PTSD after sexual assault or rape: symptoms, treatment and support in the UK

Sexual assault is any sexual act that a person did not consent to or was forced into against their will; the NHS says it includes rape and other offences such as groping, forced kissing and child sexual abuse, and that it can happen to anyone of any age. It also notes that most assaults are carried out by someone known to the person, and that not having visible injuries is not uncommon.

PTSD is a mental health condition caused by very stressful, frightening or distressing events; the NHS lists physical or sexual assault among its causes. PTSD UK, a charity, says one major factor in developing PTSD after sexual assault is the feeling of shame and guilt, and that risk factors include thinking your life was in danger during the assault, not having a support network and a history of depression or anxiety.

Not everyone who is assaulted develops PTSD. Many people have distressing reactions in the first weeks that ease with time and support. The diagnosis is considered when the symptoms persist, cause significant distress or interfere with daily life.

The NHS describes the main symptom of PTSD as repeated distressing thoughts about the traumatic event, which may be flashbacks, vivid intrusive images or thoughts, and recurring dreams or nightmares. Other symptoms in adults include the following.

• Avoiding people or places that remind you of the event.

• Not being able to fully remember what happened.

• Negative thoughts about yourself, and losing interest in things you used to enjoy.

• Problems in relationships, and feeling disconnected from yourself and the world (dissociation).

• Difficulty controlling feelings, low mood, irritability or anger.

• Difficulty sleeping, and feeling very anxious and always looking for danger (hypervigilance).

• Headaches, tummy problems or pain with no physical cause.

The NHS advises seeing a GP if you think you have symptoms of PTSD, or if you have been diagnosed and treatments are not helping. You can also self-refer to NHS talking therapies for anxiety and depression if you are 18 or over (or 16 or over in some areas) without a GP referral.

If you have just been assaulted, the NHS says you should get medical help for any injuries and because you may be at risk of pregnancy or sexually transmitted infections. If you are in immediate danger, call 999. If you are having thoughts of suicide, tell someone, call the Samaritans free 24-hour support service, go to A&E or contact NHS 111.

The NHS says sexual assault referral centres (SARCs) are located across the country and are available for everyone regardless of gender, age, the type of incident or when it happened. They offer crisis care, medical and forensic examinations and emergency contraception, and can arrange access to an independent sexual violence advisor and referrals to mental health support. A forensic examination is your choice, and you can decide at any stage.

The NHS also lists a GP surgery, sexual health clinics, NHS 111, and voluntary organisations such as Rape Crisis, Women's Aid, Victim Support, The Survivors Trust and the Male Survivors Partnership. The NHS says the Rape Crisis England and Wales support line is free and open 24 hours a day, every day of the year, with online chat. These services are confidential and do not require you to report to the police.

A GP will ask about your symptoms and refer you to a mental health specialist such as an NHS talking therapies service or a psychiatrist, who will ask about mood, behaviour, health and family history. NICE says clinicians should ask specific questions about re-experiencing, avoidance, hyperarousal, dissociation and negative changes in mood and thinking, and should be aware that people with PTSD may be apprehensive, anxious or ashamed, may avoid treatment or have difficulty developing trust.

You do not need to describe the assault in detail to a GP to be referred. It is enough to say that you have experienced a trauma and that you are struggling with the effects. NICE also notes that traumatic events may have occurred many months or years before, so it is never too late to seek help.

The NHS says PTSD usually gets better for most people, and that treatments include trauma therapy such as trauma-focused CBT, eye movement desensitisation and reprocessing (EMDR) and medicines, usually an antidepressant. NICE recommends that adults with PTSD or clinically important symptoms who present more than a month after a traumatic event are offered an individual trauma-focused CBT intervention, such as cognitive processing therapy, cognitive therapy for PTSD, narrative exposure therapy or prolonged exposure therapy.

NICE says these interventions should typically be provided over 8 to 12 sessions, but more if clinically indicated, delivered by trained practitioners with ongoing supervision, and should include education about reactions to trauma, strategies for managing arousal and flashbacks, safety planning and processing of trauma-related emotions including shame, guilt and anger. It recommends offering EMDR to adults presenting more than 3 months after a non-combat-related trauma, over typically 8 to 12 sessions.

For children and young people, NICE recommends individual trauma-focused CBT adapted to age and development, involving parents or carers where appropriate.

The NHS suggests talking to someone you trust or joining a support group, keeping a diary to spot triggers for flashbacks, breathing exercises, staying active, eating regularly, trying to get enough sleep and avoiding recreational drugs and too much alcohol. A therapist can teach grounding techniques for flashbacks.

Recovery is rarely a straight line. Anniversaries, news stories, medical examinations and intimate relationships can bring symptoms back. This does not mean therapy has failed, and NICE says treatment plans can include booster sessions around significant dates. Friends and family can help by believing the person, not pressing for details and being patient with changes in mood or closeness.

SARCs, NHS talking therapies and community mental health services are free through the NHS, and voluntary organisations are free and confidential. Waiting times for specialist trauma therapy vary between areas. Private therapists can offer trauma-focused CBT or EMDR, and it is worth checking that they are registered with a professional body and have specific training in trauma work, since the NICE guideline stresses trained and supervised practitioners.