Label <ul><li>When the perpetrator is a spouse, boyfriend, or acquaintance many victims are reluctant to label rape or physical assault as such. </li></ul>
Label <ul><li>Many victims feel emotionally dependent on their assailant </li></ul><ul><li>(generally, the greater the fear, the greater the feeling of dependence and fear of abandonment). </li></ul><ul><li>Many victims are justifiably afraid of retribution by an assailant. </li></ul>
Stigma <ul><li>Many victims are familiar with being blamed for the abuse, and they fear the stigma attached to being a victim of rape </li></ul>
Feelings <ul><li>Guilt. Many rape victims, feel responsible for what happened to them. </li></ul><ul><li>Completely helpless in a malevolent universe where violence is random. </li></ul><ul><li>Dissociative amnesia- generally the stronger, longer, and earlier the exposure, the worse the amnesia. </li></ul>
Dissociation <ul><li>Pathological levels of dissociation are strongly associated with histories of antecedent trauma. severity of the trauma are significantly related to the degree of dissociation. dissociation manifest in the immediate context of trauma is the best predictor of subsequent posttraumatic stress disorder 6 or more months later. </li></ul>
DSM-IV Diagnostic Criteria for PTSD <ul><li>Exposure to a traumatic event in which the person: </li></ul><ul><ul><li>experienced, witnessed, or was confronted by death or serious injury to self or others AND </li></ul></ul><ul><ul><li>responded with intense fear, helplessness, or horror </li></ul></ul><ul><li>Symptoms </li></ul><ul><ul><li>appear in 3 symptom clusters: re-experiencing, avoidance/numbing, hyperarousal </li></ul></ul><ul><ul><li>last for > 1 month </li></ul></ul><ul><ul><li>cause clinically significant distress or impairment in functioning </li></ul></ul>American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th ed. 1994.
Later Sexual Problems <ul><li>may result from rape or childhood abuse, from repeated painful experiences with coitus, </li></ul><ul><li>unconscious connections between the sexual impulse and overwhelming feelings of shame and guilt </li></ul>
Dysparunia <ul><li>among women seen in sex therapy clinics, the complaint is more common in women with a history of rape or childhood sexual abuse. </li></ul>
Therapy <ul><li>Victims require a multidisciplinary approach encompassing emotional, medical, social and forensic care. Appropriate therapeutic action taken early may influence the prognosis for a significant proportion of assault victims. Psychological interventions must pay attention to the particular post trauma phase of the victim. </li></ul>
Early Care <ul><li>After an assault the victim first needs to be in a place where she is physically safe and where she can rest, sleep, and eat. </li></ul>
Care <ul><li>Safety When their own resources are inadequate to deal with threat individuals need to rely on others to provide them with safety and care. </li></ul><ul><li>After an assault victims must establish contact with their natural social support system. If this system is inadequate to ensure the safety of the patient, institutional resources must be mobilized to help the patient find a place to recover. </li></ul>
Anxiety <ul><li>Anxiety Management After safety has been ensured, </li></ul><ul><li>Distinguish between the real-life threats that often persist and the haunting, irrational fears. If anxiety dominates, strengthening their coping skills. </li></ul><ul><li>Anxiety-management - deep muscle relaxation, breathing control, role playing, thought stopping, and guided self-dialogue. </li></ul>
Further Therapy <ul><li>Emotional Processing To put the event in perspective, some form of debriefing is often helpful. During this process survivors are encouraged to recreate the event in words, individually or in a group. They are asked to articulate what they think happened and what led up to it—their own contributions to what happened, </li></ul>
Further Care <ul><li>Prevention Against Recurrence After gaining an understanding of their own vulnerability, victims need to devise a plan to prevent a recurrence. </li></ul><ul><li>This may involve a geographic move or some other active measure that interrupts </li></ul>
Group Therapy <ul><li>Group Treatment Group therapy, can be extremely useful in helping victims move beyond a helpless stance in which they are vulnerable to repeating the trauma, either as victim or as perpetrator. </li></ul>
Group Therapy <ul><li>Such groups provide both human attachments and a meaningful cognitive frame for dealing with the sense of helplessness. </li></ul><ul><li>The purpose of these groups is to help the member regain a sense of trust and belonging by making interpersonal commitments. </li></ul>
Long term Effects <ul><li>Long-term follow-up of rape victims demonstrates persistence of guilt feelings, low self-esteem, phobias, and irrational lifestyle changes years after the event. </li></ul><ul><li>High incidence of PTSD 33% </li></ul>
Perpetrators <ul><li>Most rapists commit other violent crimes as well and use sex to dominate, hurt, and debase their victims. Sexual violence and physical violence often occur in the same individual. </li></ul>
Perpetrators <ul><li>that the more hurt, humiliated, and downtrodden men feel, the more likely they are to perpetrate violence, </li></ul>
The ultimate weakness of violence is that it is a descending spiral, begetting the very thing it seeks to destroy. Instead of diminishing evil, it multiplies it. Through violence you murder the hater, but you do not murder hate... Hate cannot drive out hate; only love can do that. -Martin Luther King, Jr.
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