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Not every therapist is a trauma specialist, especially when it comes to certain types of trauma. If this is an area of concern to you, it is important to work with someone who understands the very complex aspects of this essential area of treatment.

Trauma can take a variety of forms. According to RAINN (Rape, Abuse & Incest National Network), an American is sexually assaulted every 68 seconds in the United States. RAINN is the nation’s largest anti-sexual violence organization. They and other organizations like them define sexual assault as any sexual behavior or act that is threatening, violent, coercive, forced, or exploitative to a person who has not given consent or is not able to give consent (e.g., a person who is unconscious, severely intoxicated, mentally disabled, or is impaired in his or her ability to make such a decision.

Sexual abuse occurs when a child has been exposed or subjected to behaviors of a sexual nature that are inappropriate for the child developmentally. This includes inappropriate touch, exposure to pornography or to sexual acts, and to the use of the internet for grooming and soliciting children for sexual exploitation. It goes without saying that any kind of sexual touching or penetration is clearly abuse. Such acts perpetrated on a child can be extremely traumatic and lead to long-term emotional, physical, and mental health conditions.

Sexual Trauma

Sexual trauma can take many forms and occur in a variety of situations. This type of victimization includes sexual assault, intimate partner violence, childhood and adult sexual abuse, rape, and more. Surrounding us, in our schools, our faith-based communities, at family gatherings, and in our work places are those who even now could be experiencing this type of abuse at the hands of a spouse or intimate partner, a parent or family member, or someone else that person has contact with. While you yourself may have never been a victim of a sexual trauma, the likelihood that you know someone who has is extremely high.

The effects of this type of trauma vary between individuals and are often determined by a variety of complex factors. Sexual trauma all too often has long-term consequences that do not disappear simply because the abuse or traumatic event has passed; it will most certainly have far reaching consequences long afterward. Trauma leaves an indelible mark on a person’s mind, body, and soul, impacting the trauma survivor’s perceptions and beliefs about self, others, and the world.

Sexual Abuse

It is vital we understand the signs of sexual abuse both in children and in adults so that those who need help and healing can be provided the resources that will help them heal. In other words, symptoms will not present the same in children as they do in adults. Additionally, aftereffects may be immediate or may not present until some time later in life.

The age of the child when the abuse occurs will often determine his or her response to it. Other factors will, of course, include the child’s immediate environment, temperament, and relationship to caregivers. For that reason, children will express the impacts of their abuse experiences differently. For example:

  • Younger children tend to be more focused on their immediate safety and security while older children will withdraw, avoid, or shut down emotionally.
  • Cognitively, an older child will be more affected simply because they have greater awareness of what has happened to them. They may worry more, feel fearful, ashamed, or become confused about their identity or self-worth.
  • Anxiety and posttraumatic stress in young children are often expressed by developmental regression, aggression, and distress at separation from a caregiver while older children and adolescents might experience severe anxiety, have panic attacks, abuse substances, or engage in self-harming behaviors.

Whatever the developmental stage of the child or teen, caregivers play a vital role in being watchful and responsive when they see changes in their child that something is amiss. They can help by gathering accurate information, by being supportive, and by managing their own emotional responses and seeking help for their children when they need it. Because severe or ongoing childhood abuse can lead to PTSD in abuse survivors, it is important to get the abuse survivor help from a knowledgeable expert when it has occurred.

Military Sexual Trauma (MST)

Both males and females can experience military sexual trauma.

Military sexual trauma (MST) is any type of sexual assault or sexual harassment experienced during military service. Any sexual activity that you are involved against your will is considered MST, including the following:

  • Unwanted comments about your body or any kind of sexual activities that you felt were threatening
  • Unwanted or threatening sexual advances
  • Sexual contact or sexually related activities that happened without your consent, including those that occurred when you were asleep or intoxicated
  • Threats of negative treatment or negative consequences for refusing to participate in sexual activities
  • Feeling pressured or coerced into sexual activities by promises of better treatment in exchange for sex
  • Being overpowered or physically forced to have sex
  • Being touched or grabbed in a sexual way, including during “hazing” experiences, in a manner that made you feel uncomfortable

Like other types of sexual trauma, the effects may not until long after the event has occurred. These might include the following emotional, physical, and psychological consequences:

  • Nightmares or flashbacks
  • Depression or numbness
  • Isolation from family and friends or other people
  • Alcohol or other substance use
  • Sleep disturbances
  • Physical health-related conditions
  • Anger, irritability, anxiety, panic attacks

Common Reactions to Sexual Trauma

Sexual victimization affects mental health, physical health, and relational health on multiple levels. Many sexual assault survivors experience a wide range of medical conditions commonly found in sexual abuse survivors. Many survivors fail to make the connection between past abuse and current struggles with ill health and so get trapped in a health care system that is not equipped to help them with the somatic issues that are all too often rooted in their past experiences with sexual victimization. It is not at all uncommon for sexual assault or sexual abuse survivors to experience the following:

  • Substance use
  • Eating disorders
  • Sexual dysfunction/sexual problems
  • Mental health problems
  • Post traumatic stress disorder

 PTSD Resulting from Trauma and Abuse

Studies have consistently shown that one group in particular is at extreme risk for developing this condition: victims of childhood abuse face the greatest risk of developing PTSD. Individuals who have been abused as children, especially when the nature of the abuse is sexual and/or physical in nature, are highly prone to a chronic form of this disorder (Widom, 1999). According to the Associate Professor of the School of Social Work at the University of Southern California, Ferol Mennen (1999), “Child abuse has increasingly been recognized as a serious life trauma and a potential trigger for PTSD and PTS symptoms.”

Symptoms can include psychological problems, such as depression and anxiety, trouble concentrating, or physical problems, such as chronic pain and other ailments that seem to have no other explanation. Self-destructive behaviors are also common, including alcohol and drug abuse (which are also often used as a form of self-medicating). Some of the specific symptoms of PTSD can include recurrent and intrusive flashbacks of the event(s), nightmares, intense psychological distress, persistent avoidance of related stimuli, hypervigilance, extreme startle response, and dissociative disorders.

Many children who have been abused in these ways may not display the signs of PTSD until long after the abuse has ceased (Sidran, 1995-2000). Most often the symptoms do not become obvious enough to be recognized and then treated until well into the adult years. “Often a victim of repeated abuse develops a form of coping, called dissociation, in order to block out the traumatic experience from their conscious mind.” It is not uncommon for abuse survivors to attempt to dissociate from or avoid situations that remind them of their traumatic experiences in order to delay recall of their traumatic experiences.

Symptoms of PTSD are similar to those of veterans:

DSM-5 PTSD Diagnostic Criteria

The criteria for diagnosing post-traumatic stress disorder (PTSD) in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) are somewhat different than the criteria in the fourth edition. Here are the symptom criteria in the DSM-5.

Symptoms of PTSD. The following are the formal diagnostic criteria that need to be met in order to be diagnosed with PTSD.

Criterion A

You were exposed to one or more event(s) that involved death or threatened death, actual or threatened serious injury, or threatened sexual violation. In addition, these events were experienced in one or more of the following ways:

  • Directly experiencing the event
  • Witnessing the event as it occurred to someone else
  • You learned about an event where a close relative or friend experienced an actual or threatened violent or accidental death
  • Experiencing repeated exposure to distressing details of an event, such as a police officer repeatedly hearing details about child sexual abuse

 Criterion B

You experience at least one of the following intrusive symptoms associated with the traumatic event:

  • Unexpected or expected reoccurring, involuntary, and intrusive upsetting memories of the traumatic event
  • Repeated upsetting dreams where the content of the dreams is related to the traumatic event
  • The experience of some type of dissociation (for example, flashbacks) where you feel as though the traumatic event is happening again
  • Strong and persistent distress upon exposure to cues that are either inside or outside of your body that is connected to your traumatic event
  • Strong bodily reactions (for example, increased heart rate) upon exposure to a reminder of the traumatic event

 Criterion C

Frequent avoidance of reminders associated with the traumatic event, as demonstrated by one of the following:

  • Avoidance of thoughts, feelings, or physical sensations that bring up memories of the traumatic event
  • Avoidance of people, places, conversations, activities, objects, or situations that bring up memories of the traumatic event

 Criterion D

At least two of the following negative changes in thoughts and mood that occurred or worsened following the experience of the traumatic event:

  • Inability to remember an important aspect of the traumatic event
  • Persistent and elevated negative evaluations about yourself, others, or the world (for example, “I am unlovable,” or “The world is an evil place”)
  • Elevated self-blame or blame of others about the cause or consequence of a traumatic event
  • A negative emotional state (for example, shame, anger, or fear) that is pervasive
  • Loss of interest in activities that you used to enjoy
  • Feeling detached from others
  • Persistent inability to experience positive emotions (for example, happiness, love, joy)