How to Treat PTSD in Men Who Have Been Sexually Assaulted

 

In the United States, the prevalence of sexual assault can be frightening for young people. Among college students, 1 in 36 women experiences rape each academic year. And although the rates among male college students are much lower, men are still at risk of being sexually assaulted too.³ Like women, men can experience complex emotional problems such as depression and posttraumatic stress disorder (PTSD) following a traumatic event like sexual assault.³

Research shows that rape, in particular, is one of the most traumatic forms of trauma a person—male or female—can experience, which significantly increases the odds of developing PTSD after the event. While women are statistically more likely to exhibit symptoms of PTSD after a sexual assault, men do as well, though they are less likely to report the assault as the reason for their emotional distress.³ Failing to disclose their rape often leads to feelings of denial, shame, and guilt, which can also create a barrier to seeking treatment, placing boys and men at risk for developing more severe emotional problems, as well as a drug or alcohol use disorders.³

 

According to the to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), all of the following criteria are required for a diagnosis of PTSD:⁴

Criteria A (1 required): The person was exposed to: death, a person threatening death, actual or threatened serious injury, or actual or threatened sexual violence, in the following ways:

• Direct exposure
• Indirect exposure to trauma, usually through a person’s career (e.g. first responder, medic, EMT, nurse, doctor, firefighter)
• Witnessing the trauma
• Learning that a relative or close friend was exposed to a trauma

Criteria B (1 required): The person continues to experience the traumatic event, in the following ways:

• Nightmares
• Flashbacks
• Emotional distress after exposure to traumatic reminders
• Physical reactivity after exposure to traumatic reminders
• Unwanted memories

Criteria C (1 required): The person avoids triggers that are related to the trauma, including:

• Things that remind them of the trauma
• Trauma-related feelings or thoughts

Criteria D (2 required): The person has negative thoughts or feelings that become worse after the trauma in the following ways:

• They are unable to recall specifics about the trauma
• They have extremely negative thoughts and assumptions about themselves or the world
• Negative affect (emotions)
• Trouble experiencing positive affect
• They experience exaggerated blaming of themselves or others for causing the traumatic event to occur
• Decreased interest in activities
• Feeling alone or isolated

Criteria E (2 required): The person experiences arousal related to the trauma, in the following ways:

• Hypervigilance (pathologically increased awareness and sensory sensitivity)
• Feeling aggressive or irritable
• Engaging in destructive or risky behavior
• Being easily startled
• Trouble sleeping
• Difficulty concentrating

Criteria F (required): These symptoms last longer than 1 month.

Criteria G (required): These symptoms create distress or functional impairment in a person’s life (e.g., their relationships, career, finances, legal standing).

Criteria H (required): These symptoms are not brought on because of substance abuse, physical illness, medication, or other factors.

It is important to note that although a diagnosis strictly for PTSD indicates that substances are not responsible for the symptoms exhibited, very often, a person abuses substances in response to their trauma.

There are also 2 types of specifications for a PTSD diagnosis, including:

• Dissociative Specification: If a person experiences high levels of either of the following as a reaction to trauma-related triggers, they may meet the criteria for diagnosis of this specification:
  1. Depersonalization: The person feels as if they are experiencing their life from the outside—as an outside observer. This out-of-body experience can make a person feel detached from their body and mind (e.g., feeling as if they are in a dream or as if this is not happening to them).
  2. Derealization: Similar to depersonalization in that a person experiences distance or distortion in their reality. They may experience feelings that things are not real, or this is just a dream.
• Delayed Specification: A person may not meet every diagnostic criterion until at least 6 months after the traumatic event occurs. At this point, however, they may begin experiencing symptoms of PTSD immediately.

 
If you suspect that you are suffering from PTSD, see a qualified medical or mental health professional for an assessment of your symptoms. You can make an appointment with a psychologist by calling your insurance company to find a provider, asking for a referral from your primary care doctor, or visiting a treatment center.

 

For anyone—male or female—you can’t simply pinpoint when someone is going to be assaulted. For some people, the assault takes place when they are children and more vulnerable to abuse. The sexual assault may have taken place at the hands of someone in a position of power relative to them, such as an older cousin, a coach, a family member, a religious leader, or a teacher. Often, the perpetrator uses special attention, small bribes, or gifts to coerce a young boy or man into the act.⁵

When a boy or man is the victim of sexual assault, they may experience a number of reactions. This is a list of common experiences shared by males who have been sexually assaulted:⁶

• Avoiding sex altogether
• Being unable to relax
• Worrying about telling people about the assault
• Shame
• Guilt
• Feeling like “less of a man” because of the event
• Questioning their sexual orientation
• Isolating or withdrawing from others
• Becoming more aggressive
• Fear

 
Researchers of behavioral treatments have taken note that men and women respond to the trauma of sexual assault differently in some ways. For example, many men find it difficult to admit that as a man, they can be a survivor of rape due to their misconceptions about the nature of that kind of sexual assault.³

Studies also show that people’s behaviors and beliefs change as an emotional response to their trauma. There are a number of different models and theories to understand the altered thought processes—or distorted cognition in psychological terms—following rape, particularly as they relate to dominance and power dynamics.

One common distorted line of thinking that has shown up is the belief that a certain amount of resistance in a sexual encounter is normal and should be overcome by force. A surprising amount of men buy into this belief, which often leads to sexual aggression and what we know as a rape culture: in short, forcing yourself on someone sexually is normal.^3,7

However, after a man is the subject of such force, his thinking may change. Or he becomes conflicted about how to make sense of his previous belief of himself as a dominant male in the face of becoming a victim of that power. Without proper treatment, these views can interfere with someone successfully recovering from the trauma of sexual assault.³

 

Recovering from sexual assault and related PTSD is a highly personal experience. PTSD is a condition that can manifest in many different ways, and it’s important to know that recovery doesn’t mean the survivor will forget the experience or never experience PTSD symptoms ever again. Instead, a successful recovery from PTSD is more subjective. For some, recovery may look like gaining back a sense of control and ownership of their life and forgiving themselves for any shame, guilt, or regret they feel about the incident. During recovery, a survivor may work on staying present and learning ways to reduce stress.⁷

Factors that help ensure a successful recovery include:⁷

• The amount of support a person receives from friends, family, and professional treatment professionals.
• Determination to grow personally and spiritually.
• The care provided in a professional treatment center.

 
Although medication is a helpful way to treat PTSD, it is always recommended as part of a larger treatment approach that includes therapy and other psychological interventions. Experiencing sexual assault can lead to problems later in life, both psychologically and physically. Because of this, it is best to approach therapy in a holistic manner that looks at the deep physical and emotional pain associated with sexual trauma.⁷

Research indicates that sexual-related PTSD may result in physical changes to the body’s most vital systems, including the neural, immune, and endocrine systems. When a person experiences intense psychological trauma, such as rape or sexual assault, the way their body responds to stress thereafter changes. This may cause an irregularity in the way cortisol (a primary stress hormone) is released in the body.⁷ Comprehensive treatment will address this and other issues that arise after a trauma.

Certain medications may be successful in helping to treat PTSD, including:⁷

• Selective serotonin reuptake inhibitors (SSRIs).
• Monoamine oxidase inhibitors (MAOI).
• Tricyclic antidepressants (TCA).
• Anticonvulsants.
• Serotonin antagonists.

 
Common psychological therapies that have proven effective and are commonly incorporated into PTSD treatment include:⁷

• Cognitive Behavioral Therapy (CBT).
• Eye Movement Desensitization and Reprocessing (EMDR).
• Group therapy.
• Psychodynamic therapy.

 
One of the most important parts about recovery is empowering the survivor to take their life back. Strong support from family, friends, neighbors, loved ones, community centers, law enforcement, and medical professionals may better promote recovery and growth.⁷

 

Survivors who share their sexual assault story with others run the risk of experiencing secondary victimization. So, if a male survivor tells someone who they are close to about their trauma and that person does not understand or show empathy toward them, it may increase a man’s feelings of self-blame, shame, and other forms of psychological distress.⁷ Coming forward and sharing your story of sexual assault takes an incredible amount of trust and understanding from the person you’re sharing with.

If a man or boy in your life experienced sexual assault, here are a few suggestions on how to support them:

• Actively listen.
• Validate their feelings.
• Don’t ask details about what happened.
• Let them know you are there for them.
• Help them find resources.

 
Some of the organizations and websites devoted to helping survivors find ways to heal include:

• 1in6: Men and boys can find resources here and connect with other males who have been sexually assaulted. 1 in 6 offers weekly chat-based support groups.
• RAINN: The Rape, Abuse & Incest National Network is one of the largest anti–sexual violence organizations in the United States. Visit its website for resources on what to do after a sexual assault occurs.
• Safe Horizon: Safe Horizon supports victims and families affected by sexual abuse. They operate a hotline 24 hours a day, and it is also available in Spanish.