“A particular smell or a sound, and suddenly I’m there all over again. I’m terrified. I can’t breathe... Sometimes, I can even feel him again…”

“I’m losing time. It’s like I’ve wake up but I’ve no idea where I am or how I got there.”

“I feel like I’m going mad.”

At WAGN we see the effects on women of many different kinds of violence—for example, childhood sexual abuse; domestic violence (physical, sexual, psychological, emotional and financial); rape; gang rape; and torture.

In these terrible situations, victims are likely to feel intense fear, helplessness and loss of control. They may have to face the threat of their own annihilation.

Because they are overwhelmed, they can’t fight or run away. If they are trapped or taken by surprise, the trauma is often even worse.

Each woman who experiences violence will react afterwards in her own way. Who she is, as well as her community and culture, will help shape her response and how she copes.

But across these individual reactions, there are some common patterns. The links below take you to brief descriptions of these patterns.

Post-Traumatic Stress Disorder (PTSD)

If a woman experiences overwhelming terror, she may develop post-traumatic stress disorder (PTSD).

This means that she cannot lay the traumatic experience to rest: long after the danger has passed, it continues to disrupt her life. This profoundly affects her—in her mind, body and soul.

Effects of Post-Traumatic Stress Disorder

The symptoms of PTSD can be very frightening—women who experience them often say they feel as if they are going mad. But it is important to remember that PTSD is a natural and common response to trauma.

Read more about the clinical definition of PTSD

 

Symptoms of Post-Traumatic Stress Disorder (PTSD)

The main symptoms of PTSD are usually described under four headings: Hyperarousal ; Intrusion ; Constriction ; Disconnection .

Click on the links to read descriptions of what these symptoms feel like in the words of women who have experienced them; what they may look like; and information about what is happening to the body and mind of a woman who is experiencing them.

Hyperarousal

People with PTSD often feel jumpy and anxious. For no apparent reason, they will feel the physical symptoms of fear—cold sweats, hyperventilation, a racing heartbeat. When they're sleeping, they're more sensitive to noise, and will wake up more often.

In response to the trauma, the individual's body and mind has actually changed--entering a permanent state of emergency. Psychologically and physiologically, the body behaves in a way that usually only happens when a person feels in danger.

Intrusion

The survivor re-experiences the trauma in vivid memories that return spontaneously—as nightmares when a woman is asleep or flashbacks while she's awake.

These can be triggered by quite insignificant things—a simple smell or a sound—but the memory may be very vivid indeed, even as traumatic as the original event. During a flashback, a survivor may become completely oblivious of her real surroundings.

In response, some survivors develop coping mechanisms to disguise or avoid the replaying of the memory. Other survivors may try to re-enact the traumatic moment—in the hope that they can somehow undo what happened.

Constriction

In a situation of horror, a woman may escape by entering an altered state. Her self-defence system shuts down and she “freezes”, blocking emotional and physical pain. Sometimes this is so successful that she cannot remember anything afterwards.

Long after the traumatic event has passed, a woman with PTSD may continue to enter these states. They will occur spontaneously, whenever she feels threatened.

When this happens, she may seem to be in a trance or just seem detached and calm. She may feel numb or as if she is outside her own body. She may be unable to act voluntary, or feel that time is moving faster or slower than it is.

Attempts to avoid the pain of thinking or feeling about a traumatic event may affect other parts of a woman's life, as well.

She may keep away from people and places that might remind her of the trauma; restrict her emotions and not connect with other people; keep her future plans very limited. Some women may be in such pain that they seek out ways to block memories, for example, by using drugs or alcohol.

Disconnection

A woman who experiences a traumatic event may find that it radically alters her sense of self and her relation to others.

It may threaten her understanding of life, shattering her trust in others, destroying her sense of safety. The world she thought she lived in has been devastated.

Her spiritual life may also be affected, causing her to question her understanding of truth, justice, the divine.

COPING STRATEGIES

Women who have experienced violence, and may be suffering from PTSD, use a variety of strategies to help them cope with its after-effects.

These strategies may seem self-destructive, but for the women who use them they are often the only way to control overwhelming feelings of horror, fear and pain.

We can divide them into Mental Coping Mechanisms and Physical Coping Mechanisms .

Mental Coping Mechanisms

A survivor may use these mental defences to block out physical details of the traumatic event, or the feelings that accompanied their experience.

They include:

• Repression: suppressing the memories of particular aspects of or feelings about the traumatic event
• Denial: Events may be recalled, but the survivor won’t admit to their significance
• Minimisation: Diminishing the significance or impacts of what happened
• Rationalisation: Explaining away what happened—perhaps by blaming herself or by excusing the abuser
• Dissociation:  Separation from memories of the trauma by entering a detached state of mind. For some survivors, food, alcohol, drugs or self-harm can create the same sense of calm (see below).
• Distraction: Repetitive behaviours such as compulsive counting, or anxiety states, such as agoraphobia, can be used to block painful memories
• Splitting: Often found among survivors of childhood abuse—the experience is so horrendous that the child’s psyche splits, forming alternative personalities. These will play different protective roles—for example, one may experience the abuse for her; another may emerge in situations of danger to protect her.

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External Coping Mechanisms

Self-harm

Although it can seem very disturbing and can become very destructive, self-harming behaviour is not a sign of sickness or insanity. Many women self-harm as a way to cope with a situation or with feelings that they find unbearable.

Self-harm takes different forms, including eating or not-eating; burning or cutting one’s body; addictions to drugs or alcohol.

Every woman who self-harms will have her own unique set of reasons for developing this pattern of behaviour, but there are some common aspects: we explore some of these below.

Eating or Not Eating

Food is of vital significance to all humans, and to be able to control what, how and when you eat is very empowering.

Eating disorders—such as anorexia nervosa, bulimia nervosa or compulsive eating—are common coping strategies for survivors of violence.

Anorexia Nervosa

Women with anorexia nervosa exercise strict control over what they eat. They often have a distorted body image, believing that they are obese, when in fact they are dramatically underweight.

Some anorexics will only eat certain foods—of which they know the calorific value. Others try to stop eating altogether.

Common reasons why women become anorexic include:

• Demonstrating the pain inside—the thinner a woman becomes, the more visible her inner pain
• Self-empowerment—regulating the intake of food is a way of taking back the control lost during her experiences of violence
• Self-hatred—she may feel that her body made her vulnerable to being attacked and want to punish it
• Safety—to make herself less attractive, and therefore less vulnerable to experiences of violence

Young women or girl children who have been abused may choose not to eat because they are unwilling or afraid to become an adult and let their bodies show signs of sexual maturity. Alternatively, they may feel that abuse denied them a childhood, and be trying to recapture this by not eating.

Bulimia Nervosa

Women with bulimia nervosa binge on certain foods, often in secret. Although this does temporarily alter her mood, a sense of disgust and recrimination often follow. This is relieved by purging—often by vomiting, or using laxatives or diuretics.

Sometimes bulimia develops in response to certain therapeutic regimes used to treat anorexia. A woman who has been made to eat may reassert her control over her body by purging.

There are strong links between childhood sexual abuse and oral rape: a woman who has been orally raped may develop bulimia as a way of regaining control over what enters her body.

Every woman will have her own reasons for developing this pattern of behaviour, but common motivations include:

• Self-empowerment—taking back lost control
• Self-hatred—punishing the body that she thinks let her down and made her vulnerable to abuse

Compulsive Eating

Food can bring a sense of comfort or act as a substitute for feeding other needs. Over-eating can numb or block painful feelings.

For some women, gaining weight may help them to feel bigger and more powerful. For others, it may help them to become invisible—in a society where fat is often equivalent to unattractive.

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Burning and Cutting

Women choose to cut or burn their bodies for many different reasons. These may include:

• As a reaction to feelings of self-loathing, shame or guilt about what has happened. A woman may feels she hates her body for getting her into trouble, and want to punish it.
• As a non-verbal way to express the pain or the memories of an experience for which a woman has no words. She may use self-harm to send out signals to others that something is wrong.
• To produce endorphins—natural painkillers—that help reduce feelings of distress and anxiety, or give an energy rush.

Addictions to Drugs or Alcohol

Addiction to drugs and alcohol has a similar role to other coping mechanisms, in terms of trying to avoid and minimise overwhelming and painful feelings which result from traumatic experiences. Survivors have described how they have turned to alcohol and drugs as a relief from the pain, fear, sadness, anger, guilt, shame, isolation and guilty feelings. Others have referred to how drug and alcohol has been forced upon them by a violent partner as a form of control. Survivors have also referred to the use of drugs and alcohol to cope with the violence their experience.

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DISSOCIATIVE IDENTITY DISORDER (DID)

Sarah knows there’s something different about her from other people. For most of her life, she’s been “losing time”—periods where she can’t remember where she’s been or what she’s done. Sometimes she self-harms and discovers cuts and bruises on her body, but with no memory of what has happened. She has found clothes and shoes in her wardrobe that she can’t remember buying

Once known as Multiple Personality Disorder, DID is in fact both a remarkable survival mechanism and a shocking response to extraordinary trauma.
DID is now officially defined as:

• The presence of two or more distinct identities or personality states (each with its own relatively enduring pattern of perceiving, relating to, and thinking about the environment and self).
• At lest two of these identities or personality states recurrently take control of the person’s behaviour.
• Inability to recall important personal information that is too extensive to be explained by ordinary forgetfulness and not due to the direct effects of a substance (e.g., blackouts or chaotic behaviour during alcohol intoxication) or a general medical condition (e.g., complex partial seizures). (DSM-IV)

Although the appearance of this definition means that DID now has clear international criteria, there are still mental health professionals who dismiss it as a result of hysteria or, worse, a complex web of lies; and many who just do not have the skills or experience to recognise it.

Causes of DID

Sarah’s father first rapes her when she is seven. She loves her father and needs him. The pain, emotional and physical, is overwhelming. Sarah disassociates: she watches the experience as if she is on the other side of the room. The girl on the floor isn’t her: she is called Samantha and is younger than her. She has done something bad and that is why Sarah’s father is punishing her. When Sarah’s father hands her over to his friends to be raped, she creates Sam. He is older than her, and strong; he doesn’t care what they do to him.

DID is clearly linked to experiences of major trauma, in particular brutally sadistic childhood sexual abuse or rape in adult life. Through this remarkable,

desperate creative process, victims of abuse are able to survive an experience of suffering beyond bearing.

Research is still being done on how exactly this process happens. We don’t yet know how personalities (or alters, as they are sometimes known) are created, but recently, brainscans have revealed that DID does create changes in the brain.

As with the other effects of trauma, once these mechanisms are hardwired into someone’s body, they remain as responses to new experiences. In Sarah’s case, for example, Samantha or Sam—or any other personality she has created—may reappear when circumstances suggest they are needed.

As with the adult Sarah, most sufferers are unaware that they have DID—although they may be aware that their behaviour is somehow odd or not under their control. Many sufferers are diagnosed with other psychiatric conditions, such as depression, border-line personality disorder or schizophrenia.

Integration

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SECONDARY TRAUMATIC STRESS DISORDER (STSD) and BURNOUT

People who work with or support a woman who has been traumatised may be affected by their knowledge of what she has been through. This includes her counsellor, therapist or other helpers, and also her friends and family.

In response, they may develop secondary traumatic stress disorder (STSD) or burnou.

WAGN addresses STSD and burnout by ensuring that all our counsellors are trained in strategies for coping and receive regular counselling supervision and support.

Secondary Traumatic Stress Disorder
The knowledge that someone close to you, or someone you’re trying to help has been in a situation of extraordinary terror and powerlessness can produce secondary traumatic stress (STSD).

Symptoms of STSD include feelings of shock, confusion and sadness. A counsellor with STSD may feel powerless—unable to help her client with the effects of her traumatic experience. She may feel abused herself by hearing the details of what has happened, and may even experience flashbacks that vividly recreate the traumatic event. She may lose her sense of safety in the world and begin to feel isolated and stigmatised because of the work she is doing with survivors.

STSD can lead to changes in behaviour—for example, in eating, smoking and drinking patterns—as the sufferer tries to find ways to cope with her feelings.

Burnout
This is caused by long-term experiences of emotionally stressful work. Its symptoms develop slowly and can be difficult to spot.

The stages of development include:

• Enthusiasm: high hopes, unrealistic expectations, over-identification with clients; excessive and inefficient use of energy
• Stagnation: disillusion as expectations are not met
• Frustration: questioning effectiveness of work
• Apathy: hopelessness and loss of energy