Victims of rape: repeated assessment of depressive symptoms

Response to sexual assault: a relational perspective

It has been suggested that although the severity of the stressor is the primary determinant of acute posttraumatic stress disorder (PTSD) symptoms, pre-existing personality patterns may be the primary contributors to the development of chronic PTSD symptomatology. The authors postulate that of the multiple personality factors that influence behavior and response to traumatic events, relational capacity or the ability to sustain interpersonal relationships provides an overarching construct for understanding the contribution of social contextual factors to post-trauma response. The results of this exploratory study support the authors' hypothesis that relational capacity is a significant factor in explaining persistent PTSD symptoms in a sample of adult women who have been raped. Significant correlations were found between measures of relational capacity, the Bell Object Relations Inventory and the Inventory of Interpersonal Problems and measures of distress, the Posttraumatic Symptom Scale, and the Beck Depression Inventory.

Prevention of post-rape psychopathology: preliminary findings of a controlled acute rape treatment study

Violent sexual assault such as rape typically results in extremely high levels of acute distress. The intensity of these acute psychological reactions may play a role in later recovery, with higher levels of immediate distress associated with poorer outcome. Unfortunately, post-rape forensic evidence collection procedures may serve to increase, rather than reduce initial distress, potentially exacerbating future psychopathology. To address these concerns, an acute time-frame hospital-based video intervention was developed to: (a) minimize anxiety during forensic rape exams, and (b) prevent post-rape posttraumatic stress disorder (PTSD), panic, and anxiety. Preliminary data indicated that (1) psychological distress at the time of the exam was strongly related to PTSD symptomatology 6 weeks post-rape, and (2) the video intervention successfully reduced distress during forensic exams.

Juvenile male rape victims: is the level of post-traumatic stress related to personality and parenting?

OBJECTIVE

The purpose of this study was to assess the level of post-traumatic stress in juvenile male rape victims and to test for its relationships with perceived parental rearing and personality dimensions.

METHOD

Fifteen subjects (mean age of 16 years) were recruited from a correctional camp for juvenile criminals in Arkhangelsk, Russia. They were investigated by means of the "Revised Impact of Event Scale," the "Child Self-Report Post-Traumatic Stress Reaction Index," the "Hospital Anxiety and Depression Scale," the "EMBU" (perceived parental rearing) and the "Temperament and Character Inventory" (TCI).

RESULTS

The level of post-traumatic stress, in most cases moderate to high, correlated with the temperament dimensions of harm avoidance and reward dependence. As concerns parental rearing, the total level of post-traumatic stress reaction was negatively correlated with paternal emotional warmth and positively with paternal rejection.

CONCLUSIONS

The experience of post-traumatic stress is influenced by temperamental characteristics as well as by perceived parental rearing practices. Assumingly, these factors also play a role in becoming a rape victim, which deserves further investigation.

Crime-related trauma: psychological distress in victims of bankrobbery

This study examines the relationship between the experience of a traumatic event, that is, a bankrobbery, and its psychological consequences. Two groups of employees of a major commercial bank in the Netherlands participated in this study. One group (n = 310) consisted of subjects who had experienced a bankrobbery and worked in high-frequency bankrobbery areas; the other matched control group (n = 214) consisted of nonrobbed employees from banks in the same area. Victimized subjects displayed more signs of psychological distress than the control subjects, but distress decreased over time. The main findings of this study are that a depressive/avoidant coping style, strong threat perception during the robbery, and additional life events were positively related to posttraumatic distress as assessed by the Impact of Event Scale and the Symptom Check List (SCL-90), and self-esteem was negatively associated with the SCL-90 only.

The long term effects of childhood sexual abuse: rationale for and experience of pharmacotherapy with nefazodone

Studies estimate that 1 in 6 women and 1 in 10 men experience childhood sexual abuse (CSA). Whilst ill-health is not an inevitable consequence, approximately 20% of victims go on to have serious long-term pathology. This is reflected in an excess incidence of CSA survivors in problem populations, be they medical, forensic or psychiatric. Four groups of research studies suggest that PTSD-related mechanisms might be a major mediating factor in the development of symptoms: 1. There is high incidence of PTSD following sexual trauma; 2. Psychometric studies show evidence of impaired limbic functions; 3. There is evidence of neuroendocrine disturbances similar to those seen in war veterans with PTSD; 4. MRI studies show evidence of hippocampal atrophy. There is a growing database of studies showing that drugs that act as seroionergic modulators are effective in the treatment of PTSD. Drugs such as nefazodone which block 5HT2 receptors and inhibit the uptake of serotonin may be of particular value. Studies suggest that trauma-related issues are not always addressed in patients with a history of abuse. Given the problems posed, there is a need to review their treatment in the light of emergent knowledge. Further research is needed to validate these findings.

Psychological treatment of chronic posttraumatic stress disorder in victims of sexual aggression

The aim of this research was to test the comparative effectiveness of two therapeutic modalities in the treatment of chronic posttraumatic stress disorder in victims of sexual aggression: (a) self-exposure and cognitive restructuring and (b) progressive relaxation training. The sample consisted of 20 patients (victims of rape in adulthood or adult victims of childhood sexual abuse) selected according to DSM-III-R criteria. A multigroup experimental design with repeated measures (pretreatment, posttreatment, and 1-, 3-, 6-, and 12-month follow-up) was used. Most treated patients improved, but the success rate was higher in all measures in the exposure and cognitive restructuring group immediately on posttreatment and at follow-up. Implications of this study for clinical practice and future research in this field are commented on.

The effects of forced sexual intercourse on white female adolescents

In the 1987 National Survey of Children the question was asked: "Was there ever a time when you were forced to have sex against your will, or were you raped?" Among White females, aged 18-22, those who answered yes (n = 41) and no (n = 400) were compared on a number of social-psychological and sexual variables that might be thought of as outcomes affected by having had coercive sexual experience(s). Those who reported being forced to have sexual intercourse, compared to those who did not, had more permissive attitudes about 16-17-year-olds having intercourse and a younger age of first voluntary sexual intercourse themselves. They also had lower internal locus of control and higher depression scores, and they needed and received more psychological help than those not reporting forced sexual intercourse. Dividing the forced sexual intercourse group (FSI) into those reporting FSI before versus after their first date, and those whose FSI was before versus after age 12, yielded essentially the same findings. Even in the presence of multivariate control variables. FSI experience remained a significant predictor of age at first voluntary sexual intercourse, locus of control, depression, and perceived need for psychological help. These analyses of national survey data support the clinical perspective that forced sexual intercourse causes or exacerbates various sexual and psychological problems.

Assault characteristics and posttraumatic stress disorder in rape victims

A diagnosis of posttraumatic stress disorder (PTSD) encompasses several of the symptoms associated with the response to rape. The object of this study was to determine the incidence of PTSD among 51 rape victims and to compare the groups with and without PTSD with respect to the characteristics of the assaults. The results showed that 70% of the victims had PTSD and further suggested that PTSD was likely to be a long-term problem for these women. The results supported the view that psychological treatment approaches to rape victims should take into account the posttraumatic nature of the response. The incidence of rapes by strangers, of physical force being used, of weapons being displayed and of injuries being sustained by the victim were all higher in the group of women who had PTSD. These are all features that can be readily identified in the initial assessment of the rape victim and may help to identify the victims at risk of developing long-term psychological sequelae after rape. Appropriate therapeutic action taken early may influence the prognosis for a significant proportion of rape victims.

Reality therapy with rape victims

Rape is a violent act that inflicts injury on the very essence of the self. Reality therapy offers an applicable conceptual framework for the treatment of rape victims. Reality therapy groups minimize attention to the concept of mental illness. The warm, friendly atmosphere of the reality therapy group provides a supportive arena where the victim can tell her story, diminish her desire to withdraw from others, and recognize control over her behavior. Through her involvement she can begin to fulfill her needs to love and be loved, and feel worthwhile to herself and others.

Psychological management of victims of sexual assault

Sexual assault, as a crime of violence, induces a life crisis which inflicts major psychological and physiological trauma upon the victim. Lack of mutual consent is present in all sexual assaults. Post-traumatic symptoms occur immediately and for a large percentage of victims this trauma is not integrated for many years. Symptoms include the classic triad of post-traumatic stress symptoms of haunting, intrusive recollections, numbing or constriction of feelings and focus and lowered threshold of anxious arousal subsequent to experiencing intense fear, terror and loss of control. Long term effects include anxiety, depression, phobic reactions to situations reminiscent of the sexual assault, sexual dysfunction, impaired social adjustment and diminished capacity to enjoy life. Post-traumatic stress responses, symptomatology, psychodynamics and management of the victim of recent and nonrecent sexual assault are reviewed.

Counseling rape victims: the nursing challenge

Rape and sexual assaults are a pervasive problem encountered by women in our society today. Treatment approaches specifically useful with rape victims have been identified by nursing staff at the Sexual Assault Resource Service (SARS). This nursing research demonstration treatment program funded by the National Institute of Mental Health identifies seven essential components of counseling during the initial crisis period, which are discussed in this article.

Psychological reactions of women who have been raped. A descriptive and comparative study

Twelve women, reporting rape to the police, were interviewed on three occasions over a 4-month period. Their psychological and behavioural experiences, during that time, were compared with those of 12 controls: women who were attending a Family Planning Clinic and without a history of such trauma, and small numbers of victims of non-sexual assault. All victims showed, initially, high levels of distress or some psychopathology but only the rape victims were reliable in attending follow-up appointments. In all but one case the acute, intense symptoms of distress resolved, but other substantial changes in lifestyle had taken place. The particular difficulties in counselling and research in this area were highlighted by this pilot work. Would-be counsellors should be cautious about taking on this kind of work unless considerable practical and emotional support is available to them.

[The effects of rape 6 months after the attack and factors associated with recovery]

In this study a group of 27 victims seen approximately 6 months after the assault was compared to a matched control group. The results show significantly higher scores on two subscales of IPAT ("ego weakness" and "disposition to guilt") and on 4 scales of the MMPI ("denial", "hypochondriasis", "depression" and "conversion hysteria"); also, the victims' social adjustment seems inferior and the frequency of sexual relations has been reduced considerably for them. The following factors have been evaluated in order to test their relation to the adjustment to the assault: rape by a stranger versus someone known, degree of violence, feelings of self-blame, problems during the crisis, predominant thoughts, professional help, social support, stable relationship, allusion to victim's responsibility for rape and conviction or not of the aggressor. Even though most of these variables show a significant simple correlation with adjustment to rape only four among them remain significantly associated when sociodemographic variables, pre-rape psycho-social problems and life stressors are controlled; the very subjective variable "predominant thoughts" seems to best explain differences in adjustment. The importance of pre-assault variables and of the subjective reaction to rape is discussed.

Coping and adjustment to genital herpes: the effects of time and social support

The current study investigated the relationship of the passage of time and membership in a self-help group with coping behaviors and distress among people with genital herpes. A comparison between 116 people in herpes support groups and 36 community volunteers on the use of coping and level of emotional adjustment was undertaken. Results of the study indicated that people employed fewer coping strategies with increasing time since the onset of the stressor. This pattern was particularly clear in non-support-group subjects. In comparison, support-group members did not exhibit as significant a decrease in the use of coping strategies or as great an improvement in the level of depression and degree bothered by herpes over time. Selection factors and effects of self-help group membership are discussed as alternative explanations for these differences. Future research in the area of group membership as well as helpful and nonhelpful processes in these groups is suggested.

Personality test reliability: correlates for older subjects

This study reports the findings of an investigation of psychological and social factors related to test-retest stability and change in scores on the Eysenck Personality Inventory given to 167 older men and women. Higher reliability coefficients on the Eysenck were associated with better scores on a measure of well being and higher levels of education.

Depressive symptoms in rape victims. A revisit

Ninety recent victims of sexual assault were assessed within 4 weeks of the assault for evidence of depressive symptomatology and major depressive disorder. The results suggested 43% of the subjects met Research Diagnostic Criteria for major depressive disorder, with sleep disturbance and dysphoria being the most frequently endorsed symptoms. Older subjects and subjects who had been sexually victimized prior to the current assault were at significantly higher risk for developing major depressive disorder post-assault. Follow-up assessments revealed a diminution of depressive symptoms by 3 months after initial assessment and a continuing stabilization of mood at 6 and 12 months.

Coping with domestic violence: social support and psychological health among battered women

This study suggests a conceptual framework for examining the impact of stress (i.e., level of violence), personal resources, social support, institutional responsiveness, and coping upon the psychological health (i.e., depression, mastery, and self-esteem) of battered women. Respondents were 60 women who had sought assistance from a shelter for battered women. Results indicated that increased levels of violence, minimal personal resources, lack of institutional and informal social support, and greater avoidant coping styles were related to lowered self-esteem and more severe depressive symptoms. Exploratory analyses suggested that stress (i.e., level of violence) and personal resources may have indirect effects upon functioning through their impact on coping responses and the availability of social support. In particular, women who had fewer social contacts unaccompanied by their partner were less likely to receive supportive responses from friends. Implications for research and practice are discussed.

Analysis of the need systems of twenty male rapists

15 needs from Murray's theoretical work (1938) were used to assess and analyze the need systems of 20 men convicted of forcible rape and compared to those of a control group of 20 violent, but non-sex, offenders. Three instruments were used: Edwards Personal Preference Schedule, the TAT, and a semi-structured interview. As predicted, the over-all need profiles of the rapists and the non-rapists were statistically non-parallel on two of the three instruments. Rapists also differed significantly on four specific needs on two of the three instruments. These results are discussed with relation to psychoanalytic theory.