Handout 4: Common reactions to rape

(Extracted from Technical Guidelines for Overseas Medical Staff developed by Medical Services)

Coping Mechanisms During Rape. Burgess and Holstrom also have studied the victim's coping behavior at three points relative to the attack: during the early awareness of danger, during the attack itself, and after the attack. This ability to react often depends on the amount of time between the threat of attack and the attack, on the type of attack, and on the type of force or violence used. Initial strategies include verbal tactics, such as conversation, joking or screaming, and physical action, such as struggling, biting or kicking. If these fail, the coping task of the victim is to survive the rape despite the demands forced upon her such as oral, vaginal, and/or anal penetration.

Victims often cope during the rape itself by mentally distancing themselves from the reality of the event. Volunteers have described the whole range of internal defense mechanisms to cope psychologically with the fear produced by attack: denial ("This isn't happening to me.); disassociation ("I felt like I was at a movie watching it happen to someone else"); suppression ("This will be over in few minutes; it's not the end of the world.); rationalization ("This poor man, he looks desperate, is this the only way he knows to get sex?"). Not all coping behavior is voluntary and conscious. Some screaming and yelling is involuntary, and victims have also reported physiological responses of choking, gagging, nausea, vomiting, pain, urinating, hyperventilating, and losing consciousness.

The stressful situation is not over for the victim when the actual rape ends. She must alert others to her distress, escape from the assailant, or free herself from where she has been left, victims always are hopeful that someone will come to their aid, and they may spend time concentrating on how to obtain help. One Volunteers's fear and loneliness were heightened by the fact that passerby did not respond to her cries for help. However, after the attack when she was able to run to a group of workers, she was eventually able to convince them of her need for assistance.

By listening for the coping behaviors of the victim during the attack, the PCMO or other helper can have a therapeutic effect. Identifying the coping behavior tells the victim her behavior functioned as a positive adaptive mechanism to allow her to survive a life-threatening situation. This also helps alleviate some of the guilt suffered by victims who tend to think, "I did not do enough -- I could have done more." Affirming the coping behavior also reinforces a positive sense of self-esteem and worth. Appreciation of the fact that the victim has successfully managed to survive a life-threatening assault is a positive beginning to her long-term process of coping with the aftermath of rape.

Common Physical Reactions. Some physical reactions a woman may have in addition to the injuries she may have received are:

- General Soreness

- Loss of appetite

- Nightmares

- Tension headaches

- Gynecological and urinary tract problems

- Inability to sleep

- Nausea, stomach pains

- Waking up during the night and being unable to return to sleep

- Fatigue

Stages of Emotional Reaction. As noted above, the immediate physical and emotional reactions usually overlap the more long term reactions. The longer-term reactions may be classified into three distinct phases. An understanding of these phases has many implications for the treatment of Volunteer victims.

Phase I: Acute Reaction. The first step, lasting from a few hours to a week, is characterized by feelings of numbness, a state of shock, terror, disgust, a sense of powerlessness, and humiliation. The victim is seen in a disorganized, emotionally active state, weeping, distraught, unable to think clearly or the victim is emotionally constrained with only occasional signs of emotional pressure, such as inappopriate smiling or increased motor activity.

Initially, this turmoil of emotions may be too overwhelming for her to be able to single out, identify, or recognize. Instead, she feels numb, confused, and is unable to express her feelings clearly. Any apparently calm demeanor should not be mistaken for evidence that the rape did not occur or that she is unaffected by it. Other victims may handle these overwhelming emotions in other ways. They may be hysterical - crying, laughing, screaming. Laughter should not be taken as a sign of levity it is one reaction to severe anxiety. In these more vocal reactions, the victim may or may not be able to express her feelings clearly, but the emotions are closer to the surface.

Phase II: Outward Adjustment. This second stage, which begins about two weeks after the rape, involves an attempt by the victim to return to normal routines and place the rape in the past. This stage is often characterized by the victim not wanting to discuss the attack.

After the initial shock and chaos of the rape experience has subsided, the victim enters into a period of outward adjustment. At this time she has returned to work or school and is getting back to the normal routine of her life. She begins to resist talking about the rape, insists that it is in the past, and wants only to forget about it. Although this closure is premature, and all the feelings have not yet been expressed or understood, it is in part a healthy defense - a wish to return to normality.

Phase III: Integration and Resolution. This third stage may begin anywhere from one month to many years after the rape.

With appropriate support, the victim has found ways to integrate this trauma into her life experience. While, in general, she may have reached her pre-crisis level of functioning, she may have times of feeling again her old unresolved feelings about the rape. Sometimes her previous adjustment is shattered by a reminder of the rape - seeing the assailant in court or on the street, passing the scene of the crime. Unresolved feelings may recur following an unhappy life change such as a divorce, or several months or years of sleepless nights may finally cause the victim to decide to seek help. From their experience counseling rape victims, McCombie and Arans report that rape work, like grief work, takes approximately two years to complete, in the psychological sense of integration and resolution.