The effects of rape and violence against women.

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Rape’s long shadow: Dealing with the personal costs of sexual assault
by ZOSIA BIELSKI, The Globe and Mail, Aug. 06, 2015

When women who have been raped come to Amanda Dale’s trauma recovery group, many don’t know what damage the attack may be wreaking.

“They just know they’re in trouble,” says Dale, executive director of Toronto’s Barbra Schlifer Clinic, which helps women facing violence.

Some survivors feel deep shame, others anger and debilitating grief. Some will suffer panic attacks, startling at the slightest sound. Others, overwhelmed by humiliation and a sense of being devalued, will self-destruct, drinking or abusing drugs to cope. Many will struggle with trust issues, developing serious trouble in their intimate relationships.

Even as we encourage women to come forward and tell their stories, the long shadow of sexual assault is something not often discussed. Research shows that the effects of the trauma endure for a long time; front-line services, however, are lacking in this country.

The immense personal costs are hinted at in the pivotal New York magazine profile, by Noreen Malone and Amanda Demme, of 35 women who allege comedian Bill Cosby drugged and sexually assaulted them over four decades. The women spoke of pained self-recrimination, shattered self-esteem, an inability to form real relationships with partners, depression and substance abuse. One woman described the after-effects as a “secret tumour.”

“The group of women Cosby allegedly assaulted functions almost as a longitudinal study – both for how an individual woman, on her own, deals with such trauma over the decades and for how the culture at large has grappled with rape over the same time period,” the journalists wrote.

Trauma for victims of sexual assault is individual and unpredictable, the symptoms appearing in pulses over the years. Directly after an attack, there is often shock and visceral fear. Particularly when a victim knows the rapist, there can be guilt and self-doubt. Another layer to contend with is the physical trauma, which can include injuries, sexually transmitted diseases and pregnancy. The emotional damage can take a longer time to emerge and can include anxiety, long-term insomnia, a sense of alienation and thoughts of suicide. While some women get hyper-vigilant, others start taking risks. Especially if women experience victim-blaming, the assault can leave them feeling worthless and turning to harmful coping strategies.

“It impacts your everyday living and your intimate relationships,” Karyn Freedman, author of the recent book One Hour in Paris: A True Story of Rape and Recovery, says.

“As a society, we’d prefer it to be not that big of a deal: one or two conversations with someone and you’ll be better. What the New York magazine piece showed us is that the effects are lifelong,” Freedman, now an associate professor of philosophy at the University of Guelph, said.

A 2015 meta-analysis found that trauma causes neural changes and has a measurable and enduring effect on brain function, including regions involved in “emotional regulation.” For victims of sexual violence, trauma can live in the body as a chronic condition.

“When you’ve had your trust violated, at a physiological level your body doesn’t know when it’s safe any more,” Dale says. “You can wind up navigating your entire life from a position of high alert. That translates into a form of constant vigilance that intrudes into your sleep time and your sexuality so that you cannot rest or enjoy your body.”

Without support, the aftershocks of sexual violence can be profound: “It remains something that you have a relationship to for the rest of your life,” Dale says. “But if you don’t have assistance … the experience of the violation can become part of one’s identity, or in some of the worst cases, all of one’s identity.”

The long-term effects of rape are particularly pronounced when victims are shunned. Research suggests that the reception a woman gets the first time she discloses her attack can shape her experience of trauma. With supportive reception, survivors’ psychological distress can lessen, making them less susceptible to re-victimization. But women who are dismissed when they speak up for the first time often do not talk about it again, a silence that can be extremely detrimental.

“When your experience is undermined, when no one takes you seriously and when you can’t talk about it, you don’t have a chance to repair the damage that’s done,” Freedman, who didn’t tell anyone about her rape for a decade, said. “I lived in a world of terrible shame and I was emotionally crippled by the experience. I abused alcohol more than I ought to have. That’s a coping mechanism that’s sometimes easier than facing the reality of what’s happened to you – especially in a culture that refuses to face it alongside with you.”

So why is it easy for society to recognize trauma in soldiers and victims of violent crimes such as robberies but harder for some to extend that empathy to victims of sexual violence?

Diane Hill, who has worked as a counsellor for assaulted women, says people react with discomfort to the sexual elements of the attack. “It’s not a romantic episode gone awry. It needs to be taken out of that category and put into the category of violent crime,” says Hill, senior director of marketing and communications at the Canadian Women’s Foundation, which raises funds for sexual assault counselling centres, women’s shelters and violence prevention programs for youth.

“I think we’re suffering the Victorian hangover,” Dale says, “of still being focused on the fact that the violence is sexual in nature. That somehow changes our reception of it as a crime.”

As public education improves, victim blaming gets called out online and women are increasingly encouraged to come forward, Freedman hopes we’ll see the “longevity of trauma” shrinking. But while experts are glad publicized allegations such as those against Cosby and Jian Ghomeshi (who faces five charges of sex assault and one charge of choking) are moving women to tell their own stories, they stress that front-line services need bolstering. According to figures from the Canadian Women’s Foundation, sexual-assault centres saw spikes in calls after the headlines but had trouble meeting the demand thanks to flat-lined funding and wait times of more than a year for in-person counselling.

“I can’t help but think about all the women who are finally able to talk about what happened to them. They need support to address these long-festering issues that they’ve had to put a lid on because they were not believed or because the support wasn’t there,” Hill said.

“It’s irresponsible to raise awareness without raising the capacity to receive these stories,” Dale says. “We got 30 calls last week. We don’t want to keep those women waiting for a response. They’re ready. They’re calling.”

---------------------------------------------

The costs of sexual violence

The trauma of sexual violence can impact victims for a lifetime, affecting their health, education and employment. With 460,000 people reporting a sexual assault in one year alone in Canada, the annual costs are staggering: $1.9-billion when you factor in the physical, emotional and financial toll on victims and the costs for health and social services, police, courts and employers.

Counselling and legal advice can help survivors regain control but experts are agitating for more investment in violence prevention programs for youth that model healthy relationships from the get-go – all to temper the devastating personal costs for survivors and the collective costs for society.

The cost to survivors:

$75.9-million: mental-health services

$2.6-million: health-care costs

$23.9-million: productivity losses

The cost to society:

$161.3-million: police

$21.3-million: courts

$172.4-million: social services

$1.3-million: employers

Source: Canadian Centre for Policy Alternatives; Canadian Women’s Foundation; Statistics Canada

Editor's note: The 35 women included in the New York magazine article mentioned in this story were allegedly assaulted over four decades. Incorrect information appeared in the original version of this article.

http://www.theglobeandmail.com/life/relationships/rapes-long-shadow...

Stop Telling Me To Forgive My Abuser

Oct 17th, 2015 | By Christina Enevoldsen

As much support and love as there is in the community of survivors that gather online, there is a topic that seems to divide us. I’ve rarely witnessed discussion topics that become as hostile as the issue of forgiveness.

It’s easy to understand why there would be so much disagreement considering that there are so many definitions of forgiveness. To some it means accepting the past. Others define forgiveness as letting go of negative emotions. To some, it coincides with reconciliation or feeling no ill will toward towards the abuser, while others believe it has nothing to do with a relationship the abuser.

Added to that, forgiveness is very often preached as necessary for other survivors. It’s one thing to say that forgiveness is important to you, but quite another to insist that it’s important for all survivors or to tell others what’s best for their own healing. That’s when forgiveness discussions turn into defenses against boundary violations and condescending remarks.

On a recent quote I posted on OSA Facebook, (a quote that didn’t really have anything to do with forgiveness), the discussion took an interesting turn. It was interesting to me because it illustrated where I believe discussions on forgiveness become unhealthy.

    “I used to have a fear that I’d be obligated to stop talking about my abuser if he was sorry, as though that changed anything about what he had done to me. Now I believe that if there are consequences for his actions, it’s not up to me to protect him, no matter what his intentions and actions are now. No matter what happens after the abuse, I still have a right to tell my story—even if my abuser is remorseful; even if my abuser turns into a loving person; even if my abuser builds wells in impoverished countries; even if I restore a relationship with my abuser; even if my abuser is incapacitated; even if my abuser dies—I still have a right to tell my story.” The Rescued Soul by Christina Enevoldsen

I appreciated this insight from one of the commenters:

“Even if your abuser was remorseful, he would know you have the right to be hurt and heal and shouldn’t stop you from it. They would own up and take responsibility for the consequences and know that what they have done will always be part of your life. They would understand—if truly remorseful. They would even stop others from doing what they did. The sad thing is, too many never are.”

This spells out what I believe true remorse is. It’s being concerned for the well-being of the one you harmed. It’s pursuing amends instead of escape from the consequences.

So far, none of the abusers in my life have shown remorse, though one claimed to be remorseful to avoid prison. When that didn’t work, he returned to claiming he was being treated unfairly.

I believe that it’s possible for a sexual abuser to be remorseful—only I haven’t seen or experienced it. The problem is that they tend to be so manipulative and deceptive that it can be hard to know the truth unless you see evidence of change over a long period of time—which isn’t possible when you don’t want them in your life. Even then, how can you really know for sure?

The commenter continued:

“Someone hurt me last year and I feel the need for them to be remorseful because I want to believe change can happen but I’m not expecting it and they are removed from my life. Even if they were [remorseful], I don’t feel I could forgive and definitely not forget or [that] it would mean I have to forgive them.”

This echoes very much what I expressed in the original quote. There is no obligation to me no matter the improvements my abusers make or claim to make.

However, another commenter continued the thought on forgiveness with this response directed toward the previous commenter:

“In time I hope you can forgive because it will help in your healing process.”

Do I Need to Forgive My Abuser to Heal?

Do I have to forgive my abuser to heal? I was told forgiveness was a condition of healing for years after I first remembered that my dad had sexually abused me. Our relationship continued as it had. I called it forgiveness, but I hadn’t even validated my own pain yet. It wasn’t really forgiveness since I hadn’t faced that there was anything to forgive. I was in denial; I just swept it all away and pretended it never happened.

The commenter added:

“Also in life’s journey, you/we all will need to be forgiven for the wrong we may say or do at some time or another.”

Saying that we all need to be forgiven isn’t helpful. That discounts the serious and repetitive nature of sexual abuse. It’s a shame-making statement to compel a survivor into doing what they “should”. It’s each survivor’s decision to work out what’s best for him or her.”

When I intervened, the commenter directed this to me:

“Do you not believe that you yourself will need to be forgiven for ANYTHING you may have said or done to anyone along life’s journey or do you not ever apologize for anything you say or do wrong??! No one is without spot or blemish/wrong doing?”

This is another approach I’ve heard so much. Yes, I do wrong others. I need to apologize. I need to be forgiven.

I don’t handle my wrong-doing the same way that most abusers do. When I discovered that I’ve wronged someone, I feel pain for the injury I’ve done. It wounds me to know I’ve wounded someone else. I feel a responsibility to do something about that. I apologize and make appropriate amends. I work to change my behavior so I don’t repeat it.

What Does Being Imperfect Have to Do With It?

There’s an added insult in that statement too. “You will need to be forgiven” comes as a threat: You don’t deserve to be forgiven unless you forgive.” My dad, and many other abusers, have used that reasoning to imply that you’re wrong for protesting or complaining about abuse at all unless you’re perfect.

“You’re not perfect so who are you to judge?”

“You’re not perfect so why should we believe you?”

“You’re not perfect so your hands are dirty too.”

What’s Wrong With Being Angry About Abuse?

The commenter added:

“I’m wondering, you may be physically free from your abuser(s) but how long are you going to hold a grudge towards your abuser(s) & still live mentally as a hostage by them in keeping angry ill feelings towards them???”

“holding a grudge”

“resentful”

“bitter”

“angry”

Those are all very triggering words to most survivors that I know. Why wouldn’t they be? Who wants to be around someone who is bitter? Who wants to extend support to someone who is resentful? Being labeled as angry means rejection. Those accusations are intended to get us “in line”—to make us conform to cultural norms and to put the happy face back on.

That comment prompted me to actually look up the meaning of those words. The dictionary definitions:

Grudge comes from the German word, “to complain”. It means feeling ill will or resentment toward someone.

Resentment is the feeling of displeasure or indignation at some act, remark, person, etc., regarded as causing injury or insult. Anger

What’s wrong with feeling ill will toward your abuser? What wrong with complaining about them? What wrong with feeling indignant about their abuse? What’s wrong with expressing anger?

 

Those are the things I needed to do to heal. Previously, I was numb to the things that happened to me. Coping with the abuse required me to agree with my treatment and to shut down my feelings. But unfeeling isn’t the same as being healed.

To heal, I had to do the opposite of what forgiveness demanded. I had to finally become my own ally instead of my abuser’s. I had to acknowledge the depth of betrayal and offense that I’d experienced. I had to get in touch with my emotions and feel the pain and anger that was buried. I had to turn with compassion toward myself and give myself the comfort I needed.

While I was pressured to forgive, I didn’t make any progress in my healing. I only healed once I started to make me the focus of my healing without worrying about my abusers or my feelings toward them.

Who Is Forgiveness For?

I was told that forgiveness was for my benefit, not for my abusers, but it wasn’t for my benefit to be pushed. I needed time to sort through my feelings and then to decide for myself without guilt from outside sources.

Forgiveness is touted as something we do to free ourselves, but how freeing is it to be told you have to do something? How freeing is it to be told to let go of your feelings? I was separated from my feelings long enough while I coped with the experience and effects of my abuse. Accepting my emotions was a sign that I was finally considering and connecting with me.

Forgiveness is touted as something we do to free ourselves, but how freeing is it to be told you have to do something? How freeing is it to be told to let go of your feelings? I was separated from my feelings long enough while I coped with the experience and effects of my abuse. Accepting my emotions was a sign that I was finally considering and connecting with me.

Many claim that if we don’t forgive, we are likely to get stuck in a place of anger and bitterness. But all of those feelings pass when they are properly directed and expressed. When survivors feel permission to grieve for our losses and to express all the feelings that are a part of that grief, it frees us to move though it. Getting stuck isn’t the result of freedom to feel; it comes from the pressure to move on before we’re ready.

Survivors are amazingly capable of moving through the healing steps when we are validated and encouraged to listen to ourselves. No one else has a better sense of timing for our own process than we do.

External pressure doesn’t produce true forgiveness anyway. Forgiveness comes from the generosity of a full heart. When our hearts are broken and we are taught to forgive, it’s another soul betrayal. It’s being generous with the person who crushed us rather than being generous with ourselves.

 

I did end up forgiving, but that was the result of my healing, not the cause of it. Forgiveness came for me when I expressed—and ran out of—the anger. I ran out of anger because I stopped judging myself for feeling it. I ran out because I directed it where it belonged: toward my abusers. I ran out of anger because I gave myself permission to express it in healthy ways.

Is Advising Abuse Survivors to Forgive Their Abusers Helpful?

I’m not against forgiveness. What I am against is anyone telling me or other survivors to forgive. I’m against other survivor’s healing process being invalidated by being told they aren’t doing it right.

I’m sure most people who recommend that others forgive their abusers are only trying to be helpful. We were abused by being overpowered and controlled and part of our healing is to break away from that. To be pressured or manipulated to do something “good” for us is not really good for us.

What truly is loving and useful is to allow others the freedom to choose their own healing journey. Every survivor deserves true support instead of being “helped” by conforming to someone else’s beliefs about what is healthy for them. All survivors deserve the chance to decide for themselves if forgiveness is a step they want to take and if so, when they are ready to take it.

What are your views on forgiveness? Have you experienced pain around this issue? If you’ve chosen to forgive your abuser, did you benefit from it? Was it your choice or did you feel pressure? I’d love to hear your feelings and experiences about this. Please share them with me below and remember to subscribe to the comments so you don’t miss any of the discussion.

Christina Enevoldsen

http://overcomingsexualabuse.com/2015/10/17/stop-telling-me-to-forg...

 

The Neuroscience of Trauma from Sexual Assault
Guest Post by Kathryn Gigler, Northwestern University
May 26, 2015

“I believe that you believe something happened to you.” The young woman repeated the detective’s statement to me again. It had been the detective’s response to her question of whether he believed her account of the brutal sexual assault she had experienced the past weekend.

As a counselor on the local rape crisis hotline, it was not the first time I had heard such a demoralizing story of an individual’s attempt to report sexual violence to law enforcement. Because her story had been disjointed, and she had stumbled over several sections of it, the detective had thought that she was confabulating, creating a crime where none had occurred.

When I hear of this dynamic, my thoughts often turn to the neuroscience of trauma. The brain’s response to trauma is complex, and human behavior in response to trauma, particularly sexual violence, is not well-understood but recent research does offer some important insights.

The rate of false report in sexual violence is actually low, estimated by most studies to be around 7% (to compare, this is considerably lower than the rate of insurance fraud). Moreover, research shows that sexual violence is in fact underreported: Many more incidents of violence occur than are reported to law enforcement or other legal authorities. Studies show that there are many factors that may predict whether an individual will report, including level of acquaintance with the perpetrator and whether alcohol was consumed.

Taken together, research findings on the factually low rate of false report and on the underreporting of the crime itself demonstrate a clear contradiction in people’s conceptions of sexual violence and that violence in reality. There is a mismatch between media portrayals of “ideal victims”- young, sober women attacked at knifepoint in parking lots at night – and research on real-world victims- nearly three quarters of whom know the perpetrator (rising to nearly 90% on college campuses) and only 7% of whom were attacked with a firearm, knife, or other weapon.

This kind of misunderstanding of an individual’s experience of sexual assault is heartbreakingly common. A high school student’s report of sexual assault was viewed skeptically by an elected lawmaker, who stated on the public record that “some girls, they rape so easy.” More recently, a fan base made it clear that it did not believe a woman accusing a sports hero of rape, and that she was making the story up for attention.

Why are victims so often not believed? A large amount of this disbelief may be linked to the behavioral patterns of victims themselves, which can vary widely from case to case and often include behaviors of which the average police detective would be skeptical. To understand these patterns, it is helpful to look at how the brain and body respond to stress and trauma, such as that experienced during sexual violence.

A relatively new area of the literature on human response to trauma, particularly the trauma experienced during sexual violence, is that of “tonic immobility.” Defined as self-paralysis, or as the inability to move even when not forcibly restrained, tonic immobility has long been studied in non-human animals as the “freeze” response to extreme stress. Recently, it has been observed in the laboratory as a stress response in humans, as well. This finding explains the reaction of many victims of sexual violence, who report that they felt like they could not escape, even when no weapon was present.

Additionally, due to an entire cascade of hormonal changes, which includes oxytocin and opiates, associated with pain management, adrenaline, commonly associated with “fight or flight,” and cortisol, functional connectivity between different areas of the brain is affected. In particular, this situation affects pathways important for memory formation, which means that an individual can fail to correctly encode and store memories experienced during trauma. While an individual generally will remember the traumatic event itself (unless alcohol or drugs are present in the system), these memories will feel fragmented, and may take time to piece together in a way that makes narrative sense.

Behavioral patterns in individuals who have experienced sexual violence mirror those seen in other traumatized populations, like combat veterans. This pattern of symptoms, known as post-traumatic stress disorder, or PTSD, can include emotional numbness, intrusive memories of the traumatic event, and hyperarousal (increased awareness of one’s surroundings, or constantly being “on guard”).

Research shows that the majority of individuals who experience sexual assault demonstrate at least some of these symptoms of PTSD immediately after the assault and through the two weeks following the assault. Nine months after the assault, 30% of individuals still reported this pattern of symptoms. Overall, it is estimated show that nearly one-third of all victims of sexual assault will develop PTSD at some point in their lives.

These findings are complicated by the fact that the response of any given person to trauma can look extremely different, based on previous life experiences and health factors. Research has found that cognitive variables, such as perceived negative responses of other people and poor coping strategies, were significantly linked both to development of PTSD and severity of PTSD. In another study, lower cortisol levels as measured in the emergency room have been related to increased risk for the development of PTSD. In other words, a maladaptive version of nature/nurture is involved in individuals’ responses to trauma.

As with many questions related to health, it is difficult to pinpoint the cause: existing neurobiological and psychosocial risk factors, such as mental illness, can contribute to the development of PTSD, and PTSD can lead to other health problems. There is no hard and fast rule of victimology: every individual who experiences sexual violence will respond differently.

Therefore, the detective who was unable to believe the story told to him by my crisis caller was likely misinterpreting the discrepancies in her story as lies, rather than as her brain’s responses to extreme trauma. Best practices now suggest that officers wait at least two sleep cycles, generally 48 hours, before interviewing a victim of sexual violence. Additionally, the interview should be handled in a victim-centered manner, not as an interrogation. Research-informed practices have the potential for not only better outcomes for survivors of sexual violence, but also for reporting and prosecution rates for our legal system.

Kathryn Gigler is a doctoral candidate studying the cognitive neuroscience of learning and memory at Northwestern University. She also serves as director of the Women’s Center at Elizabeth City State University.

A version of this column also appeared on Huffington Post as “How Brain Science Can Help Explain Discrepancies in a Sexual Assaul....”

http://www.cogneurosociety.org/sexualassault_gigler_may15/

8 Steps that Explain "Why She Doesn't Leave"
by Crystal Sanchez, Huffington Post, 02/03/2016

The question that is always asked of victims of domestic abuse is "Why don't/didn't you just leave?" I know sometimes even victims don't really understand why.

I've heard that question over and over.  While there are many different reasons we give for not leaving, there is a "scientific explanation" for why it is so difficult to leave an abusive situation. I will explain the cycle of brainwashing as studied by Psychologist Robert Jay Lifton but will be discussing it as it specifically pertains to domestic abuse.

Last year, after years of hiding my abuse from almost everybody I knew, I decided to publicly share my story.  Recently, after my research on brainwashing, I went back to read the story I had written last year.  I was shocked.  Each experience I described was the step by step brainwashing process. What's even more shocking, is that my abuser was only 15 years old.  

I am not a Psychologist, I speak from years of personal experience and from spending time with women who have endured domestic abuse.  When somebody's only objective is to keep you loyal, they will go to great lengths to achieve it.  

This is what the brainwashing process looks like:

Stage I- Breaking Down the Self

Step 1- Assault on Identity

When somebody is trying to control another, they begin to attack their sense of self, their identity. They start to say things that cause the victim to doubt who they are.

"You are a slut."
"You're worthless."
"You are not a good mom."
"You are ugly, nobody will want you."

The attacks are repeated consistently for days, weeks, and sometimes years. As a result, the victim becomes disoriented, confused, and begins to doubt everything they believed to be true. Eventually the victim will begin to adopt these same beliefs.

The idea of brainwashing is to destroy the old identity and replace it with a new one, one that matches with the beliefs, values, and ideas of the manipulator. The effects of an attack on the identity can last long after the victim is no longer in the abusive situation.

Step 2- Establishment of Guilt

Guilt is an effective tactic in mind control and is introduced in different ways. The abuser criticizes the victim for any reason, small or large and sometimes no reason at all.

"This is your fault."

"You made me do this."

The abuser will take a small flaw and embellish it to the extreme. Abusers will shift responsibility of their actions to the victim or justify their behavior by blaming the victim.

"If you wouldn't have talked back, I wouldn't have had to hit you."

An abuser will make the victim feel guilty for disagreeing with them or not meeting extremely high expectations.

An abuser may blame the victim for the abuser's transgressions by making the victim believe they deserved it, or are a result of something the victim did. After the assault on identity, the constant criticisms cause the victim to believe the punishment and mistreatment are warranted.

Guilt can easily turn into shame when it is internalized. Inducing guilt, humiliation, and shame destroy confidence and self worth. A victim begins to feel culpable all the time and everything they do or say is wrong. When shame sets in, the victim no longer feels bad about things they've done, they begin to feel they are bad.

Step 3- Self-Betrayal

Once a victim is overwhelmed with guilt and shame, they begin to abandon their own needs and make choices that are harmful to their wellbeing. The victim is bullied into cutting off communication from friends and family who share the same beliefs or behaviors. This is when isolation begins, the abuser believes the victim's friends and family are a threat to the relationship. The abuser will blame friends or family for problems in the relationship. The victim's betrayal of their own beliefs and the betrayal to the people to whom they once felt a sense of loyalty to, increases the feelings of shame and guilt which further destroys their sense of self. As a result, the more isolated a victim becomes, the more dependent they are on the abuser.

Step 4- Breaking Point

At this point, the victim no longer recognizes themselves, they don't know who they are any longer. They may have lost their grip with reality. Gaslighting techniques are used to push the victim over the edge. Gaslighting is an attempt by one person to overwrite another's reality.

"You're crazy - that never happened."

"You're making that up, it's all in you head."

"You're paranoid."

The victim is confused and disoriented from gaslighting and from being fed a distorted version of reality. The victim questions themselves constantly and feels like "the crazy one" and/or feels depressed, anxious, traumatized and other negative emotional and physical symptoms like insomnia and paranoia.

Some may call this a "nervous breakdown." A nervous breakdown is the point of exhaustion reached after an extended period of extreme anxiety. The overwhelming anxiety, depression, and stress leads to a sense of hopelessness, helplessness, and absolute exhaustion. The victim's ability to think and reason at this stage is severely compromised and they become temporarily unable to function normally in day-to-day life.

Stage II- Possibility of Salvation

Step 5- Leniency & Opportunity

Just when a victim can literally take no more, the abuser offers leniency. This is when the abuser offers a small act of kindness amid the psychological abuse and the victim feels a deep sense of gratitude completely out of proportion to the deed.

Because the victim's perception is so skewed, the small act shifts emotions to relief and a sense of admiration. Since these small acts of kindness are so infrequent, the kind gesture is magnified. It can be something as small as offering a glass of water, a hug, or a compliment. This can lead to a sense of false hope. It puts the responsibility on the victim to do things better, to try harder, in hopes the acts of kindness will become more frequent.

These unpredictable responses are detrimental to mental wellbeing, confidence, and self-esteem. The abuser can have an extreme reaction one day, and then the next day have the complete opposite reaction. This unpredictability can cause a great deal of stress and anxiety.

Step 6- Compulsion to Confess

The victim is so grateful for the small gesture between abuse and manipulation, they begin to agree with the criticisms. For the first time in the brainwashing process, the victim is faced with the stark contrast between the harsh criticism & abuse and the relief of leniency.

This is when the victim looks within and tries to find those "evil" parts of themselves and attempts to remove them from every part of their being. This leads directly to their "new" identity. The victim begins to acquire the beliefs and values the abuser has ingrained. At this point, the victim is willing to say anything to recreate those moments of leniency.

Step 7- The Channeling of Guilt

The victim does not know what they have done wrong, they just know they are wrong. They begin to feel guilty for who they are and about the beliefs they've held. This creates a blank slate so the abuser can attach the guilt to whatever belief system the abuser is trying to replace. The victim comes to believe it is their belief system that is causing all of the problems, the more they accept the abuser's way of thinking, the more shame they feel about who they were. Essentially, this is when the victim begins to adopt the new way of thinking and relinquishes their old way of thinking.

Step 8- Releasing of Guilt- Logical Dishonoring

By this stage, the victim has come to believe that they themselves are not bad, but the belief systems they held are wrong, and they can escape that wrongness by completely changing their belief systems. They denounce their former belief system and the people they associated with. They confess to acts associated with their former belief systems. After a full confession, they complete the process of rejecting their former identity. Now, the abuser offers up the new identity.

These tactics are very similar to those used on prisoners of war or members of a cult. In a domestic abuse situation, the brainwashing process becomes a cycle and the steps continue to be repeated. The moment an abuser begins to feel the victim is "slipping from their control," they will re-assault their identity. This will begin the process all over again.  Victims continue to believe in the ideas of their abusers long after they have left the abusive environment.  The new belief system has been so deeply rooted, it could take years to change.  

There is hope. Abuse thrives only in silence. If you are healing from an abusive relationship, know the most important thing to do is forgive yourself. If you find yourself in this situation, please seek support. An extremely effective way to get out of the darkness of guilt and shame is by shining a light on it. Start talking about it, don't keep the feelings inside. Shame can only survive in darkness.

If you are in an abusive situation...
The National Domestic Violence Hotline
1-800-799-7233
http://www.thehotline.org/help/

http://www.huffingtonpost.com/crystal-sanchez/8-steps-that-explain-...

TED Fellow develops online reporting system to help sexual-assault victims
by Marsha Lederman, The Globe and Mail, Feb. 15, 2016

If people who have been sexually assaulted were able to report (and record) details of the assault electronically – without having to go directly to the authorities immediately – would more victims report? Would more assailants be caught?

Sexual-health educator and researcher Jessica Ladd has developed a system meant to encourage victims of sexual assault to come forward – one she believes could also make a difference for alleged victims in the courtroom.

At the TED Conference in Vancouver on Monday, Ms. Ladd offered an arsenal of troubling statistics about sexual assault on university campuses: One in five women and one in 13 men will be sexually assaulted at some point in their U.S. college career. Fewer than 10 per cent will report the assault and on average they will wait 11 months to make that report. More statistics: Some 90 per cent of sexual assaults are committed by repeat offenders. But the vast majority of sexual-assault assailants “get away with it. This means that there’s practically no deterrent to assault in the United States,” Ms. Ladd, a TED Fellow and an infectious-disease epidemiologist by training, told the conference.

“This to me is a tragic, but a solvable problem.”

Ms. Ladd has developed a system that allows victims to fill out a record of their sexual assault online, using a third-party website, and save it as a time-stamped document. They can submit the report to authorities (the police, college officials) or save it as a record of their experience. At any point, victims who choose not to submit the report initially have the option of logging back in and sending the report. Or they can elect to have it submitted automatically if somebody else files a report naming the same assailant.

The sexual-assault recording and reporting system, called Callisto, was developed by Ms. Ladd’s startup Sexual Health Innovations, in consultation with sexual-assault survivors. It was launched at two U.S. colleges last August – University of San Francisco and Pomona College in Claremont, Calif. “We do have a number of users at both schools,” Ms. Ladd told The Globe and Mail. “That seems to indicate to us that we’re reaching a lot of the survivors.”

More schools will be brought on board in August.

Ms. Ladd herself was sexually assaulted when she was at college – a catalyst for developing this system. She reported the incident but did not pursue it. So she is well aware of the difficult decisions involved in reporting such cases.

“A lot of survivors face this issue, where you can either go through with it but then you’ll get eviscerated on the witness stand and probably have a horribly re-traumatizing experience that’s unlikely to result in justice; or you can stay silent … and then often beat yourself up in some ways for not taking action which is horrible because now you’re feeling guilty for something you didn’t do after you were assaulted. So [we’re] really trying to help survivors out of this bind, this Catch-22, where you can’t win no matter what you do and help us have the best chance that we can at justice, and support each other through the process.”

Ms. Ladd believes her system can help alleviate the challenges for complainants in sexual-assault cases such as those that have emerged during the trial of former CBC broadcaster Jian Ghomeshi.

“That’s the hope,” Ms. Ladd said in the interview. “If you can create a time-stamped record that’s prompting you for the information you need closer to the time of the incident … you can write it all down then in a way that feels safe and then you can return to that.”

The issue of sexual assault on campus has also been in the headlines with allegations that have erupted at the University of British Columbia against a PhD candidate. On Monday, UBC interim president Martha Piper outlined the key findings of a report into how UBC staff handled that case. The lawyer hired to investigate the complaints found there was no breach of the university’s policies but also said the system for handling such sexual-assault complaints was “flawed” and “needs to change.”

While Callisto was designed for university campuses, it has wider applications – the military for instance or a particular workplace.

Ms. Ladd wasn’t the only one to speak at TED Monday about the need for a change in the system for dealing with sexual assault.

Amanda Nguyen is working to implement a Sexual Assault Survivor Bill of Rights in the United States. At TED, she talked about being re-victimized after she herself was assaulted. First, there were the difficulties undergoing the three- to seven-hour-long examination for a rape kit. “It takes this long because the crime scene is your body,” she said. Then there is the ongoing fight to keep the rape kit – the evidence – from being destroyed.

Ms. Nguyen and Ms. Ladd, who did not know each other before they became TED Fellows, plan to do some advocacy work together this spring.

“We don’t have to live in a world where 99 per cent of rapists get away with it,” Ms. Ladd told the TED audience to a standing ovation. “We can create one where those who do wrong are held accountable; where survivors get the support and justice they deserve; where the authorities get the information they need and where there’s a real deterrent to violating the rights of another human being.”

http://www.theglobeandmail.com/news/british-columbia/ted-fellow-dev...

Four Concrete Steps for Working with Trauma

with Bessel van der Kolk, MD
and Ruth Buczynski, PhD

Step 1: Start with Self-Regulation

Dr. van der Kolk: I would say the foundation of all effective treatments involves some way for people to learn that they can change their arousal system.

Before any talking, it’s important to notice that if you get upset, taking 60 breaths, focusing on the out breaths, can calm your brain right down. Attempting some acupressure points or going for a walk can be very calming.

Dr. Buczynski: So this is learning to modulate arousal?

Dr. van der Kolk: Yes, and there’s alarmingly little in our mainstream culture to teach that. For example, this was something that kindergarten teachers used to teach, but once you enter the first grade, this whole notion that you can actually make yourself feel calm seems to disappear.

Now, there’s this kind of post-alcoholic culture where if you feel bad, you pop something into your mouth to make the feeling go away.
“The issue of self-regulation needs to become front and center in the treatment of trauma.”

It’s interesting that right now there are about six to ten million people in America who practice yoga, which is sort of a bizarre thing to do - to stand on one foot and bend yourself up into a pretzel. Why do people do that? They’ve discovered that there’s something they can do to regulate their internal systems.

So the issue of self-regulation needs to become front and center in the treatment of traumatized people. That’s step number one.

Step 2: Help Your Patients Take Steps Toward Self-Empowerment

The core idea here is that I am not a victim of what happens. I can do things to change my own thoughts, which is very contrary to the medical system where, if you can’t stand something, you can take a pill and make it go away.

The core of trauma treatment is something is happening to you that you interpret as being frightening, and you can change the sensation by moving, breathing, tapping, and touching (or not touching). You can use any of these processes.

It’s more than tolerating feelings and sensations. Actually, it is more about knowing that you, to some degree, are in charge of your own physiological system.

There needs to be a considerable emphasis on “cultivating in myself,” not only as a therapist, but also as a patient – this knowing that you can actually calm yourself down by talking or through one of these other processes.

So, step number two is the cultivation of being able to take effective action. Many traumatized people have been very helpless; they’ve been unable to move. They feel paralyzed, sit in front of the television, and they don’t do anything.
“Programs with physical impact would be very, very effective treatments.”

Programs with physical impact, like model mugging (a form of self-defense training), martial arts or kickboxing, or an activity that requires a range of physical effort where you actually learn to defend yourself, stand up for yourself, and feel power in your body, would be very, very effective treatments. Basically, they reinstate a sense that your organism is not a helpless (tool) of fate.

Step 3: Help Your Patients Learn to Express Their Inner Experience

The third thing I would talk about is learning to know what you know and feel what you feel. And that’s where psychotherapy comes in: finding the language for internal experience.

The function of language is to tie us together; the function of language is communication. Without being able to communicate, you’re locked up inside of yourself.
“Without being able to communicate, you’re locked up inside of yourself.”

So, learning to communicate and finding words for your internal states would be very helpful in terms of normalizing ourselves - accepting and making (the communication of internal states) a part of ourselves and part of the community. That’s the third part.

Step 4: Integrate the Senses Through Rhythm

We’re physical animals, and to some level, we’re always dancing with each other. Our communication is as much through head nodding and smiles and frowns and moving as anything else. Kids, in particular, and adults, who as kids were victims of physical abuse and neglect, lose those interpersonal rhythms.
“Rhythmical interaction to establish internal sensory integration is an important piece.”

So, some sort of rhythmical interaction to establish internal sensory integration is an important piece that we are working on. With kids, we work with sensory integration techniques like having them jump on trampolines and covering them with heavy blankets to have them feel how their bodies relate to the environment because that’s an area that gets very disturbed by trauma, neglect, and abuse, especially in kids.

For adults, I think we’ve resolved rhythmical issues with experiences like tango dancing, Qi Gong, drumming – any of these put one organism in rhythm with other organisms and is a way of overcoming this frozen sense of separation that traumatized people have with others.

Dr. Buczynski: These are four keystones that can make healing from trauma faster and more effective. In order to give patients the best chance for recovery, consider these steps as you plan your interventions and treatments.

We’d like to hear from you. Which of these 4 steps do you think is most critical in the treatment of trauma?

Please tell us about your experience in the comment section below.

And when you comment, you’ll get a downloadable or printable version of this free report.

- See more at: http://www.nicabm.com/trauma-treatment-kolk

After mass rape, turning disgrace into grace
Shift in thought

New services for women assaulted in conflict, such as in the Rohingya crisis, aim to restore a survivor’s dignity and remove social stigmas. Another aim is to help end gender inequality and the culture of impunity toward wartime rape....

February 2, 2018 —The United Nations calls it “the most urgent refugee emergency in the world.” Since August, nearly 700,000 Muslims known as Rohingya have fled violence against them in Myanmar, a largely Buddhist nation. The sprawling camps of refugees in Bangladesh are indeed a catastrophe. Yet the crisis is becoming known for something else just as extraordinary: Aid workers are offering special services to Rohingya women because of the sexual violence committed against many of them.

The services, provided in shelters only for female refugees, assist survivors of rape and other sexual assault to overcome any shame, social stigma, or shunning. The women are offered medical help, of course, but just as important are the mental healing and restored dignity that allow them to better integrate into families and communities.

The techniques are subtle. Survivors are offered “dignity kits” that include soap and other personal aids. Mirrors are placed on shelter walls to remind the women of their beauty. Flowers and other decorations remind them of the beauty of life. Counselors then lead the women in discussions. The goal is to replace feelings of loss, disgrace, and sadness with calmness, safety, and empowerment.

The women may also be taught a livelihood. Many survivors learn to end their silence, thus reducing the culture of impunity and gender inequality, which fuels the cycle of abuse.

Such services are relatively new in the history of conflicts with mass sexual violence, such as Islamic State’s enslavement of Yazidi women in Iraq and Boko Haram’s kidnapping of girls in Nigeria. They were developed with the help of international campaigns over the past decade aimed at turning such acts of terror and humiliation into opportunities to bring peace to individuals and communities – and achieve a victory over the sexual abusers.

“Women’s bodies have always been used as battlefields,” says Dr. Helen Durham, director of law and policy at the International Committee of the Red Cross. “But we need to be clear that sexual violence in war is not something inevitable. It is preventable and we all need to work together to strengthen efforts in prosecution, prevention, and in finding practical solutions to help those affected.”

One initiative started by the British government in 2012, known as Preventing Sexual Violence in Conflict Initiative (PSVI), has trained thousands of security and aid workers on ways to challenge the negative attitudes associated with sexual violence. The techniques are tailored to the cultural sensitivities about women and sexual assault in different cultures and religions. In a document issued last fall called Principles for Global Action, PSVI spells out very specific recommendations. Here are two examples:

•“Reinforce directly and indirectly that all human beings have worth, and being a victim/survivor/child born of rape does not change someone’s inherent value.”

•“Ensure the definition of justice is not narrowed to legal processes and takes account of what the individual victim/survivor considers justice to be (such as reparations, re-gaining employment, community reintegration etc.).”
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The idea is to be survivor-centered and reverse traditional thinking about sexual assault. Or, as Tariq Mahmood Ahmad, head of PSVI, puts it, “We must see stigma for what it is – a weapon intended to undermine and prevent social, political and economic recovery for individuals, communities and societies.”

Lifting the stigma of war-time rape is a big step toward ending the use of such a weapon altogether. At the refugee camps in Bangladesh, the women survivors seeking help are not so much victims of rape as they are now heroes of peace.

https://www.csmonitor.com/Commentary/the-monitors-view/2018/0202/Af...

Are sexual abuse victims being diagnosed with a mental disorder they don't have?
The lack of recognition for complex PTSD by the psychiatric establishment means it is difficult for sexual abuse victims who might suffer from it to receive the right diagnosis

by Alexandra Shimo, 2 Apr 2019

Suppose, for the sake of a thought experiment, that a new psychological disorder was discovered. It is supported by dozens of studies and recognized by some of the world’s leading psychiatrists and psychologists, but not by the North American psychiatric establishment. And let’s say the refusal to accept this new disorder had devastating consequences for #MeToo survivors.

That claim is asserted by a growing number of sexual abuse victims, psychiatrists and psychologists worldwide.

The disorder is called complex PTSD. It was identified in 1990 by American psychiatrists studying the experiences, behavior and symptoms of sexual abuse victims and other patients who have experienced extreme trauma and neglect, usually at a young age. A decade later, new science – in the form of brain scans – revealed this was a distinct condition affecting certain areas of the brain.

While the condition is referenced and discussed in peer-reviewed publications, North America’s official bible of psychiatry – The Diagnostic and Statistical Manual (DSM) – doesn’t recognize its existence. The DSM determines how mental illness is defined, and is the key to insurance coverage, special services in schools, disability benefits and treatments.

Someone who is dealing with complex trauma will be told they are having a problem regulating their emotions
Sly Sarkisova, psychotherapist

This lack of recognition means it is difficult for sexual abuse victims who might suffer from it to receive the right psychological diagnosis.

Rather than being diagnosed with complex PTSD, many will be misdiagnosed with borderline personality disorder (BPD), says Sly Sarkisova, a Toronto-based psychotherapist who specializes in trauma.

BPD and complex PTSD are different disorders, but have similar symptoms. But one major indicator sets them apart: the latest research shows that BPD is 55% inherited whereas complex PTSD is not caused by genetics but prolonged exposure to traumatic events, usually in childhood. While BPD is defined primarily by risk-taking symptoms (such as suicidality, impulsivity, self-harm, anxiety, emptiness, difficulty with relationships, and extremes of volatile emotion), complex PTSD patients tend to be less impulsive, frantic, unstable and less likely to engage in self-harm, according to a 2014 study in the European Journal of Psychotraumatology.
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This misdiagnosis affects sexual survivors more than anyone else because they commonly display the psychiatric symptoms common to both disorders, such as anxiety, mood swings, depression, emptiness and displaced anger. As a result, “Someone who is dealing with complex trauma will be told that they are having a problem regulating their emotions,” Sarkisova explains.

This means that sexual abuse victims have to wrestle with receiving a BPD diagnosis that is pejorative and stigmatising (they are told their personality is “disordered”; they are called “difficult”; and as the condition can’t be cured, some psychologists avoid treating them.)

“The borderline diagnosis for sexual abuse survivors is nonsense and misleading because it suggests that the problem is within the personality of the survivor rather than a result of what has happened to them,” explains Gillian Proctor, program leader of the psychotherapy and counselling master’s program at the University of Leeds and a clinical psychologist in private practice.

For others, it’s political. BPD has become associated with a “parody of supposed feminine characteristics”, explains Glyn Lewis, the head of psychiatry at University College London. “BPD is a label that is often misused and applied especially to women, or people who were assigned female at birth, to pathologize them for emotional expressions of suffering,” Sarkisova says.

There is little hope of re-diagnosis with complex PTSD because therapists are reluctant to diagnose patients with a condition that isn’t recognized by the DSM

‘It was sexist’

Concerns about the misdiagnosis of sexual abuse victims surfaced early on. BPD was added to the DSM in 1980, and to the UK’s International Classification of Diseases (ICD) in 1996.

As these changes were happening, Bessel van der Kolk, a professor of psychiatry at Harvard Medical School, and Judith Herman, a Harvard professor of psychiatry, began to wonder if the developments were correct. What if these patients didn’t have disordered personalities, but were suffering the psychological consequences of childhood abuse?

They began to interview male and female patients with a BPD diagnosis and published their findings in 1989 in the American Journal of Psychiatry. Their hunch proved right: 81% of patients diagnosed with BPD reported severe child abuse, including sexual, and/or neglect, usually before the age of seven. Van der Kolk and his team proposed that these people be re-diagnosed as having complex PTSD.

For this to happen, the American Psychiatric Association would have to add complex PTSD as a new diagnostic category to the DSM. Van der Kolk and his team travelled to New York in 1990 to present their case to Robert Spitzer, one of the founders of the DSM and professor of psychiatry at Columbia University. Victory seemed in sight: in 1993, the American Psychiatric Association’s PTSD committee voted to accept Van der Kolk’s changes and add complex PTSD to the next version of the DSM.

Twenty-six years later, nothing has happened.

Our field was dominated by men, and the men were seeing these women as ‘difficult'
Katherine Porterfield

“It was sexist,” argues New York-based Katherine Porterfield, a child psychologist at New York University’s Medical School. “Yes, this was happening to women because they are more likely to be abused, but it was also because our field was dominated by men, and the men were seeing these women as ‘difficult’.”

Those attitudes may have affected the science: many are reluctant to further explore a psychological condition that isn’t recognized in North America, explains Audrey Cook, a Vancouver-based family therapist who has worked with sexual abuse victims since 1994, so instead these patients are labelled “difficult to treat”. Without research money, there are no studies on complex PTSD cure rates or most effective treatments.
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Dr Van der Kolk, who went on to become one of the world’s leading trauma experts and the author of the New York Times bestseller, The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma, says that misdiagnosis is now the norm. “The diagnosis determines the treatment that you can get, what insurance companies will pay for,” he explains. “As long as complex PTSD does not exist, [medical] insurance companies will not reimburse you for [psychological] treatments that might work.” Instead, he argues, “patients are likely to receive pejorative diagnoses and labels that make their lives only more difficult”.
‘It’s easier for the world to flush us down the toilet’

“It’s powerfully and deeply ironic to me that women who experience profound trauma [ie sexual abuse] are pathologised as having a personality disorder,” explains Winnipeg-based freelance journalist, artist and resilience coach Lisa Walter, 50, a sexual abuse victim who says she has been misdiagnosed with BPD. “I think it makes it easier for the world to flush us down the toilet.”

Historically, a BPD diagnosis was made if women were considered resistant to treatment and on the “borderline” of psychotic. Later, the incurable part of the disorder was explained through genetics. Although the modern-day definition does not mention psychopathy or sociopathy – which are different psychological disorders – the term is still used by some therapists and the public to imply someone irrational, inconsiderate and beyond control.

However, psychiatrists and psychologists in UK and North America are divided on the BPD diagnosis question. Some, like Dr Proctor, believe the label is never helpful, especially for sexual abuse victims who she believes are actually suffering from complex PTSD. Others, such as Dr Choi-Kain, director of the Massachusetts-based McLean Hospital Borderline Personality Disorder Training Institute, believe they are separate conditions: comorbid, yes, but a person can suffer from both.

“When you tell [BPD patients]: ‘this is something millions of people have; you are not alone; there are good treatments and outcomes’; it’s a really positive, clinical message,” Dr Choi-Kain says.

But because studies have linked BPD to increased criminality, it has meant that some sexual abuse survivors won’t disclose what has really happened to them to mental health professionals for fear of being diagnosed with it.

For a long time, Andrea Nicki hid that she was sexually abused as a young child by an adult male family member. “Normally I’m reluctant to talk about sexual abuse because as soon as you say it, people think BPD,” explains Nicki. “They think she’s unstable, she’s got a personality disorder.” Then, in 2008, the Vancouver-based poet and business ethics professor revealed it to a psychiatrist, whom she just saw once.

He diagnosed her with BPD even though she did not fit the BPD psychological profile: she lacked most of its symptoms except anxiety and minor depression due largely to financial troubles. A misplaced laugh (when her psychiatrist said “I really care for you”) might have tipped the balance: it prompted him to write down she was emotionally volatile.

‘Stuck in individualising, pathologising diagnostic ghettos’

A number of scientific developments have improved the understanding of complex PTSD. Thanks to growing interest and funding for neuroscience and neurobiology, there has been an explosion of scientific imaging tools, such as Functional magnetic resonance imaging and electroencephalography, that have allowed scientists to peer inside the brains of complex PTSD patients. The scans have allowed scientists to determine which parts of the brain are impacted by prolonged trauma, an advancement useful to trauma therapists hoping for possible cures.

Still, misdiagnosis remains common and affects the success rate of psychological treatments, according to Van der Kolk. Complex PTSD usually requires different treatments from those given to patients with BPD. Sexual abuse should be treated with some form of trauma-related therapy, Van der Kolk says, while BPD requires learning to control one’s aggressive urges, improve one’s relationship with others, moderate difficult emotions and compulsive behaviours.

Once misdiagnosis occurs, a patient can face stigma from the public and healthcare professionals

Once misdiagnosis occurs, a patient can face stigma from the public and healthcare professionals. In a 2015 study in British Journal of Clinical Psychology, an actor was videotaped having a panic attack. When doctors were told she had BPD (she didn’t), they rated her problem as worse and gave her less hope for recovery.

Lisa Walter, the Toronto writer, was diagnosed with BPD in 2008 after going through a depression and a period of self-harm. She too is a survivor, molested by a neighbour at eight and raped at 21. After diagnosis, she researched the condition, and found some of the symptoms did not fit. Her psychiatrist downplayed her concerns, and told her not to protest, because the BPD diagnosis was the only way of accessing a free, six-month course combining several therapies.

But with the BPD diagnosis on her medical chart, medical professionals approached her differently, she said. Nurses seemed less compassionate when she self-harmed. An ER doctor appeared irritated by the diagnosis and attempted to stitch up a self-inflicted leg wound without an anesthetic.

Her BPD diagnosis also led to dismissive treatment away from medical situations. While giving witness testimony in a case alleging police brutality at the 2010 G20 Toronto summit, the defense lawyer used the BPD diagnosis to humiliate her, holding open a book of mental health disorders and suggesting that because she had it, she had behaved irrationally angrily and aggressively at the protest. (She later sued the police and they settled.)

“As soon as you say BPD, people think irrational, angry woman,” Walter says. “There are extremely negative connotations with that phrase.”

In the UK, the situation is changing, albeit slowly. Last year, the National Health Service formally recognized complex PTSD as a psychological condition. Preliminary versions of the UK’s bible of psychiatry, the ICD-11, also includes it and most expect the final version, scheduled for publication in 2022, to do the same.

However, some UK therapists are still skeptical. “The new ICD-11 diagnosis of complex PTSD was expected to revolutionise how we see and treat patients,” explains Dr Jay Watts, a clinical psychologist who has written extensively about Complex PTSD. It does not, she says: the diagnostic criteria are “so limited” that most people who have Complex PTSD will not qualify and instead be “stuck in individualising, pathologising diagnostic ghettos”.

In North America, there are still no plans to include complex PTSD in the DSM. Research into effective cures for sexual abuse survivors and other complex PTSD patients remain stymied by the institutional rigidity, misdiagnosis and lack of funding.

“Survivors of trauma and sexual violence should get appropriate support,” Wood says. “They should be treated with care and respect, not shamed and stigmatised further by this dehumanising label.”

• This article was amended on 27 and 29 March 2019. An earlier version misattributed a quote, and some personal details were removed.

https://www.theguardian.com/lifeandstyle/2019/mar/27/are-sexual-abu...

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