Impact of Sexual Violence on Mental Health

Trauma Responses

There are four common responses to a traumatic event such as sexual violence, often referred to as the four F’s of trauma: fight, flight, freeze, and fawn. They represent four different nervous system states that the body will choose depending on what it considers the best strategy to keep the survivor safe. These reactions represent completely normal bodily responses to extreme circumstances. It is important to recognize that the body will also enter into these states when the survivor’s memory of a trauma is triggered.

	FIGHT In this state, the body activates in preparation to fight off the danger. Some of the body cues that signal one is in the fight state include a racing heart, dilated pupils, hearing loss, and quicker, shallower breathing.
	FLIGHT Similarly to the fight state, the body will activate in order to run away or avoid danger. Body cues for the flight state are very similar to those for the fight state.
	FREEZE In this state, the body stops in its tracks, in order to “play dead” and to effectively wait for the danger to pass. Body cues for the freeze state include numbness, dissociation, and the feeling of being ‘stuck’ and not being able to move.
	FAWN In this state, the body will abandon its own needs and the person will serve others to avoid danger. This is often also called the ‘please and appease’ response. The fawn state often involves feelings of shame and guilt.

When the body experiences a traumatic event like a sexual assault, the brain retains certain aspects of that memory as well as a number of cues from the internal and external environment. When any of those environmental cues are brought up after the trauma, the survivor may react as though the traumatic event is happening in real-time, complete with one of the four trauma responses. This is commonly referred to as being triggered and is one of the most impactful long-term effects of a traumatic experience. Some triggers can be identified and easily avoided; however, others can often catch the survivor off guard.

Another way that survivors may re-experience their trauma is through flashbacks and nightmares. Flashbacks are often very vivid and may feel as though the experience is actually happening. In these cases, the brain is trying to make sense of the traumatizing experience by integrating it into schemas about the world. This task, given the shocking and impactful nature of sexual assault, is particularly difficult for the brain to do, leading it to bring up the experience more often. Flashbacks are often brief experiences, lasting only a few seconds, however, the emotional effects of a flashback can remain for hours afterward.

Triggers and flashbacks are only some of the mental health issues that may impact a survivor long after their traumatic experience. Other commonly associated long-term mental health issues after trauma include the following.

• Increased vigilance: Also sometimes referred to as hyperarousal or hypervigilance, increased vigilance is characterized by difficulty sleeping and concentrating, shakiness, muscle tension, as well as being easily startled. Those who have experienced a traumatic event like a sexual assault may have a distorted view of the world as being filled with danger, causing their bodies to be on high alert at all times. While this increased vigilance may be useful in a dangerous situation, it can be harmful to the body’s stress system when it continues even in safe situations. Increased vigilance can persist for years after a trauma has occurred.
• Dissociation: This is a mental process that disconnects a person’s thoughts, memories, feelings, actions, and/or their sense of identity, and is characterized by fixed or “glazed” eyes, flattened affect, periods of silence, and a monotonous voice. The majority of people have experienced dissociation at one time, for example arriving at work with no memory of the drive there. However, dissociation can also be a reaction to stress and trauma, as a protective element that distorts time, space, or identity for the survivor. Dissociation protects the survivor by distancing them from the experience as a survival mechanism. This symptom can become very pervasive and can lead to dissociative identity disorder.
• Grief & depression: Survivors of sexual violence may feel down, sad, and/or hopeless after their trauma, and may find themselves crying more often. They may also lose interest in people and activities that they used to enjoy or feel that plans they had for the future don’t seem to matter anymore. These are common expressions of grief and grief includes a wide range of emotions that may include depression.
• Self-medication: According to Edward Khantzian’s self-medication theory, survivors choose substances based on their specific effects, for example, to block out painful memories, thoughts, and feelings related to the trauma, or to manage the effects of depression. Some survivors may use alcohol or drugs to try to improve their sleep or to forget their nightmares. The use of substances can vary based on a number of factors, such as which trauma symptoms are most pronounced. Chronic use of substances can impact one’s recovery from the trauma and may cause its own issues.
• Intrusive thoughts: These are thoughts and memories associated with the trauma that survivors may experience without warning or desire, with or without the presence of a trigger. These thoughts and memories can come on very quickly, which is referred to as “flooding” and can be significantly disruptive for the survivor.
• Emotional dysregulation: Some survivors of sexual violence may have difficulty regulating their emotions and may turn to high-risk or self-harming behaviours as a way to regulate themselves. For example, disordered eating, gambling, overworking, and repression of emotions may be seen in survivors. Typically, traumatic stress presents itself in two emotional extremes: either feeling too much, leading to being overwhelmed, or feeling too little, leading to numbing.