches that are reviewed are considered in reference to 2 basic coping modes: approach and avoidance. The importance of understanding the process of coping with trauma is discussed to better understand treatment effectiveness. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
... Guilt and shame surrounding the abusive experience is expressed almost universally by the adolescents in the group (Browne & Finkelhor, 1986;Rose, 1986). They feel they are to blame for the abuse in some way. ...
... Also common are feelings of distrust (Browne & Finkelhor, 1986;Rose, 1986). The teens describe tremendous difficulties in trusting others. ...
This article describes a support group of two years' duration for physically, sexually, and emotionally abused adolescents in an inpatient unit at the University of Michigan Child and Adolescent Psychiatric Hospital. Group characteristics, group dynamics, and emotional reactions of the adolescents are discussed. This experience suggests that a support group does not necessarily need a homogeneous membership, as the literature often indicates, to be successful.
... For Young et al. (2000), sexual violence may include unwanted and forbidden verbal, physical, coercive and sexual advances and sexual events. Rose (1986), on the other hand, defines sexual assault as any form of sexual contact that takes place without the consensus of the other partner and that may violate the other person's control and power over their body. Intimate partner violence is one pertinent form of sexual violence that needs special consideration in developing nations of the world. ...
Perpetuation of rape myths in news reporting
... It follows that ST may be a particularly salient form of interpersonal trauma in terms of adverse outcomes. Rose (1986) posited that ST is especially traumatic because of the threat of loss of life, both literally and in the sense that important aspects of the self are destroyed; in this way " [r] ape disrupts the sense of autonomy, control, and mastery over one's body" (p. 820), as does CSA. ...
Sexual trauma (ST) occurs with alarming frequency in the United States in the form of both childhood sexual abuse (CSA) and adulthood sexual assault (ASA). It is well established that the effects of ST are pervasive and that ST can be a risk factor for the development of several psychiatric disorders. However, the potential for distinct psychological consequences or neural correlates between CSA and ASA has received little attention. Furthermore, despite the high prevalence of sexual revictimization, the combinatorial effects of CSA and ASA are understudied in comparison to each form of ST on its own. In the current review, we present results from both clinical psychology and neuroscience research on the impacts of CSA and ASA, describing major psychological, biopsychosocial, and neuroimaging findings for each form of ST. We further highlight limitations in the current state of the research and needed areas of future research to better understand the distinct, overlapping, and cumulative effects of ST in both childhood and adulthood. The present study summarizes the state of the literature on this critical form of trauma and provides recommendations for future clinical research practices to mitigate the deleterious outcomes of ST.
... Behavioral self-blame has been viewed as a better strategy because behavior is changeable ("I won't walk in that neighborhood again"). However, several authors have challenged this notion, positing that all kinds of self-blame, despite its use as an adaptive strategy, have negative consequences [42][43][44][45]. Other coping strategies such as avoidance, cognitive restructuring, or the way one thinks about events that are happening, have happened, or will happen, can also have adverse outcomes. ...
This paper examines the coping strategy of humor presented by eight adult women aged 26 through 61 in a small clinical practice setting. Each woman had been sexually abused by a variety of family members during childhood. They were seeking therapy for life-phase issues (e.g., divorce, retirement, marital problems, parent/child issues). The reemergence of sexual violence memories and the ways in which these women used humor as a coping strategy to alleviate the effects of childhood sexual abuse (CSA) are presented.
... In general, interpersonal traumas result in higher rates of PTSD than noninterpersonal traumas such as motor vehicle collisions or natural disasters (9,(76)(77)(78). Furthermore, prior literature suggests that sexual assault is by its nature unique even when compared with other types of interpersonal trauma because it is a crime that violates and "disrupts the sense of autonomy, control, and mastery over one's body" (79). This unique nature of ST may explain why it is a singularly important risk factor for later psychopathology, and taken together with prior literature, the current results suggest that history of ST exacerbates posttraumatic dysfunction following a new trauma. ...
Background
Prior sexual trauma (ST) is associated with greater risk for posttraumatic stress disorder after a subsequent traumatic event; however, the underlying neurobiological mechanisms remain opaque. We investigated longitudinal posttraumatic dysfunction and amygdala functional dynamics following admission to an emergency department for new primarily nonsexual trauma in participants with and without previous ST.
Methods
Participants (N = 2178) were recruited following acute trauma exposure (primarily motor vehicle collision). A subset (n = 242) completed magnetic resonance imaging that included a fearful faces task and a resting-state scan 2 weeks after the trauma. We investigated associations between prior ST and several dimensions of posttraumatic symptoms over 6 months. We further assessed amygdala activation and connectivity differences between groups with or without prior ST.
Results
Prior ST was associated with greater posttraumatic depression (F1,1120 = 28.35, p = 1.22 × 10⁻⁷, ηp² = 0.06), anxiety (F1,1113 = 17.43, p = 3.21 × 10⁻⁵, ηp² = 0.05), and posttraumatic stress disorder (F1,1027 = 11.34, p = 7.85 × 10⁻⁴, ηp² = 0.04) severity and more maladaptive beliefs about pain (F1,1113 = 8.51, p = .004, ηp² = 0.02) but was not related to amygdala reactivity to fearful versus neutral faces (all ps > .05). A secondary analysis revealed an interaction between ST and lifetime trauma load on the left amygdala to visual cortex connectivity (peak Z value: −4.41, corrected p < .02).
Conclusions
Findings suggest that prior ST is associated with heightened posttraumatic dysfunction following a new trauma exposure but not increased amygdala activity. In addition, ST may interact with lifetime trauma load to alter neural circuitry in visual processing regions following acute trauma exposure. Further research should probe the relationship between trauma type and visual circuitry in the acute aftermath of trauma.
... Sexual assault is defined as "any form of sexual contact without voluntary consent, and that violates a person's sense of autonomy, control and mastery over their body" [45]. The prevalence of PTSD due to sexual assault is 50%, making it the most common trauma resulting in PTSD in women [46]. ...
Trauma exposure is one of the most important and prevalent risk factors for mental and physical ill-health. Prolonged or excessive stress exposure increases the risk of a wide variety of mental and physical symptoms, resulting in a condition known as post-traumatic stress disorder (PTSD). The diagnosis might be challenging due to the complex pathophysiology and co-existence with other mental disorders. The prime factor for PTSD development is exposure to a stressor, which variably, along with peritraumatic conditions, affects disease progression and severity. Additionally, many factors are thought to influence the response to the stressor, and hence reshape the natural history and course of the disease. With sufficient knowledge about the disease, preventive and intervenient methods can be implemented to improve the quality of life of the patients and to limit both the medical and economic burden of the disease. This literature review provides a highlight of up-to-date literature on traumatic stress, with a focus on causes or triggers of stress, factors that influence response to stress, disease burden, and the application of the social-ecological public health model of disease prevention. In addition, it addresses therapeutic aspects, ethnic differences in traumatic stress, and future perspectives, including potential biomarkers.
... Unwanted sexual experiences are often measured along a continuum, including categories of unwanted sexual contact (e.g., kissing or fondling), verbal coercion, attempted rape, and rape, presumed to reflect the least to most severe experiences. Different methods of coercion: arguments and pressure, misuse of authority, alcohol or drug intoxication (separate questions for attempted and completed acts), and physical force used by the perpetrator has been conceptualized to vary in extent of trauma perceived [2]. Another distinction was attempted on the basis of forcible and incapacitated rape. ...
... 1 In their 1974 American Journal of Psychiatry article, Burgess and Holmstrom reported that there was little information on the physical and psychological effects of rape or how to manage the treatment of a survivor of sexual assault in the psychiatric literature. 1 In the past, rape survivors were thought to need only counseling-that is, direct, problem-focused treatment-rather than broader, more in-depth treatment such as psychotherapy and, if the survivor did undergo psychotherapy, the major focus was on preexisting psychopathology. 2 The United States Centers for Disease Control and Prevention (CDC) estimates that sexual violence affects one in three women and one in four men over the course of their lifetimes. 3 The treatment of survivors of sexual assault gains benefits from several general and specialized types of psychotherapy including psychodynamic psychotherapy, traumafocused cognitive-behavioral therapy (TF-CBT), and eye movement desensitization and reprocessing therapy (EMDR). ...
Sexual assault and abuse can result in severe physical and emotional trauma to the victim. Deploying targeted psychotherapeutic treatment that is individualized for the survivor is important to achieving optimal patient outcomes. There are several valid and evidence-based treatments available for posttraumatic stress disorder (PTSD) and interpersonal difficulties that can result from sexual abuse and assault. In this article, the authors discuss psychodynamic psychotherapy, trauma-focused cognitive behavioral therapy (TF-CBT), and eye movement desensitization and reprocessing therapy (EMDR) for the treatment of patients following sexual assault and abuse. The authors also provide practice points on common issues in the management of the treatment of sexual assault survivors, including transference, countertransference, and avoiding retraumatization. Composite case vignettes are used to illustrate treatment techniques.
... Unwanted sexual experiences are often measured along a continuum, including categories of unwanted sexual contact (e.g., kissing or fondling), verbal coercion, attempted rape, and rape, presumed to reflect the least to most severe experiences. Different methods of coercion: arguments and pressure, misuse of authority, alcohol or drug intoxication (separate questions for attempted and completed acts), and physical force used by the perpetrator has been conceptualized to vary in extent of trauma perceived [2]. Another distinction was attempted on the basis of forcible and incapacitated rape. ...
... Studies have found that most patients with DD report a history of childhood trauma, usually involving physical and/or sexual abuse (Saxe et al., 1993). Physical and/or sexual abuse is reported in 88.5-96 percent of DD patients (Rose, 1986), and higher rates of suicide or chronic self-cutting are found in DD patients with early trauma than in other psychiatric conditions (van der Kolk, Perry, & Herman, 1991). Most DD patients experience suicidal ideas and behavior. ...
Preclinical studies indicate that stress early in life can cause long-term alterations in brain development. Studies have shown alterations in the brain functions of patients after experiencing trauma. Our aim is to examine whether the integrity of white matter tracts might be affected in dissociative disorder (DD) patients. A total of 15 DD patients and 15 healthy controls were studied, with the groups matched by age and gender. Diffusion-weighted echoplanar brain images were obtained using a 1.5 Tesla magnetic resonance imaging scanner. Regions of interest were manually placed on directional maps based on principal anisotropy. Apparent diffusion coefficient and fractional anisotropy (FA) values of white matter were measured bilaterally in the anterior corona radiata (ACR) and by diffusion tensor imaging in the genu and splenium of the corpus callosum. Significantly lower FA values were observed in the right ACR of DD patients versus healthy individuals. We also found an association between bad paternal relationships and lower FA in the genu of the corpus callosum in female patients. Alterations in the right ACR suggest that diffusion anisotropy measurement can be used as a quantitative biomarker for DD. Paternal relationships may also affect the brain’s microstructure in women with DD.
... It has also been asserted that the partners of sexually assaulted women may come to view the victims as 'damaged goods', who were 'contaminated' by their sexual contact with another man (Rose, 1986). A husband who felt this way might be less likely to seek to be intimate with his wife. ...
Extemsive research has been conducted regarding factors contributing to the breakdown of marriage, focusing on problems such as infidelity, domestic violence, money problems and mid-life crises. This study explores a new question: does crime victimization contribute to the dissolution of marriage? Unique information from a national panel survey, the National Crime Victimization Survey, was analyzed in a longitudinal format to determine whether married crime victims were more likely than non-victims to become divorced or separated in the six to twelve months following the crime. Logistic regression analysis indicated that crime victims were generally more likely to experience marital disruption. Robbery victims were 2.7 times more likely (significantly so) than non-victims to be divorced or separated within six to twelve months of the crime, while this risk was non-significantly higher for burglary, assault, and theft victims. Those victimized by their spouse were nearly nine times more likely to later be divorced or separated. Assault victimization had a more detrimental impact on marriage for women than for men. Otherwise, the effects of victimization were similar for men and women. Although it has been speculated that sexual assault could jeopardize marriages because some husbands would view their victimized wives as ‘damaged goods’, we found no significant effect on marital disruption. We speculate that men in recent times may have become less likely to devalue victimized women in this way.
... Treatment services, struggling to understand how to treat crack addiction and how to care for women addicts, face yet another new task in program development: care for those who suffer from trauma-spectrum disor- ders. The development of trauma treatment for such women must build on both the experience of treating posttraumatic stress disorder in veterans (Haley, 1985; Scurfield, Corker, Gongla, & Hough, 1984) and the growing experience of treating sexual abuse (Rose, 1986). That body of work would suggest that peer support will be a critical element in recovery. ...
The involvement of women in crack cocaine abuse has had a severe impact on their health, the health of their children and the stability of their communities. Of particular concern has been the development of a system of barter in which crack‐for‐sex exchanges are the means through which women obtain the drug. Earlier studies have suggested that drug abuse may be related to and exacerbated by trauma. In the project described herein, we interviewed women crack users in Harlem to study the relationship between trauma, crack use, and crack‐related sexual behavior. Results suggested the existence of three types of trauma: (1) traumas that predate the respondent's onset of crack use; (2) traumas that were the direct sequelae of crack use; and (3) stigma trauma, that is, trauma that results from membership in a despised or oppressed group. We observed a complex inter‐relationship involving crack use, crack‐for‐sex transactions, and these three types of trauma. Treatment of the eventual co‐morbidity of trauma and addiction is an urgent challenge.
... We would, therefore, postulate that women previously abused would be at an elevated risk of revictimization within an institutional setting. The effects of rape have almost exclusively been studied among younger to middle-aged women (Burgess & Holmstrom, 1974;Calhoun & Atkinson, 1991;Rose, 1986), leaving us with almost no knowledge of the effects of sexual assault on older women. If the case reported by McCartney and Severson (1997) is found to be typical, however, we will find that the effects of rape experienced by older women may well be pervasive and debilitating, often leading to severe restrictions in independence and quality of life. ...
Little is known and less is written about post-traumatic stress disorder (PTSD) in institutionalized older adults, especially in the context of their past exposure to child sexual assault. The behavioral and psychological manifestations displayed by child sexual abuse survivors are considered especially in the context of possible symptom reactiva- tion throughout the life course. Analysis is offered of the ways in which aging itself and the organizational practices of long-term care institu- tions may serve to reactivate and exacerbate long-dormant child sexual abuse thoughts, feelings, and symptoms in residents. Specific recom- mendations for needed research as well as nursing home staff training, programming, and policy are put forward. (Article copies available for a fee from The Haworth Document Delivery Service: 1-800-HAWORTH. E-mail address: Website: © 2003 by The Haworth Press, Inc. All rights reserved.)
TRAUMATIC SYNDROMES OF INCESTUOUS AND NON-INCESTUOUS RAPE
Jean-Michel DARVES-BORNOZ
The role played by sexual assaults in the onset of mental disorders is a point which has long been
debated in psychiatry. And yet disbelief and ignorance of the facts have long hampered the development of
research and therapeutic treatments in this area.
This work first provides a historic overview of the notion of psychological trauma of sexual origin and
then describes the typology of trauma in sexual abuse. The main points concerning the epidemiology of sexual
abuse are then dealt with. Indeed, over the past decade, major epidemiological surveys have reported high
levels of sexual abuse taking place in childhood or adulthood.
Four clinical studies are presented investigating the psychopathological aftermath of incestuous or
non-incestuous rape.
The first of these is a year-long prospective study involving one hundred and two subjects over
thirteen years of age who were victims of incestuous or non-incestuous rape, and who presented consecutively
in the forensic center for victims of rape and incest, within the department of gynecology at the University
teaching hospital in Tours, France (chapter IV). The subjects were regularly interviewed by a psychiatrist using
a standardized battery of clinical instruments for the diagnosis of mental disorders, and more generally for the
assessment of their clinical condition. This study showed that three traumatic syndromes were very frequently
observed following rape. These we called :
1. Syndrome Secondary to Traumatic Stress : this nosographic entity was previously termed traumatic
neurosis, and is elsewhere called Post-Traumatic Stress Disorder (PTSD) ;
2. Dissociative and Phobic Traumatic Syndrome : this syndrome includes somatoform disorders and
specific phobias, but also and especially dissociative disorders, in Pierre Janet's meaning of that term, and
agoraphobia ;
3. Borderline-like Traumatic Syndrome : this syndrome accounts for the alteration in identity and
personality, secondary to the narcissistic wound caused by rape.
We moreover determined that the early onset of one of these two latter syndromes, the incestuous nature of the
rape and experiences of physical violence apart from rape were factors predictive of chronic Post-Traumatic
Stress Disorder one year after rape.
This work further presents specific studies giving an account of the clinical forms of disorders
following rape, in incestuous rape, in adolescents, in males and psychiatric patients :
1. for incestuous rape (chapter V), the Tours cohort is studied from this point of view ;
2. for adolescents (chapter VI), firstly those subjects from the Tours cohort are presented for whom
rape took place before the age of twenty (78% of the cohort) ; next INSERM1 survey data on rape in
adolescence are presented, as studied Marie Choquet, Jean-Michel Darves-Bornoz and Sylvie Ledoux ; the
INSERM survey was carried out using a representative sample of 8255 teenage schoolgoers from the general
population ;
3. for rape in males (chapter VII), the results from the Tours cohort are presented first ; data on rape in
boys as found in the INSERM survey by Marie Choquet, Jean-Michel Darves-Bornoz and Sylvie Ledoux are
then presented ;
4. for the psychiatric patients (chapter VIII), two systematic studies are presented. The first deals with
ninety women suffering from schizophrenia and bipolar disorder. The second study deals with ninety women
consecutively admitted to the Psychiatric Department in the Tours University Hospital. This study attempts to
explain why psychiatric patients as a whole, and whatever their initial diagnosis may be, are frequently rape
victims, and so with a comorbidity frequently presenting the three above-mentioned syndromes.
The work then shows that several approaches (neuropsychological, psychodynamic, behavioral and
psychobiological) can contribute to an understanding of the etiology in these disorders. Finally, different
methods of treating the victims are considered, and the principles applied at the Victims of Psychological
Trauma Consultation Unit at the University Teaching Hospital in Tours, set up by Jean-Michel Darves-Bornoz
in 1992, are illustrated through a single case study (chapter X).
The work firmly concludes that rape and incest form part of the more general field of trauma.
However, it is also noted that, in rape and incest, it is a narcissistic wound that causes the trauma, and that it is
the subject's psychological survival that is at stake. The significant change in impact of the trauma can
therefore be linked to both its specific cause and target.
1. National Institute of Health and Medical Research
This article has discussed the most common sequelae of victimization with regard to incest, rape, and battering. Although legislators and law-enforcement officials have traditionally been viewed as having primary responsibility for the prevention and control of violence, it is now known that physicians must also act in this regard. Their action is especially required with regard to victim assessment and treatment. Physicians serve as the entry points not only to the health care system, but also to other resources for victims of violence. By identifying their victimized patients and by understanding the antecedents of their patients’ symptoms, physicians can go much further in meeting their patients’ needs for physical, mental, and social well-being. Given the scope and impact of violence, physicians have a moral and ethical obligation to inquire about the possibility of current violence, past violence, or both in their patients’ lives.
This is the book that started an are of research and practice of compassion fatigue, secondary traumatic stress and stress reactions, vicarious trauma, and most recently compassion fatigue resilience
The literature on the theory and clinical implications of posttraumatic stress disorder (PTSD) has grown enormously over the past 10 years, yet clearly in striking contrast to the relative paucity of literature regarding psychometric assessment. There are few psychological instruments in use which have adequate norms for the evaluation of PTSD, particularly for nonmilitary traumatic events. Currently, there is much evidence that many kinds of “civilian” disasters (e.g., rape, violent assault, natural disasters, hostage situations, etc.) can produce a stress response (Green, Lindy, & Grace, 1985; Horowitz, 1976, 1985; Krystal & Niederland, 1968; Sales, Baum, & Shore, 1984).
A crisis may be defined as a “functionally debilitating mental State resulting from the individual’s reaction to some event perceived to be so dangerous that it leaves him or her feeling helpless and unable to cope effectively by usual methods.”1 Family physicians would add “debilitating physical State,” for often the crisis we see involves somatic complaints with or without psychological distress signals. There are many situations, such as bereavement, pregnancy loss, or family violence, that will precipitate crises in our patients and their families. Often, the family physician is the person of first contact and is responsible for the initial crisis Intervention. Principles of crisis management have been developed to assist clinicians in their approach to the patient in crisis. The physician should become knowledgeable about typical reactions to precipitating events. He will need to explain the range of responses and provide anticipatory guidance. By attending to physical and emotional complaints, a physician can evaluate his patients and help them in their return to a fully functional, gratifying life.
Multiple personality disorder (MPD) and posttraumatic stress disorder (PTSD) were formulated in medical consciousness at about the same time that modern psychiatry was being molded by its Age of Giants. During this period of 1880 to 1920, MPD was pulled from its millennia-old identification with demonology and possession into the rational spheres of psychology (Ellenberger, 1970). The “cowardice” of warriors who relived scenes of terror in sweating nightmares acquired a new etiology in the trenches of World War I, namely, “shell shock,” later to become the “combat fatigue” of World War II, and the PTSD of today. All too often throughout history the MPD and PTSD patient shared similar fates: isolation or death for the “possessed,” rejection or execution for the craven. Until recently, however, it was not realized that MPD and PTSD had two similarities in etiology and phemonenology: origin in exposure of the victim to shattering psychological trauma—in childhood in the instance of MPD, in later life in PTSD—and the subsequent need for the person to dissociate as a coping mechanism.
The popular concept of "the inner child" and "inner child work" will be evaluated and compared to various theories of personal development, including object relations, self psychology ,Jungian and dissociation theories. It will be suggested that much of what is being accessed in such work is compatible with these theories and may be at least ego-state based rather than just a pleasing visualization or metaphor. Terminology clarifications and cautions as well as directions for effective hypnotic approaches will be outlined.
objective: The article reviews the relationship between rape and mental disorders specially Posttraumatic Stress Disorder, Methodology: Published original articles and selected reviews. Literature was surveyed using MEDLINE and LILACS. Results: Despite of operational difficulties in estimating and identifying, the prevalence of rape is significant; it is related to disfunctional behaviour patterns and a increased risk to develop psychiatric disorders. Posttraumatic Stress Disorder, the most frequent consequence of rape, is described in its clinical picture, course, risk factors and incidence. Conclusions: Because of the high prevalence of sexual assault, its pathogenic potential and the frequent victim's refusal to talk about; it is necessary for mental health professional to conduct specific assessment of traumatic abuse history.
The empowerment of women is a broadly endorsed strategy for solving a host of difficult problems, from child poverty to gender violence to international development. The seventeen international scholars in this multi-disciplinary volume offer thoughtful critiques of the notion of empowerment based on their studies in twenty countries in all regions of the world. The comparative introduction places concepts of empowerment in the context of models of the market and of community, showing how contradictions in these models as they are enacted on the ground provide both spaces and constraints for women. The chapters consider opportunities for women in the context of globalization, resurgent nationalism and politicized religion, cultures of masculinity, and the HIV/AIDS epidemic in Africa. They show how initiatives at national or global levels are transformed by local cultures and power structures, and demonstrate the fruitfulness of tensions between universal values of human rights and contextualized understandings. This landmark, multi-disciplinary collection of original studies by distinguished international feminist scholars will be an essential addition to the fields of Political Science, Women's Studies, Economics, Sociology, International Development, and Environmental Studies.
In this existential-phenomenological investigation seven women were interviewed about their experiences of recovering from rape trauma. The purpose of the study was to discover the meaning of recovery from the perception of the victim, how recovery is experienced, and what contributed to the growth and recovery of the woman who has been raped. Transcribed interviews were analyzed using a hermeneutic process. The thematic structure of a woman's recovery from rape comprises three main themes: reaching out, reframing the rape, and redefining the self. These findings are important to professionals working with women who have been raped because it is the raped woman, rather than the clinician, who is able to define what constitutes recovery.
In an effort to address research challenges posed by the study of coping with extremely stressful life events, this chapter will outline a conceptual framework provided by a dynamic consideration of immediate and long-term coping with trauma and will consider the relationship of coping to psychological well-being. Although we consider such a fremework to be useful and necessary, we will also point to limitations of current research in operationalizing such a framework, especially as it relates to extreme stress and long-term adaptation. Specific illustrations of the suggested paradigm will be provided from the literature and from our study of coping efforts of Holocaust victims during the period of victimization and by survivors in the aftermath of the Holocaust.
How do clinicians identify with culture in the clinical encounter? Medical textbooks reify certain patient demographics without considering their salience to the clinician-patient interaction. Previous research on cultural transference and countertransference likewise presume that culture belongs exclusively to the clinician or the patient. More recent scholarship has departed from the supposed objectivity of each party toward the intersubjectivity of the relationship. This article modifies Ogden's notion of the analytic third to suggest the coconstruction of the cultural third for further explorations into shared and different cultural meanings within therapy.
Over the last 30 years, major advances have been made in our understanding of how bio-logical factors and sociocultural influences contribute to gender differences, gender identity formation, and gendered role behavior. Sensitivity to the psychological effects of changing family structure and workforce composition, the contribution of reproductive events, and the high rates of exposure to trauma in women is essential for optimal psychiatric assessment and treatment planning. This knowledge has not been systematically integrated into residency training. The authors present an outline for a curriculum in gender and women's issues, including educational objectives, learning experiences through which residents could meet these objectives, and recommended readings. The authors also discuss potential obstacles and suggest helpful strategies for implementing the proposed curriculum.
Little is known and less is written about post-traumatic stress disorder (PTSD) in institutionalized older adults, especially in the context of their past exposure to child sexual assault. The behavioral and psychological manifestations displayed by child sexual abuse survivors are considered especially in the context of possible symptom reactivation throughout the life course. Analysis is offered of the ways in which aging itself and the organizational practices of long-term care institutions may serve to reactivate and exacerbate long-dormant child sexual abuse thoughts, feelings, and symptoms in residents. Specific recommendations for needed research as well as nursing home staff training, programming, and policy are put forward.
A training programme in rape crisis intervention for lay therapists (members of Rape Crisis in Cape Town) is described and evaluated. Apart from this experimental group (N = 8), there were two control groups: one consisting of members of Rape Crisis who did not attend the programme (N = 9) and the other consisting of people who were not members of Rape Crisis and had not attended the programme (N = 8). Levels of facilitativeness (FAC) and action orientatedness (ACT) that subjects were able to offer before and after the programme were assessed, using a modification of the instrument developed by Carkhuff. The levels of FAC that subjects were able to offer were not affected by the programme. Members of Rape Crisis offered significantly lower levels of FAC than those subjects who were not members of Rape Crisis, both before or after the programme. The programme appeared to increase the levels of ACT that subjects were able to offer. Theoretical and practical explanations for, and implications of, these results are examined.
This paper is part of a larger study of reported and unreported crime on the campus of East Carolina University. The survey was conducted during the Spring of 1994, and involved a total sample of 760 respondents. Those questions dealing with rape, other sexual offenses, stalking, and lewd phone calls were used to determine the level of both reported and unreported incidents, and the relationship of such experiences to the students' overall fear of crime, and avoidance of night classes. Overall, students exhibited an extremely high concern about crime. Students who reported having received lewd and/or threatening phone calls were the most concerned and reluctant to take night classes.
A four-phase group plan is presented to help survivors of childhood sexual abuse move beyond dissociative coping to more effective coping strategies. A group format provides the opportunity for survivors to receive feedback about the extent to which they dissociate, help in understanding what triggers them to dissociate, and the impact dissociation has on relationships. Group members also learn active coping strategies and have the opportunity to practice new behaviors within the safety of the group. Outcomes include increased self-acceptance, awareness, and self-control.
A number of case reviews and observations have reported on the effects, on counsellors, of working with victims of violence. In this study two groups of counsellors, sexual assault counsellors (n = 41) and counsellors from a range of other therapy areas (n = 32), were compared on a number of measures including the Maslach Burnout Inventory, Ways of Coping Scale and a Beliefs and Values Questionnaire. The results indicate that sexual assault counsellors experience greater emotional exhaustion and use more escape/avoidance coping strategies. Responses concerning beliefs and values are discussed in terms of McCann and Pearlman's constructivist self-development model and indicate support for the concept of vicarious traumatization. Implications of these findings for Sexual Assault Services are discussed.
This article examines countertransference in the assessment and treatment of recovery from traumatic incidents of adulthood, with specific focus on victims of violent crime. It reviews Freud's impediment theory, with particular attention to implications concerning empathic strain and vicarious traumatization. It introduces Wilson and Lindy's Type I Countertransference (avoidance), Type II Countertransference (overidentification), and their respective manifestations. It then proposes a Type III Countertransference (communicative) that applies a more totalistic perspective that utilizes concepts of splitting, projection, projective identification, and intersubjectivity. It differentiates between countertransference orientations to trauma that are content-based or processed-based as well as those that may be figure or ground. Finally, it presents some common countertransference reactions and roles that become enacted and therefore have treatment implications, examines the interaction between therapeutic and real relationships as contributors to those scenarios, and presents case examples.
Argues that classical conditioning plays a major role in the development of certain posttraumatic phenomena among combat veterans (L. C. Kolb and L. R. Multalipassi, 1982). The article focuses on the phenomenology of a state of intense arousal often experienced by veterans in combat, and later reexperienced in a variety of situations. Known as the "combat rush" by many veterans, this state is particularly likely to recur in conjunction with flashbacks, and in other circumstances that are ordinarily very stimulating. These include fights, risky activities, and the abuse of certain drugs. Regardless of a therapist's approach to treatment, problems related to the combat rush complicate the therapeutic relationship and may emerge as a major obstacle to successful resolution of trauma. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Provides practical guidelines for therapy using music combined with appropriate hypnotic words to guide attention and experience along a congenial pathway into hypnosis. In its simplest use in the hypnotic situation, music makes an effective and widely acceptable deepening technique and clinicians are advised to begin with this use of music to acquire their own communication skills in the area. Music can also be used as the primary focus of attention for induction as well as deepening, and, when hypnosis is achieved, it can be a very effective vehicle for carrying verbal suggestions, a primary stimulus for production of emotional experiences, or a background for therapeutic fantasy, guided imagery, or imaginal rehearsal. Music can also provide a safe and appropriate vehicle for self-hypnosis in stress-management. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Applies a model of consciousness based on the behavior of certain neural networks to explore mechanisms that result in dysfunctions in consciousness. These mechanisms are offered as a basic conceptual framework for describing the dysfunction of consciousness seen in 2 psychiatric disorders with prominent dissociative features: multiple personality disorder (MPD) and posttraumatic stress disorder (PTSD). These mechanisms provide a model of the role of trauma in dissociative dysfunctions of consciousness. Consciousness in neural network terms can be approximated by the sequence of stable states through which a net passes in response to changing environmental constraints, whereas dissociation represents a relatively discontinuous jump from one state to another. The persistence of traumatic schemata, their easy reactivation, and the dissociative features found in MPD and PTSD can be modeled via parallel distributed processing. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The management of the sexual assault victim is a complex challenge for the emergency physician. A combination of medical, forensic and psychological consequences for the victim require a well prepared, team based approach which includes doctors, nurses, counsellors, police and others. Protocols for the reception of the victim in the emergency department, the medical assessment and subsequent follow up must be in place before the victim's arrival. The most important aspect of caring for the survivor is to ensure that she (or he) is in control of the manner in which support is provided. This review details the important aspects of the provision of medical care, the forensic evaluation and the psychological effects of the sexual assault.
The present research investigated the question of how therapists’attitudes toward sexual assault victims predict their inferences about and treatment of clients. In addition, this study asked the following questions: (a) What percentage of female psychotherapy clients have been victims of sexual assault? (b) What treatment approaches are therapists using with victims and what attitudes toward victims do these therapists hold? (c) On the average, which demographic groups of therapists hold the most positive views of victims and are the most knowledgeable about working with victims? The results of the study indicated that therapists who held negative attitudes toward victims were more likely to endorse victim-blaming themes and therapeutic treatments which blame victims for sexual assault. Of therapists’current female clients, 18.5% (n= 257) had been sexually assaulted at some point in their lives. On the average, therapists were knowledgeable about working with victims and showed positive attitudes toward victims.
This paper gives an account of the relationship between hypnosis, hypnotizability, dissociation and disordered eating. A detailed update of the outcome of studies employing hypnotic techniques in the treatment of the two dieting disorders anorexia nervosa and bulimia nervosa is provided. The role of dissociation and the contribution of hypnosis is evaluated.
This chapter reflects recent UK legislative proposals for the detention of dangerous individuals with severe personality disorder
as a starting point for deriving insight into the deployment of the terminology of evil in everyday discourse. We concern
ourselves specifically with the public safety role of high-security hospitals and consequent contribution to the assuagement
of collective anxieties. This, in turn, is linked to Julia Kristeva’s notion of the abject, with an analagous relationship
to anxiety containment seen in people’s encounters with horror movies.
In a longitudinal study of 81 adult rape victims reinterviewed four to six years later, effects of the rape on subsequent sexual functioning are analyzed. Most victims who had been sexually active were found to experience changes in frequency of sexual activity and in sexual response. Interview responses of victims are reported, and suggestions are offered for the counseling of rape victims and their sexual partners.
Problems of measurement of the incidence of rape are considered, and empirical findings are summarized regarding prevalence, demographic and psychiatric characteristics of offenders, spatial and temporal distribution of offenses, victim-offender relationships, and evidence about recidivism and progression of crimes. Findings are discussed in the framework of blame models and their implications for treatment and prevention.
Quantitative and interview data on rape victims' self-evaluation and attributions of personal responsibility were studied to explore the relevance of theories of "defensive attribution" and maintenance of belief in a "just world." Clinical implications of the findings for adjustment of victims, counseling, victim compensation, and the legal system are discussed.
In a longitudinal study of the effects of rape on a woman's subsequent psychological functioning, objective measures of mood state and psychological distress were obtained at four intervals from 4 6 recent rape victims and 35 nonvictims. Initial response to rape was characterized by in tense generalized distress. Three months and six months later, this distress had diminished, leaving a residual of fear and anxiety problems that were clearly rape-related. Implications for treatment are discussed.
Thirteen young victims of rape were seen, in most instances within 48 hours, .by a mental health team. Followup of each revealed a similar sequence of reactions, falling in three distinct phases. Understanding of this pattern permits the design of supportive mental health intervention. (PsycINFO Database Record (c) 2013 APA, all rights reserved)
This handbook is intended to be a comprehensive resource for those in volved in providing crisis intervention to rape victims. The medical, legal, and counseling needs of the rape victim are presented to prepare helping professionals to offer sensitive and skillful assistance to women who have suffered sexual assault. The interdisciplinary thrust of the book reflects our conviction that health professionals, police, and prosecuting attorneys must share their expertise and coordinate their efforts in order to successfully meet the multiple needs of rape victims and their families. While an exten sive literature on rape has developed in the past decade, to the best of our knowledge there is no single source for the practical treatment-oriented information sought by those who work directly with victims. The primary objective of this book is to offer just such a guide to service providers. The book is organized into sections that deal with a specific area of the treatment of victims. Detailed guidelines are provided for the nursing, med ical, counseling, police, and legal services involved in comprehensive crisis intervention. Interdisciplinary teaming and the emotional impact of rape on service providers are discussed by authors actively involved in rape crisis work. Rape laws are explained and court preparation for victim-witnesses is carefully outlined. Of particular relevance to counselors is an overview of crisis theory and a psychodynamic perspective on rape trauma.
Most of the 224 children who were survivor-plaintiffs of the Buffalo Creek disaster were emotionally impaired by their experiences. The major factors contributing to this impairment were the child's developmental level at the time of the flood, his perceptions of the reactions of his family, and his direct exposures to the disaster. The responses of children under 12 to fantasy-eliciting techniques are described and their observed behavior after the flood compared with developmental norms for their age and reports of their previous behavior. These children share a modified sense of reality, increased vulnerability to future stresses, altered senses of the power of the self, and early awareness of fragmentation and death. It is pointed out that these factors could lead to "after-trauma" in later life if they cannot make the necessary adaptations and/or do not receive special help to deal with the traumas. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
This paper discusses (1) how my own interest in the treatment of sexual assualt victims developed and how I view the scope of this problem; (2) myths and facts about sexual assault; (3) common reactions of those who work with rape victims; (4) the rape trauma syndrome; (5) an approach to immediate and short-term treatment; and (6) the long-term effects of sexual assault and related treatment issues.
Accounts from both offenders and victims of what occurs during a rape suggest that issues of power, anger, and sexuality are important in understanding the rapist's behavior. All three issues seem to operate in every rape, but the proportion varies and one issue seems to dominate in each instance. The authors ranked accounts from 133 offenders and 92 victims for the dominant issue and found that the offenses could be categorized as power rape (sexuality used primarily to express power) or anger rape (use of sexuality to express anger). There were no rapes in which sex was the dominant issue; sexuality was always in the service of other, nonsexual needs.
The specific contribution of the psychiatrist to the team study of the human disaster at Buffalo Creek focuses on the course of psychic trauma. The initial violent intrusion by the flood waters was followed by a second phase of the traumatic cycle, the physical dislocation of the survivors, with disruption of their "ground" and "surround." During this long subsequent period the level of trauma did not recede but kept rising, although at a slower pace. Distant effects of the trauma may succeed the more immediate ones. The finite psychic space of the survivors is encroached upon by traumatic memories for an indefinite period of time, leaving fewer resources available for normal effective living. The absorption and merging of traumatic stimuli into a traumatophilia poses still another potential problem. The unprecedented legal decision as to the linear effects of psychic trauma on a succession of connected individuals will need further interdisciplinary clarification.
The Rape Crisis Intervention Program at Beth Israel Hospital utilizes volunteer multidisciplinary counseling teams drawn from psychiatry, social work, psychology, and nursing staffs. The premise of the program is that early crisis intervention can prevent later development of psychological disturbances in later development of psychological disturbances in victims. Counselors accompany victims throughout emergency room procedures: follow-up begins 48 hours after the initial contact and continues at regular intervals for at least a year. The authors discuss the problems of implementation, which include staff resistance, finding questions, and varying levels of counseling sophistication, and describe how these difficulties have been handled in their program. They note that this program is becoming a resource center for the community.
Rape challenges a woman's ability to maintain her defenses and thus arouses feelings of guilt, anxiety, and inadequacy. Women's individual responses are determined by life stage considerations as well as their defensive structures: concerns about separation-individuation may be aroused in the young woman; a divorced or separated woman may find her credibility questioned; older women's fears of sexual inadequacy may be compounded. In counseling, the victim's previous adjustment should be assessed, she should be given support and reassurance, and specific considerations related to her life circumstances should be acknowledged and dealt with.
The authors interviewed and followed 146 patients admitted during a one yr 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 a rape trauma syndrome 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 3 reactions. Crisis intervention counseling is effective with typical rape trauma syndrome; additional professional help is needed in the case of 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.
The association of anxiety with sexual excitement has been noted since the early part of this century. The authors present case reports of a schizophrenic and a neurotic patient in whom no direct sexual precipitants of spontaneous ejaculation could be identified but in whom severe anxiety was evident. The central noradrenergic neurophysiology that anxiety may share with sexual excitement could provide a basis for spontaneous ejaculation during anxiety. The pharmacology of spontaneous ejaculation during opiate withdrawal is used to elaborate this central noradrenergic model.
A 4-year follow-up study of 25 school-bus kidnapping victims and one child who narrowly missed the experience revealed that every child exhibited posttraumatic effects. Symptom severity was related to the child's prior vulnerabilities, family pathology, and community bonding. Important new findings included pessimism about the future, belief in omens and prediction, memories of incorrect perceptions, thought suppression, shame, fear of reexperiencing traumatic anxiety, trauma-specific and mundane fears, posttraumatic play, behavioral reenactment, repetitions of psychophysiological disturbances that began with the kidnapping, repeated nightmares, and dreams of personal death. Brief treatment 5-13 months after the kidnapping did not prevent symptoms and signs 4 years later.
This study analyzes data pertaining to 12 rapes and rape-murders committed by one male adolescent offender over a 4-year period. All offenses except the first were committed while the offender was under psychiatric and probationary supervision. The use or relinquishment of violence by the offender was found to be dependent on subtle interpersonal factors. The authors stress the importance of the use of crime scene data and interviews of patients who have committed sex crimes, the role of psychological profiles in apprehension of suspects, and the contribution of law enforcement as a data resource.
Of 130 women initially seen in a general hospital emergency room after being raped, the authors were able to interview 41 of the women 1-21/2 years after the rape. Half of the women continued to fear being alone and three-quarters reported still being suspicious of others. Many also felt restricted in their daily lives and had self-reported episodes of depression and sexual problems, which they attributed to the rape; none had a history of mental or emotional disturbance. The authors recommend that short-term, issue-oriented therapy be made available for all rape victims, as well as resources for the treatment of long-term symptoms.
There is a consensus among clinicians treating patients who have experienced a trauma that a number of common themes emerge. Using a manual that codified ten of these themes, their frequency was measured in the case material of 30 psychotherapy patients treated for posttraumatic stress disorders after bereavement or personal injury. The themes found to be most prominent in bereavement cases included sadness over loss and discomfort over discovered personal vulnerability. In the personal-injury cases, fear of a repetition of the event and feelings of responsibility emerged most frequently. Rage at the source of the trauma figured prominently in both bereavement and personal-injury cases.
It has been generally recognized that it is important to do follow-up counseling with rape victims, not only for good clinical care but also to establish a research data base on the long-term effects of rape. In our study we had difficulty achieving ongoing follow-up on many of the victims. Although our sample was small, it seems representative of certain populations of rape victims previously described in the literature and in crime statistics. Several factors inherent in the trauma of rape make follow-up difficult--the victim's defenses of denial and suppression, the characteristics of some women who are more vulnerable to rape, the response of some victims to change their phone numbers and addresses following a rape, and anger at the assailant being projected on to the "assault" of the follow-up. In working with rape victims it is important to be aware of these inherent difficulties in follow-up and try to devise methods of dealing with them.
Fourteen male rape victims treated in a county hospital emergency room over a 30-month period are compared with 100 randomly selected female victims treated over the same period. The male victims as a group sustained more physical trauma, were more likely to have been a victim of multiple assaults from multiple assailants, and were more likely to have been held captive longer. They were more reluctant to reveal initially the genital component of their assault and were more likely to use denial and control their emotions in reaction to the assault. Proper diagnosis and treatment of male rape victims requires a high index of suspicion and sensititivty to the likelihood of major, hidden trauma.
In an analysis of 22 cases of male rape in a community setting, the gender of the victim did not appear to be of primary importance to some of the rapists, but for others, males appeared to be specific intended targets, and the rapists' assaults were an effort to deal with unresolved and conflictual aspects of their lives. For all offenders the sexual assault was an act of retaliation, an expression of power, and an assertion of their strength and manhood. The impact of rape on the male victims was similar to that on female victims, disrupting their biopsychosocial functioning; however, male rape appears to be underreported due to the stigma associated with it.
Twenty-three children involved in a school-bus kidnapping were studied from 5 to 13 months following the event. Each child suffered posttraumatic emotional sequelae. The author found that the children suffered from initial misperceptions, early fears of further trauma, hallucinations, and "omen" formation. Later they experienced posttraumatic symptoms consisting of posttraumatic play, reenactment, personality change, repeated dreams (including predictive dreams and those in which they died), fears of being kidnapped again, and "fear of the mundane." Differences between child and adult response to psychic trauma are discussed.