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The difficulty of documenting genital findings in rape victims by gross visualization is well known. However, we report two cases in which cervical findings were readily established by colposcopic examination and photography. Use of the colposcope may significantly increase the reliability of establishing findings in rape victims.
The Rape Treatment Center at Jackson Memorial Hospital, Miami, Florida, has cared for more than 5,000 victims of sexual assault since January, 1974. Forcible rape is a violent crime, and it is now generally accepted that rapists are sexual deviants. Few of the victims have serious physical injuries, but they all suffer psychological trauma that will affect their lives and the lives of those around them. These victims need expert medical care and psychological counseling if they are to adjust and re-enter society without major difficulties. It is essential that people dealing with these patients understand the dynamics of the situation so that they can care for them intelligently.
In a short period of time, the law in Scotland has developed in two ways. Firstly, the law changed recently to allow the prosecution of a husband where a couple were in fact separated at the time of the rape. Secondly, the law moved forward again to the present position where a charge of rape is competent even if the couple are living together at the time of the incident complained of.
Changes over the past decade in statutory rape laws and their enforcement have created anxiety and confusion for nurses and other health care providers in jurisdictions across the country. Mandated reporting of statutory rape as child abuse potentially has the unsought effect of deterring some of the adolescents most in need of confidential health care from seeking that care. Knowledge and advocacy on the part of nurses can help mitigate the harms of overly inclusive reporting and enforcement.
OBJECTIVE: The purpose of this study was to assess the level of post-traumatic stress in juvenile male rape victims and to test for its relationships with perceived parental rearing and personality dimensions. METHOD: Fifteen subjects (mean age of 16 years) were recruited from a correctional camp for juvenile criminals in Arkhangelsk, Russia. They were investigated by means of the "Revised Impact of Event Scale," the "Child Self-Report Post-Traumatic Stress Reaction Index," the "Hospital Anxiety and Depression Scale," the "EMBU" (perceived parental rearing) and the "Temperament and Character Inventory" (TCI). RESULTS: The level of post-traumatic stress, in most cases moderate to high, correlated with the temperament dimensions of harm avoidance and reward dependence. As concerns parental rearing, the total level of post-traumatic stress reaction was negatively correlated with paternal emotional warmth and positively with paternal rejection. CONCLUSIONS: The experience of post-traumatic stress is influenced by temperamental characteristics as well as by perceived parental rearing practices. Assumingly, these factors also play a role in becoming a rape victim, which deserves further investigation.
This paper identifies the self-reported concerns of 122 sexually abused teenagers and compares them with their parents' reactions and the assessments made by pediatric housestaff and trained rape counselors. The predominant rape reaction reported by the teenagers was a fear for their life or safety. Second was embarrassment and self-blame. Physicians and counselors, similar to parents, emphasized anger toward the perpetrator and anxieties about future sexual relations. Physicians and counselors often missed subtle, fantasized fears of bodily damage, which were also common concerns of these teenagers. They also judged parents more often supportive of the victims than did the victims themselves. The data suggest that professionals tend to identify with parental reactions, which do not always coincide with teenager's concerns.
OBJECTIVE: This study aimed to determine whether the General Health Questionnaire, a simple psychological screening instrument, could be useful to non-specialists in screening for psychologically traumatized rape victims. STUDY DESIGN: 285 rape victims (mean age 22.5, men 8%) attending consecutively a Consultation for Victims of Psychological Trauma at the University Hospital in Tours, France, were assessed through the Structured Interview for Post-Traumatic Stress Disorder (SI-PTSD), and the French 28-item version of the self-rated General Health Questionnaire (GHQ-28). RESULTS: 70% had Post-Traumatic Stress Disorder (PTSD) and 72% a GHQ-28 overthreshold score. The principal component analysis of the GHQ-28 ratings yielded a 4-factor solution: social dysfunction, feeling of foreshortened future type of depression, somatoform complaints and hyperalertness anxiety. GHQ-28 reliability and validity in screening for PTSD were studied through computation of Cronbach's alpha coefficient (0.95), sensitivity (88%) and positive predictive value (86%). CONCCLUSION: Using the GHQ-28 is valid and appropriate for practical use.
The purpose of this study was to assess the relationship between sleep difficulties and drinking motives in female rape victims with posttraumatic stress disorder (PTSD). Seventy-four participants were assessed for PTSD symptoms, depression, sleep difficulties, and drinking motives. Results demonstrated that neither PTSD symptoms nor depression were related to any motives for using alcohol. On the other hand, after controlling for education, sleep difficulties were significantly related to drinking motives for coping with negative affect, but not pleasure enhancement or socialization. The findings suggest that sleep difficulties may be an important factor contributing to alcohol use in rape victims with PTSD.
To assess the impact of dissociation on information processing, 66 college women with high and low levels of trait dissociation were studied with regard to how they unitized videotape segments of an acquaintance rape scenario (actual assault not shown) and a nonthreatening control scenario. Unitization is a paradigm that measures how actively people process stimuli by recording how many times they press a button to indicate that they have seen a significant or meaningful event. Trait dissociation was negatively correlated with participants' unitization of the acquaintance rape videotape, unitization was positively correlated with danger cue identification, and state dissociation was negatively correlated with dangerousness ratings.
We examined the effect of disclosing to others an attempted or completed rape. Eighty-five undergraduate women who acknowledged attempted or completed rape wrote about their experience and read their narratives. In a 2 x 2 design, we examined the value of writing only factual information versus factual plus emotional information, and reading to oneself versus reading aloud to another woman. Before and 1-month after the task, symptoms of dysphoria, social anxiety and posttraumatic stress disorder were assessed. Greater detail and a moderate level of personalization in the description of the trauma were associated with decreased symptoms of dysphoria and social anxiety. Neither the nature of the writing task nor the presence of another woman predicted degree of symptom reduction.
This paper describes how the values of a feminist research team influenced methodological decisions in a study of rape survivors. Building upon concepts from community psychology and urban sociology, the authors created a community-based research design that respected the emotional needs of rape survivors without sacrificing methodological rigor. We developed relationships with community members in diverse settings, such as nail and hair salons, child care centers, churches, and bookstores, to advertise the study and recruit participants. Consistent with feminist approaches to interviewing, our goal was to create a safe setting for survivors to tell their stories. Although the purpose of this study was research rather than intervention, most survivors reported that participating in these interviews was healing. Our experiences in this project suggest that allowing values to influence the process of research may have beneficial outcomes for both researchers and participants.
The accumulative effect of prior high-magnitude trauma exposure on memory was examined in 73 rape victims, 92% of whom had current posttraumatic stress disorder (PTSD). Participants were administered the Logical Memory component of the Wechsler Memory Scale, the Quick Test to obtain an estimate of intelligence, and were assessed for prior traumatic experiences. Prior exposure to high-magnitude stressors (e.g., child rape, being kidnapped) was significantly correlated with poorer performance on the memory tasks. Regression analyses controlling for estimated IQ and psychopathology severity demonstrated that magnitude of prior trauma exposure predicted performance on the memory task, suggesting that in the current sample, deficits in verbal memory may be related (in part) to the degree of accumulative stress experienced over the lifetime.
This article examines men's sexual arousal to rape cues and its possible role in sexual assault. The article presents six different models that have been described in the literature to account for men's sexual arousal to descriptions of rape. The models are divided into two broad categories, response control models and stimulus control models, and are further divided into models postulating a "trait" that might distinguish rapists from other men and those postulating a "state" that might be present in men while they commit a sexual assault. A number of the models are supported by empirical data, and some of these data are reviewed. The article suggests that different models may be operating in different men when they commit sexual assault. These models are discussed in relation to the current literature on the classification and diagnosis of sexual offenders.
Rape victims with posttraumatic stress disorder (PTSD; N = 45) were randomly assigned to one of four conditions: stress inoculation training (SIT), prolonged exposure (PE), supportive counseling (SC), or wait-list control (WL). Treatments consisted of nine biweekly 90-min individual sessions conducted by a female therapist. Measures of PTSD symptoms, rape-related distress, general anxiety, and depression were administered at pretreatment, posttreatment, and follow-up (M = 3.5 months posttreatment). All conditions produced improvement on all measures immediately post-treatment and at follow-up. However, SIT produced significantly more improvement on PTSD symptoms than did SC and WL immediately following treatment. At follow-up, PE produced superior outcome on PTSD symptoms. The implications of these findings and direction for treatment and future research are discussed.
The relation of situational factors, offender aggression, and victim resistance to women's sexual abuse and physical injury during sexual assaults was analyzed using police reports and court testimonies of 274 women who either avoided rape or were raped. Hierarchical multiple regression showed that after situational factors were partialed out, (a) women's screaming/yelling was related to less severe sexual abuse, and (b) offender physical aggression was related to increased physical injury. An a priori model of the interrelations among offense components and injury outcomes was tested with path analysis. More forceful victim resistance was directly related to less severe sexual abuse even when partialing level of situational danger and the level of offender aggression. In contrast, more forceful victim resistance was not related to the level of physical injury when both the level of situational danger and the level of offender aggression in the assault were controlled.
Two experiments were conducted to identify the specific dimensions in portrayals of sexual violence that inhibit or disinhibit the sexual responsiveness of male and female college students. The first experiment replicated earlier findings that normals are less sexually aroused by portrayals of sexual assault than by depictions of mutually consenting sex. In the second experiment, it was shown that portraying the rape victim as experiencing an involuntary orgasm disinhibited subjects' sexual responsiveness and resulted in levels of arousal comparable to those elicited by depictions of mutually consenting sex. Surprisingly, however, it was found that although female subjects were most aroused when the rape victim was portrayed as experiencing an orgasm and no pain, males were most aroused when the victim experienced an orgasm and pain. The relevance of these data to pornography and to the common belief among rapists that their victims derive pleasure from being assaulted is discussed. Misattribution, identification, and power explanations of the findings are also discussed. Finally, it is suggested that arousing stimuli that fuse sexuality and violence may have antisocial effects.
A previously published cross-sectional model of cognitive mediation of rape's impact on health (M. P. Koss, A. J. Figueredo, & R. J. Prince, 2002) was replicated longitudinally. Rape survivors (n = 59) were assessed 4 times at 3-24 months postrape. Growth curve analysis demonstrated significant change in all mediators and outcomes. Previously reported effects of Characterological Self-Blame, Behavioral Self- Blame, and Maladaptive Beliefs on Psychosocial Distress were partially cross-validated in intercept and slope data. The results suggest that Characterological Self-Blame sets the initial level of Psychosocial Distress and that reduction in Behavioral Self-Blame drives recovery. These effects on distress were wholly mediated through self-blame's association with alterations in beliefs about self and others.
Psychological functioning within the first four weeks after rape was compared for married and single victims. Marital status did not significantly affect psychological symptoms following the assault. For married women, lack of support by the partner--particularly when it was unexpected--was significantly related to poor psychological functioning after the rape.