Conceptualizing the harm done by rape: applications of trauma theory to experiences of sexual assault

Risk and protective factors affecting the symptom trajectory of posttraumatic stress disorder post-rape

INTRODUCTION

The prevalence of posttraumatic stress disorder (PTSD) in rape survivors is considerably higher than the prevalence in non-sexual trauma survivors. Few studies have investigated risk and protective factors in survivors early-after-rape in a prospective longitudinal design.

METHODS

In a sample of 639 rape-exposed women who were assessed within 20 days of rape and over 6 months, baseline data were used to predict PTSD symptom severity scores up to 6 months post-rape.

RESULTS

The incidence of PTSD at 3 months was 48.5% and the cumulative incidence at 6 months post-rape was 54.8%. Baseline experience of rape stigma (guilt, shame, self-blame, social devaluation and discredit) and depression were significant predictors of PTSD symptom scores over time, in mixed linear regression models. Higher levels of depression and rape stigma were associated with higher PTSD scores. Assault-related factors were not associated with PTSD scores.

LIMITATIONS

We could not measure PTSD symptom trajectories in all rape survivors, some of who may be at greater risk for PTSD e.g. non-disclosing rape survivors, those who declined participation and those who were extremely distressed at the time of recruitment.

CONCLUSION

Addressing internalised and externalised stigma and resultant mental health effects on women who present to rape clinics may reduce the long-term adverse effects of rape on mental health outcomes, such as PTSD. Rape survivors who present with high levels of depression soon after a rape should be carefully monitored and appropriately treated in order to reduce PTSD severity.

“God Helped Us”: Resilience, Religion and Experiences of Gender-Based Violence and Trafficking among African Forced Migrant Women

In this article, I explore how faith and religion shaped the resilience of forced migrant women subjected to intersecting gender-based violence (GBV) and trafficking. Adopting a social constructivist perspective, I draw upon interviews with 11 Christian and 4 Muslim displaced survivors of 10 African nationalities temporarily residing in Tunisia. I first outline the experiences of intersecting violence to understand what displaced survivors were resilient to, and then describe faith pathways to resilience, sometimes with spiritual struggles and unmet religious needs. I delineate ways in which personal prayers and cooperating with God enabled all but one survivor to cope with exploitation and perilous journeys toward imagined refuge. I offer insights for practitioners working with forced migrants on the move and highlight the importance of spiritual support for displaced survivors who are religious. I discuss the findings and offer implications for future research and practice.

"When Her Visa Expired, the Family Refused to Renew It," Intersections of Human Trafficking and Domestic Violence: Qualitative Document Analysis of Case Examples from a Major Midwest City

This study aimed to further understand typologies of trafficking that occur in the home, by an individual's intimate partner (IP) or family members and this overlap with extant knowledge on perpetrator manipulation via the Power and Control Wheel. Inductive and deductive techniques were used to analyze secondary data from a federally funded anti-trafficking program in a Midwest metropolitan area recorded between 2008 and 2017. Cases were included if there was indication of sex or labor exploitation initiated by an IP, family member, or other in the domestic setting via elements of abuse; 59 cases of 213 met this criteria. Most cases included the IP as the trafficker, followed by family members, then others in the domestic setting. Abuse was more commonly used than the threat of abuse. From the Power and Control Wheel, the most frequent types of abuse were using privilege, physical abuse, economic abuse, isolation, and sexual abuse. Case typologies included: those with elements of sex trafficking, specifically forced commercial sex by an IP or family member; those with elements of labor trafficking such as domestic servitude (with or without childcare provision abuse), exploitation in a family business by an IP or family member, or work environments by family and non-family; those with elements of sex and labor trafficking included servile partnerships and forced marriage. Trafficking exploitation by an IP, family member, or in the domestic setting is not uncommon. Intimate relationships with a trafficker, psychological coercion, and threats may reduce reporting of abuse, subsequent provision of services, and result in misclassification as victims of IP violence. This study sheds light on various typologies of trafficking and exploitation in the domestic setting, further expanding the anti-trafficking movement's evidence base for intervention and prevention and adding complexity and nuance to the pathways to trafficking exploitation.

Systematic Review: Effectiveness of psychosocial interventions on wellbeing outcomes for adolescent or adult victim/survivors of recent rape or sexual assault

Sexual assault and rape are common forms of sexual violence/abuse. The psychological/health consequences represent significant and ongoing harm. It seems imperative that victim/survivors receive evidence-based support within first response settings. To assess what psychosocial interventions work for victim/survivors of a recent sexual assault. Twenty-seven electronic databases were systematically searched. Narrative data synthesis was used to read across studies. Reporting format follows PRISMA checklist. Ten studies were identifed including range of interventions. The evidence is sparse and scientifically weak, common flaws are reviewed. There is some weak evidence for the impact of video and cognitive behavioural therapy (CBT) based interventions, especially trauma processing. There is a gap in the evidence base on psychosocial interventions for victim/survivors of sexual assault and higher quality research is required.

Structural and Symbolic Violence Exacerbates the Risks and Consequences of Sexual and Gender-Based Violence for Forced Migrant Women

While much attention is focused on rape as a weapon of war, evidence shows that forced migrant women and girls face increased risks of Sexual and Gender-Based Violence (SGBV) both during and following forced displacement. In this paper, we argue that gendered forms of structural and symbolic violence enable and compound the harms caused by interpersonal SGBV against forced migrant women and girls. These forms of violence are encountered in multiple contexts, including conflict and post-conflict settings, countries of refuge, and following resettlement. This paper illustrates the consequences of resultant cumulative harms for individuals and communities, and highlights the importance of considering these multiple, intersecting harms for policy and practice.

Women's Contexts and Circumstances of Posttraumatic Growth After Sexual Victimization: A Systematic Review

Sexual violence is a concerning public health and criminal justice problem. Even though extensive literature has linked sexual victimization to a multitude of mental and physical problems, some victim/survivors recover and are able to lead lives without notable negative impacts. Little is known about women who experienced posttraumatic growth following sexual victimization. This review brings together knowledge accumulated in the academic literature in the past decade. It was informed by the PRISMA-P guidelines. Databases were searched using a combination of keywords to locate original peer-reviewed research articles published between January 2010 and October 2020 focusing on posttraumatic growth following sexual victimization. The initial search identified 6,187 articles with 265 articles being read in full, identifying 41 articles that were included in the analysis. The results suggest that recovery from sexual victimization is possible with the healing process being idiosyncratic. Victim/survivors employed various strategies resulting in higher degrees of functioning, which were termed growth. Following a synthesis of themes that emerged from the thematic analysis, a higher order abstraction, using creative insight through reflexivity, discussions among the research team and consistent interpretation and re-interpretation of the identified themes as a second stage analysis, resulted in the identification of two superordinate topics "relationship to self" and "relationship to others." Findings indicated that women engaged in deliberate introspection to connect with themselves and utilized altruistic actions and activism in an attempt to prevent further sexual victimization Helping victim/survivors deal with the sexual violence facilitated growth as a collective. We concluded that helping others may be a therapeutic vehicle for PTG. Given research in this area remains in its infancy, further investigation is urgently needed.

"I just became like a log of wood … I was paralyzed all over my body": women's lived experiences of tonic immobility following rape

Tonic immobility is considered the last involuntary self-protecting act/mechanism experienced by victims of rape when they are under attack. It is associated with trauma related mental health risks post-rape. Despite this, tonic immobility has not received priority as an area of research on Nigerian female victims of rape. As a result, little has been known about this phenomenon by nurses and other professionals who are involved in the care and management of rape survivors in Nigeria. The limited knowledge about tonic immobility as a phenomenon might have resulted in mismanagement and secondary victimization of rape victims experiencing manifestations suggestive of tonic immobility during or after rape. This study was a qualitative narrative inquiry that explored, analysed, and interpreted the lived experiences suggestive of tonic immobility, and the meaning attached to such experiences by victims. A sample of fourteen Nigerian women who self-identified as rape victims was utilized. Individual semi-structured, in-depth interviews were conducted to generate data. Thematic data analysis revealed four overarching themes: namely (i) Tonic immobility as an Altered Physical State, (ii) Tonic Immobility as Mental Paralysis, (iii) Painful Loss of Self-defence, and (iv) Constant Self-blame. The findings provided an insight into the traumatic experience of raped women and the psychological implication of tonic immobility as extreme defence mechanism. This study will prove invaluable to nurses and other professionals/stakeholders involved in the care and management of rape victims; to help them develop and use appropriate strategies for management and prevention of secondary victimisation.

Sexual Violence and Mental Health: An Analysis of the Mediating Role of Self-Compassion Using a Feminist Lens

Feminist theories describe how women who experience sexual violence often internalize cultural narratives which can lead to self-blame and disconnection. Self-compassion has the potential to provide a buffer against these negative outcomes. This study explored self-compassion as a mediator of the association between experiencing sexual violence and negative mental health outcomes. The sample consisted of 368 undergraduate women. A path analysis revealed that experiencing sexual violence prior to the beginning of the semester was positively associated with self-criticism, anxiety, depression, and PTSD symptoms at the end of the semester directly and indirectly through self-compassion mid-semester. Clinical and research implications are also discussed.

Advancing Theory, Methods, and Dissemination in Sexual Violence Research to Build a More Equitable Future: An Intersectional, Community-Engaged Approach

Sexual violence is a devastating trauma with long-lasting effects on survivors' health and well-being. Despite the substantial impacts of the last 25 years of research, the prevalence of sexual violence has remained stable. It will be necessary to reconceptualize our work, challenging our theories, methods, and strategies for dissemination and implementation moving forward. We outline an intersectional, community-engaged approach for sexual violence research to center the stories of survivors who face systemic oppression and inequity. Finally, we suggest applications of this approach for justice, healing, and prevention to inform our collective work to end sexual violence.

Genocide Rape Trauma: A Conceptual Framework for Understanding the Psychological Suffering of Rwandan Survivors

In 1994, the Rwandan genocide claimed the lives of approximately 1 million Tutsi and moderate Hutu citizens. Systematic rape was a strategic component of the Hutu extremist plan to eradicate the Tutsi minority population. This involved collective and repeated sexual assaults with brutal violence, public humiliation, and torture. This article maps the ongoing psychological impact on Rwandan genocide rape survivors and identifies implications for international nursing practice. The research formalizes their narratives, identifying a number of interconnected elements that combine to produce myriad forms of chronic psychological suffering in the Rwandan context. This work in turn reveals the specific needs of these survivors that may be addressed by nursing. It allows nurses, as experts in managing the human responses to health and illness, to develop a more complete understanding of psychological suffering as it pertains to vulnerable populations during and in the wake of extreme social conflict. This clarifies the roles of nurse educators, clinicians, and policy advocates as key agents in providing genocide rape survivors with the resources and expertise needed to effectively manage their ongoing trauma.

Mental Health Among Help-Seeking Urban Women: The Relationships Between Adverse Childhood Experiences, Sexual Abuse, and Suicidality

Adverse childhood experiences (ACEs) and adult mental health were explored in a sample of urban Aboriginal ( n = 83) and non-Aboriginal ( n = 89) women. Childhood sexual abuse (CSA) was associated with negative home environments, teenage pregnancy, lifetime suicide attempts, and treatment seeking. Aboriginal women with CSA witnessed higher levels of physical/sexual abuse of family members. The severity of current psychological distress was associated with a history of childhood neglect. The results indicate that CSA rarely occurs in isolation, and that multiple ACEs are strongly associated with suicide attempts and treatment seeking in adulthood. Future studies should focus on the role of CSA in suicidality, as well as familial, community, and cultural protective factors.

Sexual assault victimization and psychopathology: A review and meta-analysis

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.

"There Were Rapes!": Sexual Assaults of African American Women and Children in Jim Crow

Using data from 92 interviews, this article examines the narratives of African Americans' experiences as children and young adults during Jim Crow in the Southeast and Southwest. It gives voice to the realities of sexual assaults committed by ordinary White men who systematically terrorized African American families with impunity after the post-Reconstruction south until the 1960s. The interviewees discuss the short- and long-term impact of physical, mental, emotional, and sexual assaults in their communities. We discuss the top four prevalent themes that emerged related to sexual assault, specifically (a) the normalization of sexual assaults, (b) protective measures to avoid White violence, (c) the morality of African American women, and (d) the long-term consequences of assaults on children.

Structural Models of the Relations of Assault Severity, Social Support, Avoidance Coping, Self-Blame, and PTSD Among Sexual Assault Survivors

A number of studies have identified which survivors of sexual assault are more likely to develop symptoms of posttraumatic stress disorder (PTSD). Most correlates that have been identified have been at the individual level. Insufficient attention has been given to whether survivors' social interactions impact their individual responses to assault and subsequent levels of psychological symptomatology. In this study, a large, diverse sample of community-residing women ( N = 636) was surveyed. Structural equation modeling was used to examine the relationships between assault severity, global support, negative social reactions, avoidance coping, self-blame, traumatic life experiences, and PTSD symptoms. The results suggest that negative social reactions and avoidance coping are the strongest correlates of PTSD symptoms and that the association typically observed between victim self-blame and PTSD symptoms may be partially due to the effect of negative social reactions from others. These reactions may contribute to both self-blame and PTSD. Implications for future research and clinical practice are discussed.

A Heated Debate: Theoretical Perspectives of Sexual Exploitation and Sex Work

The theoretical and often political framework of sexual exploitation and sex work among women is widely and enthusiastically debated among academic and legal scholars alike. The majority of theoretical literature in this area focuses on the macro perspective, while the micro-level perspective as to theory and causation remains sparse. This article provides a comprehensive overview of the philosophical, legal, and political perspectives pertaining to sexual exploitation of women and girls while addressing the subsequent controversies in the field.

From Exploitation to Industry: Definitions, Risks, and Consequences of Domestic Sexual Exploitation and Sex Work Among Women and Girls

In the last 15 years, terms such as prostitution, sex trafficking, sexual exploitation, modern-day slavery, and sex work have elicited much confusion and debate as to their definitions. Consequently several challenges have emerged for both law enforcement in the prosecution of criminals and practitioners in service provision. This article reviews the state of the literature with regard to domestic, sexual exploitation among women and girls in the United States and seeks to (1) provide definitions and describe the complexity of all terms relating to domestic sexual exploitation of women and girls in the United States, (2) explore available national prevalence data according to the definitions provided, and (3) review the evidence of mental health, social, and structural risk factors at the micro-, mezzo-, and macrolevels.

Condom negotiation: findings and future directions

The aim of this review was to summarize factors associated with condom negotiation among heterosexual men. Literature searches were conducted using multiple databases spanning several disciplines. Studies examining psychological, demographic, relational, communication, and environmental factors related to condom negotiation are described, and a three-dimensional framework of condom negotiation is proposed. This framework of condom negotiation may aid researchers in operationalizing this construct, organizing this literature, and facilitating measurement development. We used this three-dimensional framework to articulate the influence of gender, ethnicity, relationship type, partner characteristics, trauma history, post-traumatic stress, and alcohol use on condom negotiation. Areas for future research are outlined. More research is needed to understand how these factors interact to influence condom negotiation, as well as the interaction between gender and the identified factors.

Revictimization and recovery from sexual assault: implications for health professionals

Twenty-seven adult females' responses from an online qualitative questionnaire were analyzed to explore their views on being recovered from an experience of sexual assault, and identify aspects of their postassault health service encounters that facilitated or impeded their recovery process. Being recovered involved accepting the experience, being freed from negative states, regaining control and trust, and receiving help from and being believed by others. Participants predominantly reported negative experiences with health services. Factors perceived as impeding the recovery process include health professionals' inexperience in dealing with survivors of sexual assault, adhering to rape myths and stereotypes, and disrespectful or inconsiderate treatment of survivors. We argue that these postassault negative experiences revictimized survivors. Addressing these factors may reduce revictimization, facilitate recovery, and decrease assaulted women's long-term use of health services.

PTSD Symptoms in Intellectually Disabled Victims of Sexual Assault

The high rates of sexual violence in the country suggest that people with intellectual disabilities (ID) are likely to be sexually victimised. Rape and sexual assault have negative consequences for survivors, with Post Traumatic Stress Disorder (PTSD) being the most common psychiatric diagnosis used to capture the reaction to this trauma. This study sought to investigate the presence of PTSD symptoms in a group of people with ID who had been sexually abused. The Child PTSD Checklist was administered to 54 individuals with ID — 27 with and 27 without a known history of sexual abuse. The Checklist was also administered to the care-givers of those who had been sexually abused. Higher rates of a PTSD diagnosis and a higher intensity of PTSD symptoms were found in the group with than in the group without a history of sexual abuse. There were no significant differences between self and care-giver reports with respect to the prevalence of a PTSD diagnosis, but there were differences on the different symptom clusters. The results indicate that survivors with ID should be asked directly about their internal subjective experiences, with care-giver reports being used as collateral information, and that therapeutic interventions following sexual abuse should be offered.

Managing in the contemporary world: rape victims' and supporters' experiences of barriers within the police and the health care system in Tanzania

Grounded theory guided the analysis of 30 in-depth interviews with raped women and community members who had supported raped women in their contact with the police and health care services in Tanzania. The aim of this study was to understand and conceptualize the experiences of the informants by creating a theoretical model focusing on barriers, strategies, and responses during the help seeking process. The results illustrate a process of managing in the contemporary world characterized as walking a path of anger and humiliation. The barriers are illustrated by painful experiences of realizing it's all about money, meeting unprofessionalism and irresponsibility, subjected to unreliable services, and by being caught in a messed-up system. Negotiating truths and knowing what to do capture the informants' coping strategies. The study indicates an urgent need for improvement in the formal procedures of handling rape cases, improved collaboration between the police and the health care system, as well as specific training for professionals to improve their communication and caring skills.

“Trauma of Rape” Discourse: A Double-Edged Template for Everyday Understandings of the Impact of Rape?

We map a discourse of the trauma of rape that was widely drawn upon by 29 “lay” New Zealand women and men in focus group discussions about the impact of rape. Using a discursiv e approach, we identify the key interlocking elements of this discourse. It centers on the contention that rape is traumatic, and depicts this trauma as unique, sev ere, long lasting, and in need of healing. We discuss the ways in which this ostensibly more enlightened and sensitiv e framework of meaning brings forth its own ways of potentially othering, stigmatizing, v iolating, and obstructing av enues of support and understanding for women who hav e experienced rape.

Telling stories without the words: ‘Tightrope talk’ in women’s accounts of coming to live well after rape or depression

Narratives and language available within a cultural context reflect and reify power structures that are reproduced in everyday social interactions. In this article, we explore the narrative challenges and possibilities that emerged in our respective research programmes with women who have faced depression or rape. These experiences are, at least in part, products of patriarchy and are regulated by hegemonic discourses that individualize and depoliticize women’s experiences. In our studies, we faced significant challenges of conducting research when dominant narratives fail the storytellers, and came to understand these as products of what Marjorie DeVault has termed ‘linguistic incongruence’. We examine women’s attempts to negotiate the telling of their stories without adequate language and framings, and our attempts to listen carefully to the emergence of counterstories. We introduce the notion of ‘tightrope talk’ to refer to participants’ attempts to make meaning of their experiences, as they negotiate both agency and blame in ways that dominant narratives fail to do. We conclude by discussing the potential dangers of these efforts.

Partner stalking: psychological dominance or "business as usual"?

Partner stalking may remain one of the least clearly understood forms of intimate violence. This review examines the literature guided by two main goals: (a) to examine how partner stalking is distinct from nonpartner forms of stalking and (b) to describe areas of research on partner stalking that need to be systematically addressed to deepen the understanding of partner stalking and to craft more effective mental health and criminal justice responses. These areas of research include three overarching questions: (a) Is partner stalking a unique form of psychological dominance or is it just "business as usual"? (b) What components characterize stalking differently from business as usual for women? and (c) How is psychological distress within the context of partner stalking best characterized?

An ecological model of the impact of sexual assault on women's mental health

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.

Parent--child relationship and mother's sexual assault history

Although there is clinical conjecture regarding the effects of maternal trauma on parent- child relationships, research is scarce and this area remains to be explored. In a domestic violence sample, there was significant reduction in quality of parent-child relationships when the mother had experienced sexual assault or rape during adulthood. There was no correlation between the mother's history of childhood sexual assault or rape and parent-child relationship. Survivors of sexual assault may be best served through interventions that utilize relational models. Family-based interventions may be particularly effective in addressing problems in parent-child relationships stemming from the mother's trauma history.

Psychosocial correlates of PTSD symptom severity in sexual assault survivors

This study's goal was to assess the effects of preassault, assault, and postassault psychosocial factors on current posttraumatic stress disorder (PTSD) symptoms of sexual assault survivors. An ethnically diverse sample of over 600 female sexual assault survivors was recruited from college, community, and mental health agency sources (response rate = 90%). Regression analyses tested the hypothesis that postassault psychosocial variables, including survivors' responses to rape and social reactions from support providers, would be stronger correlates of PTSD symptom severity than preassault or assault characteristics. As expected, few demographic or assault characteristics predicted symptoms, whereas trauma histories, perceived life threat during the assault, postassault characterological self-blame, avoidance coping, and negative social reactions from others were all related to greater PTSD symptom severity. The only protective factor was survivors' perception that they had greater control over their recovery process in the present, which predicted fewer symptoms. Recommendations for intervention and treatment with sexual assault survivors are discussed.

Understanding rape and sexual assault: 20 years of progress and future directions

During the past 20 years, researchers have documented the widespread problem of rape in American society. Approximately one in four women are raped in their adult lifetime, which causes severe psychological distress and long-term physical health problems. The impact of sexual assault extends far beyond rape survivors as their family, friends, and significant others are also negatively affected. Moreover, those who help rape victims, such as rape victim advocates, therapists, as well as sexual assault researchers, can experience vicarious trauma. Future research and advocacy should focus on improving the community response to rape and the prevention of sexual assault.