April is Sexual Assault Awareness Month. You may be wondering, “Why is a lupus nonprofit writing a blog on sexual assault awareness?” The answer may surprise you.
There is growing evidence that exposure to sexual trauma and other forms of abuse have been shown to increase the risk of developing lupus.
Statistically, many of you reading this will have endured sexual and/or physical trauma before being diagnosed. In this blog, we hope to present information to the best of our ability, as we approach it delicately while holding space for the many emotions that may arise from reading such content.
We urge you to seek professional support to process your experiences in safe spaces. If you would like more information on support services, please consider visiting: Better Help, The National Sexual Assault Hotline, or National Helpline Database (verywellmind.com).
Introduction:
As defined by the U.S. Department of Health and Services, “Sexual assault is any type of sexual activity or contact that you do not consent to.” This may include physical force or threats of force, rape, attempted rape, and any form of unwanted sexual touching or sexual coercion. According to the Centers for Disease Control and Prevention (CDC), one in three women and one in four men will experience sexual violence that includes unwanted physical contact at some point in their lives that can result in sexual trauma.
1 in 3 women and 1 in 4 men will experience sexual violence. -CDC
Sexual trauma refers to the physical and psychological challenges endured by the survivor of sexual assault. It is important to note that “trauma” is not what happened to you, rather it is how your body responds to the experience.
The trauma of a sexual assault can lead to feelings of fear, anger, guilt, shame, intense anxiety, and depression. In addition, people who have experienced sexual assault have an increased likelihood of developing post-traumatic stress disorder.
"Survivors of sexual assault can experience freezing, avoidance, hyper-vigilance, and flashbacks or intrusive thoughts as well as other symptoms as a result of the assault." — MICHELLE MAYS, LPC, AUTHOR OF "THE BETRAYAL BIND
Symptoms of PTSD can be life-altering and may include:
Insomnia
Fatigue
Headaches
Muscle and body aches
Nightmares
Flashbacks
Panic attacks
People who have lived through sexual assault and have sexual trauma and PTSD may also experience:
Intrusive thoughts: Repeated, unwanted memories of the event, recurrent nightmares, visualizations, and flashbacks.
Avoidance: Staying away from any reminders of the trauma that may include places, people, objects, situations, media, and more. Avoiding conversations and even any emotions that may arise. (emotional avoidance)
“Unlike other forms of psychological disorders, the core issue in trauma is reality.” ― Bessel A. van der Kolk, Traumatic Stress: The Effects of Overwhelming Experience on Mind, Body, and Society
Increased arousal: Trouble falling or staying asleep, feeling “on edge” or being easily startled or fearful, trouble concentrating, and hypervigilance to surroundings, and potential threats to safety. This can also include “hypersexualizing” which is an increase in sexuality to appease nervous system dysregulation.
Changes in thoughts and feelings: Distorted beliefs about oneself or others; recurrent feelings of fear, horror, anger, guilt, shame, or hopelessness; loss of interest in once enjoyable activities; feeling detached from others or struggling to maintain close relationships; and difficulty experiencing positive feelings like joy or satisfaction.
Dysregulation of the nervous system may look and feel different for everyone. If you are experiencing some of these symptoms and wonder if you may have PTSD from a traumatic experience, please consider talking to a healthcare professional about the appropriate next steps in your healing journey. As mentioned above, The National Sexual Assault Hotline is an excellent resource.
Sexual Assault and Lupus
Sexual Assault and the trauma it can cause not only can take a toll on someone's behavioral health, but the stress can induce several physical conditions, including lupus.
According to a study by Harvard T.H. Chan School of Public Health and Brigham and Women’s Hospital researchers, the stress that is associated with this type of trauma boosts the odds of women developing lupus, contrasted with women who had not experienced trauma. Women with PTSD were found to have nearly triple the risk of having lupus. Women who had been exposed to trauma, but did not have PTSD symptoms, had more than double the risk.
Another study, that was published on September 20, 2017, in Arthritis & Rheumatology said this:
“There is a lot of research showing that mental health, stress, and trauma affect physical health and serious physical illnesses, like lupus,” lead author Andrea Roberts, a research scientist in the Department of Environmental Health, said in a September 20, 2017 New York Times article.
“Things going on in our minds really affect our physical health.”
These studies are but a small sampling of the growing evidence that psychosocial trauma, like sexual trauma, and its associated stress responses lead to autoimmune diseases like lupus. Unfortunately, this is prevalent in the development of pediatric lupus as well.
“In the U.S., it’s estimated that over 60,000 children are sexually abused each year. When sexual abuse or assault happens repeatedly, it can lead to complex trauma.” -Mayo Clinic, Lisa Speckhard Pasque, 2023
A study by the Journal of Rheumatology assessed a group of more than 67,000 women and used the Physical and Emotional Abuse Subscale of the Childhood Trauma Questionnaire to measure each person’s experience of physical and emotional abuse during childhood. Those with high levels of childhood abuse had a nearly three-fold greater risk of developing lupus than those who reported the lowest level of abuse or no abuse.
Exposure to serious stressors early in life is being shown to potentially affect immune function and promote inflammation, leading to an increased risk of developing an autoimmune disease like lupus. One of the biggest predictors of a severely dysregulated nervous system is childhood trauma. Research suggests that extreme emotional trauma and chronic emotional stress can negatively impact the nervous system and lower a person’s natural resiliency, leaving them vulnerable to physical conditions like lupus.
“It is important to both consider strategies to prevent childhood abuse and additionally, to screen our patients for experiences of childhood trauma. We should also consider evaluation and treatment for depression and PTSD, as this may reduce risk of autoimmune disease.” -Candace H. Feldman, MD, ScD, member of the Lupus Foundation of America Medical-Scientific Advisory Council and Karen H. Costenbader, MD, MPH, chair of the Council
Outcomes:
With more data pointing to the stress/trauma/lupus connection, scientists are delving into identifying biological pathways and disease mechanisms by which trauma and PTSD are associated, to hopefully provide greater insights into disease development.
Obviously, there are genetic and environmental risk factors for lupus that cannot be controlled, however, studies are needed to determine if lifestyle interventions can reduce the risk of developing autoimmune disease (like lupus) after trauma or PTSD. Even with these uncontrollable variables, people living with lupus still have the power to support their well-being in many ways.
Fortunately, there are treatments available that have been found to help with coping with a sexual assault or PTSD.
Psychotherapy
Psychotherapy has been proven effective in treating symptoms of PTSD following sexual assault.
Cognitive processing therapy (CPT) may help people confront unpleasant thoughts and flashbacks associated with the sexual assault. During CPT, a therapist will also guide them to correct any problematic or intrusive thoughts fueling their PTSD symptoms.
Eye movement desensitization and reprocessing (EMDR) therapy helps treat trauma by using rhythmic bilateral eye or hand stimulation to help reduce the emotional effects of traumatic memories. While individual responses can vary, research has found that this approach can be effective in treating PTSD. Removing the stress related to painful association with certain memories.
Prolonged-exposure therapy targets any learned behaviors people engage in or avoid in response to situations and thoughts associated with the sexual assault and associated trauma. The hope is that by confronting feared emotions, thoughts, and situations, they can learn that anxiety and fear are passengers in the car, but they have control over the wheel.
American Psychological Association. Clinical practice guideline for the treatment of PTSD.
Support Groups
Joining an online or in-person support group provides the opportunity to connect with other survivors of sexual assault and get advice on overcoming the challenges associated with that trauma. It allows a space to be seen and heard. As Ann Voskamp states, “Shame dies when stories are told in safe spaces.”
Support groups provide an excellent opportunity to develop supportive, trusting, and healthy relationships with other people with a shared experience. There is something profound about collective grief…we are wired for community, and the listening and sharing of life stories is healing and powerful.
Your primary care physician or mental health professional is often the best place to start when searching for a local support group.
“Anything that’s human is mentionable, and anything that is mentionable can be more manageable. When we can talk about our feelings, they become less overwhelming, less upsetting, and less scary. The people we trust with that important talk can help us know that we are not alone.” -Fred Rogers
Self-Help
In addition to talking to a therapist and/or joining a support group, there are some lifestyle changes and coping techniques you can do on your own to calm your body and mind and manage your symptoms.
Find "Your People.” Spend time with supportive loved ones. Go for a walk, grab a coffee, or talk on the phone.
Practice relaxation strategies. Find time for meditation, yoga, or prayer.
Get some fresh air. Getting out into nature and moving your body can help regulate your mood and emotions.
Keep a journal. A journal can offer a consistent place to write and process your feelings and experiences.
Go have fun in a group! Go to a concert, comedy show, dance class, or church! *Back in the early 1900’s a sociologist named Émile Durkheim first developed the term “collective effervescence” after witnessing what he described as a magical presence that he observed during religious ceremonies. He investigated this scene of connection, communal emotion, and “sensation of sacredness” that seemed to happen when people were engaging in something bigger than themselves. His evaluations concluded that these experiences of “community” would shift one's focus from self to group.
Medications
Diving into your past can be difficult and depressing. Medications — such as antidepressants to help anxiety or depression, or mood stabilizers for those who have trouble regulating their emotions — can help lay the groundwork for therapy or work alongside therapy.
Closing
Whether it is a “top-down” approach focusing on a person's thinking, beliefs, and behaviors to create change, like cognitive Behavioral Therapy, or a “bottom-up” approach focusing on releasing the trauma a person holds in their body like EMDR, there are many ways to carefully process trauma associated with sexual assault.
Healing from sexual trauma is a gradual ongoing process that involves coping with the symptoms, restoring the body's balance, and reclaiming one's self-love and desires for intimacy and passions.
And if this is something that happened to you…
It does NOT define you. You are NOT what was done to you.
“Blessed are you who come with your sorrow, allowing your pain to convey all its truth.
Here is where grief is understood at its core, where the dark shadow of betrayal is seen from the inside.
Here, my dear, is where the work of healing begins.
Blessed are you who mourn as you meet yourself once again, as a little child who needed protection but did not receive it, who deserved respect but was not afforded it.
The things that should have happened but didn’t and the thing that happened but shouldn’t.
The broken family systems and normalized cruelties that allowed your pain to continue far beyond what it should have.
For you have come back now to the God who is alive, to your past, your present, and to your future, who has already moved heaven and earth to restore your dignity and return you to yourself.
And P.S. Take a minute to remind your past self that you are loved now. Tomorrow and forever. And rest. You are safe. You are loved. You are held.”
-Kate Bowler, A blessing for if you’ve had a painful childhood
Written By:
Kelli (Casas) Roseta
**All resources provided by this blog are for informational purposes only, not to replace the advice of a medical professional. Kelli encourages you to always contact your medical provider with any specific questions or concerns regarding your illness. All intellectual property and content on this site and in this blog is owned by morethanlupus.com. This includes materials protected by copyright, trademark, or patent laws. Copyright, More Than Lupus 2024.
April 2024
Sources:
Association of Trauma and Posttraumatic Stress Disorder With
Incident Systemic Lupus Erythematosus in a Longitudinal, 2017, American College of Rheumatology Andrea L. Roberts,1 Susan Malspeis,2 Laura D. Kubzansky,1 Candace H. Feldman,2
Shun-Chiao Chang,3 Karestan C. Koenen,4 and Karen H. Costenbader2
Dworkin ER, Menon SV, Bystrynski J, Allen NE. Sexual assault victimization and psychopathology: A review and meta-analysis. Clin Psychol Rev. 2017;56:65-81. doi:10.1016/j.cpr.2017.06.002
American Psychological Association. Clinical practice guideline for the treatment of PTSD.
Elbers, J., & Batista, B. (2018). Nervous system dysregulation and its association with traumatic events. Pediatrics, 141(1), doi.org/10.1542/peds.141.1MA4.305
van der Kolk, B. A. (2014). The body keeps the score: Brain, mind, and body in the healing of trauma. Viking.
Walker, P. (2014). Complex PTSD: From surviving to thriving. Azure Coyote: Lafayette.