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The National Center for PTSD (Post-Traumatic Stress Disorder) is trying to aid medical personnel in providing both short and long-term health care to victims of sexual assault. Their recent update (which touches briefly upon male sexual abuse survivors, obviously a hot-button topic for y’all) includes addressing areas of concern for sexual assault victims.
Numerous physical problems occur with greater frequency among women with sexual assault histories than among women who have not experienced sexual assault. These problems include: diabetes, obesity, arthritis, asthma, recurrent surgeries, chronic pelvic pain, irritable bowel syndrome, back pain, headache, eating disorders, poor reproductive outcomes, digestive problems, and hypertension.
A study examining HMO health care utilization found that women who reported a history of childhood sexual abuse were more likely to visit the emergency room and had annual total health care costs that were significantly higher than those without abuse histories. These differences were observed even after excluding the costs of mental health care. Adult sexual trauma victims also appear to utilize high levels of health care (more physician visits and higher outpatient costs) even when compared to women who have been victims of other types of crime.
The most widely studied psychological consequence of sexual assault is PTSD. In this study, 45% of the women who reported having experienced a rape met criteria for PTSD. This was significantly higher than the 38.8% rate of PTSD among men who had experienced combat.
Sexual assault appeared to be extremely difficult for men as well (65% of men who had been raped met criteria for PTSD), but the proportion of men in the study who experienced a rape (0.7%) was significantly smaller than the proportion of women who did (9.2%).
So let me get this straight. Victims of sexual assault of one kind or another are more likely to have medical problems ranging from high blood pressure to diabetes, and they’re often “frequent flyers” to the ER or their local doctor. Yeah, no kidding, huh?
What shocked me most initially is that sexual assault survivors have a higher percentage (45%) of PTSD than combat-active military men (38.8%). It’s true, though. While I’m pretty willing to put myself out there in general, there are some things that I just cannot talk about. Suffice it to say that I can relate to those 45% … and that, yes, rape is a hundred times worse than being in a combat zone. I know I might take flack for saying that, having never been in a combat zone, but I 100% believe it is true.
Several aspects of the medical setting may increase the likelihood that PTSD symptoms will be observed. For example, the types of procedures performed in medical offices (particularly those performed as part of yearly physicals, gastrointestinal exams, and gynecological exams) can potentially trigger a post traumatic reaction in patients who have experienced sexual trauma. In particular, pelvic exams, colonoscopies, endoscopies, and other procedures that involve placing an instrument into a bodily orifice may be sufficiently reminiscent of the sexual trauma to evoke a post traumatic reaction.
In addition, a number of other features in the medical office setting may act as trauma reminders. These include being touched (even in a typically nonthreatening place), the power differential between patient and provider, the removal or absence of clothing, and the focus on bodily pain or disorder.
In one study, a large percentage of sexual trauma survivors reported having an unpleasant experience during their gynecological exams. These unpleasant experiences included overwhelming emotions, unwanted or intrusive thoughts, having traumatic memories triggered, body memories, and feelings of detachment from the body. The survivors did not report many of these experiences to the providers.
All I can say to that is, “Hells, yeah.” And it never goes away. I think that’s the worst part. Anyway, the PTSD site made a list for medical providers aware that their patients are sexual assault survivors. Some highlights:
• Reduce the power differential between you and your patient.
• Give the patient as much control as possible.
• Take a break during the exam if necessary.
• Provide the patient with as much choice as possible.
• Engage in dialogue throughout exam.
• Explain everything you will do in advance and as you do it.
• Listen carefully to any concerns.
• Check in regularly throughout the exam about the patient’s level of anxiety.
• Remind the patient why you are performing this exam.
• Be prepared and willing to reschedule the exam if necessary.
Are those fair accommodations for a medical provider to be willing to make? And what do you think should be done about the unwillingness (some might say “inability”) of sexual assault victims to share their experience with their doctor?
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I think that’s an entirely reasonable list.
I’d also add a first point of ‘recognise a patient’s right to say no’. Far too many doctors see their way as the only way, or don’t think an individual deserves a say in what’s done to them.
And yep, here’s your flack for saying that rape is worse than being in a combat zone. You can tell me that rape is really awful, and probably comparable, but you can’t speak for experiences you don’t have. Even those who have experienced both and can give a meaningful opinion can speak only for themselves.
I can guess as to why there’s a larger percentage of PTSD, though. Since combat, while terrible is something that you’re prepared for (bootcamp, not mentally prepared) and you know that it’s coming, whereas an attack is generally a surprise. So, more things can be perceived as potential assaults since it can happen anywhere at any time.
That was my thought as well. Soldiers are physically prepared for combat and make the decision to join the military with the risk of combat in mind; they have some control over there situation. Assault isn’t something that the victim can control, and that’s probably why PTSD is so prevalent.
Though I freely admit to talking out my ass here, my thought was in the military you have support, you aren’t alone in whatever hell you stumble into, where as in rape cases you have no help, no support, just your own pain and terror.
I dunno, I suffer from an well documented, diagnosed, and currently under control anxiety disorder, and someone constantly asking me what my level of anxiety was would make me more anxious than anything else.
It seems to me that the list of things for doctors to do there would be either just good-sense bedside manner, or wouldn’t really be applicable unless an exam directly relating to a sexual assault was underway.
Personally I know that someone checking on my anxiety level and trying to “reduce the power differential” whatever that means if I went in for an earache would piss me right the hell off.
But then, I’ve been mistaken for an assault victim before, and the way the doc immediately treated me like I was a live grenade in bubble wrap just made me mad. So I might not be a good example.
[...] Medical Providers Face Unique Challenges With Sexual Assault … [...]
[...] Medical Providers Face Unique Challenges With Sexual Assault … [...]