The costs of rape

Modified prolonged exposure therapy as Early Intervention after Rape (The EIR-study): study protocol for a multicenter randomized add-on superiority trial

BACKGROUND

Sexual assault and rape are the traumatic life events with the highest probability for posttraumatic stress disorder (PTSD), which can have devastating consequences for those afflicted by the condition. Studies indicate that modified prolonged exposure (mPE) therapy may be effective in preventing the development of PTSD in recently traumatized individuals, and especially for people who have experienced sexual assault. If a brief, manualized early intervention can prevent or reduce post-traumatic symptoms in women who have recently experienced rape, healthcare services targeted for these populations (i.e., sexual assault centers, SACs) should consider implementing such interventions as part of routine care.

METHODS/DESIGN

This is a multicenter randomized controlled add-on superiority trial that enrolls patients attending sexual assault centers within 72 h after rape or attempted rape. The objective is to assess whether mPE shortly after rape can prevent the development of post-traumatic stress symptoms. Patients will be randomized to either mPE plus treatment as usual (TAU) or TAU alone. The primary outcome is the development of post-traumatic stress symptoms 3 months after trauma. Secondary outcomes will be symptoms of depression, sleep difficulties, pelvic floor hyperactivity, and sexual dysfunction. The first 22 subjects will constitute an internal pilot trial to test acceptance of the intervention and feasibility of the assessment battery.

DISCUSSION

This study will guide further research and clinical initiatives for implementing strategies for preventing post-traumatic stress symptoms after rape and provide new knowledge about which women may benefit the most from such initiatives and for revising existing treatment guidelines within this area.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05489133. Registered on 3 August 2022.

The Victim-Perpetrator Relationship and Peritraumatic Schemas as a Result of Sexual Trauma

The development of posttraumatic stress symptoms (PTSS) due to sexual trauma is complex. Various mechanisms have been studied to explain the relationship between sexual trauma and PTSS. Other studies have looked at the impact of the victim-perpetrator relationship on the relationship between sexual trauma and PTSS with mixed results. Lacking from the literature is the possible mediating effect of peritraumatic schemas for the relationship between sexual trauma and PTSS. Additionally, the impact of the type of victim-perpetrator relationship may have on the development of peritraumatic schemas has also been unaddressed. This study seeks to close the gap in the literature by asking if peritraumatic schemas mediate the relationship between sexual trauma, specifically attempted and completed rape, and PTSS. The moderating role of the victim-perpetrator relationship on the association between sexual trauma and peritraumatic schemas was also examined. Using a college student sample that had endorsed experiencing at least one sexual trauma in their life, this study examined path analysis model explaining the mediating effects of peritraumatic schemas and the moderating effects of the victim-perpetrator relationship. Results indicated that peritraumatic schemas partially mediated the relationship between attempted rape and PTSS when controlling for completed rape. This effect was not found for the relationship between completed rape and PTSS when controlling for attempted rape. The interaction between attempted rape and the acquaintance perpetrator relationship was significant, indicating that peritraumatic schemas increased more severely for those that experienced attempted rape by an acquaintance. Recognizing that PTSS partially results from the peritraumatic schemas experienced, which are impacted by the victim-perpetrator relationship, helps increase understanding of the experience of attempted rape.

Toward a more domain-specific conceptualization of female traits: A commentary on Benenson et al. (2022)

Benenson et al. (2022) amass impressive evidence of robust sex differences as support for expanding "staying alive" theory. We argue for a broader and more domain-specific conceptualization focusing on life history tradeoffs between survival and mating success. Using three examples - women's disgust, fear of rape, and cultivation of bodyguards - we illustrate these tradeoffs and suggest a broader theoretical framework.

Predicting Body-Esteem Based on Type of Sexual Victimization Experience

Almost no research exists examining the relationship between body-esteem and sexual victimization experience in adulthood. The current study contributes to the literature by examining body-esteem based on type of sexual victimization experience (i.e., none, sexual contact, attempted sexual coercion, sexual coercion, attempted rape, rape). Participants included undergraduate women (n = 750) who completed the Body-Esteem Scale (Franzoi & Shields, 1984) and the Sexual Experiences Survey-Short Form Victimization (Koss et al., 2007), and had either no history of sexual victimization experience or experience within the past year. Women with no sexual victimization experience did not differ from women with sexual contact experience, but both groups reported higher body-esteem than women with coercion, attempted coercion, and rape experience. These three latter groups did not differ from one another, but each reported lower body-esteem than women with attempted rape experience, who reported higher body-esteem than those with no experience. Findings are preliminary but suggest that body-esteem may be negatively associated with some types of sexual victimization experience (attempted and completed coercion, rape), but not others (sexual contact, attempted rape), and escaping rape may increase positive feelings toward one's body.

Social Construction and Evolutionary Perspectives on Gender Differences in Post-traumatic Distress: The Case of Status Loss Events

Women report greater post-traumatic distress (PTD) than men following physically threatening events. However, gender differences in PTD following social stressors such as status losses are understudied. Whereas the social construction account points to a general sensitivity in women following any type of stressor, the evolutionary account suggests enhanced sensitivity to status losses in men, especially following inter-males aggressions. These propositions were examined in two studies (Study 1, N = 211; Study 2, N = 436). Participants were asked to recall a status loss and to fill out measures assessing PTD and depression severity. In line with the evolutionary account, men, as compared to women, displayed enhanced PTD following status loss. Status losses conducted by men against men were associated with greater PTD than were instances involving other target-aggressor pairings. Finally, age was negatively associated with PTD in men but not in women. The examination of evolutionary challenges modifies the standard view linking the female gender to enhanced sensitivity to trauma. Thus, the pattern of enhanced sensitivity to stressful events appears to be affected by gender- and development-specific adaptive challenges.

Sexual violence in adult women and adolescents: a narrative review

Sexual violence is a widespread phenomenon, as it has been estimated that about 35.6% of women have experienced some forms of sexual abuse, with variable prevalence estimates worldwide. Sexual violence has remarkable negative consequences on women's health and quality of life, with a specific harmful impact on women's psychological well-being and sexuality. In this narrative review, we provide an overview on the phenomenon of sexual violence against adult women and adolescents, discussing its associated multiple negative consequences with a specific focus on clinical and sexological aspects. ''Women centered care'' and a multidisciplinary approach appear of pivotal importance when working with sexual violence survivors. Woman should be engaged in all the clinical activities as equal partners in the decision-making process, and should be supported by multiple and different professional figures (i.e. gynecologists, psychologists, sexologists, forensic medical doctors, lawyers) working within the framework of a cooperative integrated model.

“We will make you feel safe”: Female medical staff's experiences of meeting with raped women in Sweden

The focus of this study was on female emergency medical personnel's experiences of treating women who have been raped and on their own experiences of being women themselves working in this situation. We interviewed 12 female medical personnel in four focus groups of two to five participants each. The material was analysed using inductive thematic analysis. Participants’ experiences were structured under two main themes: Prerequisites for care and Effects on oneself. As women, the participants emphasized their understanding of other women and stressed the importance of offering flexible care and taking time with each patient. They described how their work affected them personally, making them increasingly aware of men's violence against women and their need for support from their colleagues. They also discussed structural barriers to both patient care and self-care. If unaddressed, such shortcomings risk negatively affecting raped women seeking medical care and may also be detrimental to the health and well-being of the professional offering care.

She Asked for It: Hardcore Porn, Sexism, and Rape Myth Acceptance

The present study examined pornography viewing, rape myth acceptance, and sexist attitudes. Data came from 392 male and 903 female participants. Multigroup SEM indicated neither pornography viewing, nor hardcore pornography viewing, were related to rape myth acceptance when controlling for sexist attitudes among men. Wald tests indicated hostile sexism to be a significantly stronger predictor of all rape myths examined compared to pornography viewing or hardcore pornography viewing in men and women. Latent variable interaction analyses suggested hardcore pornography viewing as a significant exacerbating factor for the relationship between hostile sexism and "she asked for it" rape myths across genders.

Prevalence and risk factors for acute stress disorder in female victims of sexual assault

Sexual assault is one of the most traumatic events a person can experience. Despite this, information regarding the risk factors associated with the development of Acute Stress Disorder (ASD) in sexual assault victims is scarce. A follow-up prospective cohort study was designed to examine the prevalence and risk factors of ASD in women exposed to a recent sexual assault. A total of 156 women were treated at the Emergency Department of a university general hospital shortly after sexual assault. Sociodemographic, clinical and sexual assault-related variables were collected. The Acute Stress Disorder Interview was used to estimate the prevalence of ASD at three weeks post-SA. From the 156 victims, 66.6% (N = 104) met ASD diagnosis using DSM-5 criteria, whereas 59.6% (N = 93) met ASD diagnosis using DSM-IV criteria. The risk factors associated with the development of ASD were nationality, psychiatric history, peritraumatic dissociation and type of assault. In conclusion, the prevalence of ASD in female victims of recent sexual assault was high, affecting approximately two thirds of them. The recognition of the risk factors associated with ASD development, like peritraumatic dissociation or type of assault, may aid in the prompt detection of vulnerable women that require early and specific interventions shortly after trauma.

True Crime Consumption as Defensive Vigilance: Psychological Mechanisms of a Rape Avoidance System

The circumvention of female reproductive choice via rape is a costly and evolutionarily persistent threat to women's reproductive fitness. This is argued to have generated selection pressure for a precautionary threat management system for rape avoidance among women. Such a system would regulate women's fear of rape as a functional emotional response to inputs providing information about the current risk and reproductive cost of rape. Fear of rape is expected to subsequently motivate adaptive behavior to avoid threats to one's reproductive choice. The current research tested key tenets of this proposed system and found that women report greater fear of rape as a function of characteristics that alter the likelihood of being victimized, including being younger, living in a neighborhood perceived as dangerous, living in close proximity to family, and having been the victim of a sexual assault in the past. We also discuss mixed and null results with respect to the role of relationship status and mate value. In turn, fear of rape was associated with behavior expected to reduce one's risk of being victimized. Specifically, women who were more fearful of rape reported consuming true crime media with greater frequency and indicated that this consumption was specifically motivated by the desire to learn strategies to prevent or escape an attack. Overall, results were fairly consistent with a threat management system approach and may help to explain why fear of rape is a powerful feature of women's psychology.

A Dyadic Study of Impacts of Sexual Assault Disclosure on Survivors' Informal Support Relationships

After a sexual assault, victims often disclose their assault to an informal support provider (SP) to receive social support. Ample research exists on social reactions of informal SPs to disclosure and how those reactions affect the victim both positively and negatively, but little research exists on how the disclosure impacts a survivor's support relationships both in the short and in the long term. This qualitative interview study examined 45 ethnically diverse informal support dyads where women disclosed sexual assault to an informal SP (e.g., friend, family, significant other). Assault disclosure was examined to determine its impact on relationship quality of survivors and their SPs. Results revealed positive and negative effects on survivor-SP relationships of assault disclosure and social reactions. In almost all matched pairs (91%), the survivor, SP, or both remarked on how the relationship had changed following disclosure. Family member SPs spoke of survivors' risk-taking and poor relationship choices. Significant others spoke of the toll of supporting survivors who sometimes left their needs unmet and strained their relationships with survivors. Friend SPs often appraised how the survivor engaged in other types of relationships, but overall felt that their relationships had become stronger or closer as a result of the disclosure. Implications of this study include acknowledging that informal supporters, particularly significant others, can experience adverse effects after disclosure, and that help is needed not only for survivors but also for their informal support sources. Future research should continue to investigate both the short-term and longitudinal impacts of sexual assault disclosure on survivors' informal support relationships.

An Evaluation of Strategies Used to Maximize Intervention Fidelity in a Randomized Controlled Trial of a Sexual Assault Resistance Program for University Women

In this paper, we describe and evaluate the strategies used to maximize intervention fidelity in a randomized controlled trial to examine the efficacy of a sexual assault resistance intervention. The EAAA program was based on the best available theory and evidence on how women can successfully resist sexual coercion from male acquaintances. Extensive protocols for hiring, training, and supervising facilitators were established a priori. Detailed intervention manuals were developed that clearly described program goals, learning objectives, core elements, troubleshooting tips, sections that must be delivered verbatim, adaptations that could be made if necessary, and the ideal and minimum dose. Program sessions were audio-recorded, and a subsample of recordings were scored for adherence to the manuals using detailed Intervention Fidelity Checklists (IFC) developed specifically for this research. The Gearing et al. (2011) Comprehensive Intervention Fidelity Guide (CFIG) was employed retrospectively to provide objectivity to our analysis and help identify what we did well and what we could have done better. The SARE (Sexual Assault Resistance Education) Trial received high scores (38 out of 44 (86%) from each of the first two authors on the CFIG, suggesting a high level of intervention fidelity. Although a potential for bias on the part of the two raters was an obvious limitation, as was our neglection to include measures of implementation receipt, which Gearing et al. (2011) recommended, our analysis underscores the utility in employing methods recommended to enhance intervention fidelity when developing and evaluating evidence-based interventions.

Preventing and Responding to Sexual Misconduct: Preliminary Efficacy of a Peer-Led Bystander Training Program for Preventing Sexual Misconduct and Reducing Heavy Drinking Among Collegiate Athletes

Sexual misconduct occurs with disproportionate frequency on college campuses, and alcohol is involved in most sexual assaults. Importantly, collegiate athletes are at risk for both heavy drinking and sexual misconduct. Thus, the current study evaluated the efficacy of a novel, 2.5-hr, peer-facilitated, interactive, group-based bystander intervention program for student athletes that integrated information on sexual misconduct and risky drinking (Preventing and Responding to Sexual Misconduct [PRSM]). In all, 205 athletes completed 25-min surveys immediately before and after the training, and 76 (of 94 invited) completed a 3-month follow-up. Participating in the workshop was associated with significant increases in acknowledgment that sexual misconduct is a problem on campus, knowledge of where to get help if sexual misconduct occurs, knowledge about the college's procedures for addressing sexual misconduct, confidence that the college's procedures for addressing sexual misconduct are fair, bystander confidence, and engagement in a range of bystander activities. A significant decrease in rape myths also was observed. Participating in the workshop also produced changes in alcohol-related beliefs and behaviors. After participating in PRSM, athletes reported increased expectations that drinking alcohol can produce negative effects including aggression and acute intoxication. Participating in the workshop also was associated with significant reductions in drinking frequency, the total number of drinks consumed per month, the maximum drinks consumed in 24 hours, the frequency of binge-drinking episodes, and the experience of alcohol-related problems. In sum, the PRSM program evidenced preliminary efficacy as a program designed to increase prosocial bystander behavior and decrease high-risk drinking among collegiate athletes; changes in beliefs and behaviors consistent with reducing risk for sexual misconduct and problem drinking were observed after workshop participation. Future research should evaluate whether the PRSM program is effective for use with other high-risk populations like fraternity members or more diverse institutions of higher education including large universities.

Piloting sexual assault care centres in Belgium: who do they reach and what care is offered?

BACKGROUND

Sexual assault (SA) is highly prevalent in Belgium. In order to mitigate the negative consequences for victims of acute SA, Sexual Assault Care Centres (SACCs) were piloted from October 2017 to October 2018 in three Belgian hospitals. SACCs offer medical and psychological care, forensic examination and the possibility to report to the police at the SACC.

OBJECTIVE

Aiming to improve SACC services, we quantitatively assessed the number and characteristics of victims attending the SACC, the SA they experienced, and the care they received over 12 months upon admission.

METHOD

Data on victims presenting at the SACC were routinely collected in electronic patient files by the SACC personnel between 25 October 2017 and 31 October 2019. These data were analysed in IBM SPSS Statistics 25.

RESULTS

Within the first year 931 victims attended the SACCs. Mean age was 24.5 years (SD = 12.8), and one-third were under 18. The majority were female (90.5%) and 63.1% presented for rape. About one-third of the victims were considered vulnerable due to previous SA (35.6%), prior psychiatric consultation (38.7%) or disability (8.5%). The assailant was known to the victim in 59.2% of the cases. Of all SACC presentations, 35.2% self-referred to the SACC while 40.9% were referred by the police. Two out of three victims attended the SACC within 72 h post-assault. Respectively 74.7% of victims received medical care, 60.6% a forensic examination, 50.2% psychological care, and 68.7% reported to the police.

CONCLUSION

Despite the absence of promotion campaigns, the SACCs received a high number of victims during the pilot year. Use of acute and follow-up services was high, although new approaches to offer more accessible psychological support should be explored. The big proportion of vulnerable victims warrants careful monitoring and adaptation of care pathways.

Predicting College Women's Body-Esteem and Self-Esteem Based on Rape Experience, Recency, and Labeling

We examined body-esteem and self-esteem based on rape experience, rape labeling status (yes; no) and recency of rape (recently, within past year; earlier, between age 14 and the past year). Undergraduate women (n = 1,005) completed the Body-Esteem Scale, Rosenberg Self-Esteem Scale, and Sexual Experiences Survey. Women raped within the past year (recently) reported lower levels of both body-esteem and self-esteem than those raped over a year ago (earlier) and nonvictims, but women raped earlier did not differ from nonvictims. Rape labeling status was not significant. Findings identify lower body-esteem, in addition to lower self-esteem, as correlates of recent rape.

Navigating Sex and Sexuality After Sexual Assault: A Qualitative Study of Survivors and Informal Support Providers

Qualitative interview data from 45 matched pairs of survivors disclosing sexual assaults and their primary informal support providers (e.g., friend, family member, significant other) were used to explore survivor and support provider perspectives on changes in sexuality postassault and how those close to them have been affected as a result. Changes in sexuality included loss of interest in sex, increase or change in sexual partners, engaging in sex work, and increased sexual behavior. Support providers generally regarded promiscuity as a risky sexual behavior. If the support provider was the survivor's sexual partner, he or she discussed exercising caution when navigating sexual intimacy with the survivor. Not all sexual encounters with romantic partners were positive; some survivors discussed being triggered (i.e., with post-traumatic stress disorder [PTSD] flashbacks) or experiencing the dissolution of their relationships due to the sexual impacts of their assault. Counseling implications are discussed in the context of improving survivors' sexual experiences in general and in romantic relationships postassault. Implications can also be applied to prevention, scholarship on sex work, and sexuality research.

Sexual Violence Victimization Among College Females: A Systematic Review of Rates, Barriers, and Facilitators of Health Service Utilization on Campus

To date, little work specifically addresses empirical studies concerning barriers and facilitators to health service use among college female sexual violence victims. The following objectives were addressed: (1) analyze studies of college-aged women who have been victims of sexual violence to examine the frequency and moderating characteristics of utilization of university-based resources available, (2) identify inconsistencies and gaps in the literature concerning sexual victimization and service utilization, and (3) provide next steps for researchers and clinical care coordinators. Six electronic databases were searched from 1990 to May 2016. Inclusion criteria for the review were (1) university or college setting or sample, (2) empirical design, and (3) inclusion of some discussion or measurement of health service use. Following preferred reporting items for systematic reviews and meta-analyses (PRISMA) procedures, 22 articles were identified for the review. Although prevalence rates of sexual victimization were high (4.7-58%), rates of service utilization were lower (0-42%). There were significant discrepancies between hypothetical use of services and actual rates of service use. Identified barriers included feelings of shame, guilt and embarrassment, not wanting friends and family to find out, and thinking the victimization was not serious enough to report. Identified facilitators included acknowledging the sexual violence victimization as a crime, receiving encouragement from friends and family to utilize health services, and receiving a positive response during the initial informal disclosure. Finally, measurement of victimization was inconsistent across studies. Recommendations are offered for college campus prevention programming and future research.

Online Interpersonal Victimization as a Mechanism of Social Control of Women: An Empirical Examination

Cyber space is an ever-expanding mode of perpetrating sexualized violence toward women. This article empirically examines the applicability of Susan Brownmiller's adaptation of the theory of social control to online interpersonal victimization (OIV) against women. Multiple regression analysis identified predictors of behaviors indicative of social control among a Canadian sample. Findings suggest that the theory of social control, which has been applied to violence against women in physical space, is applicable to OIV. This study also provides insights into the separate and compound effects of physical space and cyber space victimizations on women and identifies implications for improving methods and building theories for addressing violence against women in cyber space.

Women’s Experiences of Nature as a Pathway to Recovery From Sexual Assault

Given the serious challenges faced by female survivors of sexual assault, an understanding of how they heal after such an experience is vital. Yet little is known about how being in nature may be helpful in this regard. The purpose of this qualitative study was to develop an in-depth understanding of how nature helps women heal from sexual assault. A narrative analysis of semi-structured interview data provided by four female sexual assault survivors generated four main themes. These themes point to how nature served as a source of emotion regulation and spiritual connection, as well as how it facilitated greater acceptance and reduced dissociation. Themes also indicated reduced negative thinking and rumination, and increased attention to the here and now. Findings are contextualized within the existing literature on sexual assault, and implications for counselling and psychotherapeutic practice with survivors are provided.

Do early interventions prevent PTSD? A systematic review and meta-analysis of the safety and efficacy of early interventions after sexual assault

Objective: To review the safety and efficacy of early interventions after sexual assault in reducing or preventing posttraumatic stress disorder (PTSD). Method: Systematic searches were performed on studies (1980-2018) that examined the efficacy of interventions for PTSD within 3 months after sexual assault. Results: The review identified 7 studies (n = 350) with high risk of bias that investigated 5 interventions. Only two studies reported on safety. Contact with the authors of six studies provided no indications for the occurrence of adverse events. Two studies reported the efficacy using PTSD diagnosis as dependent variable but found no difference between groups. All studies reported on efficacy using PTSD severity as dependent variable. For the meta-analysis, 4 studies (n = 293) were included yielding significantly greater reductions of PTSD severity than standard care at 2 to 12 months follow-up (g = -0.23, 95% CI [-0.46, 0.00]), but not at 1 to 6 weeks post-intervention (g = -0.28, 95% CI [-0.57, 0.02]). The heterogeneity of the interventions precluded further analyses. Discussion: Findings suggest that early interventions can lead to durable effects on PTSD severity after sexual assault. However, due to limited availability of data, it is impossible to draw definite conclusions about safety and efficacy of early interventions, and their potential to prevent PTSD.

Postassault Substance Use and Coping: A Qualitative Study of Sexual Assault Survivors and Informal Support Providers

This qualitative interview study examined 45 informal support dyads where a sexual assault was disclosed. Data from matched pairs of survivors and their primary informal support provider (e.g., friend, family, significant other), were used to explore the survivor-support provider (SP) perspectives of coping with assault-related distress via substance use and the effects of survivor substance use on the survivor-SP relationship. Results revealed that survivors' use of drinking and/or drugs to cope had both positive and negative effects on survivor-SP relationships. Findings also showed that SPs play various roles in providing support to survivors who cope via substance use, including engaging in substance use with the survivor and efforts to help get help in their recovery from the assault and substance abuse. Suggestions are made for how safe spaces can be provided where survivors and supporters can get information and treatment, whether formal or informal, that addresses sexual assault, PTSD and substance abuse issues in an integrated way.

Sexual Assault Characteristics and Perceptions of Event-Related Distress

Sexual assault (SA) is a potent psychological stressor, linked to harmful mental health outcomes in both the short- and long-term. Specific assault characteristics can add to the toxicity of SA events. Although research has assessed characteristics of the assault itself (e.g., force, penetration), few studies have examined the larger socioenvironmental context in which SA takes place. This was the purpose of the present study. Young adults ( N = 220; 80% female; 54% current students) reported on their most recent SA during college. Cross-sectional associations were tested via structural equation modeling to determine the contributions of socioenvironmental context and assault characteristics in predicting event-related distress. Socioenvironmental context from the most recent assault included assault setting, intoxication at the time of the assault, perpetrator relationship, and prior consensual sexual experiences with the perpetrator. We also examined assault characteristics, including physical force and penetration. Participants reported how upsetting the most recent assault was (a) at the time it occurred and (b) currently. Results revealed differential patterns for socioenvironmental context and assault characteristics based on the timing of distress (past or present). Notably, many of the socioenvironmental factors showed associations with distress above and beyond the powerful effects of physical force and penetration. These findings have important implications for our understanding of the unique factors that contribute to and maintain psychological distress in sexually victimized young adults.

Sexual Assault Severity and Depressive Symptoms as Longitudinal Predictors of the Quality of Women's Sexual Experiences

Depressive symptoms are one consequence of adult/adolescent sexual victimization (ASV) and are linked to sexual health. Female nonproblem drinkers (N = 419) with an ASV history participated in a one-year longitudinal study. Participants completed measures of lifetime ASV severity and four quarterly assessments of depressive symptoms, ASV severity, and sexual experience quality. Multilevel models revealed that depressive symptoms interacted with ASV severity: Women with low-lifetime ASV severity reported higher ratings of sexual pain as depressive symptoms increased. ASV reported during assessment months predicted sexual experience quality. Interventions to improve survivors' sexual experiences should consider incorporating treatment for depressive symptoms.

Secondary and 2-Year Outcomes of a Sexual Assault Resistance Program for University Women

We report the secondary outcomes and longevity of efficacy from a randomized controlled trial that evaluated a novel sexual assault resistance program designed for first-year women university students. Participants (N = 893) were randomly assigned to receive the Enhanced Assess, Acknowledge, Act (EAAA) program or a selection of brochures (control). Perception of personal risk, self-defense self-efficacy, and rape myth acceptance was assessed at baseline; 1-week postintervention; and 6-, 12-, 18-, and 24-month postrandomization. Risk detection was assessed at 1 week, 6 months, and 12 months. Sexual assault experience and knowledge of effective resistance strategies were assessed at all follow-ups. The EAAA program produced significant increases in women's perception of personal risk, self-defense self-efficacy, and knowledge of effective (forceful verbal and physical) resistance strategies; the program also produced decreases in general rape myth acceptance and woman blaming over the entire 24-month follow-up period. Risk detection was significantly improved for the intervention group at post-test. The program significantly reduced the risk of completed and attempted rape, attempted coercion, and nonconsensual sexual contact over the entire follow-up period, yielding reductions between 30% and 64% at 2 years. The EAAA program produces long-lasting changes in secondary outcomes and in the incidence of sexual assault experienced by women students. Universities can reduce the harm and the negative health consequences that young women experience as a result of campus sexual assault by implementing this program. Online slides for instructors who want to use this article for teaching are available on PWQ's website at http://journals.sagepub.com/page/pwq/suppl/index.

Relation Between Sexual Assault and Negative Affective Conditions in Female College Students: Does Loss of Hope Account for the Association?

The present study examined dispositional hope as a potential mediator of the association between sexual assault and negative affective conditions, namely, depressive and anxious symptoms in a sample of 223 female college students. Results from conducting bootstrapped mediation analyses indicated that hope agency, but not hope pathways, mediated the link between sexual assault victimization and negative affective conditions in females. Importantly, the associations of sexual assault with both depressive and anxious symptoms remained highly significant independent of hope. Some implications of the present findings are discussed.

Men’s Perception of Raped Women: Test of the Sexually Transmitted Disease Hypothesis and the Cuckoldry Hypothesis

Rape is a recurrent adaptive problem of female humans and females of a number of non-human animals. Rape has various physiological and reproductive costs to the victim. The costs of rape are furthermore exaggerated by social rejection and blaming of a victim, particularly by men. The negative perception of raped women by men has received little attention from an evolutionary perspective. Across two independent studies, we investigated whether the risk of sexually transmitted diseases (the STD hypothesis, Hypothesis 1) or paternity uncertainty (the cuckoldry hypothesis, Hypothesis 2) influence the negative perception of raped women by men. Raped women received lower attractiveness score than non-raped women, especially in long-term mate attractiveness score. The perceived attractiveness of raped women was not influenced by the presence of experimentally manipulated STD cues on faces of putative rapists. Women raped by three men received lower attractiveness score than women raped by one man. These results provide stronger support for the cuckoldry hypothesis (Hypothesis 2) than for the STD hypothesis (Hypothesis 1). Single men perceived raped women as more attractive than men in a committed relationship (Hypothesis 3), suggesting that the mating opportunities mediate men’s perception of victims of rape. Overall, our results suggest that the risk of cuckoldry underlie the negative perception of victims of rape by men rather than the fear of disease transmission.

A Comparison of Two Models of Risky Sexual Behavior During Late Adolescence

Two models of risky sexual behavior (RSB) were compared in a community sample of late adolescents (N = 223). For the traumagenic model, early negative sexual experiences were posited to lead to an association between negative affect with sexual relationships. For the cognitive escape model, depressive affect was posited to lead to engagement in RSB as a way to avoid negative emotions. The current study examined whether depression explained the relationship between sexual trauma and RSB, supporting the cognitive escape model, or whether it was sexual trauma that led specifically to RSB, supporting the traumagenic model. Physical trauma experiences were also examined to disentangle the effects of sexual trauma compared to other emotionally distressing events. The study examined whether the results would be moderated by participant sex. For males, support was found for the cognitive escape model but not the traumagenic model. Among males, physical trauma and depression predicted engagement in RSB but sexual trauma did not. For females, support was found for the traumagenic and cognitive escape model. Among females, depression and sexual trauma both uniquely predicted RSB. There was an additional suppressor effect of socioeconomic status in predicting RSB among females. Results suggest that the association of trauma type with RSB depends on participant sex. Implications of the current study for RSB prevention efforts are discussed.

Consensual Victim-Perpetrator Intercourse after Nonconsensual Sex: The Impact of Prior Relationship

Some female victims of nonconsensual sex subsequently have consensual sexual intercourse with the perpetrator and are more likely to do so if intercourse occurred during the nonconsensual sex than if it did not. Some evolutionary psychologists have postulated that there is something significant about nonconsensual intercourse that causes women to subsequently have a sexual relationship with the perpetrator (e.g., risk of pregnancy). In this study, we investigated a parsimonious explanation that has previously been overlooked: Intercourse is more likely during nonconsensual sex when the victim and perpetrator have previously had a sexual relationship; thus, subsequent consensual intercourse may simply be a continuation of that prior relationship. A sample of 945 women completed an Internet-based survey, of whom 41% had experienced nonconsensual sex since age 14. As expected, victims who had intercourse with perpetrators prior to the nonconsensual sex event were significantly more likely than other victims to experience nonconsensual intercourse and to engage in subsequent consensual intercourse with the perpetrator. When considering only the small subsample of victims who never had a prior romantic or sexual relationship with the perpetrator, the odds of subsequent consensual intercourse were still significantly greater following nonconsensual sex with intercourse versus without intercourse.

Sexual violence in the lives of first-year university women in Canada: no improvements in the 21st century

BACKGROUND

Summarizes the frequency, type, and context of sexual assault in a large sample of first-year university women at three Canadian universities.

METHODS

As part of a randomized controlled trial assessing the efficacy of a sexual assault resistance education program, baseline data were collected from women between ages of 17 and 24 using computerized surveys. Participants' experience with sexual victimization since the age of 14 years was assessed using the Sexual Experiences Survey--Short Form Victimization (SES-SFV).

RESULTS

Among 899 first-year university women (mean age = 18.5 years), 58.7% (95% CI: 55.4%, 62.0%) had experienced one or more forms of victimization since the age of 14 years, 35.0% (95% CI: 31.9%, 38.3%) had experienced at least one completed or attempted rape, and 23.5% (95% CI: 20.7%, 26.4%) had been raped. Among the 211 rape victims, 46.4% (95% CI: 39.7%, 53.2%) had experienced more than one type of assault (oral, vaginal, anal) in a single incident or across multiple incidents. More than three-quarters (79.6%; 95% CI: 74.2%, 85.1%) of the rapes occurred while women were incapacitated by alcohol or drugs. One-third (33.3%) of women had previous self-defence training, but few (4.0%) had previous sexual assault education.

CONCLUSIONS

Findings from the first large Canadian study of university women since the 1990s indicate that a large proportion of women arrive on campuses with histories of sexual victimization, and they are generally unprepared for the perpetrators they may face during their academic years. There is an urgent need for effective rape prevention programs on university campuses.

TRIAL REGISTRATION

ClinicalTrials.gov NCT01338428. Registered 13 April 2011.

Dimensions and correlates of negative attitudes toward female survivors of sexual violence in Eastern DRC

The aim of the study described in this article is to examine the dimensions and correlates of attitudes toward survivors of sexual violence (SV) in Eastern Democratic Republic of the Congo (DRC). Four dimensions of attitudes were identified: victim responsibility, victim denigration, victim credibility, and deservingness. Gender roles attitudes represented the most significant correlate of attitudes toward survivors in this population. Other significant correlates of overall attitudes toward survivors included current employment, province of residence, knowledge about the SV law, awareness about where to go for information on sexual and gender-based violence (SGBV), and the perceived prevalence of SV in own community. There are differences and communalities in the variables associated with the various dimensions of attitudes. For example, sex of the respondent and discussion of SGBV with others were only significantly associated with the tendency to ascribe responsibility to the victim. The findings indicate that changing negative gender norms should be central to efforts aimed at promoting accepting attitudes toward survivors. Furthermore, addressing the various dimensions of attitudes toward survivors may require different strategies.