In light of the recent U.S. Senate hearing on the FBI’s failures to investigate gymnasts’ complaints of sexual abuse against Larry Nassar and the subsequent mishandling of their reports, it is timely to discuss post-traumatic stress disorder (PTSD) and its role in the investigation of sexual abuse cases.

PTSD, a disorder characterized by a set of symptoms that persist beyond a month after experiencing a traumatic event, occurs in 50% of sexual abuse survivors. PTSD has many implications on one’s perception of the abuse, emotional state, and day-to-day functioning — all of which have a direct impact on survivors’ ability to recall and report their experiences or participate in an investigation.

One of the primary symptoms of PTSD is avoidance of traumatic memories, the associated emotions, and the people, places, and things that trigger memories. Avoidance indicates that the trauma has not been emotionally processed; this unfortunately results in foggy recall of the memories wherein details may not be clear and/or may be left out because they are too emotionally difficult to verbalize.

Conversely, it is not uncommon for a sexual abuse survivor to recall the order of events associated with their abuse in calm manner, as they have not yet emotionally processed it. Thus, we cannot assume that one’s ability to recall details implies the absence of PTSD. We also cannot overlook the intense emotional pain and psychological distress that survivors may continue to experience long after the abuse.

Sexual abuse often leaves survivors with a lot of questions. “Was this really abuse?” “Am I making too big of a deal of this?” “Was this my fault?” “Will people believe me?” Such questions are usually answered via the direct and indirect messages received by others. This feedback often shapes one’s perception of the abuse and thus has the potential to either aid in the healing process or exacerbate the avoidance that maintains PTSD. As McKayla Maroney’s testimony poignantly highlighted, the callus response of the agent with whom she shared her abuse was just as traumatizing as the abuse itself.

It is beneficial for law enforcement officers and others to be mindful of the fact that many survivors have not yet received proper mental-health treatment at the time of the report. They must also be mindful of the emotional pain that goes into a person’s decision to report sexual abuse, regardless of when the abuse occurred and how the person “seems” at the time. A response that conveys praise for coming forward and validation for the pain experienced can not only play a pivotal role in one’s journey towards healing but also aid in the investigation.

Although the effects of sexual abuse are complex and lasting, PTSD is treatable. Prolonged exposure (PE) is a specific type of cognitive-behavioral therapy that was developed in Philadelphia for sexual-assault survivors. PE addresses distress related to trauma, and its avoidance, through prolonged and repeated exposure to traumatic memories in a safe setting. Survivors gain a new perspective on their experience and take actionable steps toward reclaiming their lives.

Jenna DiLossi is a clinical psychologist and cofounder of the Center for Hope & Health LLC., an outpatient treatment center in Ardmore that specializes in cognitive-behavioral treatments for PTSD, eating disorders, OCD, and anxiety disorders.