# Motivation and emotion/Book/2013/Emotional impacts of sexual assault
## Overview

In this chapter we'll be looking at answering the following focus questions:
* What is sexual assault?
* What theories help explain the process which occur after a sexual assault?
* What are some of the emotional effects that occur due to sexual assault?
* What are some of the emotional impacts resulting from a sexual assault?
* What treatments are available to help manage the emotional effects and impacts of sexual assault?

## Sexual assault

When the term sexual assault is first heard, it immediately brings to mind rape and although the two terms are interchangeable, rape is just a type of sexual assault. Sexual assault can be described as anything when a person is forced, coerced or tricked into sexual acts against their will or without their consent, or if a child or young person under 16 is exposed to sexual activities. (NSW Government Attorney General & Justice, 2013).
If you strip down sexual assault to its core, it is essentially abuse of power, whether it be through someone physically stronger or psychological manipulative.

## Theories
### Dual Representation Theory

The Dual Representation Theory was proposed by Brewin (Brewin, Dalgleish & Joseph, 1996). This theory states that experience of a traumatic event such as the sounds, smells and visual objects are firstly retained in something Brewin calls the situationally accessible memory, this is supposedly similar to the episodic memory. However the insights and meanings are reatained in the verbally accessible memory, similar to the semantic memory. According to this theory, only sensory and spatial information are kept in the situationally accessible memory, this is to prevent associated emotions to the information as they are usually negative and painful. Brewin states that from cues and stimuli associated with the event, the two locations of memories activate, causing intrusive images, sounds and smells of the traumatic event. This is usually followed by dissociation, in which both predict subsequent post-traumatic stress disorder (PTSD) (Brewin, et at, 1996).

### Stress Response Theory

The stress response theory is the idea that when faced with a traumatic and stressful situation, a persons first response is to cry out, their second response it to try to relate this new information around them to what they already know. However it has been found that at this point, a person is receiving too much information in that they are being overloaded and are having trouble making the slightest connection. In response to this chaos, bodily defence mechanisms are formed to avoid memories of the event and to slow to ability in which a person can recall after the event (Brewin & Holmes, 2003). After the traumatic experience, it becomes clear that there are two processes working against each other. The first tries to suppress any memory of the experience, whilst the second attempts to bring forward the memories to encourage the working through and acceptance of the trauma experienced. Although, failure to process the traumatic information, is thought to lead to persistant post-traumatic tendencies (Ask & Landstrom, 2010).

### Emotional Processing Theory

The emotional processing theory focuses on accumulation of knowledge especially among sexual assault victims. It is thought that the ability to gain knowledge from before, during and after would allow for an elaborate understanding of the relationship of PTSD and sexual assault. Individuals with more inflexible views pre-trauma were more susceptible to PTSD. These views could be either negative or positive and were usually either destroyed by the trauma or confirmed, such as believing that the world is a safe place, this view would be destroyed whereas the view that a person is not worthy, this viewed would be confirmed by the traumatic event (Foa, Riggs & Gershuny, 1995).

### Ehlers and Clark's Cognitive Model

Ehlers and Clark (2000) where interested in the notion that although their trauma is in their past, their patients felt more anxious about their future. Ehlers and Clark created the term mental defeat which is the frame of mind of a victim in which leads them to believe they do not have the ability to influence their own fate, and believe such self-appraisals that they are weak, vulnerable and unable to protect themselves. It is believed that retrieval of memories from the traumatic event are cue-driven and unintentional, meaning the person is sometimes unaware of their triggers. They discovered that when patient tried to intentionally recall a traumatic event their memories where unclear and fragmented, whereas patients would also experience unintentional memories in which they would re-experience the trauma in a vivid and emotional way (Ehlers, et al, 2000)

## Emotional Impact of Sexual Assault
### Biological

Humans have survived millions of years with an internal mechanism know as the fight-or-flight reaction. Whenever there is extreme stress place on the body, neurochemicals and hormones are released all over the body to help us decide whether we stay and fight or run away (flight) (Bloom 2003).
The limbic system of the brain upkeeps and directs the emotions and behaviours necessary for survival and self-preservation. During times of extreme trauma or stress, the body releases excessive amounts of norepinephrine or vasopressin and endogenous stress hormones, with excess amounts, these chemicals and hormones make it difficult to form memories, which is while in some cases, sexual assault victims may not remember all of the attack. However memories of the attack can be triggered by any physiological arousal. There is evidence that humans having experienced severe, long-lasting traumatic stress show atrophy of the hippocampus more than of other parts of the brain and depletion of norepinephrine causing damage to the memory (Foa, et al, 1995).

### Physical symptoms

It is possible that after a traumatic event such as sexual assault, emotions can be expressed in a physical manner (Bloom, 2003).
Such symptoms may include:
* Headaches and/or migraines
* Stomach pains
* Sleep disorders such as night terrors and insomnia
* Teeth grinding
* Dizziness
* Hot and/or cold flashes
* Self-harm

### Psychological
#### Short-term

Whilst experiencing the assault, victims will likely experience things such as fear, shock and possible dissociation. The primary emotions after an assault are usually anxiety and intense fear. For some, it has been found that these emotions peak at around 21 days after the assault but these emotions can also last for more than a year for a victim (Astbury, 2006). It is also possible for a high level of fear to remain due to reminders of the assault such as an investigation, the possibility of pregnancy or a sexually transmitted disease, being in similar environment to the attack or being near a person of the same gender as the attacker (Bloom, 2003).
Due to the extremely high rate of sexual assault victims who suffer from post-traumatic stress disorder (PTSD), symptoms may begin to show shortly after the assault. Things such as reliving the event in their mind, which may include recurrent nightmares and frightening thoughts and hyper-arousal or being easily startled, feeling tense and emotional outbursts (Kimerling & Calhoun, 1994).
Women are twice as likely to develop PTSD than men after a sexual assault and women's PTSD tends to last longer than men's. This coincides with the gender differences found in depression after an assault, this is thought to be due to the frequent co-occurrence of the two (Frazier, 1990).

#### Long-term

Symptoms of PTSD such as avoidance can occur in the long term. A victim will avoid anything that reminds them of the assault, even in just the slightest way (Sharma-Patela, Brown & Chaplin, 2012). Although due to different experiences, including whether or not a person went to the authorities or received treatment, people often suffer:
* Depression
* Denial
* Suicidal tendencies
* Low self-esteem
* Lack of trust
Guilt and shame are two emotions which a person may experience long-term after an assault. In some cases, a victim may feel that they are responsible for the attack due to things like if they where intoxicated or wearing an outfit they deemed provocative. Also in some cultures, a victim of sexual assault is seen as 'damaged goods' and is made to feel that they have brought shame on their family (Bloom, 2003).
Dissociation is another common long-term emotional effect of sexual assault as a person. Dissociation is when a person disconnects from their thoughts, memories and feelings, meaning that the mind is able to block out the traumatic event and leaving the personal feeling numb to the experience (Ask & Landstrom, 2010).
People who experienced sexual assault during childhood have an increased chance of domestic violence and subsequent rape later in life and are subject to higher rates of adverse health outcomes (Petrak, et al, 2002).

### Rape Trauma Syndrome

In 1974 Ann Wolbert Burgess described a condition called Rape trauma syndrome (Burgess, 1983). Rape trauma syndrome is a psychological illness which can be described within the new category of PTSD. It is an illness which affects not only emotionally but physically and cognitively as well. Rape trauma syndrome can also be described as bundle of emotional responses to the extreme stress experienced by the victim during a sexual assault (Izard, 1993). Rape trauma syndrome occurs in two phases. First there is the acute or initial stage followed by the reorganisation phase. The acute stage is usually temporary and short lasting up to a few weeks, where are the reorganisation phase can last up to a few years (Burgess, 1983).
The acute phase is usually just after the assault and victims experience total disruption of their lives. There are two subdivisions of the acute phase, expressed, which is when a victim will openly express and display their emotions, or controlled, in which victims will remain calm and contain their emotions. The reorganisation stage is where the victim learns to cope with living with a traumatic experience. In this stage symptoms such as distrust, inability to settle back into previous life, isolation, fear of being alone, denial, depression and loss of self-esteem may begin to show.

## Effects
### Individual

A person who has experienced the trauma of sexual assault will know see the world around them completely different to what it used to be. Their assumptions of safety and security have been shattered. Victims may live in constant fear or future attacks. This will lead to a person isolating themselves and restricting things such as social activities and work. This reaction may be more profound when the attacker is someone close and intimate to the victim such as a boyfriend/girlfriend or relative/family friend (Astbury, 2006).
Victims often feel the need to regain control in their life after they experience such trauma. Those who have experienced sexual assault have a high prevalence of eating disorders (Latts & Gelso, 1995). This is often due to feeling a strong sense of control again and can sometimes have body image issues after an attack. By controlling what and when they eat, a person can use food to compensate for feelings that they find overwhelming. However this control that they feel is false and can lead to further emotional damage and can create physical damage as well.
Substance abuse also occurs frequently in survivors of a sexual assault as it allows a person to block out any unwanted emotions due to the trauma they have experienced, people may also turn to substance abuse as a way of treatment due to feeling that no one would believe them, embarrassment, shame or not being able to access proper treatment (Frazier, Conlon & Glaser, 2001).
Another effect of sexual abuse is issues with sex and intimacy. There are many ways in which sexual assault can impact on intimacy within a relationship (Sharma-Patela, et al, 2012)
Such things include:
* Discomfort with contact on certain areas of the body
* Confusion with feelings of arousal
* Low or no existent libido
* Participating in sexually compulsive behaviour
* Experiencing negative feelings in reaction to a sexual response
* Only seeing sex and intimacy as negative

### Social

Interpersonal relationships of the victims may also suffer and this is usually dependent on how those around the victim react to the assault.
Those close to the victim can be affected by the assault and these people are referred to as “secondary victims”. These people may even experience the effects of trauma with similar symptoms to the victim, as knowledge of a traumatic event experienced by a loved one itself can be traumatic and this is referred to as 'secondary trauma' (Astbury, 2006).
In some cultures around the world, the victim of a sexual assault may be treated as the culprit, and that they bought it on themselves. In cases like this the victim is like to suffer from what is know as second assault. However this second assault can happen anywhere in any culture, as many have experienced disbelief and victim blaming and shaming (Kimerling, et al, 1994).

## Management

The most successful ways of managing the extreme emotional responses to a sexual assault is usually some type of therapy, as it allows the victim to talk through their emotions in a safe environment and are taught many coping mechanisms (Frazier, Conlon & Glaser, 2001). In most therapeutic sessions, they will begin with building up the trust between therapist and victim and help prepare them for the healing process. During this early phase, the victim will tell the therapist about the trauma they have experienced and this will allow for the therapist to decide which therapeutic process is best suited for their treatment (Krulewitz, 1982). The next stage of therapy is usually where most of the difficult work is done as it involves re-processing the trauma. This can occur through acknowledgement, experiencing some of the intense emotions, which have been left unexpressed, exploring feelings towards the attacker and cognitively reassessing the abuse, which may include the victim being able to let go of blame towards themselves. This is time in which new coping strategies are taught to the victim, in which they can develop self-esteem and confidence in themselves (Krulewitz, 1982).
The final phase usually involves the separation of therapist and victim and they are now empowered to make their own decisions again without fear or relying on others, whilst separating from the therapist, they are able to establish a strong support network (Krulewitz, 1982).
Cognitive processing therapy (CPT) was formulated by Resick and Schnicke (1992). This type of therapy was developed to treat the symptoms of PTSD in sexual assault victims. CPT includes education, exposure and cognitive components. This therapy was formed on the basis of information processing theory, which is the process in which information is encoded, stored and then recalled. Manage the emotional effects of a sexual assault, Resick and Schnicke (1992) stated that to reduce the fear, they must activate the traumatic memory and then give corrective information regarding conflicting thoughts and faulty attribute. For example, if a person believes that after their assault that they are doomed or will never be safe again, then through CPT a therapist will help bring the memory to the surface and then talk through with the patient their experiences, emotions and will help them change the thought process that developed from sexual assault.
A few other types of successful therapy include:
* Cognitive Behaviour Therapy – a type of therapy which combines cognitive and behavioural therapies to help patients replace their negative thought process with a positive one (Frazier, Conlon & Glaser, 2001).
* Eye movement desensitisation and reprocessing – this uses exposure therapy along with guided eye movements which allow patients to comfortably process trauma (Latts, et al, 1995)
* Exposure therapy – this form of therapy allows a patient to safely and comfortably access painful memories in an environment in which they are taught coping strategies (Frazier, Conlon & Glaser, 2001).
With the right treatment, victims can successfully overcome their trauma to go on and lead normal fulfilling lives.

## Conclusion

* Sexual assault occurs when a person is forced, coerced or tricked into sexual acts against their will or without their consent, or if a child or young person under 16 is exposed to sexual activities.
* The Dual Representation Theory is the theory that sensory and spatial information is stored in the situationally accessible memory and the insight and meanings of that information is stored in the verbally accessible memory. This is to prevent further trauma.
* The stress response theory is the theory that after a traumatic experience, two opposing processes will occur, one to suppress the trauma for protection and one to induce the trauma to work through the experience.
* The emotional processing theory is the theory that knowledge from before, during and after the event, could be used to help treat the trauma experienced. It is also thought that those with more rigid views that others were more susceptible to suffer PTSD.
* Ehlers and Clark's Cognitive Model is the model that when a person intentionally tries to recall a traumatic event, the memory is fragmented, whereas with an unintentional and intrusive memory, it is much more vivid and detailed.
* Biological effects include at times of extreme trauma or stress, the body releases excessive amounts of norepinephrine or vasopressin and endogenous stress hormones, which can lead to the inability to form memories, which is why it is sometimes difficult for a person to remember any or all of their assault.
* Physical symptoms can be exhibited after a sexual assault due to the extreme level of emotions being experienced.
* Psychological effects include short-term and long-term effects. These can range from shock, fear, anxiety, PTSD, depression and denial.
* Rape trauma syndrome is a psychological illness which occurs in two phases; Acute and Reorganisation.
* Individual impacts include substance abuse, intimacy issues, eating disorders and isolation.
* Social impacts include changes in interpersonal relationships and secondary victims.
* The best form of management for sexual assault is usually therapy. This could include cognitive processing therapy, cognitive behaviour therapy , eye movement desensitisation and reprocessing and exposure therapy.
* It is possible for people who have suffered a sexual assault lead normal fulfilling lives.