• Women who are sexually assaulted are likely to develop PTSD
  • Triggers and reminders will cause women to relive the trauma
  • The presidential campaign caused sexual assault survivors to feel victimized again; has sexual assault become acceptable?
  • Tips for sexual assault survivors and their friends and family on how to cope

The American Psychological Association (APA) recently found that approximately 50% of American adults found the 2016 election to be a source of significant distress, and this distress affected people regardless of gender and political party affiliation1. This increased level of distress is something we have seen first-hand in our practice, where we specialize in the treatment of Post-traumatic Stress Disorder (PTSD) and other anxiety disorders.

Over the course of this presidential campaign, many of our patients have expressed exacerbated stress and anxiety in response to the tenor and tone of the rhetoric, specifically as it relates to sexual assault. April is Sexual Assault Awareness Month, and given that many of our patients have experienced sexual assault or know someone who has, this led us to ask the question: How does the current political climate interact with the psychological and emotional effects of sexual trauma? Additionally, we would like to respond to survivors of sexual assault with advice on how to cope with current political climate as well as provide suggestions for friends and family members on how to be supportive.

Sexual Assault in the United States

The Department of Justice (DOJ) defines sexual assault as any type of contact or behavior that occurs without consent of the recipient. This can include:

    • forced sexual intercourse
    • child molestation
    • attempted rape.

Sexual assault happens too frequently in the United States - the DOJ estimates that there are approximately 320,000 sexual assaults committed against Americans 12 and older and 60,000 against children per year2. That averages out to more than 30,000 sexual assaults per month – a sexual assault every 98 seconds3. In comparison, the Federal Bureau of Investigation (FBI) estimates there were approximately 16,000 murders in 2015, and between 2010 and 2015 there was an average of 14 terrorist attacks per year in the United States4. It is suggested that approximately 63% of sexual assaults are not reported, so it is fair to say that sexual assault is an epidemic in the United States. Although sexual assault happens to men and women, 90% of victims are women. In fact, studies suggest that approximately 9.2% of all women will be raped and 12.2% of women will have been sexually molested within their lifetime5. In other words, upwards of 20 million women will be raped or molested at some point in their life.

Sexual Assault and Post-traumatic Stress Disorder

The psychological scars left from experiencing sexual assault can last for years and even decades if left unresolved. Astonishingly, nearly half of women who have been raped, and a quarter of women who have been molested, are very likely to develop Post-traumatic Stress Disorder (PTSD)5. PTSD is a psychological disorder characterized by symptoms that develop in response to being exposed to actual or threatened death, serious injury, and/or sexual violation.

PTSD can develop immediately following trauma or have a delayed onset (i.e. more than 6 months after the trauma occurs) and is most likely to run a chronic course. Unfortunately, it is quite common for individuals with PTSD to develop a co-occurring psychiatric condition, such as Major Depressive Disorder, an anxiety disorder, and individuals with PTSD commonly develop a substance abuse problem 6. Given the potential for PTSD to develop a chronic course with added suffering from co-occurring psychiatric disorders, it is important for individuals experiencing symptoms of PTSD to reach out for help as soon as possible.

Constantly under barrage, how are survivors of sexual assault uniquely affected by social media, news reporting, and politicians' behaviors that discuss and sometimes glorify sexual assault?

First, let's review what we know about sexual assault and PTSD. When discussing PTSD, people often first think of the psychological wounds veterans are left with after being exposed to combat. While the traumatic events themselves are quite different, we know the psychological consequences following both types of traumas are often very similar. However, for both men and women, being raped has been shown to have the strongest probability of leading to a diagnosis of PTSD, followed by combat and childhood molestation 5. What this tells us is the psychological damage caused by sexual assault shocks the emotional system of the survivor in a very unique and detrimental way. And while this emotional shock may be similar to that of a soldier who experiences a combat-related trauma, there is something uniquely disturbing about sexual assault.

A surprising fact is that approximately half of women diagnosed with PTSD have experienced either sexual assault and/or childhood molestation at some point in their lives 5. Given this alarming relationship between sexual assault and PTSD, it is no surprise that being reminded of such horrific events can be equally disturbing.

For people with PTSD, the environment can present an unlimited number of trauma reminders. Any smell, sound, or image that reminds them of their traumatic past can quickly bring back a rush of emotions (e.g. fear, shame, guilt) and physiological sensations (e.g. heart racing, upset stomach, shakiness, sweaty) that often leave a survivor of sexual assault to feel as if the trauma is happening again. Over time, these reminders can attach themselves to more and more situations in the environment, leading a survivor of sexual assault to emotionally and physically feel as though the horror of the past is happening again in the present. The original trauma from the past becomes generalized to new, previously neutral situations in the present and the experience of danger and threat is felt everywhere.

To better demonstrate this, imagine you were involved in a severe car accident while driving at night and listening to your favorite song. All of the information present before, during, and after that accident becomes encoded into this trauma memory. As previously described, anything you saw, heard, physically and/or emotionally felt, smelled, thoughts you had, etc. all become associated with the memory. As a result, you find that simply being in or near a car reflexively triggers anxiety. It is even possible you begin to experience anxiety when you smell gasoline, hear your favorite song again, or are walking in your neighborhood at night. Perhaps watching TV shows that feature cars driving fast, watching news coverage of a car accident, or hearing the sound of cars outside your house causes a spike in anxiety that feels similar to how you felt when you were in the original car accident. The same rings true for survivors of sexual assault. It is quite usual for survivors to experience intense anxiety when they hear news stories about sexual assault, see people that remind them of the of their original perpetrator, or are in large crowds of people where they cannot keep track of who is behind them. It is important to keep this in mind when considering the specific impact the recent presidential campaign can have on those individuals who have experienced sexual assault.

The 2016 election cycle featured 24/7 coverage of every story related to Donald Trump and Hillary Clinton. Political campaigns are often heated and known for intense debates between the political opponents. However, this past presidential election was different in that it seemed to feature recurring events related to sexual assault. Moreover, cable news viewership was high and often times included graphic details related to these stories featuring themes of sexual assault. While many found the lewd events and news coverage to be distasteful, survivors of sexual assault can experience these same events as painful reminders of horrific memories.

A Few Examples from the recent Trump Campaign Cycle

On October 7, 2016, an audio recording of Donald Trump and Billy Bush discussing women in a lascivious manner became worldwide news. What we heard was an unfiltered conversation between two men glorifying objectification of women and the desire to engage in non-consensual sexual acts. After hearing this, many people were disturbed and offended by the casual nature in which Donald Trump described and justified his abhorrent, sexually abusive ideas that absolutely meet the DOJ definition of sexual assault against women. However, for many survivors of sexual assault it captured a moment that felt all too real and familiar. For some women it is possible that just hearing this conversation can trigger a flood of painful memories and feelings of reliving their own horrible traumatic past. Furthermore, sexual assault survivors we work with have described hearing this conversation as confirmation of how sexual predators view women. To make matters worse, Donald Trump attempted to explain this conversation as "locker room talk." While there is no official definition of "locker room talk" it is clear this was an attempt to minimize and normalize repugnant language and sexual assault. His decision to do this sent a harmful message which threatens to invalidate the experience of sexual assault survivors everywhere. The media responded by replaying the audio clip on a loop, which only created a recurring cycle of re-exposure to, and wide-spread dissemination of, this defamatory conversation.

Another example of how political events can impact survivors of sexual assault was the way Donald Trump responded when several women accused him of sexual assault. Despite several claims of inappropriate sexual advancement that mirrored his prior statements, Donald Trump chose to not only deny these accusations, but to blame the accusers of seeking fame and attention. Blaming the victim is a familiar feeling for many survivors of sexual assault. Many women who have been sexually assaulted are often directly blamed for the assault or accused of lying. This is a unique experience as other victims of crime and trauma are not typically blamed or accused of lying. Nonetheless, when Donald Trump accused his accusers of coming forward with the intention to seek fame, women with a history of being sexually assaulted may be reminded of their own past experiences. In talking with women that have experienced sexual assault, many have expressed feeling like Donald Trump became a visual representation of their past perpetrators. Thus, when he responded to the accusations of his sexual misconduct by accusing them of seeking fame it opened up the possibility to validate victim blaming.

For many survivors of sexual assault, the election invalidated their experience. For these survivors, the willingness of so many people to vote for a candidate despite concrete evidence of inappropriate sexually aggressive language and behavior suggests that the culture in which they live considers sexual assault acceptable. For some of the women we have spoken with, they feel that the fact that Donald Trump's sexual behavior was not disqualifying to so many voters sends the message that sexual assault is not viewed as a valid cultural concern. In some ways they feel like they watched as a man was given a free pass despite multiple incidents of what many would consider sexually assaultive behavior. Furthermore, we now live in a culture where a symbol of sexual assault has been elected to the most powerful position in our country and continues to receive daily coverage. In many ways, Donald Trump is serving as a constant reminder of the sexual assault many women have experienced.

Tips for Survivors of Sexual Assault

When presented with such an influx of potentially painful triggers, it is important to be mindful of your psychological wellbeing. Here is some general advice on how to cope with current political climate.

Don't Avoid

As we know, a common reaction is to avoid reminders at all costs. This makes sense since the memory is likely the worst event you have ever experienced. However, it is important to remember that avoidance of your thoughts, memories, and emotions will only fuel your anxiety and distress further in the long run. Avoidance makes sense in the short term because it feels relieving to escape a painful experience. However, your anxiety and distress will only continue to haunt you if you try to absolutely avoid it.

Moderate your Daily Exposure

Watching every second of the news can become emotionally exhausting, so it is important to know when to turn off the news. This may sound counter to the previous point, but it is important to use moderation when allowing yourself to be exposed to unsavory triggers in your environment. How do you achieve the careful balance? Think of it this way. What are the things you want to be doing? What do you enjoy doing? Don't avoid those situations due to the potential to be triggered. Rather, embrace those situations with confidence that you can handle the possibility of feeling uncomfortable. However, if you are constantly plugged-in to 24-hour news cycle, you may run the risk of overworking your cognitive and emotional system. This may lead to fatigue, frustration, physical tension, or other somatic ailments. Know your limits and take a break from the constant negativity cycling through media outlets when necessary. Again, think of the activities you enjoy and want to be doing. Approach those more often, even if it means potentially being in situations that make you uncomfortable.

Reach Out to a Therapist

If you have experienced sexual assault at some point in your life and find that you have been experiencing intrusive, unwanted, and distressing memories of your assault, we recommend you reach out to a therapist trained in trauma-informed and evidence based therapy. Prolonged exposure is one such therapy that has consistently show positive outcomes, however there are other therapies that can be helpful for coping with the traumatic events of your past. For more information contact your medical provider or search for services through the Rape, Abuse & Incest National Network (RAINN; https://www.rainn.org/).

Tips for friends and family of sexual assault survivors

The second most common question that has come up in our clinical work is how to advise friends and family member in being supportive for their loved ones. We believe it's important to remember that you are already showing a great deal of support by simply reading this article. It shows a genuine care and concern for your loved one. Nonetheless, here are just a few suggestions to try when offering support to a loved one.

Listen

It may sound simple, but listening to your friend or family member can go a long way. By listening to your loved one and offering unconditional support, you are communicating you care about them. Even if you don't have any answers for their concerns, they will likely feel your support and concern which can be comforting by itself.

Express Empathy

Although you will not fully understand what it is like to be the victim of sexual assault, you can likely relate to the feelings experienced by your loved one. If you can find a way to connect with the feelings your loved is experiencing and then communicate your understanding, you will have found a common ground that your loved one will appreciate greatly.

Here is an important, related article that you should also read: How To Overcome Anxiety in Modern Times - Processing threatening stimuli in the age of new media

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Sources

1. American Psychological Association (2017). Stress in America: coping with change survey part one.

2. Department of Justice, Office of Justice Programs, Bureau of Justice Statistics, National Crime Victimization Survey, 2010-2014 (2015). https://www.justice.gov/ovw/sexual-assault

3. National Sexual Violence Resource Center: http://www.nsvrc.org

4. Federal Bureau of Investigation: https://ucr.fbi.gov/crime-in-the-u.s/2015/crime-in-the-u.s.-2015/additional-reports/federal-crime-data/federal_crime_data_-2015

5. Kessler, R. C., Sonnega, A., Bromet, E., Hughes, M., & Nelson, C. B. (1995). Posttraumatic stress disorder in the

National Comorbidity Survey. Archives of general psychiatry, 52(12), 1048-1060.

6. Kessler, R. C., Chiu, W. T., Demler, O., & Walters, E. E. (2005). Prevalence, severity, and comorbidity of 12-month DSM–IV disorders in the national comorbidity survey replication. Archives of General Psychiatry, 62, 617–627.