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Let’s Talk About Sex(ual) Assault

With the recent Supreme Court appointment, and the #metoo movement sexual assault has had a light shown on it in a way that we have never seen before. This have been very polarizing issue with people both cheering that women are finally speaking out against their attackers, and others saying “It’s a scary time for boys.”

Sexual assault is probably the most common cause of trauma I see patients seeking treatment for in my practice. There are countless others who are seeking treatment for various other reasons that report some form of sexual assault at some point in their lives. One criticism of victims who have come forward is “Oh if it really happened they would have said something earlier.” “They would have reported it.” I can tell you from working with countless victims of sexual assault, (men, women, and children) this is just without a doubt absolutely, positively, 100% not true.

I cannot tell you the countless number of patients who tearfully tell me their story and conclude with a cathartic cry saying that was the first time they had told anyone about the incident. I always ask if the assault was reported and (excluding cases regarding children) I could probably count on both hands the number of people who had ever reported it to police. Out of all of these people I can think of maybe two or three who’s attacker was ever prosecuted.

When I ask these victims if there was something that stopped them from reporting this, there is almost always some variant of “I was afraid what people would think,” or “I was afraid no one would believe me.” Another common thing that happens is that victims blame themselves. “Well I shouldn’t have been at that party,” “I shouldn’t have let myself be alone with him.” As a result victims often don’t seek any kind of mental health treatment, which often leads to significant mental health issues down the road.

So what happens when a person experiences a trauma? Each person may respond differently, but frequently what happens is over-activation of a part of our brain called the amygdala. The amygdala is often referred to as “the fear bean” (if you were to look at the structure that’s kind of what it resembles) and one of it’s functions is that it kind of serves as an alarm system. When we experience a trauma the amygdala sounds the alarm, when it does this it basically sends out very intense excitatory signals, warning us to be on high alert. Now trauma does not effect everyone in the same way for a variety of reasons (biologic, environmental, genetic, etc.) but frequently it results in some kind of anxiety disorder and for victims of sexual assault this commonly manifests as Post-Traumatic Stress Disorder (PTSD).

We hear a lot about PTSD related to service members and deployments, but it is important to remember that this can affect anyone who has experienced a trauma. This may present in a person as frequent distressing memories, or dreams of the trauma, re-experiencing the trauma (feeling that you are back in that traumatic situation), amnesia about an important aspect of the trauma, heightened startle response, irritability, sleep disturbances, among many other symptoms (American Psychiatric Association, 2013). This affects a person’s daily life in many ways. Imagine re-experiencing the assault every time your significant other touches you, being afraid to go to sleep due to fear of having another nightmare, or going into a panic when you hear footsteps behind you.

We spend so much time teaching and warning girls and women about precautions to take to keep themselves safe. I think it would be pretty rare to find a woman who at some point hasn’t been advised to or warned:

“Don’t ever let your drink out of your sight.”

“Don’t wear headphones or at least take them out of one ear when you’re jogging.”

“Make sure you park in a well lit area.”

“Don’t drink something you haven’t seen made in front of you.”

“Stay in groups if you have to walk somewhere at night.”

“Carry your keys in your hand so you can use them to protect yourself.”

“Don’t talk on your phone or be unaware of your surroundings when you’re walking somewhere alone.”

These are just a handful of warnings that, like I said, I’m sure every woman has heard. And the truth is we spend so much time teaching and instilling these warnings for one reason. We believe and know that it is completely possible for someone to be assaulted. Think about it, is there any other kind of event we give so much warning to? I can’t think of any. We give these warnings because we know this is not out of the realm of possibility. So why do we act like it is when someone speaks up?

We need to start fostering a culture of not condemning victims when they do report an assault so that when it does happen people are comfortable speaking up immediately, not living in fear or blaming themselves for years, and then being questioned or mocked when the courage to speak up does arise.

Something that I always try to leave my patients with who have been victims of sexual assault is acceptance that what happened is not their fault. It doesn’t matter what you were wearing, it doesn’t matter if you were drunk, it doesn’t matter if you’ve had some kind of sexual relationship with the person before. It. Is. Not. Your. Fault.

If you or someone you know has been the victim of sexual assault and needs help contact the National Sexual Assault Hotline (800)-656-4673

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