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Understanding anxiety

Please Note: The STAR Centre – Rape Crisis Ayrshire is not a medical or health service which can diagnose physical or mental health condition. The purpose of this page is to provide rape or sexual assault or abuse survivors, anyone who may be supporting a survivor, or anyone who works with survivors, information about anxiety and how it may be experienced, or show itself in the feelings or body of the survivor.

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Everyone experiences some form of anxiety in their lives. Often, we can manage it and overcome those immediate feelings of having a dry mouth, sweating palms, or feeling our hearts beating in our chest. We may talk of ‘big’ anxieties such as sitting a driving test, or having an important job interview, or some of the ‘small’ anxieties such as meeting someone new or feeling anxious about going somewhere we haven’t been before. In most cases, the anxiety fades after the event and we get back to how we feel normally. They are short lived and we can manage them.

Anxiety that is linked to previous lifetime experiences of trauma can differ significantly from those ‘big’ or ‘small’ anxieties and can have a deeply debilitating impact on both physical and psychological wellbeing of the survivor.

What happens when someone experiences the trauma of a rape, sexual assault, or is a childhood sexual abuse survivor?

If you have experienced any form of sexual violence, abuse, or sexual exploitation, it can sometimes help to understand that your mind and body responded in the way they are designed to: to protect you and help you survive when the abuse was happening, and afterwards, in an attempt to keep you safe..

In moments of intense threat, the brain shifts into survival mode. The part of the brain responsible for instinct and protection takes over, while the part that handles logic and decision-making becomes much less active. This happens automatically – you do not choose it, and you cannot control it in the moment.

Your brain doesn’t stop to ask, “Is this dangerous?” It already assumes that it is and reacts immediately to try to protect you.

This is where the body’s survival responses come in – often described as the ‘fight or flight’ response. Many people expect they would fight or run away, but in situations like sexual assault, the freeze response is, in fact, the most common reaction. Survivors often tell us they felt unable to move, speak, or react in the way they expected. This is not weakness, and it is not a failure. It is the nervous system doing its best to protect you in a situation that can be overwhelming, terrifying, and for some survivors, feeling that they will not survive the attack.

If this sounds very familiar, you may also have felt as though you had no control over what was happening in your body – and that’s because, in survival mode, the brain takes over to act as quickly as possible. The part of your brain that thinks things through, analyses situations and makes decisions, is too slow and is ‘switched off’ at this time.

After the traumatic event, it’s also very common for your body to stay on high alert. Even when you know the danger has passed, your system may still feel as though it needs to be ready to respond to another threat. This is called hypervigilance.

You might notice yourself:

Feeling constantly on edge or easily startled
Watching people closely or scanning your surroundings
Feeling anxious when someone is too close to you, if they are ‘in your space’ or touching you
Avoiding certain places or situations
Feeling unsafe in environments that remind you of what happened such as being in crowds, being outside in the dark, or being in spaces where you feel exposed or vulnerable.

These responses can feel confusing or exhausting, especially when part of you knows that, logically, you are safe. But your body is not reacting to logic – it is responding to what it has learned from the trauma.

Your responses – during the event and after – are natural, automatic reactions to something overwhelming and frightening. With time, support, and care, your body can begin to feel safe again. Healing is possible, and you do not have to go through it alone.

Understanding your trauma-related anxiety

Anxiety that arises out of the trauma experienced by a survivor of sexual violence, sexual abuse, or sexual exploitation is not just stress, but is linked to the body’s response to the traumatic event when it was happening.

A very well made and informative video by NHS Lanarkshire and Gender-Based Violence Services shows how the brain responds at the point of trauma, and how memories are recorded. This film is available on YouTube and can be viewed below.

This film shows how the brain changes when the attack is happening. Normal thinking processes are too slow to cope with the threat so the limbic system, the part of the brain that focuses on survival, takes over and begins to ready the survivor to respond to the threat.

After the danger is over, though, the brain’s ‘fire alarm’ in the limbic system sometimes gets jammed on ‘red alert’ so that you may experiences floods of cortisol into the body keeping it hyperalert, hypervigilant, with a high-level startle response, in effect, being jumpy much of the time.

This is more common in cases where a woman may be a survivor of multiple traumas such as childhood sexual abuse, or domestic abuse. Being constantly in this ‘fight or flight’ state means that any logical thinking is affected, often making you feel confused, forgetful, unable to think straight. It also means that what may be seen by others as ‘small stresses’ may be hugely magnified in this state of hypervigilance and you may feel overwhelmed very quickly.

Understanding an anxiety attack: Many survivors who experience anxiety attacks describe changes in their bodies. These happen because the anxiety has triggered the brain’s ‘fire alarm’ and is getting ready to respond to danger if it needs to. Anxiety attacks mirror trauma response in that survivors talk about:

Rapid breathing: This is the body taking more oxygen into the lungs to send this oxygen enriched blood to the muscles. This is the ‘fight or flight’ response that is often described.
Heart pounding or palpitations: The heart is working hard to ensure that oxygen rich blood is circulating well.
Cold sweat: Adrenaline rushing through the body can create the ‘cold sweat’ feeling, a mixture of sweating and chilling. This also causes hair follicles to contract which is why you may see ‘goosebumps’ or ‘goosepimples’ on your body.
Shaking: The muscles are becoming tense, ready to fight or flee, sometimes so tense that trembling or shaking begins.
Nausea, butterflies, ‘stomach churning’: When the fear response is happening, the digestive system often closes down and that’s why it’s common for someone to talk say, “my stomach was churning” or “I thought I was going to be sick”.

Many people who have an experience that causes a sudden fright find that these responses happen, but they return to their normal physical state soon afterwards. There might be a longer-term memory that sticks with them (for example, a large snarling dog is dangerous, which results in someone feeling afraid of large dogs) but day to day, they manage pretty well.

For the trauma survivor, a stressor like this can have a major impact and add to the heightened levels of anxiety and fear that you already have. Not only will the memory of the large dog (for example) loom large in your mind, but the sight of large dogs may trigger a more serious panic attack.

Panic attacks

Panic attacks are bouts of intense heightened anxiety that are sometimes described by survivors as ‘sheer terror’ or ‘feeling like I’m going to die’. Panic attacks can happen suddenly, and if you experience one, you may feel it building through physical changes in your body, such as feelings of intense fear or terror, shortness of breath, nausea/feeling sick, trembling, or a cold sweat. You may recognise the trigger for the panic attack and if so, may be able to develop coping strategies to help ease the intensity of her fear, or halt the panic attack completely.

Although panic attacks can be frightening, they are normally not dangerous. Some things that might be useful to you if you experience a panic attack are:

Trying to remind yourself that it’s a panic attack and although it feels overwhelming and frightening, you are safe, and it will pass.
If you are outside when the panic attack starts, you may feel safer if you are in place such as a women’s toilet in a store or a café. Toilets that are accessible for disabled people are generally individual rooms when you can lock the door and spend a few minutes getting your breathing back to normal and getting grounded again.
Doing something like washing your hands or face, if you are sweating, can help with the feelings of grounding
Taking some time to focus on breathing. Breathe slowly and deeply, counting each breath. This can focus your attention on your body and away from your thoughts.
Thinking about carrying a small item that may help with your grounding. This can be a small stone or crystal, or another small object that means something to you. If you feel overwhelmed, touching the object, feeling its smoothness or rough texture, can help take the focus of your thoughts to the physical feelings of the stone, rather than the panic you are feeling.

When the panic attack is over, be gentle with yourself and take some time to relax and think about how well you have coped with an often overwhelming situation. Panic attacks can be exhausting so a bit of rest time can also be useful.

Avoiding situations

Avoidance is part of the ‘fight or flight’ response we have to trauma and it’s something that we can carry on after the trauma to help protect ourselves.

Anxiety sometimes leads to avoidance of people, places, events, going out, talking about certain issues that might trigger a trauma response, not watching certain programmes or films. In some cases, this can be protective; for example, avoiding films where women are abused or hurt can protect survivors from images that are distressing, but avoidance can also be isolating. Using safe support spaces may be a good first step in tackling that avoidance and reducing the isolation that can come with it.

Managing anxiety – some grounding strategies that might help

Anxiety can be exhausting because your ‘Alert’ system is permanently switched on. There are a few gentle grounding strategies that may help.

When your body feels on high alert, grounding techniques can help bring you back to the present moment and gently remind your nervous system that you are safe right now. Different techniques work for different people—it’s okay to try a few and see what feels right for you.