SPECIAL ISSUE FOR CAREGIVERS: Male Victims of Sexual Assault Can Suffer PTSD

There is a bias in our culture against viewing the sexual assault of boys and men as prevalent and abusive. Because of this bias, there is a belief that boys and men do not experience abuse and do not suffer from the same negative impact that girls and women do. However, research shows that at least 10% of boys and men are sexually assaulted and that boys and men can suffer profoundly from the experience. Because so few people have information about male sexual assault, men often suffer from a sense of being different, which can make it more difficult for men to seek help.

Like women, men who experience sexual assault may suffer from depression, PTSD, and other emotional problems as a result. However, because men and women have different life experiences due to their different gender roles, emotional symptoms following trauma can look different in men than they do in women.

 Perpetrators

• Those who sexually assault men or boys differ in a number of ways from those who assault only females.
• Boys are more likely than girls to be sexually abused by strangers or by authority figures in organizations such as schools, the church, or athletics programs.
• Those who sexually assault males usually choose young men and male adolescents (the average age is 17 years old) as their victims and are more likely to assault many victims, compared to those who sexually assault females.
• Perpetrators often assault young males in isolated areas where help is not readily available. For instance, a perpetrator who assaults males may pick up a teenage hitchhiker on a remote road or find some other way to isolate his intended victim.
• As is true about those who assault and sexually abuse women and girls, most perpetrators of males are men. Specifically, men are perpetrators in about 86% of male victimization cases.
• Despite popular belief that only gay men would sexually assault men or boys, most male perpetrators identify themselves as heterosexuals and often have consensual sexual relationships with women.

 Symptoms of Sexual Trauma in Boys and Men

Particularly when the assailant is a woman, the impact of sexual assault upon men may be downplayed by professionals and the public. However, men who have early sexual experiences with adults report problems in various areas at a much higher rate than those who do not.

Emotional Disorders

Men and boys who have been sexually assaulted are more likely to suffer from PTSD, other anxiety disorders, and depression than those who have never been abused sexually.

Substance Abuse

Men who have been sexually assaulted have a high incidence of alcohol and drug use. For example, the probability for alcohol problems in adulthood is about 80% for men who have experienced sexual abuse, as compared to 11% for men who have never been sexually abused.

Encopresis

One study revealed that a percentage of boys who suffer from encopresis (bowel incontinence) had been sexually abused.

Risk Taking Behavior

Exposure to sexual trauma can lead to risk-taking behavior during adolescence, such as running away and other delinquent behaviors. Having been sexually assaulted also makes boys more likely to engage in behaviors that put them at risk for contracting HIV (such as having sex without using condoms).

The Impact of Male Gender Socialization

• Men who have not dealt with the symptoms of their sexual assault may experience confusion about their sexuality and role as men (their gender role). This confusion occurs for many reasons. The traditional gender role for men in our society dictates that males be strong, self-reliant, and in control. Our society often does not recognize that men and boys can also be victims. Boys and men may be taught that being victimized implies that they are weak and, thus, not a man.
• Furthermore, when the perpetrator of a sexual assault is a man, feelings of shame, stigmatization, and negative reactions from others may also result from the social taboos.
• When the perpetrator of a sexual assault is a woman, some people do not take the assault seriously, and men may feel as though they are unheard and unrecognized as victims.
• Parents often know very little about male sexual assault and may harm their male children who are sexually abused by downplaying or denying the experience.

 Because of their experience of sexual assault, some men attempt to prove their masculinity by becoming hyper-masculine. For example, some men deal with their experience of sexual assault by having multiple female sexual partners or engaging in dangerous "macho" behaviors to prove their masculinity. Parents of boys who have been sexually abused may inadvertently encourage this process.

Men who acknowledge their assault may have to struggle with feeling ignored and invalidated by others who do not recognize that men can also be victimized.

Because of ignorance and myths about sexual abuse, men sometimes fear that the sexual assault by another man will cause them to become gay. This belief is false. Sexual assault does not cause someone to have a particular sexual orientation.

Because of these various gender-related issues, men are more likely than women to feel ashamed of the assault, to not talk about it, and to not seek help from professionals.

Another myth that male victims of sexual assault face is the assumption that they will become abusers themselves. For instance, they may have heard that survivors of sexual abuse tend to repeat the cycle of abuse by abusing children themselves. Some research has shown that men who were sexually abused by men during their childhood have a greater number of sexual thoughts and fantasies about sexual contact with male children and adolescents. However, it is important to know that most male victims of child sexual abuse do not become sex offenders.

Furthermore, many male perpetrators do not have a history of child sexual abuse. Rather, sexual offenders more often grew up in families where they suffered from several other forms of abuse, such as physical and emotional. Men who assault others also have difficulty with empathy, and thus put their own needs above the needs of their victims.

 Getting Help

It is important for men who have been sexually assaulted to understand the connection between sexual assault and hyper-masculine, aggressive, and self-destructive behavior. Through therapy, men often learn to resist myths about what a "real man" is and adopt a more realistic model for safe and rewarding living.

It is important for men who have been sexually assaulted and who are confused about their sexual orientation to confront misleading societal ideas about sexual assault and homosexuality.
Men who have been assaulted often feel stigmatized, which can be the most damaging aspect of the assault. It is important for men to discuss the assault with a caring and unbiased support person, whether that person is a friend, clergyman, or clinician. However, it is vital that this person be knowledgeable about sexual assault and men.

A local rape crisis center may be able to refer men to mental-health practitioners who are well-informed about the needs of male sexual assault victims.

If you are a man who has been assaulted and you suffer from any of these difficulties, please seek help from a mental-health professional who has expertise working with men who have been sexually assaulted.

Recommended Books

Victims No Longer: Men Recovering from Incest and Other Sexual Child Abuse by Mike Lew, Foreword by Ellen Bass. (1990). HarperCollins; ISBN 0060973005

Wounded Boys, Heroic Men: A Man's Guide to Recovering from Child Abuse by Daniel Jay Sonkin and Lenore E. A. Walker. (1998). Adams Media Corporations; ISBN 1580620108

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SPECIAL ISSUE: PTSD Caregiving - Understanding Your Care Recipient

PTSD makes communication difficult. Many survivors can’t find the words to express what they’re feeling. Even when they do, it’s very normal for them not to be comfortable sharing their experience. Elements of shame, fear, anger, guilt and grief often get in the way of a calm, focused discussion.
Friends and family (and anyone else who is not the source of the PTSD but is standing by while someone attempts to heal) need something that translates PTSD language. Armed with knowledge, insight and awareness you’ll have an easier time knowing how to react, respond and relate to your PTSD loved one during the healing process. The more you appreciate things from the PTSD perspective the more helpful and supportive you can be. Now is the time for empathy, compassion and patience.

The list below will give you an overview of things to understand:

#1 – Knowledge is power. Understanding the process of a triggering event, the psychic reaction to trauma, the warning signs and symptoms of PTSD, and available treatment options for PTSD allows you to help recognize, support and guide your PTSD loved one toward diagnosis, treatment and healing.

We need you to be clearheaded, pulled together and informed.

#2 – Trauma changes us. After trauma we want to believe —as do you—that life can return to the way it was; that we can continue as who we were. This is not how it works. Trauma leaves a huge and indelible impact on the soul. It is not possible to endure trauma and not experience a psychic shift.

Expect us to be changed. Accept our need to evolve. Support us on this journey.

#3 – PTSD hijacks our identity. One of the largest problems with PTSD is that it takes over our entire view of ourselves. We no longer see clearly. We no longer see the world as we experienced it before trauma. Now every moment is dangerous, unpredictable and threatening.

Gently remind us and offer opportunities to engage in an identity outside of trauma and PTSD.

#4 – We are no longer grounded in our true selves. In light of trauma our real selves retreat and a coping self emerges to keep us safe.

Believe in us; our true selves still exist, even if they are momentarily buried.

#5 – We cannot help how we behave. Since we are operating on a sort of autopilot we are not always in control. PTSD is an exaggerated state of survival mode. We experience emotions that frighten and overwhelm us. We act out accordingly in defense of those feelings we cannot control.

Be patient with us; we often cannot stop the anger, tears or other disruptive behaviors that are so difficult for you to endure.

#6 – We cannot be logical. Since our perspective is driven by fear we don’t always think straight, nor do we always accept the advice of those who do.

Keep reaching out, even when your words don’t seem to reach us. You never know when we will think of something you said and it will comfort, guide, soothe or inspire us.

#7 – We cannot just ‘get over it’. From the outside it’s easy to imagine a certain amount of time passes and memories fade and trauma gets relegated to the history of a life. Unfortunately, with PTSD nothing fades. Our bodies will not let us forget. Because of surging chemicals that reinforce every memory, we cannot walk away from the past anymore than you can walk away from us.

Honor our struggle to make peace with events. Do not rush us. Trying to speed our recovery will only make us cling to it more.

#8 – We’re not in denial—we’re coping! It takes a tremendous effort to live with PTSD. Even if we don’t admit it, we know there’s something wrong. When you approach us and we deny there’s a problem that’s really code for, “I’m doing the best I can.” Taking the actions you suggest would require too much energy, dividing focus from what is holding us together. Sometimes, simply getting up and continuing our daily routine is the biggest step toward recovery we make.

Alleviate our stress by giving us a safe space in which we can find support.

#9 – We do not hate you. Contrary to the ways we might behave when you intervene, somewhere inside we do know that you are not the source of the problem. Unfortunately, in the moment we may use your face as PTSD’s image. Since we cannot directly address our PTSD issues sometimes it’s easier to address you.

Continue to approach us. We need you to!

#10 - Your presence matters. PTSD creates a great sense of isolation. In our post-traumatic state, it makes a difference to know that there are people who will stand by us. It matters that although we lash out, don’t respond and are not ourselves, you are still there, no matter what.

Don’t give up, we’re doing our best.

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SPECIAL ISSUE: PTSD 101 for Caregivers of Veterans

Posttraumatic stress disorder (PTSD) can occur after a person has been through a traumatic event. A traumatic event is something terrible and scary that someone sees, hears about or that happens to the person, such as: Combat exposure/military sexual trauma Child sexual or physical abuse Terrorist attack Sexual or physical assault Serious accidents, like a car wreck Natural disasters, like a fire, tornado, hurricane, flood or earthquake During a traumatic event, the person thinks their life or others' lives are in danger. They may feel afraid or feel that they have no control over what is happening around them. Most people have some stress-related reactions after a traumatic event; but, not everyone gets PTSD. If these reactions don't go away over time and they disrupt life, then the person may have PTSD. Most people have some stress-related reactions after a traumatic event. If the reactions don’t go away over time and they disrupt your life, you may have PTSD.

How does PTSD develop? Most people who go through a trauma have some stress-related symptoms at the beginning. Only some will develop PTSD over time. It isn't clear why some people develop PTSD and others don't.Whether or not a person gets PTSD depends on many things: How intense the trauma was or how long it lasted If the person was injured or lost someone important to him or her How close the person was to the event How strong the person’s reaction was How much the person felt in control of events How much help and support the person got after the event Ssymptoms of PTSD PTSD symptoms usually start soon after the traumatic event, but they may not appear until months or years later. They also may come and go over many years. If the symptoms last longer than four weeks, cause the person great distress, or interfere with work or home life, the person might have PTSD. There are four types of symptoms of PTSD: Reliving the event (also called re-experiencing symptoms) The person may have bad memories or nightmares and may even may feel like he or she is going through the event again. This is called a flashback. Avoiding situations that remind you of the eventThe person may try to avoid situations or people that trigger memories of the traumatic event. The person may even avoid talking or thinking about the event. Feeling numbThe person may find it hard to express his or her feelings or may not be interested in activities he or she used to enjoy. This is another way to avoid memories. Feeling keyed up (also called hyperarousal)The person may be jittery, or always alert and on the lookout for danger. This is known as hyperarousal.

Oother Issues People with PTSD may also have other problems. These include: Feelings of hopelessness, shame or despair Depression or anxiety Drinking or drug problems Physical symptoms or chronic pain Employment problems Relationship problems, including divorce In many cases, treatments for PTSD will also help these other problems, because they are often related. The coping skills learned in treatment can work for both PTSD and these related problems. What treatments are available? Treatment for PTSD can help. There are two main types of treatment,psychotherapy (sometimes called counseling) and medication. Sometimes people combine psychotherapy and medication.

Psychotherapy for PTSD Psychotherapy, or counseling, involves meeting with a therapist. There are different types of psychotherapy. Cognitive behavioral therapy (CBT) is the most effective treatment for PTSD. There are two different types of CBT for PTSD that are broadly offered at VA. One type is Cognitive Processing Therapy (CPT) where patients learn skills to understand how trauma changed their thoughts and feelings. Another type is Prolonged Exposure (PE) therapy where patients talk about their trauma repeatedly until memories are no longer upsetting. They also go to places that are safe, but that they have been staying away from because they are related to the trauma. Medications for PTSD Medications can be effective, too. A type of drug known as a selective serotonin reuptake inhibitor (SSRI), which is also used for depression, is effective for PTSD. Another medication called Prazosin has been found to be helpful in decreasing nightmares related to the trauma. IMPORTANT: Benzodiazepines and atypical antipsychotics should generally be avoided for PTSD treatment because they do not treat the core PTSD symptoms. __________________________