Understanding sexual violence trauma
“The human response to psychological trauma is one of the most important public health problems in the world. Traumatic events such as family and social violence, rapes and assaults, disasters, wars, accidents, and predatory violence confront people with such horror and threat that it may temporarily or permanently alter their capacity to cope, their biological threat perception, and their concepts of themselves. Traumatised individuals frequently develop post traumatic stress disorder (PTSD), a disorder in which the memory of the traumatic event comes to dominate the victims’ consciousness, depleting their lives of meaning and pleasure.”
Doctor Bessel van der Kolk goes on to define trauma: “Trauma is not the story of something that happened back then, it’s the current imprint of that pain, horror and fear living inside people.”
This single definition is at the root of understanding trauma. It shows us the complexity of trauma and the need to understand the long-term effects it has on the life of the trauma survivor.
Trauma results when someone experiences an incident or incidents that overwhelm their ability to cope. It overwhelms their central nervous system, changes how that person perceives and reacts to danger and how they continue to ‘manage’ survival. And the way the trauma survivor deals with that survival management depends on a range of factors that can have a direct effect on the healing and recovery process.
Survivors of sexual violence often fear reporting the crime to police or even speaking out about it to family or friends, because they are concerned that they will not be believed. This is a real fear because so many myths exist around sexual violence; the vindictive ex, the spurned woman, the morning-after regret, ‘she was asking for it’, ‘she deserved what she got’, are but a few of the usual suspects. The horrifyingly small number of prosecutions and subsequent convictions are more about juries’ reluctance to convict because these destructive myths are so tightly woven into the public consciousness.
As a society we are more likely to seek out reasons why the rape happened (woman was drunk, on drugs, prostituting, how she was dressed, her behaviour etc) than to accept that the perpetrator had chosen to rape or sexually assault the woman. Sexual violence survivors are often not believed and indeed blamed for the violence and abuse perpetrated against them, and because of this their trauma is not taken seriously. The impact on a survivor’s life, health and wellbeing can be profound.
Anyone who has experienced rape, sexual assault, abuse, or exploitation should have access to support when it is needed. Support is most effective when it comes from close family and friends and is consistent, unconditional, and non-judgmental. However, specialist support agencies can be invaluable at this time as a survivor may not want to share some of her experiences with those closest to her and a counsellor or support worker can fulfil this role.
Self-blame is a common survivor response to rape or sexual assault and having a strong support network around the survivor that is non-directive, non-judgmental and understands the nature of trauma can help reduce the long-term impact on mental health and wellbeing.
If a survivor is not believed, feels blamed for rape or sexual violence perpetrated against her, and lacks any kind of support, it can be a significant barrier to seeing justice done. In the UK we have an adversarial legal system and rape is prosecuted in the high court, so it is extremely serious. However, the nature of the crime is that there is very rarely any witness, apart from the victim, and the amount of evidence required may not be available if the victim has not reported within the time frame for collecting forensic samples (usually within 7 days of the incident). Although we may have heard about ‘fight or flight’ responses when experiencing a traumatic event, and even believe that in a similar situation we would respond by fighting back/running away, the reality is that in 70% of cases of rape or sexual assault, the victim will freeze. Freeze responses are common yet often result in the victim/survivor feeling guilt and shame.
Understanding the impact of trauma on the body
As well as the emotional and psychological impact of sexual violence trauma, there can be immediate and long-term effects on the physical body. Survivors commonly experience nausea and vomiting (especially in the aftermath of oral rape), inability to swallow, inability to eat, shivering and shaking as part of the immediate shock response, hypervigilance and restlessness, inability to sleep or nightmares when asleep, and possible physical injury, bruising or pain. One lesser-known physical symptom that survivors may experience in the immediate aftermath of sexual violence trauma is hearing loss or reduction in hearing.
During the traumatic event, the body responds by overproduction of adrenaline. This reduces blood flow to the ears. Those very fragile hair cells in the inner ear must have a constant flow of blood to ensure that there is enough oxygen and other nutrients for optimum functioning. Those tiny hairs need this oxygen to perform the task of translating the noise that is collected by the outer ear into electrical impulses that the brain can interpret as recognisable sounds and words.
When speaking with a survivor in the aftermath of the traumatic event, it may appear that she is not listening, avoiding answering questions, or giving answers that don’t correspond to the questions asked. These responses may be interpreted as ‘inconsistent answers’ or ‘making up answers’, but it is more likely to simply be that the survivor is finding it difficult to hear what the questioner is saying or to understand the words if the inner ear is unable to process properly. This can be helped by lowering the tone of voice, slowing down when speaking and asking the survivor is she understands what it being asked/said. This can be an additional reason for giving the survivor time to rest and process what has happened to her before making a statement.
Trauma affects memory
When faced with extreme threat, perceived danger, and fear, we act automatically with the ‘fight, flight, freeze’ response. But what does that mean? Ledoux and Pine identified this ‘two system frameworks’ where the responses register at both the conscious and subconscious levels. One of our neurological networks operates at the conscious level generating fear, alarm, anxiety while the second of these networks controls the behaviours and physiological response to the fear/alarm/anxiety. But the second set of networks operate subconsciously because that network is subcortical, deep inside our brain and disconnected from our conscious awareness.
When our brain senses extreme threat, some of that information goes directly to our inbuilt defence circuits. Our amygdala (the brain’s ‘fire alarm’) triggers the appropriate physiological response automatically and often unconsciously. Ledoux and Pine stated that “The amygdala is not itself responsible for the experience of fear, its job can be more appropriately viewed as detecting and responding to present or imminent threat.”
With the activation of the defence circuits, things change in the brain. As shown by Hopper (2018), from the activation of these circuits, the brain, body, attention, thinking behaviour and memory are all dramatically altered in particular ways. It’s not possible for a person to make a rational decision or assessment of their situation when they are in that moment of fear and terror. The process is more automatic and much faster and happens beneath our consciousness. When we’re under extreme threat, our ability to make any kind of rational decision or even conscious thoughts are reduced or significantly impaired.
When the amygdala begins this process by sending a message to the hypothalamus, which then messages the pituitary gland, which then communicates with the adrenal glands, the body is flooded with adrenaline and cortisol. This makes the heart pump faster, closes bodily functions that it deems unnecessary (such as digestion and higher cognitive functioning) and gets the body and brain to focus on survival.
The hippocampus, at this point shifts its function. The main role of the hippocampus is to process our short-term memories and storing them elsewhere in our brains. However, when the defence circuits take over, the function of the hippocampus changes and it begins to pump cortisol into the body. This, in turn impacts its ability to record and process memory.
But the memory is recorded. It’s held in the body as ‘somatic memory’ which is described by Dr Bessel van der Kolk as a phenomenon understood as far back as the 19th century. He states that:
“For more than a century, ever since people’s responses to overwhelming experiences were first systematically explored, researchers have noted that the physiological effects of trauma are stored in somatic memory and expressed as changes in the biological stress response. In 1889, Pierre Janet postulated that intense emotional reactions make events traumatic by interfering with the integration of the experience into existing memory schemes. Intense emotions, Janet thought, causes memories of particular events to be dissociated from consciousness and to be stored instead as visceral sensations (anxiety and panic) or visual images (nightmares and flashbacks)”
Isabelle Kerr © (2020)
 “Post Traumatic Stress Disorder and the Nature of Trauma” (Van der Kolk, B. Dialogues of Clinical Neuroscience, 2000 Mar; 2 (1): 7-22)
 Möller et al (2017); ‘Tonic immobility during sexual assault – a common reaction predicting post traumatic stress disorder and severe depression’. Acta Obstectricia et Gynecologica Scandinavica 96 (8).
 Ledoux & Pine (2016); ‘Using neuroscience to help understand fear and anxiety: a two-system framework’. American Journal of Psychiatry 173 (11).
 Van der Kolk, B; ‘The Body Keeps the Score: memory and the evolving psychobiology of post traumatic stress (Harvard Medical School, 1994)