1
|
Dworkin ER. Risk for Mental Disorders Associated With Sexual Assault: A Meta-Analysis. TRAUMA, VIOLENCE & ABUSE 2020; 21:1011-1028. [PMID: 30585128 PMCID: PMC6707905 DOI: 10.1177/1524838018813198] [Citation(s) in RCA: 97] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Sexual assault (SA) is a common form of trauma that is associated with numerous deleterious outcomes. Understanding the relative prevalence of psychiatric diagnoses in people who have been sexually assaulted versus people who have not been assaulted could help to prioritize assessment and intervention efforts, but there has been no quantitative review of this topic. A search of PsychINFO, ProQuest Digital Dissertations and Theses, and Academic Search Premier for articles dated between 1970 and 2014 was conducted, and unpublished data were obtained. Eligible studies used diagnostic interviews to assess Diagnostic and Statistical Manual of Mental Disorders diagnoses in both individuals experiencing adolescent/adult and/or lifetime SA and unassaulted individuals. The search yielded 171 eligible effects from 39 studies representing 88,539 participants. Meta-regression was used to aggregate the prevalence of psychiatric diagnoses in sexually assaulted and unassaulted samples as well as calculate odds ratios reflecting the difference between these prevalence estimates. Results indicated that most disorders were more prevalent in survivors of SA, and depressive disorders and posttraumatic stress disorder (PTSD) were especially prevalent. Disorder-specific differences in odds ratios were observed as a function of sample type, type of comparison group, and time frame of SA. Service providers should be prepared to address depressive disorders and PTSD in survivors of SA, and interventions that prevent the development of these disorders are especially needed.
Collapse
Affiliation(s)
- Emily R Dworkin
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| |
Collapse
|
2
|
Wiersma-Mosley JD, Jozkowski KN. A Brief Report of Sexual Violence among Universities with NCAA Division I Athletic Programs. Behav Sci (Basel) 2019; 9:bs9020017. [PMID: 30720757 PMCID: PMC6406521 DOI: 10.3390/bs9020017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 01/29/2019] [Accepted: 01/31/2019] [Indexed: 11/16/2022] Open
Abstract
Violence against women on college campuses continues to be a pervasive public health problem with approximately one in five women experiencing sexual assault and one in nine women experiencing rape while in college. The current study examined relationship and sexual violence among National Collegiate Athletic Association (NCAA) Division I universities. Based on previous research, Division I universities seem to report higher rates of sexual assault, but within-group differences have yet to be examined. The data include 1422 four-year private and public institutions with at least 1000 students who submitted Clery data (2014) on rape, domestic and dating violence, and stalking. Division I campuses reported significantly higher reports of violence against women compared to Division II, III, and universities with no athletic programs. There were no differences in violence reported across the three subdivisions within Division I, however, certain conferences reported significantly higher relationship and sexual violence within the football bowl and football championship subdivisions. These findings have important implications for targeting higher risk campuses, such as the Big 10, Big 12, Ivy League, Pac-12, and SEC with much needed sexual assault prevention programs.
Collapse
Affiliation(s)
| | - Kristen N Jozkowski
- The Department of Health, Human Performance and Recreation, University of Arkansas, Fayetteville, AR 72701, USA.
- The Kinsey Institute for Research in Sex, Gender and Reproduction, Bloomington, IN 47405, USA.
| |
Collapse
|
3
|
Dworkin ER, Menon SV, Bystrynski J, Allen NE. Sexual assault victimization and psychopathology: A review and meta-analysis. Clin Psychol Rev 2017; 56:65-81. [PMID: 28689071 PMCID: PMC5576571 DOI: 10.1016/j.cpr.2017.06.002] [Citation(s) in RCA: 340] [Impact Index Per Article: 48.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 05/22/2017] [Accepted: 06/18/2017] [Indexed: 01/18/2023]
Abstract
Sexual assault (SA) is a common and deleterious form of trauma. Over 40years of research on its impact has suggested that SA has particularly severe effects on a variety of forms of psychopathology, and has highlighted unique aspects of SA as a form of trauma that contribute to these outcomes. The goal of this meta-analytic review was to synthesize the empirical literature from 1970 to 2014 (reflecting 497 effect sizes) to understand the degree to which (a) SA confers general risk for psychological dysfunction rather than specific risk for posttraumatic stress, and (b) differences in studies and samples account for variation in observed effects. Results indicate that people who have been sexually assaulted report significantly worse psychopathology than unassaulted comparisons (average Hedges' g=0.61). SA was associated with increased risk for all forms of psychopathology assessed, and relatively stronger associations were observed for posttraumatic stress and suicidality. Effects endured across differences in sample demographics. The use of broader SA operationalizations (e.g., including incapacitated, coerced, or nonpenetrative SA) was not associated with differences in effects, although including attempted SA in operationalizations resulted in lower effects. Larger effects were observed in samples with more assaults involving stranger perpetrators, weapons, or physical injury. In the context of the broader literature, our findings provide evidence that experiencing SA is major risk factor for multiple forms of psychological dysfunction across populations and assault types.
Collapse
|
4
|
Lindquist CH, Barrick K, Krebs C, Crosby CM, Lockard AJ, Sanders-Phillips K. The context and consequences of sexual assault among undergraduate women at Historically Black Colleges and Universities (HBCUs). JOURNAL OF INTERPERSONAL VIOLENCE 2013; 28:2437-61. [PMID: 23515164 DOI: 10.1177/0886260513479032] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
To examine the context of sexual assault and postassault actions and consequences among women attending historically Black colleges or universities (HBCUs), web-based surveys were administered in November 2008 to 3,951 undergraduate women attending four HBCUs. Data on the context in which assaults occurred were generated for women who had been sexually assaulted since entering college (n = 358). Multivariate models were run on the full sample to examine the association between sexual assault and symptoms of depression and posttraumatic stress disorder (PTSD). Results indicated that most survivors were assaulted by assailants well known to them and when the survivor and perpetrator were drinking alcohol. Very few survivors disclosed their experiences to formal sources of support. Survivors had significantly more symptoms of depression and were more likely to screen positive for PTSD than nonvictims. Further research on disclosure and its moderating role on the mental health consequences of sexual assault is needed.
Collapse
|
5
|
Combs JL, Jordan CE, Smith GT. Individual Differences in Personality Predict Externalizing versus Internalizing Outcomes Following Sexual Assault. PSYCHOLOGICAL TRAUMA-THEORY RESEARCH PRACTICE AND POLICY 2013; 6:375-383. [PMID: 30740196 DOI: 10.1037/a0032978] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
For some women, the experience of being sexually assaulted leads to increases in externalizing behaviors, such as problem drinking and drug use; for other women, the experience of being assaulted leads to increases in internalizing distress like depression or anxiety. It is possible that pre-assault personality traits interact with sexual assault to predict externalizing or internalizing distress. We tested whether concurrent relationships among personality, sexual assault, and distress were consistent with such a model. We surveyed 750 women just prior to their freshman year at a large public university. Consistent with our hypotheses, at low levels of negative urgency (the tendency to act rashly when distressed), sexual assault exposure had little relationship to problem drinking and drug use. At high levels of negative urgency, being sexually assaulted was highly associated with those externalizing behaviors. At low levels of internalizing personality traits, being assaulted had little relationship to depression and anxiety symptoms; at high levels of the traits, assault experience was highly related to those symptoms. Personality assessment could lead to more person-specific post-assault interventions.
Collapse
|
6
|
|
7
|
Littleton H, Buck K, Rosman L, Grills-Taquechel A. From Survivor to Thriver: A Pilot Study of an Online Program for Rape Victims. COGNITIVE AND BEHAVIORAL PRACTICE 2012; 19:315-327. [PMID: 24009410 DOI: 10.1016/j.cbpra.2011.04.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Approximately 15% to 20% of women have been victims of rape and close to a third report current rape-related PTSD or clinically significant depression or anxiety. Unfortunately, very few distressed rape victims seek formal help. This suggests a need to develop alternative ways to assist the many distressed victims of sexual violence. Online treatment programs represent a potentially important alternative strategy for reaching such individuals. The current paper describes a pilot evaluation of an online, therapist-facilitated, self-paced cognitive behavioral program for rape victims. Five college women with current rape-related PTSD were recruited to complete the From Survivor to Thriver (S to T) program in a lab setting over the course of 7 weeks. After completing the program, 4 participants reported clinically significant reductions in PTSD symptoms and no longer met criteria for PTSD. All participants reported clinically significant reductions in vulnerability fears and 4 reported significant reductions in negative trauma-related cognitions. Implications of the results for further development of the S to T program and how clinicians could utilize this program in treating rape-related PTSD are discussed.
Collapse
|
8
|
Houston JE, Shevlin M, Adamson G, Murphy J. A person-centred approach to modelling population experiences of trauma and mental illness. Soc Psychiatry Psychiatr Epidemiol 2011; 46:149-57. [PMID: 20107975 DOI: 10.1007/s00127-009-0176-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2009] [Accepted: 12/09/2009] [Indexed: 11/29/2022]
Abstract
BACKGROUND Exposure to traumatic events has been implicated in the onset and development of a range of psychiatric disorders. People can be exposed to multiple traumatic events and previous research suggests that traumatic experiences may cluster at the individual level. METHODS This study aimed to examine the distribution of traumatic experiences in a large nationally representative sample using latent class analysis, and estimate the relationship between these classes and a number of demographic and clinical variables. Data from the National Comorbidity Survey was used. RESULTS Four latent classes, each representative of a range of traumatic experiences were identified. The classes were labelled 'high risk' (class 1), 'exposure to non-sexual adult interpersonal/non-interpersonal trauma' (class 2), 'intermediate risk/sexual abuse' (class 3), and 'low risk' (class 4). Each of the latent classes was predicted by several of the demographic variables. In addition, membership of classes 1, 2, and 3 increased the risk of each of the clinical variables. CONCLUSIONS The findings have clinical implications for the assessment of trauma histories across a range of psychiatric diagnoses.
Collapse
Affiliation(s)
- James E Houston
- Nottingham Trent University, Burton Street, Nottingham, NG1 4BU, UK.
| | | | | | | |
Collapse
|
9
|
Chen LP, Murad MH, Paras ML, Colbenson KM, Sattler AL, Goranson EN, Elamin MB, Seime RJ, Shinozaki G, Prokop LJ, Zirakzadeh A. Sexual abuse and lifetime diagnosis of psychiatric disorders: systematic review and meta-analysis. Mayo Clin Proc 2010; 85:618-29. [PMID: 20458101 PMCID: PMC2894717 DOI: 10.4065/mcp.2009.0583] [Citation(s) in RCA: 537] [Impact Index Per Article: 38.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To systematically assess the evidence for an association between sexual abuse and a lifetime diagnosis of psychiatric disorders. PATIENTS AND METHODS We performed a comprehensive search (from January 1980-December 2008, all age groups, any language, any population) of 9 databases: MEDLINE, EMBASE, CINAHL, Current Contents, PsycINFO, ACP Journal Club, CCTR, CDSR, and DARE. Controlled vocabulary supplemented with keywords was used to define the concept areas of sexual abuse and psychiatric disorders and was limited to epidemiological studies. Six independent reviewers extracted descriptive, quality, and outcome data from eligible longitudinal studies. Odds ratios (ORs) and 95% confidence intervals (CIs) were pooled across studies by using the random-effects model. The I(2) statistic was used to assess heterogeneity. RESULTS The search yielded 37 eligible studies, 17 case-control and 20 cohort, with 3,162,318 participants. There was a statistically significant association between sexual abuse and a lifetime diagnosis of anxiety disorder (OR, 3.09; 95% CI, 2.43-3.94), depression (OR, 2.66; 95% CI, 2.14-3.30), eating disorders (OR, 2.72; 95% CI, 2.04-3.63), posttraumatic stress disorder (OR, 2.34; 95% CI, 1.59-3.43), sleep disorders (OR, 16.17; 95% CI, 2.06-126.76), and suicide attempts (OR, 4.14; 95% CI, 2.98-5.76). Associations persisted regardless of the victim's sex or the age at which abuse occurred. There was no statistically significant association between sexual abuse and a diagnosis of schizophrenia or somatoform disorders. No longitudinal studies that assessed bipolar disorder or obsessive-compulsive disorder were found. Associations between sexual abuse and depression, eating disorders, and posttraumatic stress disorder were strengthened by a history of rape. CONCLUSION A history of sexual abuse is associated with an increased risk of a lifetime diagnosis of multiple psychiatric disorders.
Collapse
Affiliation(s)
- Laura P Chen
- Mayo Medical School, Mayo Clinic, Rochester, MN 55905, USA
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Campbell R, Dworkin E, Cabral G. An ecological model of the impact of sexual assault on women's mental health. TRAUMA, VIOLENCE & ABUSE 2009; 10:225-46. [PMID: 19433406 DOI: 10.1177/1524838009334456] [Citation(s) in RCA: 433] [Impact Index Per Article: 28.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
This review examines the psychological impact of adult sexual assault through an ecological theoretical perspective to understand how factors at multiple levels of the social ecology contribute to post-assault sequelae. Using Bronfenbrenner's (1979, 1986, 1995) ecological theory of human development, we examine how individual-level factors (e.g., sociodemographics, biological/genetic factors), assault characteristics (e.g., victim-offender relationship, injury, alcohol use), microsystem factors (e.g., informal support from family and friends), meso/ exosystem factors (e.g., contact with the legal, medical, and mental health systems, and rape crisis centers), macrosystem factors (e.g., societal rape myth acceptance), and chronosystem factors (e.g., sexual revictimization and history of other victimizations) affect adult sexual assault survivors' mental health outcomes (e.g., post-traumatic stress disorder, depression, suicidality, and substance use). Self-blame is conceptualized as meta-construct that stems from all levels of this ecological model. Implications for curbing and/or preventing the negative mental health effects of sexual assault are discussed.
Collapse
Affiliation(s)
- Rebecca Campbell
- Michigan State University, Department of Psychology, East Lansing, MI 48824-1116, USA.
| | | | | |
Collapse
|
11
|
Sanjuan PM, Langenbucher JW, Labouvie E. The Role of Sexual Assault and Sexual Dysfunction in Alcohol/Other Drug Use Disorders. ALCOHOLISM TREATMENT QUARTERLY 2009. [DOI: 10.1080/07347320902785541] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
12
|
Krupnick JL, Green BL, Stockton P, Goodman L, Corcoran C, Petty R. Mental health effects of adolescent trauma exposure in a female college sample: exploring differential outcomes based on experiences of unique trauma types and dimensions. Psychiatry 2004; 67:264-79. [PMID: 15491942 DOI: 10.1521/psyc.67.3.264.48986] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Most studies on the psychological impact of trauma exposure focus on the response to a single type of trauma, with little or no attention paid to the contribution of prior traumatic experiences. The goal of this study was to disentangle some of the confounding effects of multiple trauma exposures by exploring the unique contribution to mental health outcomes made by specific types and dimensions of trauma. This report compares the psychological outcomes of college women who experienced different types of trauma during adolescence, including traumatic bereavement, sexual assault, and physical assault. Young women who had experienced a single event of one of these types were compared with peers who had experienced multiple single events, ongoing sexual and/or physical abuse, as well as those who had experienced no trauma. Results, based on structured clinical interviews, and self-report measures showed that there were some significant differences in mental health outcomes based on trauma type. However, trauma exposure versus no exposure and the cumulative effects of exposure versus one-time experiences played the key roles in differentiating the groups.
Collapse
|
13
|
Murdoch M, Hodges J, Hunt C, Cowper D, Kressin N, O'Brien N. Gender Differences in service connection for PTSD. Med Care 2003; 41:950-61. [PMID: 12886174 DOI: 10.1097/00005650-200308000-00008] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Mentally ill female veterans obtain a smaller proportion of their care from Department of Veterans Affairs (VA) facilities than mentally ill male veterans do, possibly because women are less likely than men to be service connected for psychiatric disabilities. "Service connected" veterans have documented, compensative conditions related to or aggravated by military service, and they receive priority for enrollment into the VA healthcare system. OBJECTIVES To see if there are gender discrepancies in rates of service connection for posttraumatic stress disorder (PTSD) and, if so, to see if these discrepancies could be attributed to appropriate subject characteristics (eg, differences in symptom severity or impairment). RESEARCH DESIGN Mailed survey linked to administrative data. Claims audits were conducted on 11% of the sample. SUBJECTS Randomly selected veterans seeking VA disability benefits for PTSD. Women were oversampled to achieve a gender ratio of 1:1. RESULTS A total of 3337 veterans returned usable surveys (effective response rate, 68%). Men's unadjusted rate of service connection for PTSD was 71%; women's, 52% (P < 0.0001). Adjustment for veterans' PTSD symptom severity or functional impairment did not appreciably reduce this discrepancy, but adjustment for dissimilar rates of combat exposure did. Estimated rates of service connection were 53% for men and 56% for women after adjusting for combat exposure. This combat preference could not be explained by more severe PTSD symptoms or greater functional impairment. CONCLUSIONS Instead of a gender bias in awards for PTSD service connection, we found evidence of a combat advantage that disproportionately favored men. The appropriateness of this apparent advantage is unclear and needs further investigation.
Collapse
Affiliation(s)
- Maureen Murdoch
- Center for Chronic Disease Outcomes Research and Section of General Internal Medicine, Minneapolis VA Medical Center, and Department of Internal Medicine, University of Minnesota School of Medicine, Minneapolis Minnesota 55417, USA.
| | | | | | | | | | | |
Collapse
|
14
|
Resick PA, Nishith P, Griffin MG. How well does cognitive-behavioral therapy treat symptoms of complex PTSD? An examination of child sexual abuse survivors within a clinical trial. CNS Spectr 2003; 8:340-55. [PMID: 12766690 PMCID: PMC2970926 DOI: 10.1017/s1092852900018605] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Are brief cognitive-behavioral treatments for posttraumatic stress disorder (PTSD) also effective for the wider range of symptoms conceptualized as complex PTSD? Female rape victims, most of whom had extensive histories of trauma, were randomly assigned to cognitive-processing therapy, prolonged exposure, or a delayed-treatment waiting-list condition. After determining that both types of treatment were equally effective for treating complex PTSD symptoms, we divided the sample of 121 participants into two groups depending upon whether they had a history of child sexual abuse. Both groups improved significantly over the course of treatment with regard to PTSD, depression, and the symptoms of complex PTSD as measured by the Trauma Symptom Inventory. Improvements were maintained for at least 9 months. Although there were group main effects on the Self and Trauma factors, there were no differences between the two groups at posttreatment once pretreatment scores were covaried. These findings indicate that cognitive-behavioral therapies are effective for patients with complex trauma histories and symptoms patterns.
Collapse
Affiliation(s)
- Patricia A Resick
- Center for Trauma Recovery, University of Missouri-St. Louis, St. Louis, Missouri 63121, USA.
| | | | | |
Collapse
|
15
|
Chang BH, Skinner KM, Boehmer U. Religion and mental health among women veterans with sexual assault experience. Int J Psychiatry Med 2002; 31:77-95. [PMID: 11529393 DOI: 10.2190/0nqa-yaj9-w0am-yb3p] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Religion has been shown to have a positive impact on well-being and to play an important role in coping with stressful life events. However, the buffering effect of religiosity on mental health, after a particularly stressful life event such as sexual assault, has not been studied. In this study we examined the buffering effect of religion on mental health and depression for women who report experiencing sexual assault while in the military. METHOD The sample includes a nationally representative sample of 3,543 women veterans who use VA ambulatory care. Two dimensions of religiosity were used: organizational (frequency of religious service attendance) and subjective (the extent religious beliefs are a source of strength/comfort). Mental health was measured by the mental component summary (MCS) from the SF36 and depressive symptoms were measured by the Center for Epidemiologic Studies-Depression (CES-D) scale. RESULTS Women veterans who reported experiencing sexual assault while in the military had lower mental health scores and higher levels of depression. Linear regression analysis indicated that these negative impacts diminished with increased frequency of religious service attendance, supporting the buffering effect of organizational religiosity on mental health and depression. Although the buffering effect of subjective religiosity was not evident, subjective religiosity was shown to be positively associated with better mental health in both groups of women with and without sexual assault experience in the military. CONCLUSIONS Frequent religious service attendance buffers the negative impacts of sexual assault on mental health and depression of women veterans. The potential of integrating religiosity in designing interventions is discussed.
Collapse
Affiliation(s)
- B H Chang
- Boston University School of Public Health and Edith Nourse Rogers Memorial Veterans Hospital, Massachusetts, USA.
| | | | | |
Collapse
|
16
|
Abstract
Much of the literature on the psychiatric consequences of stress has focused on wartime combat trauma. However, traumatic events also frequently occur in civilian life. Controlled studies on the psychiatric effects of noncombat trauma were reviewed and a meta-analysis of these data was conducted. Generalized anxiety disorder (GAD), posttraumatic stress disorder (PTSD), substance abuse, phobia, and major depressive disorder (MDD) were significantly elevated compared with a pooled control group, whereas panic disorder and dysthymic disorder were not significantly increased. These data suggest that the psychiatric effects of civilian trauma include both anxiety and depressive disorders. The results are strikingly similar to those reported in combat veterans, suggesting that severe trauma, even in very different populations, may be associated with similar psychopathology.
Collapse
Affiliation(s)
- E S Brown
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, USA
| | | | | | | |
Collapse
|
17
|
Krakow B, Germain A, Tandberg D, Koss M, Schrader R, Hollifield M, Cheng D, Edmond T. Sleep breathing and sleep movement disorders masquerading as insomnia in sexual-assault survivors. Compr Psychiatry 2000; 41:49-56. [PMID: 10646619 DOI: 10.1016/s0010-440x(00)90131-7] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
A descriptive, hypothesis-generating study was performed with 156 female sexual-assault survivors who suffered from insomnia, nightmares, and posttraumatic stress disorder (PTSD). They completed 2 self-report sleep questionnaires to assess the potential presence of intrinsic sleep disorders. Seventy-seven percent of the sample (120 of 156) endorsed additional sleep complaints, besides their insomnia symptoms, that indicate the potential presence of sleep-disordered breathing ([SDB] 81 of 156, 52%) and sleep-related movement disorders ([SMD] 94 of 156, 60%). The potential for SDB was strongly correlated with the body mass index (BMI), an increase in arousal symptoms, and greater total PTSD severity. In some sexual-assault survivors, the relationship between sleeplessness and posttraumatic stress may be caused or exacerbated by intrinsic sleep disorders, and not be solely a function of psychophysiological insomnia--the traditional diagnostic term usually offered to explain the sleep problems associated with PTSD. Prevalence studies that use objective diagnostic evaluations such as polysomnography (PSG) are needed to test these hypotheses.
Collapse
Affiliation(s)
- B Krakow
- Department of Emergency Medicine, School of Medicine, University of New Mexico Health Sciences Center, Albuquerque, USA
| | | | | | | | | | | | | | | |
Collapse
|
18
|
Bartoi MG, Kinder BN, Tomianovic D. Interaction effects of emotional status and sexual abuse on adult sexuality. JOURNAL OF SEX & MARITAL THERAPY 2000; 26:1-23. [PMID: 10693113 DOI: 10.1080/009262300278614] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
This study examined the additive, interaction effects of emotional status with sexual abuse on adult sexual functioning and sexual responsibility. The Golombok Rust Inventory of Sexual Satisfaction (GRISS; Rust & Golombok, 1986), the Personality Assessment Inventory (PAI; Morey, 1991), and a questionnaire regarding sexual experiences, number of unwanted pregnancies, number of unsafe sexual partners, and sexual abuse history, were administered to 200 psychology students. One hundred and forty-three participants were retained in the study. Two-way multivariate analyses of variance (MANOVA) were conducted for the sexual functioning variables (as measured by the GRISS), while two-way analyses of variance (ANOVA) were conducted for the sexual irresponsibility variables (as measured by the sexual experiences questionnaire). It was found that women who have high anxiety scores on the PAI and have a history of sexual abuse reported higher numbers of unwanted pregnancies, while sexual abuse history was not associated with numbers of unwanted pregnancies for women with lower levels of anxiety. Results were not significant, however, for the sexual functioning variables. In addition, depression and alcoholism did not have interacting effect on the association between sexual abuse history and any of the sexuality variables. These results may suggest that the effects of sexual abuse on adult sexuality may not be as pervasive as was once thought.
Collapse
|
19
|
Nishith P, Mechanic MB, Resick PA. Prior interpersonal trauma: The contribution to current PTSD symptoms in female rape victims. JOURNAL OF ABNORMAL PSYCHOLOGY 2000. [DOI: 10.1037/0021-843x.109.1.20] [Citation(s) in RCA: 153] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
20
|
Contextualizing rape: Reviewing sequelae and proposing a culturally inclusive ecological model of sexual assault recovery. ACTA ACUST UNITED AC 1999. [DOI: 10.1016/s0962-1849(99)80010-9] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
21
|
Harrison JM, Murphy SM. A care package for managing female sexual assault in genitourinary medicine. Int J STD AIDS 1999; 10:283-9. [PMID: 10361915 DOI: 10.1258/0956462991914041] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This paper describes the development of a designated in-house service for the management of adult female victims of sexual assault within the Department of Genitourinary Medicine (GUM) at St Mary's Hospital, London. This was set up in 1994 as a need was identified by medical, nursing, psychological and health advising staff for an appropriate streamlined service which would provide comprehensive sexual health screening, psychological support and therapy and adequate medico-legal documentation within the limitations of a busy GUM clinic. A structured package of care consisting of medical and psychological protocols with training for relevant staff and a specialist in-house referral clinic was introduced. Fifty-four patients were seen during the first 17 months of the service, the notes of 48 of these were examined and relevant epidemiological and audit data are presented here. By auditing the quality of documentation before and after the introduction of the protocols specifically looking at the appropriateness and comprehensiveness of the sexually transmitted diseases screen and the medico-legal documentation it was clear that the quality of care to these patients was improved. We present here the development of these protocols, a detailed description of the protocols themselves and the method of their implementation.
Collapse
Affiliation(s)
- J M Harrison
- Department of Genitourinary Medicine and Clinical Health Psychology, St Mary's Hospital, London, UK
| | | |
Collapse
|
22
|
Falsetti SA. The decision-making process of choosing a treatment for patients with civilian trauma-related PTSD. COGNITIVE AND BEHAVIORAL PRACTICE 1997. [DOI: 10.1016/s1077-7229(97)80014-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
23
|
Semple WE, Goyer PF, McCormick R, Compton-Toth B, Morris E, Donovan B, Muswick G, Nelson D, Garnett ML, Sharkoff J, Leisure G, Miraldi F, Schulz SC. Attention and regional cerebral blood flow in posttraumatic stress disorder patients with substance abuse histories. Psychiatry Res 1996; 67:17-28. [PMID: 8797239 DOI: 10.1016/0925-4927(96)02735-7] [Citation(s) in RCA: 70] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Performance on an attentional task was assessed in posttraumatic stress disorder patients with substance abuse histories (PTSD-SA). Positron emission tomography (PET) was used to measure concurrent regional cerebral blood flow (rCBF). Eight male PTSD-SA patients and eight normal subjects each received three serial PET scans with 15O-labeled water under the following conditions: (1) resting, (2) auditory continuous performance task (ACPT1), and (3) repeat auditory task (ACPT2). PTSD-SA patients made more errors of commission on the ACPT than normal subjects. Examination of right frontal and parietal cortex ACPT task substrates revealed decreased parietal blood flow in PTSD-SA, which may represent a pathophysiology for poor attentional task performance in PTSD-SA. Attentional problems may underlie other symptomatology in PTSD.
Collapse
Affiliation(s)
- W E Semple
- Cleveland Veterans Administration Medical Center (11B), Brecksville, OH 44141, USA
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Zlotnick C, Begin A, Shea MT, Pearlstein T, Simpson E, Costello E. The relationship between characteristics of sexual abuse and dissociative experiences. Compr Psychiatry 1994; 35:465-70. [PMID: 7867320 DOI: 10.1016/0010-440x(94)90230-5] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Childhood sexual abuse has been associated with adult dissociative symptomatology. The purpose of this study was to examine the relationship between specific characteristics of sexual abuse and dissociative experiences in adulthood. Fifty-six female inpatients with a history of physical abuse and severe sexual abuse reported on their history of abuse and dissociative experiences. A logistic regression that controlled for physical revictimization showed that sexual abuse by a greater number of different sex abuse offenders was significantly related to an elevated level of dissociation. In exploring how many sex abuse offenders are associated with dissociative experiences, a logistic regression revealed a significant relationship between four or more sex abuse offenders and greater dissociative symptomatology. The reported age of onset of the sexual abuse was not a significant predictor of dissociation when sexual revictimization was included in the analysis. These findings suggest that severely traumatized patients with a history of multiple sex abuse offenders are highly likely to use dissociation as a primary psychological defense. The implications of the study are discussed.
Collapse
Affiliation(s)
- C Zlotnick
- Department of Psychiatry and Human Behavior, Brown University, Providence, RI
| | | | | | | | | | | |
Collapse
|
25
|
Abstract
This article describes the frequency of possible risk factors that emerged during a cross-cultural study of psychosocial response to sexual assault among African-American, Hispanic, and non-Hispanic white women presenting for treatment at a major urban rape treatment center. Of 881 victims screened, 51% had no observable risk factors while 49% fell into categories of variables that previous research has associated with increased vulnerability. Included were mental disability (psychiatric or developmental), a prior history of rape or incest, tourist or visitor status (site unfamiliarity), and homelessness. Ethnic groups differed significantly in these categories, suggesting socioeconomic and cultural variables that may affect rape statistics and that should be taken into account in rape prevention programs in the community.
Collapse
Affiliation(s)
- C S Scott
- Department of Psychiatry, University of Miami School of Medicine
| | | | | |
Collapse
|
26
|
Goodman LA, Koss MP, Felipe Russo N. Violence against women: Physical and mental health effects. Part I: Research findings. ACTA ACUST UNITED AC 1993. [DOI: 10.1016/s0962-1849(05)80114-3] [Citation(s) in RCA: 89] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
27
|
Smith WH. Antecedents of posttraumatic stress disorder: wasn't being raped enough? A brief communication. Int J Clin Exp Hypn 1991; 39:129-33. [PMID: 1894385 DOI: 10.1080/00207149108409628] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Many rape victims, like those traumatized by war, accidents, and natural disasters, are able to recover from their ordeal with supportive, crisis-oriented treatment. For others, however, symptoms may persist and require more intensive treatment. Hypnosis allows a modulated re-experiencing and abreaction of the traumatic event that can help to provide the victim with a relieving sense of mastery, and it fosters a receptive context for reassurance and interpretation regarding the irrational or exaggerated thoughts and feelings involved. 2 case examples are presented in which earlier conflicts appeared to play a role in perpetuating the patients' symptoms. Detecting and addressing these antecedents resulted in complete alleviation of long-standing problems through relatively brief treatment using hypnosis.
Collapse
Affiliation(s)
- W H Smith
- Menninger Clinic, Topeka, KS 66601-0829
| |
Collapse
|
28
|
Mullen PE. The long-term influence of sexual assault on the mental health of victims. ACTA ACUST UNITED AC 1990. [DOI: 10.1080/09585189008408451] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
|
29
|
Moscarello R. Psychological management of victims of sexual assault. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 1990; 35:25-30. [PMID: 2180547 DOI: 10.1177/070674379003500104] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
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.
Collapse
|