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ship, the more devastating the impact of the abuse. Betrayal can lead to an inability to regain trust, including trust of oneself.

Both in child abuse and sexual assault, the response of others upon learning of the assault has been identified as a critical factor in healing the victim. When the family and others dose to the victim have a negative reaction, blame the victim, do not want to ever talk about what happened, do not believe that it happened, or protect the perpetrator, the results are psychologically devastating and set up a poor prognosis for the victim's ability to heal from the trauma. How the case is handled by the law enforcement agencies also has a powerful impact on the victim.

How victimization affects an individual may depend on these significant factors:

  • If the victim feels responsible for the crime or participation in the crime;

  • If, prior to the attack, the victim had poor self-regard as a chronic or temporary state of mind;

  • If the immediate response to the learning of the attack is empowering and supporting; and

  • If she is informed that many women become victims of assault and that this did not happen because of who she is, but because the perpetrator is a person of bad intentions and a criminal.

In assessing a crime victim for adjudication or mental health treatment, an understanding of these factors is critical. The individual's self-image and sense of empowerment or dependence will affect her experience and self-explanation of the crime. Rape trauma syndrome and post-traumatic stress disorder (PTSD) are well recognized as encompassing the range of normal psychological responses to trauma. Victims of sexual assault have more intense and perhaps more frequent physical reactions than those of victims of other types of crime. Physical changes that are obvious are changes in eating and sleeping routines, mood changes, and an overall level of more neediness (for children, a reversion to an earlier stage of life that required great nurturing and attention). In addition, crime victims may run away; stop eating altogether; eat only certain foods or a certain type or consistency of food; refuse to change clothes, bathe, or wash hair; cut hair; become aggressive or sexualized; begin sexual self-stimulation or mutilation; acquire or request change in hair color, tattooing, piercing,

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