Rape Trauma Syndrome

Rape Trauma Syndrome

Rape Trauma Syndrome: Sustained maladaptive response, violent sexual penetration against the victim’s will and consent.

Rape trauma syndrome refers to the immediate period of psychological trauma undergone by a rape victim that involves disturbances to normal physical, emotional, cognitive, and interpersonal behavior. Every victim responds differently to rape; most common response occur immediately following a rape, but which can also occur for months or years afterward.

A person, male or female, who has been raped will generally experience element of the syndrome as a response to high levels of distress directly thereafter. These feelings may recede over time for some sexual assault survivors; nevertheless, individually each syndrome can have long destructive effects on rape victims and some victims will endure experiencing some form of psychological distress for the remainder of their lives.

Cultural prejudice, social biases, preconceived notions about rape victims may make it painful and unmanageable for victims to speak about the crime. It has also been learned that rape survivors are at high risk for acquiring substance use disorders, major depression, generalized anxiety disorder, obsessive-compulsive disorder, and eating disorders.

Fighting rape myths, improved education about the impact of rape, providing information to the public about sexual assault, and coaching potential support providers to withdraw negative reactions may help reduce the trauma of the assault and increase the possibility that victims obtain the assistance they are seeking when they turn to others for advice, guidance, and cooperation.

Related Factors

Here are some factors that may be related to Rape Trauma Syndrome:

  • Rape
  • Sexual assault trauma

Defining Characteristics

Rape Trauma Syndrome is characterized by the following signs and symptoms:

  • Aggression; muscle tension
  • Anxiety, agitation
  • Change in relationships
  • Denial
  • Depression
  • Disorganization
  • Dissociative disorders
  • Feelings of revenge
  • Guilt, humiliation, embarrassment
  • Hyperalertness
  • Inability to make decisions
  • Loss of self-esteem
  • Mood swings
  • Nightmare and sleep disturbances
  • Paranoia, phobias
  • Physical trauma (e.g., bruising, tissue irritation)
  • Self-blame
  • Sexual dysfunction
  • Shame, shock, fear
  • Substance abuse
  • Suicide attempts
  • Vulnerability, helplessness

Goals and Outcomes

The following are the common goals and expected outcomes for Rape Trauma Syndrome:

  • Patient experiences hopefulness and confidence in going ahead with life plans.
  • Patient verbalizes relief or reduction of discomfort from physical injuries.
  • Patient adopts healthy coping practices.
  • Patient displays resolution of anger, guilt, fear, depression, low self-esteem.
  • Patient acknowledges the right to disclose and discuss abusive situations.
  • Patient lists common physical, emotional, and social reactions that often follow a sexual assault before leaving the emergency department or crisis center.
  • Patient states the results of the physical examination completed in the emergency department or crisis center.
  • Patient speaks to a community-based rape victim advocate in the emergency department or crisis center.
  • Patient refers to self as a victim or survivor not as being responsible for the rape.
  • Patient discusses the need for follow-up crisis counseling and other supports.

Nursing Assessment

Assessment is required in order to distinguish possible problems that may have lead to Rape Trauma Syndrome.

Assessment Rationales
Evaluate the extent of injury sustained during the assault: abrasions; bruises; lacerations; scratches; vaginal, oral, and rectal trauma; knife wounds; gunshot wounds; strangulation marks. Although injuries range from minor to disabling and life-threatening, all injuries have a strong emotional impact on the victim. Patient may not remember any detail of the assault if he or she has been unconscious or psychologically guarded during the encounter.
Examine emotional and behavioral responses. Defensive coping behaviors that may appear normal following sexual assault may become ineffective if they continue and interfere with recovery.
Determine survivor’s willingness for a physical, genital, and/or pelvic examination. The patient may respond to the intrusiveness of the examination as a continuation of the sexual assault. Explaining may help the patient understand the importance of determining the extent of physical trauma.
Know the patient’s past coping mechanisms, including cultural, religious, and personal beliefs about assault. Previous coping mechanisms may or may not be effective in the present situation. Understanding about sexual assault will affect the patient’s ability to come to terms with the situation and whether family and friends will be effective support systems.
Observe the response of family members and significant others toward the patient. Family members and significant others may strive with their perceptions about the patient and the assault. They may undergo feelings and reactions similar to the patient including blame, resentment, shame, or humiliation. Different responses play a big role in the patient’s recovery.
Listen for the language the patient uses to describe himself or herself and his or her feelings about the assault. It is regarded as a usual response for survivors to display feelings of embarrassment or guilt about the assault. The patient may call himself or herself dirty and unclean. The patient may need anticipatory supervision to reframe these perceptions and see himself or herself as a victim and survivor of the assault. When extremely negative feelings continue for an extended duration, they post a substantial threat to the recovery of the survivor.

Nursing Interventions

The following are the therapeutic nursing interventions for Rape Trauma Syndrome:

Interventions Rationales
Provide immediate safety of the survivor. Anger, fear of death, horror, terror, and humiliation may be the emotions experienced by the survivor. They may feel uneasy and threatened in a strange environment. Survivors need to know that they are in a safe place and guarded against further infliction.
Help the survivor in knowing and reaching for family or significant others. The survivor may require help and support in identifying the most supportive family member or significant other regarding the situation.
Give access to sexual assault advocate, crisis intervention specialist, or social services counselor. These specially equipped and qualified sexual assault response teams give active and useful assistance and immediate crisis intervention to survivors.
Support the survivor’s expression of sentiments and need to talk about the sexual assault. Show care attention, respect, and attending without judgment. Avoid statements and interrogations that may be interpreted as attacking or blaming the survivor. A phase of emotional or psychological shock may be present at this time. Give time to process reactions. Survivors need guidance understanding that they did what was certain to survive the assault, regardless of how others may interpret their behavior during the assault.
Recognize the survivor’s different responses to the assault. The survivor may be feeling guilt and embarrassment, as well as agitation, aggression, and resentment.
Encourage the survivor to direct anger and hostility toward the assailant, not himself or herself. Expressing anger towards the assailant is necessary to promote effective coping.
Prepare the patient for the physical, genital, and/or pelvic examination:

  • Obtain written consent.
  • Explain each step of the procedure beforehand, and ask permission.

 

 

 

  • Collect and prepare evidence in accordance with procedures required by law, for example:

1. Blood
2. Combing pubic hairs
3. Semen samples
4. Skin from underneath nails

Survivors may undergo an intense loss of control over their bodies. These approaches help the survivor regain a sense of control. The patient needs to understand that the specimens will be sent to the hospital laboratory, forensic laboratory for analysis, and considered legal evidence if the offender is caught and faces criminal charges.

Evidence must be collected and protected until it can be given to proper law enforcement officials. Deviation from procedures may result in evidence being disallowed in future court proceedings.

Render appropriate care for injuries and physical manifestations.

  • Administer tetanus toxoid.
  • Give wound care.
  • Administer medications for pain, nausea, and muscle tension.
  • Administer medications to prevent sexually transmitted infections.
  • Offer the survivor medication to prevent pregnancy.
The degree of physical injury sustained during the assault will decide priorities for physical care. Tetanus toxoid is given as prophylaxis if the patient has not had a booster immunization in the previous 10 years. The patient needs to know that medication is available to prevent pregnancy that might occur from the rape. The survivor’s cultural and religious beliefs may influence a decision to accept this type of medication.
Do not let the patient be discharged without any family member or significant others. Allow the sexual assault response team to arrange for someone to accompany the patient home. It is important that the survivor feel secure and safe during the transition from hospital to home. Fear may continue to be present for an extended period.
Inform and educate the survivor, family and significant others about the possibility of long-term outcomes of rape-trauma syndrome. The survivor needs to understand that intense mixed emotions and mood swings may be present for months and years after the assault.
Explain to the survivor signs and symptoms that many people experience during the long-term phase, for example:

  • Anxiety, depression
  • Insomnia
  • Nightmares
  • Phobias
  • Somatic symptoms
Many survivors believe they are going crazy as time goes on and are not aware that this is a process that many victims have experienced.
Talk with family and significant others ways to give support for the survivor. This approach will have a direct effect on long-term efforts to reorganize his or her life.
Direct survivor to follow-up care to assess for complications from the physical trauma of the assault. The survivor may need assessment for sexually transmitted infections, pregnancy, and HIV infection at appropriate intervals after the assault.
Provide strict confidentiality. The survivor’s situation is not to be talked over with anyone other than medical staff involved unless he or she gives consent to it.

See Also


Other nursing diagnoses available:

Further Reading


Recommended books and resources:

  1. Nursing Care Plans: Diagnoses, Interventions, and Outcomes
  2. Nurse's Pocket Guide: Diagnoses, Prioritized Interventions and Rationales
  3. Nursing Diagnoses 2015-17: Definitions and Classification
  4. Diagnostic and Statistical Manual of Mental Disorders (DSM-V-TR)
  5. Manual of Psychiatric Nursing Care Planning
  6. Maternal Newborn Nursing Care Plans
  7. Delmar's Maternal-Infant Nursing Care Plans, 2nd Edition
  8. Maternal Newborn Nursing Care Plans