Sociological Studies of Patterns of Family Violence Have Found That

Mcgill J Med. 2006 Jul; ix(2): 111–118.

Sexual assault and posttraumatic stress disorder: A review of the biological, psychological and sociological factors and treatments

Abstract

Sexual assault occurs with alarming frequency in Canada. The prevalence of Posttraumatic Stress Disorder (PTSD) in set on survivors is drastically higher than the national prevalence of the disorder, which is a strong indication that the current therapies for sexual-assault-related PTSD are in need of comeback. Increasing cognition and understanding of the pathologies associated with rape trauma in biological, psychological and sociological domains will assist to develop more effective treatments for survivors. A dysregulation of the Hypothalamic-Pituitary-Adrenal (HPA) axis is observed in survivors of sexual assault and this may exist a fundamental cause of the structural and functional abnormalities contributing to PTSD symptoms. Pharmacotherapies are available to treat PTSD; even so, they are frequently inadequate or unwanted past the survivor. Psychological health is compromised following interpersonal trauma and many psychological therapies are available, but with varying efficacy. A person's cognitions accept a dramatic effect on the onset, severity, and progress of PTSD following sexual assault. Sociological impacts of set on influence the evolution of PTSD through victim-blaming attitudes and the perpetuation of rape myths. Perceived positive regard and early social back up is shown to be important to successful recovery. Education is vital in rape prevention and to foster a supportive environment for survivors. The biological, psychological and sociological impacts and treatments should not remain mutually exclusive. A amend appreciation of the biopsychosocial repercussions of sexual assault will aid in developing a more holistic and individualized therapy to aid alleviate the physical and emotional pain following the trauma of rape.

Keywords: posttraumatic stress disorder, trauma, sexual assault, rape, pharmacotherapy

INTRODUCTION

One adult female is sexually assaulted in Canada every minute (1). Sexual assault is any grade of sexual contact without voluntary consent andthat violates a person's sense of autonomy, control and mastery over their torso (2). At the Academy of Alberta, 21% of students have reported at least one unwanted sexual feel (three). Sexual assail is widespread and occurs with alarming frequency.

Recovery from sexual- assault- related Posttraumatic Stress Disorder (PTSD) is not solely measured by eliminating symptoms or achieving specific outcomes. Healing from this trauma does non hateful that the survivor volition forget the experience or never once again experience any symptoms. Rather, successful recovery is subjective and measured by whether the survivor increases his or her interest in the present, acquires skills and attitudes to regain control of his of her life, forgive him or herself for guilt, shame and other negative cognitions, and gain stress reduction skills for overall amend performance (4). At that place are many factors involved in successful recovery, including the degree of back up received, previous self-concept, personal strength, and professional person treatment provided by the medical and justice systems (5). PTSD is one of the issues that may result from failure of the recovery procedure.

PTSD is caused by exposure to a traumatic outcome and intense psychological distress occurs every bit a outcome of re-experiencing the upshot (6). PTSD is diagnosed when symptoms last longer than one month (vii). To prevent the distressing reactions, survivors will avoid stimuli that provoke these feelings and this avoidance behaviour tin exist severe plenty to significantly impair daily life (8).

The consequences of a sexual assault may be manifested biologically, psychologically, and sociologically. By gaining a better appreciation of the repercussions of sexual attack, a holistic and individualized therapy tin be developed to ameliorate the concrete and emotional hurting following the trauma. The bug facing individuals who have experienced sexual assault will be discussed and improvements in current treatments will exist suggested, with hopes to develop more than effective and holistic therapies in the hereafter.

POSTTRAUMATIC STRESS DISORDER

The Us National Comorbidity Survey Report estimates the lifetime prevalence of PTSD among N Americans to exist 7.eight% (9). The lifetime prevalence of PTSD for women who have been sexually assaulted is 50% (10). Moreover, sexual assault is the most frequent cause of PTSD in women, with one study reporting that 94% of women experienced PTSD symptoms during the first ii weeks afterwards an assault (9).

The alarmingly high rate of PTSD in survivors of sexual assault is a stiff indication that the current therapies for rape victims are inadequate and in demand of improvement. In that location is no 'cookie cutter' treatment for every victim suffering with PTSD, equally the disorder can manifest itself in many ways (eight). Information technology is important to consider the biological, psychological, and sociological impacts when developing effective handling and intervention methods for sexual-assault-related PTSD.

PTSD PATHOPHYSIOLOGY

Before handling for sexual-assault-related PTSD can be adult, an understanding of the pathophysiology of PTSD is disquisitional. The dysregulation seen in individuals with PTSD can be observed and measured on all major systems of the body including the neural, endocrine and allowed systems (6). The Hypothalamic-Pituitary-Adrenal (HPA) axis plays a key regulatory role in the trunk, controlling all 3 systems through negative feedback inhibition. Cortisol is a major hormone of the HPA axis and is the primary stress hormone in the body. It is released when stimulated past Corticotropin Releasing Hormone (CRH) and inhibited via negative feedback interim at the hypothalamic and pituitary levels. Intense psychological trauma such equally sexual abuse can crusade changes in the body'due south response to stress by increasing levels of CRH and dysregulating the HPA axis (11, 12). This results in a decreased number of CRH receptors in the anterior pituitary, decreased pituitary responsiveness to CRH, and disturbed negative feedback inhibition (13). Reduced responsiveness to CRH causes overactivation of the HPA axis and can disturb negative feedback by cortisol (Figure 1). Cortisol has widespread action and its dysregulation affects other neural systems including the mesocorticolimbic dopaminergic system, leading to inappropriate fright reactions and persistent mild depression (14).

PHARMACOTHERAPY TREATMENT OPTIONS FOR PTSD

Cognition of the biological changes with PTSD has led to the development of new treatments that offer more than comprehensive management of PTSD and enable patients to enjoy an improved quality of life (11). For example, diverse drug treatments have been adult to treat PTSD. In that location are 5 main goals for treating PTSD with medications, including a reduction of the core symptoms such as anxiety and flashbacks, an improvement in stress resilience, an comeback in the quality of life, and a reduction in inability and comorbidity (xv). Equally Brunello et al. notes, it is important to maintain health and prevent relapse (6).

Concurrent with HPA centrality dysfunction, disruption of glutamatergic, serotonergic, and adrenergic systems is a fundamental cause of the structural and functional abnormalities which contribute to the symptoms of PTSD. Such symptoms include hyperarousal and re-experiencing feelings associated with the trauma through flashbacks or nightmares (11). The persistent re-experiencing of traumatic events may cause an increment in CRH levels, which damages the hippocampus, an important region of the encephalon associated with learning and memory (16, 17). With psychological trauma, a decrease in hippocampal volume has been observed (6). This volume decrease, when coupled with hypersensitivity of the HPA axis, is associated with a reduction of cognitive functioning drastically affecting the operation of afflicted individuals (xviii). Selective Serotonin Reuptake Inhibitors (SSRIs) have been successfully used to treat these hyperarousal symptoms purported to be caused past a subtract in hippocampal volume. SSRIs are commonly used to treat depression and at that place is some evidence that they may promote neurogenesis, which might be the therapeutic mechanism by which these medications issue changes in behaviour (eighteen). For example, Bremner and Vermetten demonstrated a 4.6% increase in the volume of the hippocampus and an comeback in memory of PTSD patients through treatment with the SSRI Paroxetine (18).

Many hormones and receptors in the glutamatergic, serotonergic, and adrenergic systems have been identified as key factors in retentivity and perception, one of which is the gamma-aminobutyric acid receptor (GABA-R) (xi). Following sexual corruption and the evolution of PTSD, the dysregulation of the HPA axis can stimulate the adrenergic organisation, activating GABA-R (15). The multifaceted interactions between these systems may explain the connections of emotions with factual memory. Information technology has been proposed that while a traumatic memory is re-lived during a flashback, in that location is an increase in the stimulation of GABA-R caused by an increase in the release of endogenous benzodiazepines (15). To control the overstimulation of GABA-R and thereby control anxiety and flashbacks, benzodiazepine inhibitors such as flumazenil have been used successfully (11). This has also been achieved with clonidine to stop nightmares by decreasing the release of catecholamines, a cardinal component of the feet-provoking 'fight or flight' response of the autonomic nervous organization (19).

The immune system is reciprocally regulated by the neural and endocrine systems and can also exist affected by PTSD (20). PTSD often co-occurs with various inflammatory diseases, probable due to HPA centrality dysregulation affecting the immune arrangement (21). Immunomodulation is therefore important to avoid this subsequent dysregulation of the immune system and this tin be achieved with SSRIs such as Fluvoxamine.

Fluvoxamine has been shown to exist constructive in decreasing the hyperresponsiveness of the HPA centrality, thereby increasing levels of interleukins and other essential immune factors (22). Interestingly, there is a sexual dimorphism in allowed functioning, as men with PTSD were found to accept an inhibited cell-mediated amnesty, while women showed enhanced cell-mediated amnesty (21). A amend understanding of this is necessary and information technology is of import to consider sexual dimorphism for immunomodulation.

Other drug treatment options are bachelor for PTSD including Tricyclic Antidepressants (TCA), Monoamine Oxidase Inhibitors (MAOI), SSRIs, serotonin antagonists, and anticonvulsants and are described in Tabular array 1 (23). Although at that place are some promising studies for medications, reviews of pharmacotherapies for PTSD have revealed that most treatments are inadequate, aside from some supportive show of SSRI effectiveness (24). Therefore it is useful to look towards other disciplines for additional treatment.

Table one

Summary of pharmacologic handling options for PTSD

Drug classification	Drug Name	Effects on PTSD improvement
Tricyclic antidepressants	Amitryptiline Imipramine	- 50% of treated patients had a terminal CGI-I1 score of 1 or 2 ("very much" or "much improved") as compared to 17% for placebo - 25% decrease from baseline in IES2 scores for treated patients every bit compared to 5% for placebo - 65% of treated patients were found to improve on a Global Calibration equally compared to 28% for placebo
Monoamine Oxidase Inhibitors	Phenelzine Brofaromine Moclobemide	- 45% subtract from baseline in IES score as compared to 5% for placebo - Reductions in PTSD symptoms were reported, however no difference was found between treatment group and placebo group - xi of 20 participants no longer met the criteria for PTSD at the cease of a 12 week trial
Selective Serotonin Reuptake Inhibitors	Fluoxetine Sertraline Paroxetine Fluvoxamine	- 85% of treated patients showed improvement on a Global Rating Scale every bit compared to 62% of patients taking placebo - Response rate on Loftier Cease State Functioning was 41% for handling grouping and 4% for placebo - 43% decrease in CAPS3 score for treatment group as compared to 31% for placebo - 39% decrease in DTS4 score for treatment group as compared to 24% for placebo - 50% decrease in DTS score for handling group - forty% subtract in IES score for treatment group - 64% of patients had a Duke Improvement score or 1 or 2 - Meaning reductions in mean scores for all efficacy scales used (Meridian-85, DTS, IES)
5-HT2 Antagonist	Nefazodone	- A decrease in PTSD severity on a Primary Assessment Scale in both gainsay veterans and civilians was observed
Anticonvulsants	Lamotrigine Carbamazepine Valproate	- 50% of patients in treatment group responded every bit compared to 25% for placebo group* - 70% of patients had a response of "moderate" or "very much" comeback - Approximately 70% of patients had a response of "moderate" or "very much" improvement

PSYCHOLOGY OF PTSD AND COGNITIVE FACTORS

Although the pathology associated with PTSD has a biological basis, the treatment need non be restricted to drugs. For example, a serious consequence of HPA axis dysregulation is the effect on the steroid hormones, namely estrogen and testosterone, which are also modulated through this axis (25). Every bit a issue, some survivors of sexual attack tin can become infertile due to sex activity steroid dysregulation. Interestingly, inquiry indicates that fertility may exist restored with cerebral behavioural therapy (CBT), but one example of many where psychological intervention was used to treat a biologically based malady (26).

After an assault, survivors feel The Rape Trauma Syndrome (RTS), which affects not only victims of rape, but too victims of all types of sexual violence and would perhaps be ameliorate labelled every bit Sexual Set on Trauma Syndrome. RTS is characterized past three phases (27). The Acute Phase occurs immediately following the assault when the survivor is in crisis and experiences a wide range of emotional reactions. These reactions may be categorized as Expressive, such as shaking, crying or yelling; or Controlled such as flattened affect, appearing outwardly at-home and subdued. The 2d stage is Outward Adjustment, when the survivor focuses less on the attack, often with a loftier level of denial, and involves themselves in normal daily activities. The final phase is Long Term Reorganization, in which the survivor integrates the attack into their view of themselves and resolves their feelings virtually the attacker. There are many psychological furnishings to consider following a sexual assail such equally feelings of shame, guilt, anxiety or low (ix). These feelings may be even stronger and more harmful if the survivor does not receive back up from their family, friends or authorities (9).

Cognitive factors play a big office in the onset, severity, and event of PTSD after sexual attack (28). These factors include mental defeat and defoliation, negative appraisal of emotions and symptoms, avoidance and perceived negative responses from others (5). If the survivor of sexual assault believes that others have failed to react in a positive and supportive manner, there is a greater risk of PTSD (nine). It has been suggested that trauma recovery is characterized by a reprogramming, integration, and habituation to the traumatic images, leading to a restoration of a sense of safety (29). Over time, PTSD symptoms volition subtract, the survivor volition be less preoccupied with blame towards self and others, and a will achieve a regained sense of control (29).

Events perceived as uncontrollable are much more lamentable than controllable events, therefore with uncontrollable events such every bit sexual assault, survivors will attempt to attribute arraign to behavioural, dispositional or vicarious causes (30). Behavioural self-arraign has the potential to be adaptive equally information technology promotes the conventionalities that negative outcomes can exist avoided in the future; whereas dispositional self-blame attributes the traumatic consequence to i's personality and this thinking does non give a sense of future control (xxx). Vicarious control refers to the perception that some other person or entity had control over the occurrence of that event (30). Attributing arraign in any of these means focuses on the by and is associated with poorer outcomes in PTSD. To ameliorate PTSD, treatment outcomes accent should be on decision-making the present situation and what can be washed well-nigh the impact of the outcome, rather than how it could have been avoided or can be avoided in the future (xxx). In view of the fact that command over the recovery process results in lowered distress levels, fostering this form of command could be an important component of interventions for sexual assault survivors (30).

Early intervention is critical for sexual assault victims because the level of distress immediately post-obit the assault is strongly correlated to future pathologies and PTSD (31). In a study collecting self-reports from survivors of assault that assessed their degree of support and psychological distress during and immediately post-obit the rape, it was found that high distress levels significantly predicted increased levels of fear and anxiety in the months post-obit the assault (31). Every bit the level of distress is strongly correlated to PTSD symptoms, an attempt to decrease levels of distress immediately following sexual assault may result in a more positive handling event. When survivors seek medical help, the forensic rape exam can be very traumatizing (32). Resnick et al., demonstrated that meeting with a rape crunch counsellor or viewing a video earlier a forensic rape exam depicting in detail what to await during the exam, resulted in decreased levels of stress after the test in exam groups compared to the non-video control group (32). Of all the eligible women, 81% agreed to participate in this video study, indicating that this is a feasible mode to decrease distress and reduce futurity PTSD development following the concrete examination.

Since Nov 1999, the Edmonton Uppercase Health Authority has run the Sexual Assail Response Team of Edmonton (SARTE) (33). This form of intervention has been very effective in lowering levels of distress in the infirmary setting. SARTE consists of a team of nurses who are sensitized to the detail needs of survivors, and specialized in dealing with victims of sexual assault. When working with survivors, the nurses explain in detail the procedures they will perform, assist patients in reporting to the police, and maintaining an open environs where the survivor is able to make equally many decisions on their own every bit possible (28).

PSYCHOTHERAPY TREATMENT OPTIONS FOR PTSD

In addition to promising social programs, there are many therapies focussing on the psychological aspect of PTSD. CBT focuses on changing thought patterns and cognitions to decrease negative emotions, develop skills to cope with anxiety and negative thoughts, restore constructive social skills, and develop means to manage anger and future trauma symptoms (nine).

Eye Motion Desensitization and Reprocessing (EMDR) is an Information Processing Therapy that combines elements of CBT, psychodynamic, interpersonal, experiential and trunk-centred therapies to care for PTSD (34). During EMDR, the client thinks of by or present traumatic experiences while meantime focusing on a stimulus such as auditory tones, tactile stimulation, or visual cues (34). This leads to dual attention, irresolute the processing of the traumatic memories and decreasing anxiety when thinking well-nigh the traumatic experience. It has been suggested that PTSD is due to an disability to fairly procedure the trauma and EMDR may be useful in this reprocessing (35). In an EMDR study by Rothbaum, only ten% of participants who were treated with EMDR therapy exhibited PTSD symptoms later on treatment, compared to 88% of non-handling control patients (36). Although the role of the middle movements has been contested, EMDR is proving to be an effective handling option for PTSD (36).

Grouping therapy can exist very effective to assist survivors focus on the present and share experiences with others in a prophylactic and empathetic environment. According to ane survey, over half of the women who experienced sexual set on within the previous v years never told anyone about their trauma (37). This silence can take an of import touch on on the development of PTSD, every bit the degree of support received can influence symptom severity (five). Individuals who receive bad or no support report more PTSD symptoms (28).

Psychodynamic therapy focuses on the emotional conflicts caused by the trauma, especially as they pertain to early on life experiences. This helps to develop cocky-esteem, effective ways of thinking and coping, and may be used to treat PTSD (9). As discussed earlier, focusing on the past is associated with poorer adjustment and present control should be encouraged (30). As such, psychodynamic therapy may be less effective than other therapies for assault victims.

New psychological therapies and treatments are continually adult as older ones are re-evaluated. For instance, trauma debriefing is common practise to reduce distress and assist in recovery immediately following a traumatic experience. Recently, it has been institute that debriefing did not prevent the onset of PTSD and may even increase the risk of PTSD symptoms, demonstrating that treatments should be continuously evaluated and modified (38).

Both pharmacotherapy and CBT are viable treatment options for PTSD, however it is clear that empowering victims by giving back control is crucial in successful recovery. In 1 study, survivors were asked to choose between CBT with prolonged exposure to traumatic stimuli or the SSRI medication Sertraline (39). Participants of the study rated CBT as more than credible and had more than positive feelings towards this handling option, citing effectiveness and potential side effects every bit the two master factors in their determination. When presenting treatment options, it is important to explain both options and put side effects in perspective. Many women do not want pharmacotherapy and the therapy provider should give victims of assault a pick when deciding treatment options, to aid them regain a sense of command (39).

SOCIOLOGICAL ISSUES CONTRIBUTING TO PTSD

Recovery from psychological issues due to sexual assault related PTSD is non solely an individual challenge, only also a challenge for those close to the affected individual (27). The recovery process is also a sociological issue and societal aspects should not be ignored. Research indicates that initial levels of distress and perceived control are fundamental factors in the onset and severity of PTSD (31). Perceived positive regard and support has as well been shown to be important to recovery (28). Less than one-half of individuals who have been sexually assaulted disembalm the set on to others and it is articulate that many are not getting the support they require. As a large part of the recovery procedure is related to a solid support network, part of the give-and-take of treatment and prevention of PTSD should be sociologically directed by targeting attitudes towards and origins of sexual assault with considerations of how these attitudes may create a rape-prone guild and allow for such a high frequency of sexual assault.

There are many rape myths in our lodge, for instance, beliefs that individuals prevarication about being assaulted, perpetrators are easily identifiable, or that men cannot be sexually assaulted. These myths promote negative attitudes and victim-blaming philosophies. Education is the first step in preventing PTSD associated with assault. The number of sexual assault victims willing to tell someone most their experience is increasing, potentially considering in that location is less of a stigma attached to it today and there are more voluntary and professional support agencies (37). Although this shows some improvement, many individuals still have attitudes that sex role stereotyping, adversarial sexual beliefs, and acceptance of interpersonal violence, all of which lead to greater acceptance of rape myths (40). Although sexual assault programs are becoming more pervasive beyond college campuses, these programs are not e'er effective in implementing meaningful changes in noesis and behaviour (32). By understanding the failures of pedagogy programs, directions for improvement are constitute. Increasing program length may let for more meaningful changes in cognition and behaviours to occur (41). Targeting the attitudes that atomic number 82 to greater acceptance of rape myths may lead to a more than supportive community for victims of sexual assault. Didactics is vital in rape prevention and to foster a supportive surround for survivors of this crime, just it is clear that more research is needed to better the efficacy of these programs.

Many survivors who disembalm their assault to others experience secondary victimization. Secondary trauma occurs when survivors seek help from medical, legal or healthcare professionals, but these professionals oftentimes exhibit and employ victim-blaming behaviours (42). Contact with many services especially those which practice not specialize in sexual assault traumatization, tin increase survivors' psychological and physical distress (43).

Society contributes to the acceptance of rape myths through individuals the survivor solicits for assistance as well as past contributing to the negative cognitions of the survivors themselves. Negative cognitions foster cocky-blame and increase the hazard of post-assault psychopathologies, likely contributing to the low disclosure rates.

Decision

Recovery from rape trauma is a deeply personal and highly individualized journey. As knowledge of the pathophysiology of PTSD improves, more effective medications are developed to care for and manage the biological aspects of this disorder. Psychological therapies are available to aid survivors in their recovery. The number of rape prevention centres and pedagogy programs are on the ascent with aims to deflate rape myths, change victim-blaming attitudes and de-stigmatize the subject. One of the most important aspects in assisting the recovery process is empowering the survivor and putting control back into their hands. The three-treatment modalities for the biological, psychological, and sociological impacts should non remain mutually sectional. Physicians, therapists, law enforcement agencies, and family and friends must work together to find the meaning of recovery from the perspective of the survivors and to sympathize what conditions will facilitate growth and recovery. When the therapies available to treat sexual-assault-related PTSD are brought together during the right stages in the recovery process to grade a comprehensive treatment of the highly private survivor, greater success in decreasing the rate of PTSD associated with sexual set on may be achieved.

REFERENCES

2. Rose DS. Worse than Expiry: Psychodynamics of Rape Victims and the Need for Psychotherapy. The American Periodical of Psychiatry. 1986;43(7):817–824. [PubMed] [Google Scholar]

iv. Matsakis, A. I Can't Go Over Information technology: Handbook for Trauma Aurvivors. Oakland, California: New Harbinger Publications; 1996.

5. Dunmore Due east, Clark DM, Ehlers A. Cerebral Factors Involved in the Onset and Maintenance of Post Traumatic Stress Disorder (PTSD) afterwards Physical or Sexual Assault. Behaviour Research and Therapy. 1999;37:809–829. [PubMed] [Google Scholar]

vi. Brunello Due north, Davidson JRT, Deahl One thousand, Kessler RC, Mendlewicz J, Racagni 1000, et al. Posttraumatic Stress Disorder: Diagnosis and Epidemiology, Comorbidity and Social Consequences, Biology and Treatment. Neuropsychobiology. 2001;43:150–162. [PubMed] [Google Scholar]

7. Butcher JN, Mineka S, Hooley JM. Abnormal Psychology 12th Edition. Boston, MA: Allyn and Bacon; 2004.

8. American Psychiatric Association. Diagnostic and Statistical Transmission of Mental Disorders (quaternary ed., rev.). Washington, DC: American Psychiatric Association; 2000.

ten. Creamer M, Burgess P, McFarlane AC. Postal service-traumatic stress disorder: Findings from the Australian National Survey of Mental Health and Well-being. Psychol Med. 2001;31(7):1237–1247. [PubMed] [Google Scholar]

11. Nutt JD. The Psychobiology of Postal service Traumatic Stress Disorder. J Clin Psychiatry. 2000;61(5):24–29. [PubMed] [Google Scholar]

12. Golden Pw, Goodwin FK, Chrousos GP. Clinical and Biochemical Manifestations of Depression: Relation to the Neurobiology of Stress, Part Ii. Northward Engl J Med. 1988;319:412–420. [PubMed] [Google Scholar]

xiii. Tizabi Y, Aguilera G, Gilad GM. Historic period Related Reduction in Pituitary Corticotrophin Releasing Hormone Receptors in Ii Rat Strains. Neurobiol Aging. 1992;thirteen:227–230. [PubMed] [Google Scholar]

14. Perry BD, Pollard RA, Blakley TL, Baker WL, Vigilante D. Development of the Brain: How States Become Traits. Infant Mental Health Journal, July 25. Retrieved Dec 8, 2005 from http://world wide web.trauma-pages.com/perry96.htm; 1995.

15. Davidson J, Glover 5, Clow A, Kudler H, Meador Thou, Sandler Thousand. Tribulin in Posttraumatic Stress Disorder. Psychol Med. 1988;xviii(iv):833–836. [PubMed] [Google Scholar]

16. VanVoorhees E, Scarpa A. The Effects of Child Maltreatment on the Hypothalamic-Pituitary-Adrenal Centrality. Trauma, Violence and Abuse. 2004;5(iv):333–352. [PubMed] [Google Scholar]

17. Maren S. LTP in the Amygdala: a Mechanism for Emotional Learning & Memory. Trends in Neurosciences. 1999;22:561–567. [PubMed] [Google Scholar]

18. Bremner JD, Vermetten Eastward. Neuroanatomical Changes Associated with Pharmacotherapy in Posttraumatic Stress Disorder. Ann NY Acad Sci. 2004;1032:154–157. [PubMed] [Google Scholar]

19. Harmon RJ, Riggs PD. Clonidine for Posttraumatic Stress Disorder in Preschool Children. J Am Acad Child Adolesc Psychiatry. 1996;35:1247–1249. [PubMed] [Google Scholar]

20. Boscarino JA. Posttraumatic Stress Disorder and Physical Illness: Results from Clinical and Epidemiological Studies. Ann NY Acad Sci. 2004;1032:141–153. [PubMed] [Google Scholar]

21. Tucker P, Ruwe WD, Masters B, Parker DE, Hossain A, Trautman RP, Wyatt DB. Neuroimmune and Cortisol Changes in Selective Serotonin Reuptake Inhibitor and Placebo Treatment of Chronic Posttraumatic Stress Disorder. Biol Psychiatry. 2004;56:121–128. [PubMed] [Google Scholar]

22. Rinne T, de Kloet ER, Wouters L, Geokoop JG, de Rijk RH, van den Brink W. Fluvoxamine Reduces Responsiveness of HPA Axis in Developed Female BPD Patients with a History of Sustained Childhood Abuse. Neuropsychopharmacology. 2003;28:126–132. [PubMed] [Google Scholar]

23. Davidson JRT. Pharmacotherapy of Posttraumatic Stress Disorder: Treatment Options, Long-Term follow-Upwardly, and Predictors of Consequence. J Clin Psychiatry. 2002;61(5):52–56. [PubMed] [Google Scholar]

24. Solomon SD, Gerrity ET, Muff AM. Efficacy of Treatments for Posttraumatic Stress Disorder. JAMA. 1992;268:633–638. [PubMed] [Google Scholar]

25. Rivier C, Rivier J, Vale W. Stress Induced Inhibition of Reproductive Functions: Role of Endogenous Corticotrophin Releasing Factor. Science. 1986;231:607–609. [PubMed] [Google Scholar]

26. Berga SL, Daniels TL, Gules DE. Women with Functional Hypothalamic Amenorrhea but not Other Forms of Anovulation Display Amplified Cortisol Concentrations. Fertil Steril. 1997;67:1024–1030. [PubMed] [Google Scholar]

27. Volunteer Preparation Manual. Sexual Assault Center of Edmonton. Edmonton, AB; 1999.

28. Koss MP, Figuerdo AJ. Change in Cognitive Mediators of Rape's Touch on on Psychosocial Health Beyond 2 Years of Recovery. Journal of Consulting and Clinical Psychology. 2004;72(six):1063–1072. [PubMed] [Google Scholar]

29. Brewin CR, Dalgleish T, Joseph S. A Dual Representation Theory of Posttraumatic Stress Disorder. Psychological Review. 1996;103:670–686. [PubMed] [Google Scholar]

xxx. Frazier PA. Perceived Control and Distress Following Sexual Assault: A Longitudinal Test of a New Model. Journal of Personality and Social Psychology. 2003;84(six):1257–1269. [PubMed] [Google Scholar]

31. Girelli SA, Resick PA, Marhoefer-Dvorak S, Hutter CK. Subjective Distress and Violence During Rape: Their Effects on Long-Term Fear. Violence and Victims. 1986;1:35–45. [PubMed] [Google Scholar]

32. Resnick H, Acierno R, Holmes Chiliad, Kilpatrick DG, Jager N. Prevention of Mail service-Rape Psychopathology: Preliminary Findings of a Controlled Acute Rape Handling Study. Journal of Feet Disorders. 1999;13(4):359–370. [PubMed] [Google Scholar]

33. Capital Wellness. Sexual Attack Response Squad. Community Sector Pamphlet, March 2004; 2004.

34. Shapiro F. EMDR every bit an Integrative Psychotherapy Approach: Experts of Various Orientations Explore the Paradigm Prism. Washington, DC: American Psychological Association Books; 2002.

35. Foe EB, Steketee Thou, Rothbaum B. Behavioural/Cognitive Conceptualizations of Posttraumatic Stress Disorder. Behaviour Therapy. 1989;20:155–176. [Google Scholar]

36. Rothbaum BO. A Controlled Study of Middle Move Desensitization and Reprocessing in the Treatment of Posttraumatic Stress Matted Sexual Attack Victims. Bulletin of the Menninger Clinic. 1997;61(3):317–334. [PubMed] [Google Scholar]

37. British Crime Survey. Rape and Sexual Attack of Women: Findings from the British Criminal offense Survey. Home Role Research Study 159:i–half dozen Retreived April three 2005 from http://world wide web.homeoffice.gov.uk/rds/pdfs2/r159.pdf; 2002.

38. Cuijpers P, Van Straten A, Smit F. Preventing the Incidence of New Cases of Mental Disorders: a Meta-Analytic Review. J Nerv Ment Dis. 2005;193:119–125. [PubMed] [Google Scholar]

39. Zoellner LA, Feeny NC, Cochran B, Pruitt 50. Handling Choice for PTSD. Behaviour Research and Therapy. 2003;41:879–886. [PubMed] [Google Scholar]

40. Burt MR. Cultural Myths and Supports for Rape. Journal of Personality and Social Psychology. 1980;38:217–230. [PubMed] [Google Scholar]

41. Breitenbecher KH, Deficient Thou. An Evaluation of the Effectiveness of a Sexual Assault Education Program Focusing on Psychological Barriers to Resistance. Journal of Interpersonal Violence. 2001;16(5):387–407. [Google Scholar]

42. Campbell R, Barnes HE, Ahrens CE, Wasco SM, Zaragoza-Diesfeld Y, Sefl T. Community Services for Rape Survivors Enhancing Psychological Well-Being or Increasing Trauma? Journal of Consulting and Clinical Psychology. 1999;67(6):847–858. [PubMed] [Google Scholar]

43. Campbell R, Wasco SM, Ahrens CE, Sefl T, Barnes HE. Preventing the "Second Rape": Rape Survivors' Experiences with Community Services Providers. Journal of interpersonal violence. 2001;sixteen(12):1239–1259. [Google Scholar]

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