The physical effects of rape include insomnia and nightmares, gastro-intestinal disorders, menstrual irregularities, and increased muscle tension. Psychological effects may be depression, generalized anxiety, flashbacks, decreased sexual enjoyment, irritability, and apathy. Behavioral changes include social withdrawal, altered sexual activity, loss of autonomy, and alcohol or drug abuse. Other effects are a sense of helplessness, loss of control, and self-blame. In the United Kingdom, volunteers most often provide short-term crisis intervention for rape victims. Currently, health professionals are rarely involved in counseling rape victims at the early acute stage of reaction. One reason for this is the avoidance of any implication that the victim's reactions constitute an illness. Professionals generally provide services to rape victims when it is clear they have not made a satisfactory adjustment within a reasonable time frame.