Rape trauma syndrome
Rape trauma syndrome: Excerpt from Professional Guide to Diseases (Eighth Edition)
The term rape refers to illicit sexual intercourse without consent. It’s a violent assault in which sex is used as a weapon. Rape inflicts varying degrees of physical and psychological trauma. Rape trauma syndrome occurs during the period following the rape or attempted rape; it refers to the victim’s short-term and long-term reactions and to the methods the victim uses to cope with this trauma.
In most cases, the rapist is a man and the victim is a woman. However, rapes do occur between persons of the same sex, especially in prisons, schools, hospitals, and other institutions. In some cases, the victim is a man and a woman is the rapist.
The prognosis is good if the rape victim receives physical and emotional support and counseling to help her deal with her feelings. Victims who articulate their feelings are able to cope with fears, interact with others, and return to normal routines faster than those who don’t.
Causes and incidence
Rape isn’t primarily about sex. It’s a violent crime linked to feelings of rage or hatred in the assailant. Some of the cultural, sociological, and psychological factors that contribute to rape are increased exposure to sex, permissiveness, cynicism about relationships, feelings of anger, and powerlessness amid social pressures. Many rapists have feelings of violence or hatred toward women or sexual problems, such as impotence or premature ejaculation. They may feel socially isolated and be unable to form warm, loving relationships. Some rapists may be psychopaths who need violence for physical pleasure, no matter how it affects their victims; others rape to satisfy a need for power. Some were abused as children.
In the United States, a rape is reported every 6 to 7 minutes. The incidence of reported rape is highest in large cities and continues to rise. However, many rapes — possibly even most — are never reported.
Known victims of rape range in age from 2 months to 97 years. The age group most affected is 10- to 19-year-olds; the average victim’s age is 13½". About one in seven reported rapes involves a prepubertal child; most of these cases involve manual, oral, or genital contact with the child’s genitals by a member of the child’s family. More than 50% of rapes occur in the home; about one-third of these involve a male intruder who forces his way into a home. In about half the cases, the victim has some casual acquaintance with the attacker. Most rapists are between ages 25 and 44 and have planned the attack. Alcohol is involved in one-third of cases.
Signs and symptoms
When a rape victim arrives in the emergency department, assess her physical injuries. If she isn’t seriously injured, allow her to remain clothed and take her to a private room where she can talk with you or a counselor before the necessary physical examination. (See If the rape victim is a child.) Remember, immediate reactions to rape differ and can include crying, laughing, hostility, confusion, withdrawal, or outward calm; anger and rage may not surface until later. During the attack, the victim may have felt demeaned, helpless, and afraid for her life; afterward, she may feel ashamed, guilty, shocked, and vulnerable and have a sense of disbelief and lowered self-esteem. Offer support and reassurance. Help her explore her feelings; listen, convey trust and respect, and remain nonjudgmental. Don’t leave her alone unless she asks you to do so.
Being careful to upset the victim as little as possible, obtain an accurate history of the rape, pertinent to physical assessment. (Remember, your notes may be used as evidence if the rapist is tried.) Record the victim’s statements in the first person, using quotation marks. Also, document objective information provided by others. Never speculate as to what may have happened or record subjective impressions or thoughts. Include in your notes the time the victim arrived at the facility, the date and time of the alleged rape, and the time that the victim was examined. Ask the victim if she’s allergic to penicillin or other drugs, if she has had recent illnesses (especially venereal disease), and if she was pregnant before the attack. Find out the date of her last menstrual period and details of her obstetric and gynecologic history.
Thoroughly explain the examination she’ll have, and tell her it’s necessary to rule out internal injuries and obtain a specimen for venereal disease testing. Obtain her informed consent for treatment and for the police report. Allow her some control if possible; for instance, ask her if she’s ready to be examined or if she would rather wait a bit.
Before the examination, ask the victim whether she douched, bathed, or washed before coming to the hospital. Note this on her chart. Have her change into a hospital gown, and place her clothing in paper bags. Label each bag and its contents.
Alert Never use plastic bags because secretions and seminal stains will mold, destroying valuable evidence.
Tell the victim she may urinate, but warn her not to wipe or otherwise clean the perineal area. Stay with her, or ask a counselor to stay with her, throughout the examination.
Diagnosis
Even if the victim wasn’t beaten, the physical examination (including a pelvic examination by a gynecologist) will probably show signs of physical trauma, especially if the attack was prolonged. Depending on specific body areas attacked, a patient may have a sore throat, mouth irritation, difficulty swallowing, ecchymoses, or rectal pain and bleeding.
If additional physical violence accompanied the rape, the victim may have hematomas, lacerations, bleeding, severe internal injuries, and hemorrhage; if the rape occurred outdoors, she may suffer from exposure. X-rays may reveal fractures. If severe injuries require hospitalization, introduce the victim to her primary nurse if possible.
Assist throughout the examination and carefully label all possible evidence. Before the victim’s pelvic area is examined, take vital signs; if she’s wearing a tampon, remove it, wrap it, and label it as evidence. The pelvic examination is typically very distressing for the victim. Reassure her and allow her as much control as possible. During the examination, assist in specimen collection, including those for semen and gonorrhea. Carefully label all specimens with the patient’s name, the physician’s name, and the location from which the specimen was obtained. List all specimens in your notes. If the case comes to trial, specimens will be used for evidence, so accuracy is essential. (See Legal considerations, page 338.) Most emergency departments have “rape kits” that include containers for specimens.
Carefully collect and label fingernail scrapings and foreign material obtained by combing the victim’s pubic hair; these also provide valuable evidence. Note to whom you give these specimens.
For a male victim, be especially alert for injury to the mouth, perineum, and anus. As ordered, obtain a pharyngeal specimen for a gonorrhea culture and rectal aspirate for acid phosphatase or sperm analysis.
Assist in photographing the patient’s injuries (this may be delayed for 1 day or repeated when bruises and ecchymoses are more apparent).
Most states require medical facilities to report rape. The patient may not press charges and not assist the police. If the patient doesn’t go to a facility, she may not report the rape.
If the police interview the patient in the facility, be supportive and encourage her to recall details of the rape. Your kindness and empathy are invaluable.
The patient may also want you to call her family. Help her to verbalize anticipation of her family’s response.
Treatment
Treatment consists of supportive measures and protection against venereal disease, human immunodeficiency virus (HIV) testing and, if the patient wishes, testing for pregnancy.
Special considerations
❑ Give antibiotics, as ordered, to prevent venereal disease.
❑ Because cultures can’t detect gonorrhea or syphilis for 5 to 6 days after the rape, stress the importance of returning for follow-up venereal disease testing.
❑ To prevent pregnancy as a result of the rape, the patient may be given two Norgestrel and ethinyl-estradiol (Ovral) tablets orally immediately, plus two tablets 12 hours later. If so, explain the possible adverse effects of Ovral. The victim may wait 3 to 4 weeks and undergo dilatation and curettage or vacuum aspiration to abort a pregnancy.
❑ If the patient has vulvar lacerations, the physician will clean the area and repair the lacerations after all the evidence is obtained. Topical use of ice packs may reduce vulvar swelling.
❑ Offer all victims of rape testing for HIV infection as well as medical counseling and follow-up. If there’s a chance that the rapist was infected with HIV, postexposure prophylaxis may be done to reduce the odds of infection by the immediate use of antiretroviral organisms.
❑ Refer the patient for psychological counseling, if needed, to cope with the aftereffects of the attack. Recovery from rape, which may be prolonged, consists of the acute phase (immediate reaction) and the reorganization phase. During the acute phase, physical effects include pain, loss of appetite, and wound healing; emotional reactions typically include shaking, crying, and mood swings. Feelings of grief, anger, fear, or revenge may color the victim’s social interactions. Counseling helps the victim identify her coping mechanisms. She may relate more easily to a counselor of the same sex.
During the reorganization phase, which usually begins 1 to 3 weeks after the rape and may last months or years, the victim is concerned with restructuring her life. Initially, she often has nightmares in which she’s powerless; later dreams show her gradually gaining more control. When she’s alone, she may also suffer from “daymares” — frightening thoughts about the rape. She may have reduced sexual desire or may develop fear of intercourse or mistrust of men.
❑ If the patient is engaged in legal proceedings during this time, she’ll be forced to relive the trauma, leaving her feeling lonely and isolated, perhaps even temporarily halting her emotional recovery. To help her cope, encourage her to write her thoughts, feelings, and reactions in a daily diary, and refer her to organizations such as Women Organized Against Rape or a local rape crisis center for empathy and advice.
Pictures
Book Source Details
- Book Title: Professional Guide to Diseases (Eighth Edition)
- Author(s): Springhouse
- Year of Publication: 2005
- Copyright Details: Professional Guide to Diseases (Eighth Edition), Copyright © 2005 Lippincott Williams & Wilkins.
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