psychological remedies for abused women

1. MILEN SANTIAGO RAMOS MA, MSc, PhD
Clinical Psychology Neuroscience Criminology
PSYCHSERV

4. Rape trauma syndrome
(RTS) is the psychological trauma
experienced by a rape victim that
includes disruptions to normal physical,
emotional, cognitive, and interpersonal
behavior. The theory was first described
by psychiatrist Ann Wolbert Burgess
and sociologist Lynda Lytle Holmstrom
in 1974

6. Acute stage
The acute stage occurs in the days or weeks after a rape
U.S. Rape Abuse and Incest National Network (RAINN) asserts that,
in most cases, a rape victim's acute stage can be classified as one of 3
responses:
1)expressed ("He or she may appear agitated or hysterical, [and] may
suffer from crying spells or anxiety attacks")
2)controlled ("the survivor appears to be without emotion and acts as if
'nothing happened' and 'everything is fine'");
3)shock/disbelief ("the survivor reacts with a strong sense of
disorientation. They may have difficulty concentrating, making
decisions, or doing everyday tasks. They may also have poor recall of
the assault").

7. Behaviors present in the acute stage can include:
Diminished alertness.
Numbness.
Dulled sensory, affective and memory functions.
Disorganized thought content.
Vomiting.
Nausea.
Paralyzing anxiety.
Pronounced internal tremor.
Obsession to wash or clean themselves.
Hysteria, confusion and crying.
Bewilderment.
Acute sensitivity to the reaction of other people.

9. The outward adjustment
stage
Survivors in this stage seem to have resumed their
normal lifestyle. However, they simultaneously
suffer profound internal turmoil, which may
manifest in a variety of ways as the survivor copes
with the long-term trauma of a rape.
In a 1976 paper, Burgess and Holmstrom note that
all but 1 of their 92 subjects exhibited maladaptive
coping mechanisms after a rape. The outward
adjustment stage may last from several months to
many years after a rape

10. RAINN identifies five main coping
strategies during the outward
adjustment phase:
minimization (pretending 'everything is
fine')
dramatization (cannot stop talking
about the assault)
suppression (refuses to discuss the
rape)
explanation (analyzes what happened)
flight (moves to a new home or city,
alters appearance)

11. Other coping mechanisms that may appear during the outward adjustment
phase include:
poor health in general. continuing anxiety
sense of helplessness
hypervigilance
inability to maintain previously close relationships
experiencing a general response of nervousness known as the "startle
response"
persistent fear and or depression at much higher rates than the general
population[11]
mood swings from relatively happy to depression or anger
extreme anger and hostility (more typical of male or masculine victims than
female or feminine victims
sleep disturbances such as vivid dreams and recurring nightmares
insomnia, wakefulness, night terrors
flashbacks
dissociation (feeling like one is not attached to one's body)
panic attacks
reliance on coping mechanisms, some of which may be beneficial (e.g.,
philosophy and family support), and others that may ultimately be
counterproductive (e.g.,self harm, drug, or alcohol abuse

12. Lifestyle
Survivors in this stage can have their lifestyle affected in some of the
following ways:
Their sense of personal security or safety is damaged.
They feel hesitant to enter new relationships.
Questioning their sexual identity or sexual orientation (more typical of
men raped by other men or women raped by other women.
Sexual relationships become disturbed.
Many survivors have reported that they were unable to re-establish
normal sexual relations and often shied away from sexual contact for
some time after the rape. Some report inhibited sexual response
and flashbacks to the rape during intercourse. Conversely, some
rape survivors become hyper-sexual or promiscuous following sexual
attacks, sometimes as a way to reassert a measure of control over
their sexual relations.

13. Physiological responses
Whether or not they were injured during a sexual
assault, rape survivors exhibit higher rates of poor
health in the months and years after an assault,
including acutesomatoform disorders (physical
symptoms with no identifiable cause).
Physiological reactions such as tension headaches
, fatigue, general feelings of soreness or localized
pain in the chest, throat, arms or legs. Specific
symptoms may occur that relate to the area of the
body assaulted. Survivors of oral rape may have a
variety of mouth and throat complaints, while
survivors of vaginal or anal rape have physical
reactions related to these areas.

14. Nature of the assault
The nature of the act, the relationship with the offender,
the type and amount of force used, and the circumstances
of the assault all influence the impact of an assault on the
victim.
When the assault is committed by a stranger,
fear seems to be the most difficult emotion to manage for
many people.(Feelings of vulnerability arise).
More commonly, assaults are committed by
someone the victim knows and trusts. May be heightened
feelings of self-blame and guilt.

15. Underground stage
Victims attempt to return to their lives as if nothing happened.
May block thoughts of the assault from their minds and may not
want to talk about the incident or any of the related issues. (They
don't want to think about it).
Victims may have difficulty in concentrating and some
depression.
Dissociation and trying to get back to their lives before the
assault.
The underground stage may last for years and the victim seems
as though that they are "over it", despite the fact the emotional
issues are not resolved.

16. Reorganization
May return to emotional turmoil
The return of emotional pain can extremely frighten people in this
stage.
Fears and phobias may develop. They may be related
specifically to the assailant or the circumstances or the attack or
they may be much more generalized.
Appetite disturbances such as nausea and vomiting. Rape
survivors are also prone to developing anorexia nervosa and/or
bulimia.
Nightmares, night terrors feel like they plague the victim.
Violent fantasies of revenge may also arise

18. The renormalization stage
In this stage, the survivor begins to recognize his or her adjustment phase.
Recognizing the impact of the rape for survivors who were in denial, and
recognizing the secondary damage of any counterproductive coping tactics
(e.g., recognizing that one's drug abuse began to help cope with the aftermath
of a rape) is particularly important.
Male victims typically do not seek psychotherapy for a long time after the sexual
assault—according to Lacey and Roberts,[
less than half of male victims sought therapy within six months and the
average interval between assault and therapy was 2.5 years; King and
Woollett's study of over 100 male rape victims found that the mean interval
between assault and therapy was 16.4 years.
During renormalization, survivors integrate the sexual assault into their lives so
that the rape is no longer the central focus of their lives; negative feelings such
as guiltand shame become resolved, and survivors no longer blame
themselves for the attack.

21. This phenomenon appears in the bizarre attachment of some hostages
to their captors known as the "Stockholm Syndrome. " It explains why
some victims love their abusers.
In a bank vault in Stockholm, Sweden twenty-seven years ago, Kristin,
the hostage was held by Olafson, the armed assailant. She could not
speak, she could not eat, she could not use a toilet without his
permission. She was not only terrified, she was infantilized
Kristin denied that Olafson, her captor, was the source of her pain.
Many hostages deny or repress or forget that fact. They do realize,
consciously and deep inside, that someone with the power to take their
life is not killing them. On the contrary, this powerful person gives them
food and blankets and permission to speak and the right to use a toilet.
The hostage feels grateful and attached

22. Only when the feeling of attachment has faded, sometimes years
later, do they fully appreciate what occurred and arrive at a
reasonable explanation. They describe that they did not seek a
loving or compassionate attachment to a killer (many hostage
survivors saw their captors kill others). The survivor often tried to
fight a feeling of affection. But gradually they felt warmly toward
one or more hostage holders, particularly those that showed some
signs of nurturance.
If the age and gender were appropriate, the positive feelings could
approximate romantic love. Kristin felt it so strongly toward Olafson
that she became his lover and broke off an engagement to another
man

23. Patty Hearst felt it toward Cujo, one of her
Symbionese Liberation Army captors
a battered wife might love her spouse because she
was trained from infancy to love an abusive parent
--that is, to equate love with the intimate enduring
dependence on one who provides life's necessities
and who also hits and hurts.
the battered wife might love her spouse because
relief from punishment is so rewarding that she has
learned to savor this feeling while denying the pain
of physical abuse.
Or, she might love qualities that are lovable and
suppress any outrage in response to behaviors that
are cruel. Love is notoriously irrational, complex
and paradoxical.

25. Posttraumatic stress disorder (PTSD) may develop after a person is
exposed to one or more traumatic events, such as major stress,
sexual assault, terrorism, or other threats on a person's life.
The diagnosis may be given when a group of symptoms, such as
disturbing recurring flashbacks, avoidance or numbing of memories of
the event, and hyperarousal, continue for more than a month after the
occurrence of a traumatic event.

30. Child sexual abuse
accommodation
syndrome (CSAAS) is a syndrome
developed by Roland C. Summit in 1983 to describe how he
believed sexually abused children responded to ongoing sexual
abuse.
Roland Summit described how children try to resolve the
experience of sexual abuse in relation to the effects of disclosure
in real life. Summit posited five stages:[
Secrecy
Helplessness
Entrapment and accommodation
Delayed disclosure
Retraction

31. According to Mary de Young, CSAAS featured heavily in the
satanic ritual abuse moral panic of the 1980s and 90s, because
it purports to explain both delayed disclosures and withdrawals
of false allegation of child sexual abuse.
De Young argued that CSAAS is used to justify any statement
made by a child as an indication that sexual abuse had
occurred, because immediate disclosure could be an indication
of abuse, but also delayed disclosure, withdrawal and sustained
denial.
Margaret Shiu wrote in 2009 that "There is empirical evidence to
support both the scientific validity of CSAAS and the tendency
for sexually abused children to recant their allegations of CSA
(Child Sexual Abuse)
The accommodation syndrome is proposed as a simple and
logical model for use by clinicians to improve understanding and
acceptance of the child’s position in the complex and
controversial dynamics of sexual victimization.

33. The False Memory Syndrome
came about in 1992 . A foundation was formed by
Pamela and Peter Freyd, after their adult daughter Jennifer
Freyd accused Peter Freyd of sexual abuse when she was a child.
The FMSF describes its purpose as the examination of the concept
of false memory syndrome and recovered memory therapy and
advocacy on behalf of individuals believed to befalsely accused of
child sexual abuse[3]
with a focus on preventing future incidents,
helping individuals and reconciling families affected by FMS,
publicizing information about FMS, sponsoring research on it and
attempting to discover methods to distinguish a true or false
allegation of abuse

34. Play therapy seemed to be the most effective treatment for
social functioning
Cognitive-behavioral, abuse-specific, and supportive therapy
in either group or individual formats was most effective for
behavior problems
Cognitive-behavioral, family, and individual therapy seemed
to be the most effective for psychological distress
Abuse-specific, cognitive-behavioral, and group therapy
appeared to be the most effective for low self-concept.

35. Cognitive therapy (CT) is a type
of psychotherapy developed by American psychiatrist Aaron T.
Beck. CT is one of the therapeutic approaches within the larger
group of cognitive behavioral therapies (CBT) and was first
expounded by Beck in the 1960s. Cognitive therapy is based on the
cognitive model, which states that thoughts, feelings and behavior
are all connected, and that individuals can move toward overcoming
difficulties and meeting their goals by identifying and changing
unhelpful or inaccurate thinking, problematic behavior, and
distressing emotional responses. This involves the individual
working collaboratively with the therapist to develop skills for testing
and modifying beliefs, identifying distorted thinking, relating to others
in different ways, and changing behaviors

36. Behavioral therapy is a treatment that
helps change potentially self-
destructing behaviors. It is also
called behavioral modification or
cognitive behavioral therapy. Medical
professionals use this type oftherapy to replace
bad habits with good ones

37. Individual vs. Group psychotherapy
The therapeutic alliance in group psychotherapy is with the group
itself (comprised of the group psychotherapist and the group
members) and not just with the psychotherapist.
Different therapeutic factors are at work in group psychotherapy. In
group psychotherapy, interpersonal feedback from peers is
considered the most powerful therapeutic factor.
The attachment process is different in group psychotherapy. The
attachment is to the group itself and attachment issues are analyzed
and worked through within this context.
In group psychotherapy, a client participates in a plethora of roles
and relationships and learns about the many complex roles and
relationships that make up the fabric of life

38. Individual Therapy
individual therapy is one-to-one work between client and therapist.
Some people simply want the supportive environment of an unbiased
third party, some people want help in pursuing meaningful life direction.
Within the framework of individual therapy, psychotherapist can use
techniques from one or a variety of theoretical orientations.
Family therapy involves two or more members of a family (couples
therapy is technically a subset of family therapy). Family therapy is best
used when there is a need to address problems or issues that affect
family functioning when one or more family members are affected. While
family therapists employ a variety of treatment approaches, family
therapy is consistent in emphasizing the entire family as a unit. This
approach to therapy focuses more on inter-relational issues than on an
individual's internal concerns.