Part four of ‘Ten years after rape’
PTSD (post-traumatic stress disorder) is a mental health condition that occurs in some people who have experienced a traumatic event or events. Many different types of traumatic events can lead to PTSD, including war, child abuse and violent attacks. One of the common traumatic events that causes PTSD is rape. The reasons why some people get PTSD while others don’t isn’t fully understood but there are certain factors that predispose people such as lacking social support, existing mental health issues, a family history of mental illness and suffering abuse or neglect in childhood.
The diagnostic criteria
To be diagnosed with PTSD there are a number of criteria that must be met but there are many other people who experience distressing symptoms without meeting the full criteria. Immediately after a traumatic event it is normal to experience psychological distress, but if symptoms persist beyond six weeks it may indicate a person has PTSD and treatment may be helpful. PTSD usually begins within 6 months of the traumatic event, although it can begin later.
To be diagnosed with PTSD according to the ICD 10 (the classification of diseases used in the UK) a person must meet the following criteria:
A. Exposure to a stressful event or situation (either short or long lasting) of exceptionally threatening or catastrophic nature, which is likely to cause pervasive distress in almost anyone.
B. Persistent remembering or “reliving” the stressor by intrusive flashbacks, vivid memories, recurring dreams, or by experiencing distress when exposed to circumstances resembling or associated with the stressor.
C. Actual or preferred avoidance of circumstances resembling or associated with the stressor (not present before exposure to the stressor)
D. Either (1) or (2)
(1) Inability to recall, either partially or completely, some important aspects of the period of exposure to the stressor.
(2) Persistent symptoms of increased psychological sensitivity and arousal (not present before the exposure to the stressor) shown by any two of the following:
a) Difficulty falling or staying asleep
b) Irritability or outburst of anger
c) Difficulty in concentrating
e) Exaggerated startle response
From: World Health Organization. (1992). The ICD-10 Classification of Mental and Behavioural Disorders. Geneva, Switzerland: Author.
How the criteria applies to me
I was diagnosed with PTSD in 2012, although I had actually been struggling with it for years at that point. The exact form symptoms take are different in every person but I will give some examples of how I met the criteria.
A. I was a victim of rape
B. I experienced regular nightmares. Sometimes they were replaying what happened but often they took a slightly different form, for example my rapist would attack me again or I would be raped by another person. Sometimes just seeing him in my dreams, even without anything happening would be bad enough.
I had flashbacks (where I felt like it was happening in the present) and vivid memories (where I would see aspects of the night replayed in my mind like a video). My flashbacks and vivid memories often occurred when I saw something that reminded me of that night such as a man with similar hair or hearing a phrase he said on TV.
C. I began only watching films my boyfriend had already seen to try avoid triggers because TV and films were one of the most common ways to trigger flashbacks. I felt sick if I saw a packet of Marlboro Lights so I asked my friends to try avoid leaving the packet out when I was around. I went out of my way to avoid where his family worked or lived. I avoided canals, pizza, anything to do with Afghanistan… After court I also began avoiding passing courts and police stations and watching police or law programmes (including Judge Judy!) My life was basically organised around avoiding every possible trigger I could think of. It was frustrating and limiting for both me and those close to me.
(1) I don’t think I have an inability to recall any important aspects of the period of exposure to the stressor.
a) I found it really difficult to fall asleep because I was scared of having nightmares. I often only slept in the day, when I felt safer. When I did sleep, the nightmares sometimes woke me up.
b) I don’t think I experienced irritability or outbursts of anger although you might have to ask those who were around me at the time.
c) I was doing my A Levels and then a degree in the years after the rape. I often found it difficult to concentrate, especially when the topics were triggering, for example two of the set texts in A Level English included rapes and my psychology and law module talked a lot about tactics used by barristers.
d) I was always on the lookout for danger, scanning every situation and doubting the motivations of people around me. It went beyond just looking out for danger. I was always planning exactly how I would react to the imagined situations.
e) Exaggerated startle response is still very much with me now. I jump at every little thing. People often find it amusing. I’ve learnt to laugh it off and consider it a quirk but it doesn’t change the fact my heart pounds in my chest and I immediately begin sweating.
PTSD is distressing but there are treatments available.
EMDR (eye movement desesnitisation and reprocessing) is recommended by the National Institute of Health and Clinical Excellence (NICE) for PTSD. It involves thinking about the traumatic event while receiving sensory input, such as eye movements. It is not something I have experience of so I recommend you do your own research if you are considering it.
NICE also recommend CBT (cognitive behavioural therapy) as a treatment for PTSD. I had group CBT at The Havens and found it was really helpful, although initially it made my symptoms worse. It was explained to me that this is common but if you can ride it out, it will eventually help the memories to lose some of their power (I will discuss this more in my post about memory and PTSD).
I had a very long period of psychoanalytic psychotherapy which helped me look at the impact the rape had on my world view and helped me manage my other mental health issues. Once my other issues were more under control, I was more able to deal with what had happened to me.
I also had a brief period of existential psychotherapy to look at my relationship issues and how my experience of rape had impacted my sexuality.
There are so many different types of psychological therapy. Some will suit some people better than others so if the first type you try doesn’t help, it might still be worth trying another.
Medication, such as antidepressants, might also help lessen PTSD symptoms. I personally haven’t found this, but they did help get my bipolar disorder more under control which helped me have the strength to work on the PTSD symptoms.
Some techniques I have used to manage my PTSD symptoms include talking to myself (saying things like “You are safe. It was in the past”), helping myself stay in the present by feeling the fabric of my clothes or things around me, and both creative and autobiographical writing. Writing out what happened was really difficult but going through it from start to finish helped me to process the memories (I’ll write more about this in my post on memory and PTSD).
Everybody is different so, unsurprisingly, each person will find different things that help.
PTSD is a distressing reaction to rape (and other traumas) but many people recover and, even if a person does not completely recover, things can improve.
Part five: Eight reasons I am to blame for being raped