1. The Acute Phase The acute phase starts during the assault and may last for several weeks. During the Acute Phase, the most common feeling is a heightened sense of fear: fear of the rapist returning, fear of men, fear of being alone, fear of the dark. Specific fears related to the assault may develop. For instance, someone assaulted in their bedroom may fear sleeping in bedrooms. The survivor may also be feeling guilty, ashamed, embarrassed, confused and angry. These are common reactions. Other feelings during this time may include:

• sorrow
• confusion/bewilderment
• shock
• dulled senses
• anxiety
• numbness/diminished alertness
• short term memory loss
• disorganized thoughts
• detachment/dissociation

Not everyone exhibits outward signs of their pain and trauma. Some survivors may appear unaffected by the assault. 2. The Outward Adjustment Phase The Outward Adjustment phase can last from several weeks to several years. During this time, the survivor may feel depressed and experience a general sense of loss. Former feelings of well being, security, and control over life have been taken away from her by the assault. She may deny that the rape has affected her and will assure everyone that she is fine. She may stuff her feelings to avoid pain or due to a belief that people are tired of hearing about the assault or her feelings. The survivor may withdraw from social relationships or personal interactions with friends and relatives. She may spend all her waking hours distracting herself from feeling or thinking. During this time, the survivor may change eating and sleeping patterns and may experience a lot of anger. Other feelings or symptoms associated with this phase may be:

• Continued anxiety
• Sense of helplessness
• Persistent fear
• Depression
• Mood swings from relatively happy to depression or anger
• Sleeping all of the time
• Vivid dreams, recurrent nightmares, insomnia, wakefulness
• Physiological reactions such as tension, headaches, fatigue, general feeling of soreness or localized pain in chest, throat, arms or legs
• Pain in the area(s) of the assault (mouth, throat, vagina or anus)
• Appetite disturbances such as nausea, vomiting, not eating, overeating
• Denial, this is a time when there are efforts to repress thoughts of the assault from the mind or consciousness.

It is common for a sexual assault to disrupt the survivor’s typical routine. Most people continue to work or go to school, but may be unable to do more than what is essential. Others may work all the time or volunteer for every activity or assignment possible in order to block the memories of the assault. Some survivors quit all activities and stay at home, only venturing out if accompanied by someone else. Sexual assault is usually a life-altering experience. Some of these changes may be:

• Personal sense of security and/or safety may be damaged
• Increased distrust of existing relationships and/or hesitation to initiate new ones
• Sexual relationships may suffer (Some women report that they were unable to reestablish their typical sexual patterns after the assault because of inhibited sexual response and flashbacks of the rape during intercourse.)
• Self-imposed restrictions on life/activities that interfere or interrupt the lifestyle they had before the assault, as the world is now perceived as more threatening
• Phobias or excessive fears such as fear of crowds, being alone, of the dark, of sleeping
• Specific fears related to the characteristics of the assailant, such as a moustache, curly hair, the smell of alcohol or cigarettes, type of clothing or car
• Distrust of all men, or strangers, or of everyone

3. The Integration Phase During this stage, the survivor integrates the assault into her life so that the incident is no longer the daily central focus. Survivors are now able to go through their daily activities without having constant memories or feeling that the assault is at the forefront of their mind. Feelings and behavior changes identified in the earlier stages may also be identified in this stage, although not as strong or as often. Survivors do not progress through these stages as if they are steps. Instead, it is a process the included being in all three stages at different times, depending on many factors such as the individual’s lifestyle, stressors, support systems, coping skills, and how often the survivor may be triggered. During the integration stage, the survivor is also dealing with any harmful effects of coping strategies adopted in earlier stages. For example, if she self-medicated through the daily use of sleeping pills, at this time she will also deal with how to sleep or relax without those aids. Part of the aftermath for sufferers of PTSD is being “triggered” by sensory stimuli or feelings into reliving the traumatic event. They may also experience “flashbacks” of visual memories (like watching a movie) of the event in their mind; and may feel the exact same level of fear or terror while reliving the event. There is no time line for healing; no “right” way or one way to process the trauma. The descriptions of the stages of Rape Trauma Syndrome serve as a loose guideline for survivors in the aftermath of a sexual assault. Memories of the assault will always cause pain; it is not something the survivor “gets over.” In time the pain subsides. This process is similar to the way people cope with the death of a loved one or other losses.