PTSD and sexual violence

PTSD is not anxiety. Anxiety is focused on the future, on what might happen. PTSD is a re-experiencing of what has already happened.

Based on what you hear on the news, you probably think of [PTSD] as something mainly affecting combat veterans. In fact, the most common cause of PTSD is sexual violence. Most survivors of child sexual abuse have experienced it at some point in their lives. Even if your symptoms are not serious enough for a diagnosis of PTSD, there's a good chance you're experiencing some degree of post-traumatic stress right now. In a million ways, you don't remember what happened to you, you relive it. In fact, you can relive the trauma in your body even if you don't remember what happened. . . . PTSD is a delayed psychological response to traumatic events, and it manifests itself through thoughts, dreams, ‘flashbacks,’ emotions, bodily reactions, problems sleeping, poor concentration, being constantly ‘on guard,’ being easily startled, finding yourself avoiding reminders of the trauma, feeling detached or numb, or completely ‘spacing out.’
Complex PTSD

Complex PTSD sufferers (typically those who have experienced chronic trauma such as child abuse) show the regular symptoms of PTSD, plus:
  • uncontrollable temper outbursts;
  • easily hurt feelings;
  • feelings of worthlessness and guilt;
  • problems with emotional intimacy; and
  • feeling distant from people.
. . . If you are reading this and you suffer from PTSD, you probably have the complex version.
Dealing with triggers

One of the most important things a PTSD sufferer can learn is how not to get triggered.

How do you not get triggered? It's tricky. You're getting pulled back to the past, reliving past abuse or just the feelings associated with it. You need to ground yourself and concentrate on the present. Here are the steps:
1. Name five things you can see.
2. Name five things you can hear.
3. Name five things you can feel. For instance, you may feel:
  • the seat of the chair beneath you;
  • your feet on the ground;
  • the breath going in and out of your lungs;
  • the feel of the clothes on your body; or
  • the temperature of the air in the room.
Repeat the whole exercise, looking for four things in each category, then three, then two, then one. If that still doesn't help you feel present, try experiencing powerful sensations by doing something like:
  • listening to loud music;
  • sucking on a lemon; or
  • holding a piece of ice.

What is addiction?

I explain why addiction and chemical dependence are not the same thing.

How do I, as a therapist, decide whether [my client] Paul is an alcoholic? Do I ask questions to determine whether he has withdrawal symptoms if he stops drinking? The answer, surprisingly, is no. It doesn't matter from my point of view whether Paul is physically dependent or not. . . . You see, just about every adult in the Western World is chemically dependent on caffeine. Go without coffee in the morning, and you may end up with a pounding headache by lunch time. However, coffee drinking doesn't cause problems in most people's lives. I don't hear wives and girlfriends threatening to leave because their husbands or boyfriends drink coffee. I don't hear of people getting an impaired driving conviction for driving after having a latte. I don't hear of folks ending up in jail because they overindulged in java. . . . Paul, though, couldn't stop drinking even when his wife threatened to leave. He was an alcoholic. Viewed that way, an addiction doesn't even have to involve a substance. You can have a process addiction such as sex, as you saw in the previous chapter. The consequences can be devastating.
Cognitive behavioral trauma therapy

I give an example of how I work with a traumatized client using the techniques of cognitive behavioral therapy (CBT).

Pete's mother seduced him when he was 13, and he had struggled with addiction and anger all his life. He'd recently spent the weekend in jail after being picked up for being drunk and disorderly. The weekend before that he'd spent in hospital after he hit on a woman with a very jealous boyfriend.

‘I wonder who told you that you were a screw-up,’ I persisted.

‘I just am, that's all.’ He bowed his head and looked down at his shoes.

‘Because of what your mom did to you?’

He didn't answer, but tears dripped onto his jeans as he shook with grief.

‘You think it was your fault?’

‘I'm a screw-up because I let her abuse me,’ he said, sobbing.

I waited until the tears subsided. ‘Pete,’ I asked, ‘If women abuse teenage boys, I wonder if it's the boys' fault. If we should blame them.’

Wordlessly, he shook his head. I again asked if he thought it was his fault, but this time he said no. All his life he had thought he was a screw-up because he had sex with his mom. For the first time, he was able to acknowledge he had done nothing wrong.
Mothers, the most common perpetrators

News reports may have you thinking most sexual abuse of boys is perpetrated by priests, but only one of [my] hundreds of male clients was a victim of clergy abuse. One was abused by a coach, and most of the rest by females. . . But here's something you may have trouble believing: . . . mothers are by far the most common perpetrators disclosed by male survivors in my practice.

The NSPCC survey reported that four out of seven boys with female perpetrators were abused by mothers. . . A quick calculation shows that 29 to 36 percent—roughly a third—of sexual abuse of boys is perpetrated by mothers. (This is the same rate at which sexual abuse of girls in the survey was perpetrated by fathers or stepfathers.) When I explain this to female colleagues, their most common reaction is: ‘Well, I never see it. In my experience, it's really rare.’ Over and over, however, male clients tell me they were unable to disclose abuse to women therapists. I assure my female colleagues that they're counseling a lot of male clients sexually abused by mothers, whether they realize it or not.
Beware of hostile therapists!

If you're a female survivor of sexual abuse by a male, your therapist will probably treat you with compassion and empathy. If you're a male survivor of sexual abuse by a female, I can almost guarantee your therapist will rush to defend your perpetrator.

There is a phrase I can pretty much guarantee every male survivor reporting abuse by a female is going to hear: ‘I wonder what made her do that?’ You may see nothing wrong with that question, but consider this: at the moment when you disclose, when you are most vulnerable, when you most need acknowledgment and validation, your therapist is rushing to defend a child molester. If something made her do it, she's not responsible for her actions, so who is? That's right: you. You must somehow be to blame for your own abuse. . . Yet every female therapist I have ever been to—every single one—has said it to me. Can you imagine a counselor listening to a female client's story of rape by her father, then saying: ‘Huh. I wonder what made him do that?’ Does that sound okay to you? . . . If your therapist is a licensed professional, a Google search will quickly turn up details on how to register a formal complaint.
Shattering sexual stereotypes

In One in Six I meticulously analyzed the largest-scale, most authoritative studies to uncover some astonishing findings. Please note I'm not the one making these claims.

  • Men are raped at the same rate as women.
  • Men experience sexual violence at almost the same rate as women.
  • One in four men has experienced sexual violence.
  • Three out of five male survivors of lifetime sexual violence reported no male perpetrators.
  • Five out of eight male survivors of lifetime sexual assault reported no male perpetrators.
  • At least forty percent of child sexual abuse survivors are male.
  • At least one in six men has experienced childhood sexual abuse.
  • Most sexual abuse of boys involves female perpetrators.
  • One in ten to twelve men has experienced female-perpetrated child sexual abuse.
  • Mothers are responsible for roughly a third of sexual abuse of boys.
  • M. C. Black et al., The National Intimate Partner and Sexual Violence Survey: 2010 Summary Report (CDC).
  • Shanta R. Dube et al., Long-Term Consequences of Childhood Sexual Abuse by Gender of Victim, American Journal of Preventive Medicine (2005).
  • National Society for the Prevention of Cruelty to Children, Children Talking to ChildLine About Sexual Abuse (2010).