SERVICES FOR VICTIMS OF
DOMESTIC VIOLENCE AND SEXUAL ASSAULT

Child sexual abuse can cause a variety of different symptoms in its survivors. Below you will find some of the symptoms that may be expressed during different development stages. Not all symptoms apply to every individual.

You can use this as a parent to check if your child has any of these symptoms. If the child does, he or she may have been sexually abused. If you are an adult survivor of childhood sexual abuse, you can use this to identify some of the symptoms you may have suffered while growing up as a result of your abuse.

This information was adapted from the book, The Physically and Sexually Abused Child- Evaluation and Treatment, by C. Eugene Walker, Barbara L. Bonner and Keith L. Kauffman. Pergammon Press.

INFANCY-AGE 4

• loss of toilet-training
• sleep disturbances
• fear of men (if perpetrator was male)
• excessive clinging
• sex talk ("Joe poke my back")
• vulvar or anal reddening

At this stage, the child needs to express anger at the perpetrator and needs to resolve anxieties, such as the fear of sleeping in his/her own bed.

AGES 4-6

• physical complaint (excessive vaginal discharge, pharyngeal gonorrhea)
• depression (changes in eating habits, weight, sleeping patterns, etc)
• family conflict

At this stage, the child may feel guilty. He/she may need to express anger at the non-abusing parent (if the abuser was a parent.)

AGES 7-12

• child reports the abuse with a desire for justice
• recent decline in grades
• stomach pains
• depression

At this stage, the child needs confidentiality. The child may need a same-sex therapist. However, many times it is more important to look for a therapist that is the opposite sex of the abuser. A male/female team of therapists may be beneficial as well. The chid may avoid discussing problems directly. However, the child may express them in play, drawings and fairy tale stories.

ADOLESCENCE

• Runs away
• displays promiscuity
• makes suicide attempts
• mood swings
• pregnancy fears
• independence from parents
• critical view of parents

In this stage, the survivor may be ready to explore the details of the sexual abuse incidents and the emotions that go along with it.

ADULT SURVIVOR

• depression
• suicide attempts
• multiple rapes or re-victimization
• parenting troubles
• marital problems

In this stage, a survivor may be having trouble with their intimate partner. The survivor may have great concern for protection of her own children, especially if the perpetrator was her father or other family member who still poses a threat. Some of the things the survivor may be ready to work on in this stage are: improving self-esteem, venting her pent-up anger and frustrations and exploring her need to confront the perpetrator.

The above symptoms are not all-inclusive. There is a large variety of symptoms that survivors of sexual abuse deal with. The important thing the survivor must learn is that, no matter what her symptoms are, she is NOT CRAZY. Many of the problems survivors deal with are directly related to the sexual abuse they endured. Many go from doctor to doctor, therapist to therapist, being misdiagnosed with different physical and mental disorders. In time, they start to believe that they are crazy, because that is what they have been told. In reality, most survivors symptoms fall under the category of "Post-Traumatic Stress Disorder" - a condition that people suffer when they are subjected to traumatic experiences that are outside of the realm of normal human experience-experiences that they have no control over. We used to call this "shell shock" in men who were returning from wars and had endured unspeakable things.

The survivor must be careful in finding a therapist who has a good understanding of sexual abuse and its effects on its victims. The therapist must be empathetic and not place judgment on the survivor. In order for therapy to be beneficial, both the survivor and therapist must feel comfortable in working with each other. If this is not the case, the survivor should move on to a new therapist until she finds someone she feels comfortable with.

• EMOTIONAL SHOCK: The victim will feel numb or experience an unexplained calmness.
• DISBELIEF: There might be a feeling that it happened to someone else or the victim was dreaming.
• EMBARRASSMENT: The victim worries what people will think, perhaps that it is the victim’s fault or that she is "damaged goods". She might be afraid to tell anyone.
• SHAME: This might be characterized by a "dirty" feeling and constant bathing in order to become "clean" again.
• GUILT: The victim may find herself asking why she didn’t take an alternative route, stay at home, lock the windows, etc., as if somehow she could have prevented what happened.
• DEPRESSION: The victim experiencing depression will find great difficulty staying avake and will have a feeling of hopelessness.
• POWERLESSNESS: This feeling of lack of control over any situation.
• FLASHBACKS: Remembering all or part of the attack or simply recoiling when touched unexpectedly even by a friend or family member.
• DENIAL: The victim might question her right to be emotional about the assault when there is no lasting physical damage.
• FEAR: The victim may have nightmares, may be afraid to let anyone be intimate again, may worry about pregnancy or venereal disease and AIDS.
• ANXIETY: Physical symptoms include difficulty breathing, muscle tension, sleep disturbances, changed eating habits, nausea, stomach problems, and bedwetting.
• ANGER: The victim may have intense feelings of hostility towards the attacker or anger about the fact that it could happen to her.

The reactions to rape vary from woman to woman but in general, these are the stages the women go through.

STAGE I--DURING THE RAPE

• Victims often report that in order to withstand what is happening, they mentally remove themselves from their bodies.
• They will report: "I thought of anything else except what was happening." This kind of denial is necessary to survive the ordeal.
• Many women report that their life flashed before them. All they could think about was not being murdered. Even if a man does not have a weapon, the woman may be so scared that she may submit.
• It is important to remember that rape is an ACT OF AGGRESSION, not a sexual act. Women will verify that it was one person AGAINST another, not a sexual act. Women frequently experience a profound terror for their life and safety.
• There is a higher percentage of incest victims among rape victims than in the general population. During the course of counseling it may be useful to query whether she has been sexually assaulted previously.

STAGE II --DAYS TO WEEKS POST RAPE

• The victim may be in a daze, in a shock-like state.
• She may be still functioning and doing things automatically, but the least upset can set her off crying, make her hysterical, etc.
• At this point, she is usually repeating her story many times to many people (police, family, friends, etc.). This ads to her ruminating about the rape.
• Nightmares about the rape may begin in this stage.
• The woman may be too frightened to go out of the home. She may withdraw into her home.
• It is important that she be in counseling now. One thing we stress in this stage is that time does heal.

STAGE III --GUILT AND DEPRESSION

• The victim finally accepts that the rape did happen to her. Now, she may begin to turn her feelings inward and say over and over: "What did I do to get raped?"
• Old tapes may reinforce this, such as remembering Mother saying: "Your skirt is too short," or "I told you to be careful," etc.
• The more she tells her story to people, the worse she feels now and tries to convince herself that it was her fault.
• Acquaintances may be very destructive now. Rape is a very sensational crime and people can be so insensitive and ask for all the gory details.
• Counseling at this point is geared to help her realize that she is the VICTIM, not the guilty one.

STAGE IV --ANGER AND DISTRUST

• Hopefully, the woman can turn her anger OUT, instead of inward.
• Counseling is geared toward helping her become angry in an appropriate way. That is, anger at the rapist, not at all men. Physical ventilation as well as verbal can be helpful at this point.
• She may have a profound distrust of any and all men now, including significant men in her life such as husband, boyfriend, etc. Hopefully she will realize "not all men are like that."

STAGE V --RE-INTEGRATED

• The purpose of crisis counseling is to get the woman to where she was before the rape or better. It may be short-term and may deal mostly with the rape and its implications.
• We help her to put the past in perspective. Yes, she was raped, but her life must go on.
• The re-integrated female is not blaming herself any more.
• She realizes that all men are not potential rapists.
• She regains a trust in men.
• She has the ability to say "NO" when asked to repeat her story about the rape.
• She does what she has to do to get on with her life. For some women, this means moving to a new location and cutting the past ties with a home that perhaps she loved much.

COUNSELING

• Some aspects of counseling have already been mentioned. In general, we want to:
  • Help the woman catharses.
  • Help her not to severely withdraw.
  • Give her lots and lots of support.
  • Help her realize she’s the victim.
  • Assist her in expressing her anger, verbally and physically. Throwing marshmallows at a wall, hitting pillows, or yelling can be helpful.
• At some point we want to involve a significant male in her life in the counseling process. Men certainly need to understand what has happened, work through their own feelings, and support the woman.
• Rape is one of the most devastating aggressive acts against women. It affects the victim’s physical, psychological, social, spiritual, intellectual and economic well-being. It touches EVERY aspect of a woman’s life.

• To be treated with dignity and respect by institutional and legal personnel.
• To have as much credibility as a victim of any other crime.
• To be considered a victim of rape when any unwanted act of sex is forced on her/him through any type of coercion, violent or otherwise.
• To be asked only those questions that are relevant to a court case or to medical treatment.
• To receive medical and mental health services whether or not the rape is reported to the police, and at no cost.
• To receive medical and mental health treatment, or participate in legal procedures only after giving her informed consent. (Information should include all possible options.)
• To be treated in a manner which does not seize control from the victim, but which enables her/him to determine her/his own needs and how to meet them.
• To not be exposed to prejudice against race, age, class, lifestyle, or occupation.
• To have access to support persons, such as advocates, outside the institutions.
• To have access to peer counseling.
• To be provided with information about her/his rights.
• To have the best possible collection of evidence for court.
• To not be asked questions about prior sexual experience.
• To have common reactions to the rape, such as sleeplessness, nightmares, hostility toward men, anxiety, fear, etc., not be considered pathological behavior.
• To have access to a secure living situation, or other measures which might help to allay fears of future assault.
• To have her/his name kept out of the media.
• To be considered a victim of rape regardless of the assailant’s relationship to the victim, such as the victim’s spouse.
• To have deterred her/his assailant by any means necessary. No victim should be criminally prosecuted for harming the assailant in the process of preventing an attempted rape.
• To receive medical treatment without parental consent if she/he is a minor.
• To have access to supportive legal services.
• To have a preliminary hearing in each case when an arrest has been made.
• To be advised of the possibility of a civil suit.