HJNO Sep/Oct 2024

SEXUAL VIOLENCE 24 SEP / OCT 2024 I  HEALTHCARE JOURNAL OF NEW ORLEANS   anything at the time?” Recent research on “tonic immobility,” based on animal predation studies, has provided a physiological explanation for expe- riences of immobilization during sexual assault. No matter how genuine these questions may be for the inquirer, they animate an atmosphere of suspicion around the victim and their story. Or worse, they exacerbate feelings of shame that may be just beneath the surface. 21 In his book Missoula: Rape and the Justice Sys- tem in a College Town , Jon Krakauer writes: ❝ It is very tempting to take the side of the perpetrator. All the perpetrator asks is that the bystander do nothing. He appeals to the universal desire to see, hear, and speak no evil. The victim, on the con- trary, asks the bystander to share the bur- den of pain. The victim demands action, engagement, and remembering … 18 Research shows that women who reported “freezing” during a sexual assault are more likely to not only face condemnation by others but also to suffer from PTSD or other forms of psychologi- cal distress after the violation. 21 ❝ Rape and war, she explained are among the most common causes of post-trau- matic stress disorder, and survivors of sexual assault frequently exhibit many of the same symptoms and behaviors as survivors of combat: flashbacks, insom- nia, nightmares, hypervigilance, depres- sion, isolation, suicidal thoughts, out- bursts of anger, unrelenting anxiety, and an inability to shake the feeling that the world is spinning out of control. 18 Post-Traumatic Stress Disorder Post-traumatic stress disorder (PTSD) is described as the experience of harm, actual or threatened; the intrusion of upsetting memories or dreams that mimic the actual or threatened harm; avoidance of circumstances and stimuli reminiscent of the traumatic experience; nega- tive changes in cognitions, mood, arousal, and reactivity. 3 The diagnostic definition for PTSD is an “intense or prolonged psychological distress at exposure to internal or external cues that sym- bolize or resemble an aspect of the traumatic event(s).” 22 Intimate Partner Violence Intimate partner violence (IPV) is defined as “the physical, sexual, psychological, economical, or stalking abuse, both concrete and menaced, per- petuated by current or ex-partners.” 23,24 Victims of IPV are confronted with a range of decisions to make regarding abuse and their abuser. A primary choice is to stay in or leave the relationship. 24 The decision to leave a relationship, particularly a mar- riage, is influenced by family dynamics, cultural dynamics, societal and gender expectations, and religious pressures. Trauma bonding is another psychological process that also influences a per- son’s decision to leave or to stay. 24,25 Trauma Bond The association between traumatic bonding and PTSD symptoms is controversial within the behavioral health communities. One considered theory is that of Stockholm syndrome. Stockholm syndrome functions as a method of coping with trauma as a maladaptive coping strategy. 3,26,27,28,29 Stockholm syndrome theory postulates a posi- tive emotional relationship between victims and abusers that developed because of the trauma. 30 From this line of reasoning, we could assume that traumatic bonding and Stockholm syndrome keep a victim stuck in an abusive relationship, which may provide further opportunities for trauma to occur, thus increasing the risk of developing PTSD symptoms. 31,32 Abusive relationships are a vicious cycle, as they say. Trauma bonding becomes an adaptive function but is also an unhealthy mal- adaptive coping strategy that increases the like- lihood of developing or exacerbating preexisting PTSD symptoms. 5,28,29 ❝ [T]raumatized people chronically feel unsafe inside their bodies: The past is alive in the form of gnawing interior dis- comfort. Their bodies are constantly bombarded by visceral warning signs, and, in an attempt to control these pro- cesses, they often become expert at ignoring their gut feelings and in numbing awareness of what is played out inside. They learn to hide from their selves. 1 Getting Free As stated, attachment styles can change. 2 From the attachment perspective, when a partner sig- nifies availability, responsiveness, and love, the development of a secure attachment bond is possible. When a partner’s behavior satisfies the other partner’s needs, it directly improves the wel- fare of the partner in the receiving position and advances the stability and quality of the rela- tionship. Gratitude, in response to such support, which is the most common response, also has beneficial effects on relationship satisfaction. 4,33,34 Empathy Research shows empathy to have a wide range of psychological outcomes, which play a criti- cal role in interpersonal social skills. Empathy, defined by Bloom, distinguishes between expe- riencing others’ emotions (emotional contagion) and wanting others to do well and not suffer without necessarily experiencing their emotions (compassion). 35 Batson defines empathy as an other-oriented emotional response elicited by, ❝ Rape and war, she explained are among the most common causes of post-traumatic stress disorder, and survivors of sexual assault frequently exhibit many of the same symptoms and behaviors as survivors of combat: flashbacks, insomnia, nightmares, hypervigilance, depression, isolation, suicidal thoughts, outbursts of anger, unrelenting anxiety, and an inability to shake the feeling that the world is spinning out of control. ❞ — Jon Krakauer, Missoula: Rape and the Justice System in a College Town