After the Assault For some survivors of childhood sexual abuse the psychological ramifications of PTSD linger.

He’s chasing her. She doesn’t know who he is but she is certain he’s going to hurt her. So she runs, and he chases. She opens her mouth to cry for the people near her to come help her, to save her, to do anything. But nothing comes out and no one comes running. She’s out of breath and out of time. His hand closes around her throat. It’s like explaining a scary movie, she says, but it feels real. She’s running from the remnants of memories that continue to haunt her. And this running began when she was thirteen, when the first night terror she ever had caused her to punch the wall she always slept against with her fist. She woke up thinking what she had seen was real, feeling confused and terrified. She got out of bed and turned on every light in the room to stay awake, and to chase away the whispers of those awful dreams. Every time she closes her eyes, she doesn’t know if she’s going to relive the worst moments of her life. These night terrors are just one symptom of the post traumatic stress disorder Rachael Rainwater, a 22-year-old college student, has as a result of sexual abuse she endured as a child and teenager. It’s hard for her to tell what day she’s dreaming about. There were too many days, too many nightmares. Women are twice as likely to develop PTSD compared to men, the American Psychological Association reported in 2006, even though they are less likely than men to experience a traumatic event. This could be because women are more likely to be sexually assaulted or abused, which can contribute to the development of PTSD. One in five girls are a victim of child abuse in the U.S. For boys, it’s one in 10. They’re most vulnerable to this abuse when they’re between 7 and 13 years old, according to the National Center for Victims of Crime. When she was a first grader, she would go over to a friend’s house. On these visits her friend’s parents -- sometimes one, sometimes both -- would molest her. They always treated it as a game, a secret one, that no one was to speak about. At the time, Rachael didn’t tell her parents because she didn’t understand what was happening. This continued through third grade until her parents moved and enrolled her in a new school. In small ways, evidence of the abuse was apparent: she didn’t like being touched, she didn’t trust people, and she didn’t like strangers being close to her. In elementary gym classes she would wait until everyone had left and lock herself in a bathroom stall before changing. It’s easy to miss these signs of sexual assault, since children often keep silent about what they have endured. They’re afraid that adults won’t believe them, or that their abuser will hurt them for opening up. When children do open up, it’s typically a gradual process. And most of the time, not a word is said until they become adults. Abusers are often people the children know - 30 percent are family members, and 60 percent are other people kids are close with, like babysitters, family friends, or neighbors, according to a division of the U.S. Justice Department, the Center for Sex Offender Management. And when these symptoms aren’t treated, they can turn into long-term problems in adulthood, like post-traumatic stress disorder. As a young girl she grew up on a small Indiana farm with both parents, older siblings, and her beloved German Shepherd. Sundays were spent attending church. Rachael was taught that a woman’s place was in the home and they were to conform to the opinions of others. Women were not to cut their hair, show skin, or wear makeup. Her body was sacred. She was told over, and over, and over again that a woman’s value is placed in her modesty and purity, something forcefully taken from her as a little girl. This is important to understand because Rachael grew up being told these absolutes of a woman’s place in the world. These messages had felt wrong, but she didn’t understand why. _____ Rachael, now 12, sat in a pew next to her family listening to a preacher give his sermon. It was a gorgeous summer day at the church camp they often frequented. The congregation sang, hands pointed to the sky, and Rachel sang along with them. In that church, she reflected on all the days, over four years earlier, when she would visit her friend.

She was dirty. She was broken. She had no worth left, and it was her fault. It settled on her. There she was, in the middle of a congregation, feeling like the most worthless of them all. The need to tell someone pressed on her heart. Maybe there was something someone there could do. Maybe, in such a holy place, there was some way to absolve her of this pain. Hope remained. It was time to open up. Turning to her mom, she asked for a moment alone. “I really need to talk to you,” Rachel told her mom. “It can wait,” her mom responded. “I need to talk to you right now.” The two left the church and sat down outside. “There’s something I’ve never told you,” Rachael began, “And it’s something I’ve been thinking a lot about.” Rachael walked her mom back to all those moments in her friend’s house when she had been touched in ways she never welcomed. Tears fell from her eyes as she reached back into her memories. She didn’t understand what those moments had meant, or why it happened, or what came next. “I don’t know what to do,” Rachael said. Her mom looked back at her with a steady expression. “There’s nothing you can do. Don’t tell anyone about it.” Rachel took a couple of deep breaths, stopped crying, and entered the church. Rachael had shared her truth only to be told to deny it. Like 92 percent of sexual assault survivors, Rachael told at least one person about her assault. Hearing her mom tell her to pack away her memories, her emotions, changed the way Rachael found support. For survivors of sexual assault, being exposed to negative social reactions changes the way they recover, the Journal of Community Psychology reported in 2014. Survivors don’t feel in control of their recovery process when they are treated differently by the person they told. If survivors hear them say it was their fault, attempt to control their actions, or see that person focus on their own feelings, they feel like they’ve given up some of their power. From there, they may be discouraged to seek help from friends or talk to others about their feelings concerning the assault. While these negative reactions impact survivor’s efforts at social coping, it is possible that it doesn’t deter them from coping on their own. When women can’t rely on other people for support, they figure out how to cope on their own. For Rachel, that meant holding her silence through middle school. ____ Nowhere was safe. Trusting people wasn’t safe. And she was angry, angry that there was no justice, and angry that the only people who suffer from violence are the victims. School officials had heard about these problems in her family and required her to go see the school counselor. She sat across the room from the person who was suppose to provide all the answers. As the counselor tried to make small talk, Rachael sat silent, regarding her. “How are you feeling?” the counselor asked. “Do you want to talk about it?” Well no, Rachael thought, My world fell apart. If I wanted to talk about it, I would have come and talked to you of my own volition. She was being her normal, sarcastic self. What was most annoying to Rachael was that the counselor at the private Christian school she attended just seemed to want to talk about why the problems were happening, but never what to do about it. “How about you talk to me like a normal human, not an injured animal you found on your walk in the woods. Talk to me like a normal human and we’ll have a productive conversation.” For almost a month, Rachael met with this counselor for an hour and a half twice a week. During these meetings, the counselor would try to talk to Rachael about spiritually related ways to cope with the stress. “The power to healing is prayer,” she would tell Rachael. When the therapist recommended writing a letter to God, it was then Rachael knew this was not the person to trust with the years of abuse she had endured. Yet again, Rachael wasn’t given the comfort or support needed to cope. It was her story, and she was in control of her story. And then, in that moment, wasn’t the right time to share it.



The next time she opened up to someone about the abuse, it was with the strongest person she had ever known.

Sitting in her sister Autumn’s home in Cincinnati, Ohio, Rachael began to explain what it had felt like to be that little girl over eight years ago. The high school sophomore told the person she most trusted everything without restraint. She didn’t hold back, and let all the untold stories fall out of her. Words that had never crossed her lips before fell now. Wiping tears from her eyes as she recounted these memories, she looked to Autumn, who didn’t regard her with pity or shock. Autumn, five years older than Rachael, knew her best. The two had always been close, sharing everything, and that didn’t change now. She just let Rachel cry freely as she poured out feelings she had never been able to voice aloud before. Autumn never asked Rachael to give her details, she just wanted to know how she was doing and what else she needed. This doesn’t define you, she would tell Rachael, and it’s perfectly understandable to feel this way. This is not all you are meant to be. This is not your fault. You are not broken. You are strong. “You are going to be okay because you are made for more than this,” she told Rachael. For a moment, Rachael didn’t have to be strong as her sister took on some of her burden. “When you have your hero tell you that you’re stronger, and one of things where she’s incredibly strong and then she’s telling you that you’re strong, it’s like, you actually start to believe it.” Rachael said. “You start to believe, oh, this isn’t the end, this isn’t the most important thing, I’m going to be so much more.” As her sister listened to Rachael and reassured her it wasn’t her fault, she was exemplifying the positive reactions people can give survivors. These positive social reactions could help survivors feel better and feel more in control of their recovery. When people feel more in control of their recovery they use better coping strategies, which impacts the development of PTSD symptoms. Autumn offered her unwavering support to Rachael. And while Rachael knew her sister would always be her best friend and confidant, living a state away made it harder to take her up on it. Even so, Rachael knew she could go to her sister whenever she needed to, for whatever she needed. “It changes your entire belief system. The world is suddenly very scary in a way that never occurred to you before. But I have seen her grow to be happy and healthy in college. She has found love and purpose. You have to. If you don’t choose to move forward the darkness will eat you up.” Autumn said in an email. For the first time, Rachael was told that she is worth more. Finally, someone tells her that it wasn’t her fault. She is worth more, because she is more than her abuse. Anyone who deals with a traumatic situation when they could have died, were seriously injured, or sexually violated could develop PTSD. The National Center for PTSD says that in the United States, 50 percent of women go through one trauma in their life. Living through a trauma doesn’t guarantee PTSD: approximately eight percent of the population develops it. But for those who do, the nightmares and insomnia may keep them up at night. The anger may cause them to lash out at those they love; the sadness cause them to envelope into themselves. The anxiety, the depression, the headaches, the flashbacks, the alertness, all add up to the same thing: a change in the person’s personality. And these are just a few of the possible symptoms they deal with; the experience is different for each survivor. To be diagnosed with PTSD, there are four symptom clusters people experience. Intrusion, avoidance, negative impacts on their mindset and mood, and changes in the reactions. The symptoms they experience can’t be attributable to an existing medical condition, substance abuse, or medication, according to the American Psychiatric Association’s Diagnostic and Statistical Manual. Back in her hometown, Rachael decided to try counseling again with a high school counselor. She said he didn’t understand since he hadn’t had to face “anything like that” and didn’t feel comfortable opening up to him. She talked to him a few times but after that she felt it wasn’t worth it. But it was during these discussions that she first heard of the possibility of PTSD. It was when she was in college speaking to a counselor that she received the actual diagnosis. Rachael visited a counselor she knew personally one day and spoke to them about all that she had experienced throughout her life. It was then that she was told that she had PTSD. “It helps to talk to somebody who’s not personally invested in my life as much,” she said. After over a decade of dealing with unattributable symptoms, Rachael found someone to talk to. She finally gets an explanation for why she’s struggling. There’s a reason for what’s going on, so there’s got to be a way to cope with it.