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Panic attacks and anxiety

A common issue for people who have experienced sexual abuse is intense anxiety and panic attacks. This can take the form of distressing physiological symptoms (difficulty breathing, or shaking, or tightness in the chest), coupled with thoughts that prompt dread or fear (being convinced that something bad will happen).

The combination of physical and psychological aspects can lead to a kind of vicious cycle which can be debilitating. People find themselves worrying that they are going to have more panic attacks, which can prompt more anxiety, and so on. People often say it feels like they are ‘going crazy’.

Some tips for dealing with panic attacks…

  • Learn the signs of your panic attacks.
  • When you notice the signs, say to yourself ‘I know what is happening, it’s just a panic attack’.
  • Remind yourself that you have gotten through this before and you will get through this.
  • Use your sense of touch – deliberately pay attention to the feel and texture of your chair or clothing.
  • Get yourself a glass of water if you can (don’t ask someone else to get it for you).

You can also try some of the tips for dealing with flashbacks and nightmares. Again, when you are in a quiet, safe place, you might like to try and work out the triggers.

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In some ways, nightmares can be like flashbacks you have when you are asleep. They might be very clear reminders of the abuse that you experienced, and can have the same unsettling, confusing and distressing after-effects as flashbacks. However, while flashbacks are usually recognisable memories of actual events, the content of nightmares can be less concrete.

Nightmares might also be of things that represent the abuse or trauma in some way. It might not always be clear exactly what they mean. They might seem very odd or bizarre, yet leave you with a definite sense of being afraid, scared, alone or disorientated. They might also trigger feelings of shame or anger associated with the abuse.

Similarly to flashbacks, nightmares can seem to come from ‘out of the blue’, and leave you feeling out of control.

As well as the emotional and psychological aspects of nightmares, they can also have physiological effects (sweating, increased heart-rate, breathing troubles). If nightmares happen regularly, they can also bring about anxiety about sleeping.

The same ideas that can help deal with flashbacks are also useful for nightmares. Again, there are 2 parts of this. First is the immediate work of calming or grounding yourself just after a nightmare; and second, you may like to explore their meaning in more depth.

Check out the next section which describes an exercise that can help to deal with persistent nightmares.

What can I do about nightmares

If, in the morning, you can put aside the nightmare and concentrate on getting on and doing what it is important to you, then do. If, however, a nightmare persists or becomes particularly disruptive you might try the following exercise.

  1. Pick an unpleasant dream/nightmare, one that is not a direct replay or a re- enactment of a distressing event and write it down.
  2. Write the unpleasant dream down in as much detail as you can. Only in this telling of the dream change the ending so that it suits you. Remember it is your choice to do this and that you can stop writing or thinking about the dream and do something else any time you want.
  3. Now, get to know this new preferred version of the dream, rehearse it each night for about 5-15 minutes prior to going to sleep.
  4. Once you have rehearsed the dream, perform a relaxation exercise, one that you are familiar with and helps you to fall asleep peacefully. If you wake up, it can be useful to repeat this relaxation exercise, breathing deeply and slowly.
  5. When you are satisfied that you have re-storied the unpleasant dream to better suit you, you can choose to work on another nightmare that is slightly more intense than the last. Make sure that this process is a gradual increase in intensity and do not work with more than 2 nightmares in one week. Also take care of yourself; you do not have to over describe the upsetting content within the dream.
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Many men who have been subjected to sexual abuse experience flashbacks. Flashbacks are memories or fragments of memories from recent or past events. They can be jarring, painful and intrusive. Flashbacks can last a few brief seconds or be very drawn out and detailed.

Flashbacks can be visual, auditory (sounds), emotional, physiological, and/or sensory (smells, tastes, touch).

One of the most confusing things about flashbacks is that they can seem like you are right back in the situation. If the flashback is related to times when someone was doing something sexually abusive to you, this can be extremely distressing.

Flashbacks are often triggered by things or events in the present. Triggers can be very specific, like a certain smell or sound, or general, like some kind of personal crisis.

Although flashbacks can be very unwelcome and distressing, sometimes they can contain information and feelings that fill in gaps in your memory. Some men have said they provided the ‘piece in the jigsaw’ that helped them make better sense of what happened, especially if their memory is foggy or unclear.

It can be a good idea to find a counsellor to help you work out how these memories ‘fit’ or ‘don’t fit’ into place.

Tips for dealing with flashbacks

When the flashback happens…

Try to bring yourself back to the ‘here and now’. Deliberately and slowly notice what you can see, hear, and touch where you are right now. Touch your chair or the fabric of your clothes, and describe the texture to yourself (rough, smooth, etc).

Focus on your breathing. Deliberately slow down your breathing in and out. Count to 5 while breathing out. Try to breathe deep into your diaphragm.

Remind yourself that you are not back where the original event happened, but here in this place, in this time. Some people find it useful to ground themselves by touching their watch, wrist band or a piece of jewellery that they have now, but did not wear back then.

Asking yourself these questions can help bring you back to here and now:

  • How old am I now?
  • Where do I live/work now?
  • What options do I have now that I didn’t have then?
  • How am I different now from back then?
  • Who can I ask for support and encouragement?
  • How do I like to spend my time?
  • Where do I want to put my energy now?
  • After the flashback has passed…

Be kind to yourself

After experiencing a flashback you might want to rest or distract yourself for a while, have a sleep, a warm drink, relax and listen to some music, watch TV, play a computer game, do some gardening or just take some quiet time for you. Words of support and encouragement to yourself are more likely to help you deal with flashbacks than questioning and evaluating yourself.

Try and work out the triggers. Choose a time when you are feeling safe and steady, and think about your last flashback:

  • What was happening when the memory appeared?
  • Where were you?
  • Who was around?
  • What were you feeling/thinking, smelling/hearing/seeing/sensing?
  • Does this relate to an event in your past?

If you can identify the triggers, your reactions begin to make more sense and become less confusing. You might still get triggered by these things, but it will be easier to put them in their place, understand what is going on and put yourself back on track.

You might want to explore these questions with the help of a counsellor. It is not always helpful to explore this by yourself if you are feeling unsteady, so try not to put yourself under pressure to ‘work it out’ on your own.

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Trust, intimacy and relationships

Men who have experienced sexual abuse can face the same pressures that all men face about self-reliance, dealing with things yourself, and so on. However there may also be other struggles that are connected to sexual abuse when it comes to closeness and relationships.

Trust is often used as a tactic of abuse, especially child sexual abuse. Such a profound betrayal of trust can lead to the conclusion that trusting people or getting close is dangerous. This conclusion is not ‘wrong’, because it is a sensible conclusion to draw from your experience. While being careful and not trusting people can be important in some circumstances, it can get in the way of intimate, close relationships with people you really care for.

If you want to feel closer to the people you care for, it might take time and feel like a slow process, but it is possible. The first thing to realize is that you can’t build intimacy by yourself – it is a shared project.

Some men have said they struggle with some of the following things, related to this betrayal of their trust.

  • Reluctance to trust someone or let anyone get close.
  • Perceiving any expression of care or attention as a sign of sexual interest, or an attempt to get something from them.
  • Feeling vulnerable.
  • Wariness about sharing personal information.
  • Feeling uncomfortable with gentle touch or touch without prior specific agreement.
  • Difficulties with any sexual intimacy.

These issues can make for unsatisfying relationships for both partners. Many men feel frustrated that they just can’t seem to get close to people, including their partner.

It is important to remember that it is not trust that causes sexual abuse, but the misuse of trust. In fact, children need to trust adults in order to survive. You did not cause or deserve to be abused because you trusted someone. The abuse happened because someone abused that trust.

Intimacy means more than sexual intimacy. It is also about sharing special and important moments with close friends. Intimacy can develop through connections you make with a friend or partner; spending time, playing together, discussing ideas, including disagreeing, shared parenting experiences, supporting family members, enhancing spirituality.

This way of relating is profoundly different to abuse. The dynamic of abuse is where one person’s ideas and wishes are important and the other person’s wishes are not considered at all. Intimacy is about developing mutuality, equality and negotiation.

It can be helpful for you and your partner to talk about some of the things that bring you together, to work out what ideas you share about your relationship and what differences can be appreciated and respected, as well what areas could do with some extra work and time being put into them. You could take some quiet time to consider:

  • What kind of relationship would you like?
  • What brings you closer to people, what pushes you away?
  • Are you aware of your friends or partner’s likes or dislikes?
  • What builds connections in your relationship with them?
  • How close a relationship do you/they want?
  • What time and energy are you willing to put in to developing intimacy in this relationship?
  • How might you start to do this?
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The ‘victim-to-offender’ myth

There is a common myth that men and boys who have been sexually abused will go on to perpetrate sexual abuse. The reality is that the vast majority of boys and men who are sexually abused do not go on to commit sexual abuse. Knowing only too well the distress caused by abuse, most men who have been abused are horrified by such a suggestion. Some choose to become advocates speaking out against sexual abuse and violence.

The ‘victim to offender’ myth itself impacts men’s lives. The idea he is ‘infected’ or ‘contaminated’ can lead to fears of harming children, despite having no conscious intention or thoughts of doing so (this is sometimes referred to as the myth of the ‘vampires bite’). This leads some men go to great lengths to limit interactions with children or avoid relationships.

The fear that others will see him as a potential ‘abuser’ is a major obstacle to men telling anyone about the sexual abuse they suffered.

If at the time of being abused, a child acted sexually with other children or was pressured to do sexual things to other children, it can add to these worries about ‘becoming an abuser’. It is important to remember that the ‘reactive’, coerced behaviours of a traumatized child are very different to an adult making a conscious decision to commit abuse.

If anyone (whether they were abused or not) is having sexualized fantasies about a child, or worried they will hurt someone, they should speak with a qualified counselor or health professional as soon as possible.

There is a more detailed discussion of the victim-to-offender issue on the Living Well website.

Questions to consider:

  • How has fear of abusing affected the way you relate to children in your life?
  • How has it affected your relationship with other people you are close to?
  • How are you different from the person/s who sexually abused you?
  • If you worry about the possibility of children being abused, and take steps to protect children, what does that say about your intentions and the kind of person you are trying to be?
  • How do you act in ways that promote greater safety, care and support for children?
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Separating sexuality from sexual abuse

Homophobia and confusion regarding sexuality can cause extra distress and stop men speaking about being sexually abused.

If a man was sexually abused by a man, he can worry that people will think he is gay and discriminate against him, or that gay sexuality is abusive. If he is gay he might worry that people will think he deserved it or that being assaulted caused him to become gay. If he was abused by a woman he might worry that people will not take his complaints seriously, and that he should be okay about it.

Sexual assault is an abusive act of power, not a question of sexuality or masculinity. Sexual abuse is not caused by the sexuality or any other characteristic of the person being abused – just as being the victim of robbery is not caused by ‘psychological issues with money’. Like any other act of violence, sexual abuse is caused by the decisions and actions of the person committing the violence.

Given societal homophobia and widespread confusion around questions of sexuality, it can be worth taking some time to consider and think through your sexual preferences and choices. You might talk with a partner or qualified counsellor/therapist and identify how you most like to express affection and your sexual energy in enjoyable ways in the present.

It can be useful to consider:

  • Is it possible to separate out sexual activity or thoughts that feel compulsive – that you feel compelled to think about or do – from those that you freely choose to engage in? What differences do you notice?
  • What does ‘healthy sexuality’ mean to you?
  • What ways of relating with your sexual partner(s) fit with the kind of person you want to be?
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Physiological reactions and sexuality

If at the time of the assault a man developed an erection or became aroused in some way, this can make him even more reluctant to speak about sexual abuse.

These physical responses do not mean that a man wanted to be sexually abused in any way. Some people who sexually abuse others will deliberately manipulate the boy or man to develop an erection, then use this as false evidence to say the abuse was ‘wanted’.

We cannot always control how our body reacts, especially in stressful situations. A boy or man might develop an erection as an unwanted response to fear or physical stimulation. These physiological responses do not say anything about his desire or sexuality.

Physical arousal can cause a great deal of confusion for men. Some men feel aroused when they recall the abuse and worry about what this means.

It is an unfortunate reality that an experience of sexual abuse can influence sexual intimacy. It can both make men hyper interested in sex or particular sexual acts, and also make them feel overwhelmed or uncomfortable about sexual contact with a partner, whereby they start to avoid sex and isolate themselves.

If sexual thoughts, reactions or difficulties are distressing or bothering you, it is a good idea to find a trained counsellor who understands sexual assault and sexuality to help you make sense of this.

Be kind to yourself. As a result of an unhelpful mix of societal messages about masculinity and sex, men can experience a profound sense of failure and despair in relation to sexual problems, or when the reality does not match the (often unrealistic) expectation.

Because sexual arousal and release is an extremely effective way of achieving short-term relief from distressing feelings, men can find themselves engaging in forms of sexual activity that ultimately leave them feeling worse. Sometimes it is helpful to simply take a break, to focus on other forms of sharing and intimacy.

If you have a partner, remember that working through these issues is also difficult for them. Open, honest communication about your feelings, worries, preferences and pleasures is important.

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Clergy abuse – Spiritual and religious beliefs

Sexual abuse by clergy and members of faith communities and the failures of religious organisations to report criminal offences or deal with allegations in appropriate, just or healing ways, has had a profound impact on individuals, families and communities.

The Royal Commission into Institutional Responses to Child Sexual Abuse clearly details the profound impact of institutional clergy abuse and the barriers and difficulties that confront those who have been victimised.

Spiritual and religious beliefs and practices, and being part of a faith community, can offer many people a sense of purpose and belonging in their lives, as well as valuable support and encouragement during tough times. However, sexual abuse committed within religious communities can shatter a person’s faith, trust and belief, resulting in some people breaking away from a particular church, group, or organised religion.

Those sexually abused within religious contexts experience particular difficulties. Some boys and men do not tell of sexual abuse out of concern it will distress religious family members. The shame and guilt associated with same sex sexual contact and threat of disconnection from faith community can be used by those perpetrating abuse to maintain silence.

A number of religions promote ‘forgiveness’ as a pathway towards healing. For some, offering ‘forgiveness’ can be personally empowering, whereas, for others offering ‘forgiveness’ to those who sexually abuse is insulting and unthinkable.

Faith, religion and spirituality can be a personal journey of discovery. For those who are interested, it can be useful to seek out someone who will support you, without pressure, to explore how you might choose to incorporate faith and spiritual practices into your life.

Questions to consider:

  • Have you experienced pressures to ‘forgive’ the person or people that abused you?
  • What sorts of reasons have you heard about why you ‘should’ forgive?
  • Do these ideas fit with your own ideas about your own sense of well-being?
  • Are there aspects of spiritual practices or beliefs that continue to be important to you now?
  • What has helped you to remain connected to these beliefs or practices?
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Tactics of abuse

A useful ‘anti-shame’ exercise is to examine the tactics used by those who abuse.

While this can be very confronting, it can help to get clear about just where the responsibility for the abuse lies and where the shame properly belongs. This can be particularly helpful for men who were abused as boys or teenagers; it can also be helpful for men sexually assaulted as adults.

The tactics of abuse are the things the person(s) abusing did, or said, or threatened to do, to commit the abuse and to try and keep it secret. They might have included ‘tricks’ or ‘special gifts’ to get you thinking that you were somehow to blame or at fault.

Sometimes the tactics of abuse can only be seen for what they are when you look back at them. For example, it is easy for an adult to convince a child that the child will get in trouble if anyone finds out. Of course as an adult we can see that this is a tactic and not the truth; but a child has no way of knowing that.

In looking back and reviewing what happened be careful not to use the knowledge you have now to judge your decisions and action back then. Take time to remember the context, how old you were, your physical size or maturity, what information you had or didn’t have about sex, what support was available?

When reviewing tactics of abuse, take care to adopt a compassionate, understanding attitude to yourself and what you might have done to survive.

Questions to Consider

  • What tricks or tactics did the person/people abuse you use? Think in terms of kinds of power- physical, intellectual, economic/financial, religious authority, social, emotional.
  • Did they call what they were doing ‘abuse?’ It is likely they used other words to describe what they were doing to distort the reality. What words did they use to try and cover over the fact that it was abuse? (e.g. ‘games’, special time, tickling…). Looking back now, what would you guess were their motivations for not calling it what it was?
  • What did they say would happen if anyone found out?
  • Often people who abuse go to great lengths to present a good image of their self to the outside world. What image did the person/people who abused you cultivate? What kind of person did they get others to see them as?
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It is not uncommon for men who have been sexually abused to feel a sense of shame. Shame can be an extremely powerful feeling. It can be paralysing. It can leave men feeling that they were somehow responsible for the abuse, or should have seen it coming, or should have been able to stop it. The fact that the abuse was sexualised can make the feelings of shame more intense (sex has a history of being considered something shameful and not to be talked about). Just thinking about the abuse and what was done can result in men feeling embarrassed, blushing, sick to the stomach, drained, ‘dirty’ and confused.

Sense of shame can stop men speaking up about the abuse.

It is an unfair legacy of sexual abuse that the person who was abused often ends up left with feelings of shame. It can be helpful to remember that the abuse was not caused by you. For some people, a sense of shame comes from thinking about how they could have avoided the abuse. There is nothing wrong with thinking about this. However, there is a difference between wishing you could have done something to stop the abuse, and being responsible. This might become clearer if you imagine how you might offer safety advice to a child who is going down the park to play with friends. By offering advice, that does not mean you would hold them responsible for the actions of an adult who hurts them.

Shame commonly manifests itself in the form of harsh self-judgements. These could be externally focussed (imagining what others are thinking about you or how they see you), or internal (judging yourself as flawed or bad or inadequate).

It is useful to be aware of the ‘function’ of shame. It can be a source of information; it can let us know that something not ok has happened, that a situation is personally dangerous or diminishing of our sense of integrity.

If feelings of shame appear when you have flashbacks or thoughts about the abuse, you might ask:

  • What are the feelings of shame telling you about that situation; not about your identity, but about the situation?
  • Was your integrity and dignity as a person being fully respected?
  • Consider carefully who was responsible for this – who had the knowledge and power? (see section on ‘tactics of abuse’).

When you notice you are feeling shame, it can be useful, practice mindfulness. In particular mindfulness of ‘Thoughts, Body Sensations & Emotions’, ‘Compassion Mindfulness’ and ‘Mindfulness of Difficult/Painful Thoughts’.

Try to take a curious observing approach to physiological sensations. These sensations are usually extremely unpleasant, leaving us feeling exposed, and it is not surprising that we usually try to distract ourselves or do whatever it takes to ‘cover up’ or make these feelings ‘go away’. Unfortunately, these actions often result in further feelings of shame if they don’t fit with your sense of values and integrity as a person. If you are able to learn some skills around tolerating these sensations, you may be able to find ways of managing them that builds a more encouraging robust sense of self.