Thursday, January 19, 2012

Trauma and Psychological Rehabilitation

Courtesy - The Island by Dr. R. A. R. Perera
M.B.B.S. (Cey) M.Sc. Psych (Col) F.A.R.C.G.P.
Consultant Psychologist O.A.C.C.P.CO C.H.T. (USA)C.Psych (Canada)

Most individuals will experience some characteristic symptoms following an extraordinary stressful event like rape. The symptoms will usually diminish with time, but a significant proportion of survivors develop chronic or recurrent difficulties. Late onset of some of the symptoms is common. The most common of these s ymptoms are

* Recurrent thoughts or image of the event accompanied by strong emotions, and dreams of the event.

* Being easily reminded of the event by stimuli associated with it, and suddenly acting or feeling as if the event was happening again (these are called flashbacks).

* These survivors have persistent arousal, such as difficulty in sleeping, poor concentration, hyper vigilance for danger and exaggerated reflexes.

* Intense anger, irritability and feelings of guilt about their behaviour during the trauma is a common occurrence among rape victimis.

Rape victims may persistently avoid stimuli associated with the trauma or become generally, numb emotionally.

They have difficulties in starting and maintaining a relationship with an outsider especially with the opposite sex.

They may feel emotionally distant from others, have reduced interest in previously pleasurable or important activities.

They are unable to recall various aspects or parts of the trauma and avoid situations which threaten to awake those feelings.

Depression or a mixed picture of anxiety is common, and may present as a physical symptom such as abdominal pain or a headache.

Irritability or aggression, moodiness, or general emotional and behavioural instability in a rape victim may falsely suggest having a personality disorder. There is an increased risk of suicide and accidental deaths among rape victims.

A wide range of psychological treatments has been used, as treatment for rape victims including hypnotherapy, psychotherapy, progressive desensitization to imagined aspects of the precipitating event and cognitive therapy.

In principle, an opportunity to talk through the experience soon afterwards, to explore the emotional impact of it, and to find a way of incorporating the experience in to the victim’s belief system seems to be necessary for normal trauma adjustment. In developed countries there are emergency rape management centers.

This can be done formally on a one- to- one basis or informally with the family or a friend. All rape victims should be identified and screened for problems initially, and again 4-6 months later. In general, the sooner problem symptoms are identified, the better.

Antidepressant drugs can be used for rape victims who have biological depressive symptoms. These drugs are very useful for victims who have intrusive thoughts or stressful dreams.

The outcome of these therapies will depend on various factors, including exposure to stressful events subsequent to the trauma, the availability of appropriate social support and specific interventions. Generally, the severer the trauma, the poorer the outcome. Between one third and one half of rape victims who have post rape complications continue to have chronic or recurrent symptoms for many years.