Cultural myths and supports for rape

This article describes the "rape myth" and tests hypotheses derived from social psychological and feminist theory that acceptance of rape myths can be predicted from attitudes such as sex role stereotyping, adversarial sexual beliefs, sexual conservatism, and acceptance of interpersonal violence. Personality characteristics, background characteristics, and personal exposure to rape, rape victims, and rapists are other factors used in predictions. Results from regression analysis of interview data indicate that the higher the sex role stereotyping, adversarial sexual beliefs, and acceptance of interpersonal violence, the greater a respondent's acceptance of rape myths. In addition, younger and better educated people reveal less stereotypic, adversarial, and proviolence attitudes and less rape myth acceptance. Discussion focuses on the implications of these results for understanding and changing this cultural orientation toward sexual assault.

Intimate partner violence, relationship power inequity, and incidence of HIV infection in young women in South Africa: a cohort study

BACKGROUND

Cross-sectional studies have shown that intimate partner violence and gender inequity in relationships are associated with increased prevalence of HIV in women. Yet temporal sequence and causality have been questioned, and few HIV prevention programmes address these issues. We assessed whether intimate partner violence and relationship power inequity increase risk of incident HIV infection in South African women.

METHODS

We did a longitudinal analysis of data from a previously published cluster-randomised controlled trial undertaken in the Eastern Cape province of South Africa in 2002-06. 1099 women aged 15-26 years who were HIV negative at baseline and had at least one additional HIV test over 2 years of follow-up were included in the analysis. Gender power equity and intimate partner violence were measured by a sexual relationship power scale and the WHO violence against women instrument, respectively. Incidence rate ratios (IRRs) of HIV acquisition at 2 years were derived from Poisson models, adjusted for study design and herpes simplex virus type 2 infection, and used to calculate population attributable fractions.

FINDINGS

128 women acquired HIV during 2076 person-years of follow-up (incidence 6.2 per 100 person-years). 51 of 325 women with low relationship power equity at baseline acquired HIV (8.5 per 100 person-years) compared with 73 of 704 women with medium or high relationship power equity (5.5 per 100 person-years); adjusted multivariable Poisson model IRR 1.51, 95% CI 1.05-2.17, p=0.027. 45 of 253 women who reported more than one episode of intimate partner violence at baseline acquired HIV (9.6 per 100 person-years) compared with 83 of 846 who reported one or no episodes (5.2 per 100 person-years); adjusted multivariable Poisson model IRR 1.51, 1.04-2.21, p=0.032. The population attributable fractions were 13.9% (95% CI 2.0-22.2) for relationship power equity and 11.9% (1.4-19.3) for intimate partner violence.

INTERPRETATION

Relationship power inequity and intimate partner violence increase risk of incident HIV infection in young South African women. Policy, interventions, and programmes for HIV prevention must address both of these risk factors and allocate appropriate resources.

FUNDING

National Institute of Mental Health and South African Medical Research Council.

Forensic application of DNA 'fingerprints'

Many highly polymorphic minisatellite loci can be detected simultaneously in the human genome by hybridization to probes consisting of tandem repeats of the 'core' sequence. The resulting DNA fingerprints produced by Southern blot hybridization are comprised of multiple hypervariable DNA fragments, show somatic and germline stability and are completely specific to an individual. We now show that this technique can be used for forensic purposes; DNA of high relative molecular mass (Mr) can be isolated from 4-yr-old bloodstains and semen stains made on cotton cloth and digested to produce DNA fingerprints suitable for individual identification. Further, sperm nuclei can be separated from vaginal cellular debris, obtained from semen-contaminated vaginal swabs, enabling positive identification of the male donor/suspect. It is envisaged that DNA fingerprinting will revolutionize forensic biology particularly with regard to the identification of rape suspects.

Indochinese versions of the Hopkins Symptom Checklist-25: a screening instrument for the psychiatric care of refugees

The United States is accepting the largest number of displaced persons since World War II. Over 70% are Southeast Asians; many have suffered serious war trauma and torture. Cultural differences in health-seeking behavior and lack of specialized mental health services make the recognition of psychiatric distress in Southeast Asia refugees difficult for American health care providers. The authors describe the development and validation of Cambodian, Laotian, and Vietnamese versions of the Hopkins Symptom Checklist-25. This brief, simple, and reliable instrument is well received by refugee patients, offers an effective screening method for the psychiatric symptoms of anxiety and depression, and is especially helpful for evaluating trauma victims.

The incidence and prevalence of intrafamilial and extrafamilial sexual abuse of female children

Data obtained from a random sample of 930 adult women in San Francisco provide the soundest basis heretofore available for estimating the prevalence of intrafamilial and extrafamilial sexual abuse of female children. This article describes the methodology of this survey, as well as some of the key findings. For example: 16% of these women reported at least one experience of intrafamilial sexual abuse before the age of 18 years; 12% reported at least one such experience before the age of 14 years; 31% reported at least one experience of extrafamilial sexual abuse before the age of 18 years; and 20% reported at least one such experience before the age of 14 years. When both categories of sexual abuse are combined, 38% reported at least one experience before the age of 18 years; and 28% reported at least one such experience before the age of 14 years. Only 2% of the cases of intrafamilial and 6% of the cases of extrafamilial child sexual abuse were ever reported to the police. A plea is made for the urgent need to recognize the magnitude of the problem of child sexual abuse, and to act to prevent it.

Characterological versus behavioral self-blame: Inquiries into depression and rape

Two types of self-blame--behavioral and characterological--are distinguished. Behavioral self-blame is control related, involves attributions to a modifiable source (one's behavior), and is associated with a belief in the future avoidability of a negative outcome. Characterological self-blame is esteem related, involves attributions to a relatively nonmodifiable source (one's character), and is associated with a belief in personal deservingness for past negative outcomes. Two studies are reported that bear on this self-blame distinction. In the first study, it was found that depressed female college students engaged in more characterologial self-blame than nondepressed female college students, whereas behavioral self-blame did not differ between the two groups; the depressed population was also characterized by greater attributions to chance and decreased beliefs in personal control. Characterological self-blame is proposed as a possible solution to the "paradox in depression." In a second study, rape crisis centers were surveyed. Behavioral self-blame, and not characterological self-blame, emerged as the most common response of rape victims to their victimization, suggesting the victim's desire to maintain a belief in control, particularly the belief in the future avoidability of rape. Implications of this self-blame distinction and potential directions for future research are discussed.

The child sexual abuse accommodation syndrome

Child victims of sexual abuse face secondary trauma in the crisis of discovery. Their attempts to reconcile their private experiences with the realities of the outer world are assaulted by the disbelief, blame and rejection they experience from adults. The normal coping behavior of the child contradicts the entrenched beliefs and expectations typically held by adults, stigmatizing the child with charges of lying, manipulating or imagining from parents, courts and clinicians. Such abandonment by the very adults most crucial to the child's protection and recovery drives the child deeper into self-blame, self-hate, alienation and revictimization. In contrast, the advocacy of an empathic clinician within a supportive treatment network can provide vital credibility and endorsement for the child. Evaluation of the responses of normal children to sexual assault provides clear evidence that societal definitions of "normal" victim behavior are inappropriate and procrustean, serving adults as mythic insulators against the child's pain. Within this climate of prejudice, the sequential survival options available to the victim further alienate the child from any hope of outside credibility or acceptance. Ironically, the child's inevitable choice of the "wrong" options reinforces and perpetuates the prejudicial myths. The most typical reactions of children are classified in this paper as the child sexual abuse accommodation syndrome. The syndrome is composed of five categories, of which two define basic childhood vulnerability and three are sequentially contingent on sexual assault: (1) secrecy, (2) helplessness, (3) entrapment and accommodation, (4) delayed, unconvincing disclosure, and (5) retraction. The accommodation syndrome is proposed as a simple and logical model for use by clinicians to improve understanding and acceptance of the child's position in the complex and controversial dynamics of sexual victimization. Application of the syndrome tends to challenge entrenched myths and prejudice, providing credibility and advocacy for the child within the home, the courts, and throughout the treatment process. The paper also provides discussion of the child's coping strategies as analogs for subsequent behavioral and psychological problems, including implications for specific modalities of treatment.

Stop blaming the victim: a meta-analysis on rape myths

Although male rape is being reported more often than before, the majority of rape victims continue to be women. Rape myths-false beliefs used mainly to shift the blame of rape from perpetrators to victims-are also prevalent in today's society and in many ways contribute toward the pervasiveness of rape. Despite this, there has been limited consideration as to how rape prevention programs and policies can address this phenomenon, and there is no updated information on the demographic, attitudinal, or behavioral factors currently associated with rape myths. This research aimed to address this gap by examining the correlates of rape-myths acceptance (RMA) in published studies. A total of 37 studies were reviewed, and their results were combined using meta-analytic techniques. Overall, the findings indicated that men displayed a significantly higher endorsement of RMA than women. RMA was also strongly associated with hostile attitudes and behaviors toward women, thus supporting feminist premise that sexism perpetuates RMA. RMA was also found to be correlated with other "isms," such as racism, heterosexism, classism, and ageism. These findings suggest that rape prevention programs and policies must be broadened to incorporate strategies that also address other oppressive beliefs concurrent with RMA. Indeed, a renewed awareness of how RMA shapes societal perceptions of rape victims, including perceptions of service providers, could also reduce victims' re-victimization and enhance their coping mechanisms.

Arousal, numbing, and intrusion: symptom structure of PTSD following assault

OBJECTIVE

This study investigated hypotheses concerning the importance of symptoms of numbing in posttraumatic stress disorder (PTSD).

METHODS

Symptoms of PTSD were assessed in 72 female rape victims and 86 female victims of nonsexual assault approximately 3 months after the crimes occurred. A principal-components factor analysis of subjects' symptoms was then undertaken.

RESULTS

The analysis yielded three factors: arousal/avoidance, numbing, and intrusion. These were somewhat different from the symptom clusters in DSM-III-R, since effortful avoidance and numbing symptoms did not load on the same factor. Numbing symptoms appeared to be particularly important in identifying individuals with PTSD.

CONCLUSIONS

The results imply that there are two patterns of posttrauma symptoms, one characterizing PTSD and the second characterizing a phobic reaction.

The components of rapists' sexual arousal

The erections of rapists and nonrapists were measured during audio descriptions of rape and nonrape sexual scenes. On the basis of their erection measures, rapists were separated from nonrapists in that the former developed erections to rape descriptions while the latter did not. The method also discriminated those rapists with the highest frequency of rape, those who had injured their victim, and those who chose children as victims.

Rape: power, anger, and sexuality

Accounts from both offenders and victims of what occurs during a rape suggest that issues of power, anger, and sexuality are important in understanding the rapist's behavior. All three issues seem to operate in every rape, but the proportion varies and one issue seems to dominate in each instance. The authors ranked accounts from 133 offenders and 92 victims for the dominant issue and found that the offenses could be categorized as power rape (sexuality used primarily to express power) or anger rape (use of sexuality to express anger). There were no rapes in which sex was the dominant issue; sexuality was always in the service of other, nonsexual needs.

Physical and sexual assault history in women with serious mental illness: prevalence, correlates, treatment, and future research directions

An emerging body of research on the physical and sexual abuse of seriously mentally ill (SMI) women documents a high incidence and prevalence of victimization within this population. While causal links are not well understood, there is convergent evidence that victimization of SMI women is associated with increased symptom levels, HIV-related risk behaviors, and such comorbid conditions as homelessness and substance abuse. These abuse correlates may influence chronicity, service utilization patterns, and treatment alliance. This article reviews the research literature on the prevalence, symptomatic and behavioral correlates, and treatment of abuse among SMI women, particularly women with schizophrenia. Within each topic, we discuss relevant research findings, limitations of available studies, and key questions that remain unanswered. We also discuss mechanisms that may underlie the relationship between trauma and schizophrenia-spectrum disorders. We conclude by outlining directions for future research in this area.

Nursing assessment for risk of homicide with battered women

The Danger Assessment is a clinical and research instrument that has been designed to help battered women assess their danger of homicide. Completing the Danger Assessment with a nurse is conceptualized as a means of increasing the self-care agency of battered women, according to Orem's nursing conceptual framework. The instrument was used in a study of 79 battered women. Results of this study, which give initial support for the reliability and validity of the Danger Assessment, are reported. The instrument is available from the author on request.

Discriminant analysis of risk factors for sexual victimization among a national sample of college women

Examined the accuracy with which rape and lesser sexual assaults were predicted among a representative national sample of 2,723 college women. A total of 14 risk variables operationalized three vulnerability hypotheses: (a) vulnerability-creating traumatic experiences, (b) social-psychological vulnerability, and (c) vulnerability-enhancing situations. Each hypothesis was tested individually, and a composite model was developed via discriminant analysis. Only the traumatic experiences variables clearly improved over the base rates in identifying rape victims, but risk variables from each vulnerability hypothesis met criteria for inclusion in the composite model. A risk profile emerged that characterized only 10% of the women, but among them the risk of rape was twice the rate of women without the profile. The concept of traumatic sexualization was used to explain this finding. However, the vast majority of sexually victimized women (75-91%) could not be differentiated from nonvictims.

Impact of sexual and physical abuse on women's mental health

The level of psychiatric symptomatology was assessed with the General Health Questionnaire and the Present State Examination in a random community sample of women. Subsequently it was ascertained which of the women had been the victims of sexual or physical abuse, in either childhood or adult life. Women with a history of being abused were significantly more likely to have raised scores on both measures of psychopathology and to be identified as psychiatric cases. 20% of women who had been exposed to sexual abuse as a child were identified as having psychiatric disorders, predominantly depressive in type, compared with 6.3% of the non-abused population. Similar increases in psychopathology were found in women who had been physically or sexually assaulted in adult life. These findings indicate that the deleterious effects of abuse can continue to contribute to psychiatric morbidity for many years.

Predictors of naturalistic sexual aggression

This research integrated within a theoretical and empirical framework varied predictor factors pertaining to males' sexual aggression against women. The selection of predictors was guided by theorizing that sexual aggression is caused by the interaction among multiple factors, including those creating the motivation for the act, those reducing internal and external inhibitions, and those providing the opportunity for the act to occur. The predictor factors assessed were sexual arousal in response to aggression, dominance as a motive for sexual acts, hostility toward women, attitudes accepting of violence against women, psychoticism, and sexual experience. A measure assessing self-reported sexual aggression (primarily among acquaintances) in naturalistic settings served as the dependent measure. The subjects were 155 males. As expected, nearly all the predictor factors significantly related to sexual aggression. In addition, much better prediction of such aggression was achieved by a combination of these factors than by any one individually. It was also found that including interactions among these predictors yielded a regression equation that was more successful in relating to sexual aggression than an equation using an additive combination only. The relevance of these data to the causes and prediction of violence against women is discussed.

Violence against women in health-care institutions: an emerging problem

Maternal morbidity and mortality in childbirth is a matter of utmost importance in public health. In this article, we argue that part of the problem lies in violence committed by health workers in childbearing or abortion services, which affects health-service access, compliance, quality, and effectiveness. We analysed rigorous research from the past decade and discuss four forms of violent abuse by doctors and nurses: neglect and verbal, physical, and sexual abuse. These forms of violence recur, are often deliberate, are a serious violation of human rights, and are related to poor quality and effectiveness of health-care services. This abuse is a means of controlling patients that is learnt during training and reinforced in health facilities. Abuse occurs mainly in situations in which the legitimacy of health services is questionable or can be the result of prejudice against certain population groups. We discuss ways to prevent violent abuse.