Volume 13 Issues 10 October, 2023
Sexual violence is a severe problem in society that often goes unreported and with a complex relationship to mental health problems. As per WHO, “rape is defined as the physically forced or otherwise coerced penetration of the vulva or anus with a penis, other body part or object.”
The effects of sexual abuse may vary according to the individual, it may have serious consequences for the somatic, psychological, and psychosocial health (e.g., depression, post-traumatic stress disorder, relationship problems, and social isolation) of the victim.
If we provide timely medical and psychological are to rape victims, that is of utmost importance, as this care can have a positive influence on the patient’s ability to process their experience and engage in healing after such a traumatic event.
For you, living another day with such trauma might be as hard as dying, but remember what happened was not your fault, and there is always a new day and there is always a new sunshine.
The World Health Organization (WHO) has emphasised the critical role of primary medical care following sexual violence in offering a form of early intervention and enabling the victims to cope with their experiences. The victims experience primary care that is clinically competent, empathetic, and non-judgmental as excellent support and has a notably positive influence on their further journey of processing and healing.
General recommendations for primary care
- The victim should be informed that the examination is voluntary, and that she may interrupt or end the examination at any time. The patient must not be put under any pressure to be examined or undergo treatment and must be given as much control as possible over the examination process.
- The doctor should listen actively (give validation, confirm the patientʼs narrative, keep an eye on the patientʼs stress level, exert a calming influence, keep things focused on the “here and now”, utilize resources, and place emphasis on the healing process) and convey a sense of calm and safety. The doctor should avoid making any criticisms in particular because negative social reactions can, for example, promote PTSD. The doctor should treat the victim objectively and with empathy, and convey the message that she is taken seriously, her trauma is acknowledged, and she is not to blame for what has happened to her. The victim should feel safe and able to trust the medical staff taking care of her.
- Primary care following rape consists of a gynaecological examination and a forensic medical examination, as well as psychosocial care.
Psychological and psychosocial support
To ensure reliable ongoing psychosocial support for the victim, it is a good idea to collaborate with womenʼs counselling services, forensic medicine examination centers, legal aid centers, financial support programs, outpatient and inpatient psychotherapy providers, womenʼs shelters, etc. In general, the following recommendations for providing psychological and psychosocial support for the victim are made:
- Build a relationship with the victim and ask her about her needs and worries.
- Investigate any tendencies to self-harm or suicidal behaviour and determine whether hospitalisation is necessary for this context.
- Help the victim access short-term relief: Who in the victimʼs social setting can offer support, and which counselling services can the victim turn to?
- Psychoeducation may be provided by informing the victim of possible psychological reactions that may occur, such as flashbacks, overwhelming emotions and phases of emotional numbness, dissociation, and increased agitation with sleeping disorders; this helps the victim to classify and understand these occurrences as reactions.
- Any risk factors that increase the likelihood of developing long-term psychological symptoms (e.g., the suspected perpetrator is the victimʼs current or former intimate partner, preexisting psychiatric conditions, previous rape or other traumatic experiences. Such as psychological, physical or sexual violence during childhood or adulthood) should be identified. Victims who have already experienced this kind of trauma before should receive a more thorough psychoeducation, including an explanation of the risks and support options.
- Victims should be given this information in writing, as concentration and memory are often impaired during acute situations.
- Prescription of benzodiazepines should be avoided if possible, as they do not prevent post-traumatic stress disorders; instead, they promote the chronification of such.
The psychological and social impact of rape can be profound. Elements contributing to post-traumatic responses include the personal meaning of the trauma, perception of life threat, actual injury, and repeat traumatisation. Psychological reactions vary greatly, but overall people who experience rape are more likely to develop post-traumatic stress disorder than victims of any other crime.
In the early weeks after rape most people experience strong emotional reactions and express a range of post-traumatic symptoms. Other early symptoms include anxiety, tearfulness, self-blame and guilt, disbelief, physical revulsion, and helplessness. Longer term difficulties include post-traumatic stress disorder, generalised and phobic anxiety, depression,difficulties with social adjustment and sexual functioning, and substance misuse. Feelings of shame and humiliation are common and persistent and contribute to low self-esteem and depression. Levels of suicidal ideation and attempted and completed suicide among people who have been raped are significant.
Key elements for early intervention are education, a space to ventilate and explore anger, reduction of shame and guilt, and consideration of coping mechanisms, and social support and integration.
Although most people recover spontaneously, treatment of clinically significant psychopathology is essential. General practitioners have an important role in identifying those requiring formal treatment and ensuring follow-up, given the risks outlined and frequency of avoidance symptoms. Management guidelines for post-traumatic stress disorder indicate that people should be offered trauma focused psychological treatment (cognitive behaviour therapy or eye movement desensitisation and reprocessing), regardless of the time since the trauma. If no noticeable improvement results, clinicians should consider an alternative psychological therapy or drugs. Antidepressants are indicated for prominent depressive symptoms or a distinct depressive illness. Short term use of hypnotics and anxiolytics may be beneficial for hyperarousal in the immediate aftermath. Management may be more complex in those with repeat traumatisation.
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