Rape and sexual assault exist on a spectrum. In this essay, I speak from both personal experience as a survivor and as a clinician who has guided many clients through recovery. I’ll discuss legal definitions, the gray areas between consent and harm, the difference between single-incident and complex trauma, and the importance of accessible, trauma-informed treatment as well as the importance of not stigmatizing sufferers and widening access to needed care.
Most legal definitions of rape involve “non-consensual sexual penetration” and lack of consent by the victim, though these definitions vary from one jurisdiction to the next and at the state and federal level. Sexual assault also applies to such things as drugging a victim, or involving a child sexually. Having read these definitions and understanding them, one is still left with a lot of gray areas including: ongoing coercion, power dynamics, and the ability, or lack of ability to consent. There is a spectrum of behavior that at the more benign but still harmful end is unwanted sexual advances or touching. At the other end is repeated violent rape and assault.
From a clinical perspective, how violent and how sustained rape and abuse are will determine the depth and breadth of traumatic symptomology and how rigidly entrenched Post-Traumatic Stress Disorder (PTSD) becomes. From a personal and treatment perspective these differences matter. Trauma responses range from acute stress reactions to complex, long-term syndromes. Single episode assault is still traumatic but usually not as deeply as repeated episodes. Multiple episode rape/assault or assault coupled with other trauma often provokes complex PTSD with a wider and more entrenched symptom profile. Addictions often accompany trauma as sufferers tend to self-medicate their symptoms. Of course, violence adds a deeper layer of trauma to any sexual assault.
My wife suffered from sexual abuse and first divulged it in group therapy. Her abuse occurred at age thirteen while spending a lot of time with a married, thirty-something year old man. He showered her with attention which she acknowledges she liked given her estrangement from her father. The perpetrator once held a faux wedding ceremony with her, offering a ring to signify their union. He did not penetrate her but did caress her developing breasts and between her legs while she was on a sleepover. The man’s wife was on the other side of the bed. When my wife divulged this in group, another assault victim cried out, “you were raped!” She never felt, and does not feel today that what happened to her rose to the level of rape. She feels minimal affect and was able to resolve her trauma in therapy. She understood that what the man did was wrong and from that night forward made sure to never again sleep at his house. But she adds that for a young female growing up in the city, men not respecting women’s bodies was run of the mill. Grabs, pinches and unwanted caresses were frequent in her experience when she was younger.
When I was a boy, I was sexually abused or assaulted by another boy a year older. He pulled down my pants and underpants and penetrated me anally. I did not consent to what he did and had no real conception of sexuality or power dynamics at that point in my short life. It’s important to note that my perpetrator was himself being perpetrated by an older man. Freighted with guilt and shame I made a decision to never tell a soul about what happened. My clinical profile, along with this sexual abuse was greatly complicated by my father’s physical and verbal abuse.
For more than two decades it was my dirty little secret. Years later, sitting in group therapy where I was fighting off a major addictions problem, a young woman opened up about episodes of sexual assault during childhood. Her words, “I was sexually abused” seemed to fly from her lips and smack me on the forehead. When she was done, I blurted out, “it happened to me too.” To divulge my abuse was completely unplanned, the decision coming from a part of me that had just started to exist; a truth telling part that wanted to be emotionally healthy. A part of me tired of holding all the secrets of my abuse. From my therapist and my fellow group mates, I got the support, direction and understanding I needed to come to terms with the complexity of my trauma.
More on the severe end of the spectrum of trauma-related sexual assault/rape are two examples from my days as a clinician (names and identifying characteristics changed for confidentiality). One person was episodically raped by a man putting the barrel of gun in the mouth of his “lover” for sexual turn on, power and control. I recall the client shaking like a leaf as they recounted their trauma.
Another man I counseled was violently raped by a priest when quite young. He had blocked out the worst of it but was left with an extreme startle response to even moderate, unexpected noise. A door closing or a shout from outside our therapy office would provoke him to lurch out of his seat with his arms spasmodically shooting up involuntarily.
It’s worth mentioning that both individuals battled chronic addictions as they had understandably self-medicated the pronounced symptomology of their Complex PTSD. I encountered both of these individuals in a short-term detox. Neither of them was receiving the kind of long term, trauma-informed, co-occurring wrap around services they needed. It was like slapping a small band-aid on a gaping wound.
To better serve rape and sexual assault survivors, we need to increase funding for trauma-informed care and expand integrated treatment for co-occurring disorders. We need to provide universal screening for trauma in clinical settings, including both behavioral health and primary care physician’s offices. We should practice safety planning, informed consent and culturally sensitive care. And, in our communities, encourage survivor-led support, peer mentoring and invest in public education to reduce stigma.
Both my wife and I were fortunate to find treatment for our trauma and have been able to forge happy, meaningful lives. This is not true for everybody who struggles with trauma. Society must find ways to judge trauma sufferers less and break down obstacles to treatment more. We’d all be better off for it.
RESOURCE LIST:
For survivors seeking help:Immediate crisis: If you are in danger or have recently experienced violence, contact your local emergency number.National hotlines (examples; update with your country):United States: National Sexual Assault Hotline — 1-800-656-HOPE (4673). Website: rainn.orgUnited Kingdom: National Domestic Abuse Hotline — 0808 2000 247. Website: wearepossible.org.ukCanada: Canadian Centre for Child Protection 1-800-892-3333; if in immediate danger, call 911.Local crisis lines and campus resources: List the relevant numbers for your country or region, including sexual violence crisis lines, campus counseling centers, and urgent care options.Finding trauma-informed care:Look for therapists who identify as trauma-informed and who have training in PTSD/Complex PTSD, EMDR, CPT, or other evidence-based approaches.Integrated care options: co-occurring disorders support (substance use, mood disorders) with trauma-informed care.Accessibility considerations: bilingual services, culturally competent care, sliding-scale fees, telehealth options.Evidence-based therapies and approachesEMDR (Eye Movement Desensitization and Reprocessing)CBT for PTSD (Cognitive Processing Therapy)CPT (Cognitive Processing Therapy)IOP/OP trauma-focused programs and translation of services into community settings
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