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KEY TO KNOW
For many survivors , it is difficult to rebuild meaning or to believe in justice and equality . Because their self-worth has been violated , they can feel worthless . The trauma theory of basic assumptions emphasises that not all traumas trigger feelings of worthlessness ; what seems to do so is betrayal , being let down by persons close to you ; abuse of trust . Being abused by a caregiver , a friend , or a helper are typical examples of betrayal . Since cognitive assumptions and worldviews are often not articulated or are unconscious , shattering them has unexpectedly sharp effects on survivors ’ ability to cope with and visualise the future .
2.5.2 Self-destructiveness and re-victimisation
Delayed reactions after abuse may include behaviours that lead to further trauma . Survivors of abuse are more likely to experience abuse again . The name for this is “ re-victimisation ”. How are we to understand it ? One factor is that survivors often exhibit behaviours that potential perpetrators pick up on . Faced by something they interpret as a threat , survivors may “ freeze ”; they do not protest but become paralysed and passive . To others , it may seem that they have lost the ability to foresee danger . Some survivors say that , because they feel worthless , it seems pointless to protect themselves ; they have already been “ destroyed ”. These responses , and survivors ’ emotions of shame and guilt , can attract abusers and make survivors easy to prey on .
Self-destructiveness can take many forms . Survivors may feel they have no right to say no . Others harm themselves to regulate their inner pain . Cutting , or burning , can substitute for mental pain , be preferred to mental pain , or may displace traumatic memories . Survivors who feel ashamed and destroyed may consider that punishment is deserved ; or use pain to wake themselves from states of numbness or dissociation .
As noted , traumatic events may elicit fight , flight or freeze reactions . In the fight reaction , aggression is an important source of energy . This aggression can later be directed outwards or inwards . Aggression that is directed inwards , that expresses itself in self-harming , is often called distorted aggression . Other forms of self-destructive behaviour can be directed at the self and at others . Intoxication , violent behaviour , breaches of ordinary norms , disruption of routines , neglect of hygiene and nutrition , can also be expressions of lack of self-respect and self-esteem .
2.5.3 Suicidal thoughts and suicide
Many survivors who have experienced sexual violence or humiliation think about ending their lives ; suicide seems to offer an “ escape ” from a seemingly hopeless situation . In meetings with survivors , it is very important to be aware of this and to show understanding and respect .
If you notice specific changes in behaviour ( such as social withdrawal ) or that a survivor talks about a death wish or wanting to disappear , ask direct questions about this . Ask if the person is thinking about taking his life . If he answers “ yes ”, you may ask what his plans are and when he plans to go through with it . As a helper , you can give the survivor hope that his situation will improve . Important guidance in this area can be found in WHO ’ s implementation guide for suicide prevention . 45
2.5.4 Injuries after torture and inhuman treatment
In almost every case , torture causes extensive mental and physical problems . All the symptoms and diagnostic categories that have been described appear in people exposed to torture and forms of inhuman treatment . 46 The most common physical disorder after torture is pain , which