I’m not going to mince words here or pretend this post is easy.

This post is not going to be easy on anyone – especially you or me or my psyche.

I am going to spend this post talking about the fucking horrible responses which show up after experiencing sexual abuse and how sexual abuse is a big fucking issue.

Very common reactions/responses to sexual abuse:

• Postpartum Psychosis/Depression
• Pre Menstrual Dysphoric Disorder (PMDD)
• Resurgence/Presence of a Pyschotic Break
• PTSD or C-PTSD
• Dissociative Identity Disorder (DID)
• Psychotic Depression (not the same as Bipolar, and often is diagnosed the same – in females, of course, because males aren’t viewed as hysterical by doctors)
• Resurgence/Presence of Schizoaffective Behaviors (would have be there before the trauma or else this is not validated by research as a result of a trauma)

I could list a shit ton more, and I really want to.

I’ll at least caveat this list of potential responses by mentioning that a lot of them overlap (making differential diagnostics a bitch), and that many of them often would not be present without the aforementioned traumatic event. In the case of having a psychiatric diagnosis before the abuse, it is considered a risk factor for (more) severe symptoms.

These are symptoms/reactions on a more severe side. That’s fair to note.

But honestly, any experience of sexual abuse is so overwhelming, it isn’t too shocking that the common responses are of a clinically severe level, at least diagnostically.

So let’s get one thing clear: sexual abuse is any abuse where there was anything of a sexual nature involved. This includes rape, forced pregnancy/delivery, drugs forced onto someone during pregnancy, forced miscarriage, abuse after miscarriage/delivery, and spans into and covers so much more and many more horrific examples.

I will talk about (mainly…) those five (5) subsets of abuse for the sake of length.

After a person experiences being raped, the trauma is horrific.

Not only is there the trauma of not feeling safe, but now there is also the overbearing fucking issue of depression and anxiety and PTSD through the roof. Rape is not a joke and the fact that literal doctors often refuse to see that rape causes PTSD is atrocious.

On a purely diagnostic level this is offensive. I don’t fucking care that PTSD is an infrequent diagnosis for distress of being raped. Sure, the person who was raped ideally doesn’t have any predisposed conditions putting them at a higher risk for PTSD. That’s great. Let’s service 95% of cases and have 5% who are misdiagnosed and now worse off. Great.

There’s enough distress and trauma from the event itself.

Getting validated that rape is traumatic doesn’t happen often. Most literal fucking medical doctors are quicker to diagnose symptoms of trauma without considering the trauma itself as a diagnostically relevant piece of information. Why? Well, why not, I guess?!?!

It’s so complicated to obtain help for this sexual trauma, because there’s further medical trauma as a result of doctors seeing symptoms and being female as indicative of a diagnostically irrelevant or wrong disorder and not PTSD (or one of many other appropriate disorders). The number of femmes whose PTSD is called “bipolar one” or “BPD” or even “schizoaffective disorder not otherwise specified”??? Fucking gross. Disgusting.

Why??? Why such a clinically wrong diagnosis?

Well, I’d goddamn fucking love to tell you the shitty rationale of this.

So let’s have at it… it’s a fucking wild ride.

So back in around the 40s and 50s, we were coming off the tail end of lobotomies as the frontline treatment for SMI cases (namely where the illness is chronic – a fucking antiquated term, but I digress). This coalesced with the beginnings of treating women for hysteria, which, to this day, is the worst mischaracterization of whatever LIST of diagnoses this encompassed.

Females were often overmedicated and forced into confinement in commonly accepted treatment of hysteria. This lasted for decades. Women (because men got real diagnoses – thank you DSM based on white men) diagnosed with hysteria were often asked to isolate and leave people alone. Another treatment somewhere in this was punishment.

Overmedication led to lots of women being unable to function. This could be seen in the negative effects of medication, where often women would get medication for symptoms that were results of overmedication prescriptions. The goal was often just to calm down the woman until she was ready to be better. (The Yellow Wallpaper explains this idea.)

Somewhere in the 70s Marsha Linnehan (a queen of self-advocacy and creating a way to solve the wrongs of medicine) created DBT as a treatment for people whose problems and presenting issue were previously under hysteria. It was part of her story; she was stuck in a medical system that promoted treating women for hysteria when the diagnosis became more severe than the provider already knew how to treat properly.

This idea looks different today and sometimes creates similar issues found when treating hysteria. Many doctors, knowing a client needs help, want to give as accurate of a diagnosis as possible. It’s hard to challenge when medical treatment seems to be working but may be just treating symptoms of medical treatment from a misdiagnosis.

When there are issues leading to a misdiagnosis, what can happen is a similar stream of overmedication, improper medication, overmedication to treat side effects, and over and over until the person ends up feeling numb and out of touch. There’s only so much that can be accomplished with treatment under these conditions and understood methods.

Modern contexts do encourage overdiagnosis (a diagnosis whose treatment will cover both in crisis contexts). That may be useful in a model of someone who is in crisis, and, also, someone not in crisis may be getting frequently overmedicated as a result. Many contexts of treatment, though, do discourage undermedicating clients.

The model of treating disorders (and especially in femmes) is to allow for a diagnostic label that allows medications to be prescribed if needed. The issue with this is now that people with diagnoses of behavioral responses to PTSD without a diagnosis of PTSD anywhere on their chart or medical record have a hard time with recieving proper medical instruction on when/how/if to take specific medications for their symptoms.

The goal of a diagnosis is sometimes to allow insurance companies less chances to reject covering your treatment. The reason people get misdiagnosed as their crisis symptoms is because part of the culture within mental health is that you shouldn’t need help unless you are in crisis. It can be really complicated in an environment where people are in not typically in crisis upon first meeting you to know when the whole story of someone in crisis is there for you or not. The model however leads to wanting to validate diagnoses and this often is where overmedication cycles of influence begin.

After a person experiences a forced pregnancy/delivery, the trauma is horrific.

Firstly, the trauma surrounding having a forced lack of bodily autonomy is shitty. Then there’s the goddamn dilemma that not only are you forced into a pregnancy, but now, you can be forced to have a literal human being who reminds you of your trauma.

No, I don’t care if that’s not a thing we say.

It’s not fair to be forced to have a child.

It’s not fair to the child to grow up that way.

When you are forced into a pregnancy (that maybe you didn’t want), that’s a whole gross level of physical and sexual abuse that is inherently the most criminal (in an objective sense, not in a sense that it’ll be prosecuted).

And yes, yes, I consider the moral dilemma wherein for some reason a religious community imposes “life begins at conception” as a medical reason to keep a pregnancy which undoubtedly harms the mother to insane extremes (understatement, to be fair).

There’s a separate place where I would place my information dump on how “the right to choose” includes the freedom to birth, rather than encourage abortions. Yet, many pregnancies are overly influenced by community members and family members who have almost zero stake in the eventual outcome.

So, just imagine: you have a forced pregnancy, and then you get shamed regardless of if you keep it or not. (Because G-d forbid men are held accountable for their actions.)

After a person experiences drugs being forced onto them during pregnancy, the trauma is horrific.

AND may the abuser burn in a firey pit of all the bad things if this somehow turns into the birth of a child who has a diagnosis matching the drug usage in question. The trauma from that component alone creates even more of the most severe responses.

The goddamn trauma of being forced to use substances while pregnant (and goddamn, I do not mean medical prescriptions), and especially if the pregnancy was forced or the result of rape (forced conception), then fuck – you deserve all the PTSD treatment.

So, we’ve got the one end of extremes where the drugs contribute to FAS (fetal alcohol syndrome/chemical dependency) and likewise conditions. The other end is the kiddo ends up stillborn. Somewhere dead center is a healthy-ish baby. Honestly, to pretend there is no impact is assuming there was the equivalent of one dose of something at a negligable amount, to the point it doesn’t even totally fall under this.

After a person experiences a forced miscarriage, the trauma is horrific.

Forced miscarriage is a horrendous trauma. I cannot express enough how much this needs to be treated as a crime against humanity. This can be in forcing someone to have an abortion or – the most horrendous pathway – using physical abuse to create one. (NOT an exhaustive list, just two disparate points of abuse and violence people experience.)

As well, miscarriages that happen naturally are already traumatic. Adding an element of being forced into one makes the trauma just that much more likely to break someone.

There’s now the absurd addition of victim blaming someone for this, which is completely bonkers mcgee, because the chance that anyone would actively select miscarriage by force/abuse/harm/torture/torment is (we hope) near zero.

Better yet, these are people who are told “you have adjustment disorder, because no one could really force a miscarriage; you’re exaggerating”…. (?????)

After a person experiences abuse after miscarriage/delivery, the trauma is horrific.

Fucking goddamn. This is just adding fucking insult to injury.

First, there’s the traumatic experience of a miscarriage.

So, I mean, after that is basically the insanity of explaining that you could (incredibly commonly) be experiencing postpartum psychosis. Not to forget the liklihood of peripartum pyschosis in the same subset of people, which means you – surpise – get the glory of double psychosis (not a term, just real talk verbiage).

After surviving all of these methods of abuse, I am exhausted and drained.

All of these were not fun and not worth the C-PTSD diagnosis. Having survived all of these means being given a mental health crisis intervention in the form of a souped up bogus court charge. We love when courts think forced mental health care works.

I’ll make a rant later about how forced treatment should never come at the expense of someone’s future or life endeavors. That’s not a win. That’s completely unethical.

But now? Now I feel better that it was at least not the worst experience in my life. Definitely the events leading up to it that I survived were way worse. And thankfully (although not always grateful for it) I survived to tell the tale and share resources.

May your journey to safety continue (or become) better than mine was.

XOXO,

Dorothy B