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Pregnancy resulting from rape.

Pregnancy resulting from rape is more prevalent than generally recognized, and violations of women's sexual and reproductive self-determination take many forms. Four themes--relationship rape, power dynamics, maternal ambivalence, and social reactions and support--can be identified in one woman's experiences and the literature. Recommended interventions, based on a woman-centered empowerment framework, include safety assessment, formulating a safety plan, and facilitating social support. Emergency postcoital contraception is a preventive option.

Battered Women↗

Counseling rape victims: the nursing challenge.

Rape and sexual assaults are a pervasive problem encountered by women in our society today. Treatment approaches specifically useful with rape victims have been identified by nursing staff at the Sexual Assault Resource Service (SARS). This nursing research demonstration treatment program funded by the National Institute of Mental Health identifies seven essential components of counseling during the initial crisis period, which are discussed in this article.

Counseling↗

Rape, race, and the death penalty in Georgia.

Following the 1972 Supreme Court decision on capital punishment, the Georgia legislature enacted a death penalty statute that attempts to avoid constitutional objections by establishing discretionary death sentencing for 361 rape cases in Georgia, comparing legal and nonlegal variables. Results indicate that blacks convicted of raping whites were disproportionately sentenced to death.

Black or African American↗

Rape: a sexual deviation.

Clinical work with offenders and victims is cited to support the concept of rape as a sexual deviation, as well as a sexual offense. It is suggested that rape is directed toward the sexual expression and gratification of needs that are not basically sexual, and that it represents a developmental crisis for the offender, which in turn triggers a situational crisis for the victim.

Aggression↗

Perceptions of rape in a British sample: effects of relationship, victim status, sex, and attitudes to women.

A study of attitudes to rape in a non-student British sample is reported. Ninety-six subjects (64 male, 32 female) were presented with a newspaper rape account in which previous relationship between victim and rapist and victim status were manipulated. Respondents were divided into females, males with traditional attitudes to the female role, and males with progressive attitudes. Relationship and status had no effect on perceptions but consistent effects were found for sex of respondent and attitudes to the female role.

Adolescent↗

Judgements about victims and attackers in depicted rapes: a review.

This paper reviews the effects on subjects' judgements of a variety of factors that have been included in experimental depictions of rape. The focus is on attribution of responsibility or fault to the victim or attacker and related judgements, particularly regarding guilt and sanctions. Generally, females make more pro-victim judgements than do males, and people with non-traditional sex-role attitudes make more pro-victim judgements than do holders of more traditional views. Other factors covered are various victim characteristics, victim-attacker acquaintance, resistance, and victim attire and a range of behaviours prior to the attack. These are limits to generalization due to populations studied and methods used, and the observed effects of several factors are either minimal or inconsistent. However, some factors have reliable effects on judgements, which it is argued are explainable in terms of their link with traditional beliefs about women's rights and roles. Males have often been found to be more susceptible to these effects. In particular, it appears that if a female engages in any behaviour deemed to be 'incautious' that results in victimization then she may be perceived to be at fault, even though these behaviours would be 'legitimate' for males, and that prior romantic involvement with the attacker mitigates the perceived seriousness of, and may even be seen as supplying justification for, a sexual attack. The existence of these attitudes implies that rape may be tacitly condoned in many situations.

Aggression↗

Prevalence of sexually transmitted infections and mental health needs of female child and adolescent survivors of rape and sexual assault attending a specialist clinic.

OBJECTIVES: To determine the prevalence of sexually transmitted infections (STIs) and the mental health needs of female child and adolescent survivors of rape and sexual assault who were referred to a specialist genitourinary medicine (GUM) clinic. METHOD: Retrospective case notes review of 98 females aged 16 or less, who attended over a 5 year period (1996-2000). RESULTS: The overall prevalence of STIs was 26%. Among the girls who were aged 0-12 years (n = 16), one had gonorrhoea and another had Trichomonas vaginalis infection. Prevalence of STIs in those aged 13-16 years, who were not sexually active before the index assault, was 24% and in those who gave a history of previous consensual sexual activity it was 39% (p = 0.17). Chlamydial infection was more common among the girls who disclosed previous consensual sexual activity than in those did not disclose previous sexual activity (p = 0.012). The overall prevalence of vaginal candidiasis was 17% and bacterial vaginosis 13%. More than one third of the study population gave a history of previous sexual, physical, or other abuse. 81% reported having current psychological difficulties. Mood changes and sleep disturbances were reported more frequently than other psychological symptoms; 15% attempted self harm. All types of psychological difficulties, except mood changes, were not affected by the time interval between index assault and first presentation to the clinic and the type of assailant. 29% had no involvement with social and mental health services before their attendance at the clinic CONCLUSIONS: The prevalence of STIs among female child and adolescent survivors of rape and sexual assault attending a specialist clinic was high. The range of mental health and social difficulties was wide and multiple. The importance of an early assessment for the presence of STIs and mental health difficulties was demonstrated.

Adolescent↗

Incidence of sexually transmitted diseases in rape victims during 1984.

During 1984, 46 women attended the sexually transmitted disease (STD) clinic at St Mary's Hospital alleging that they had been raped. At presentation, 31 (67%) were asymptomatic. Evidence of STD was found in 14 (30%) women, mixed infections occurring in four. Chlamydia trachomatis and Trichomonas vaginalis were each detected in six (13%) patients and Neisseria gonorrhoeae in three (6%). The source of the infection could not confidently be traced to the alleged rapist. Two patients were found to have cervical cytological abnormalities suggestive of cervical intraepithelial neoplasia of grades II or III. One woman became pregnant as a consequence of the sexual assault. Investigations may unveil infection or other abnormalities, which are incidental to the rape but nevertheless require further investigation and treatment.

Adolescent↗

Sexually transmitted diseases in rape victims.

From 1 January 1986 to 1 September 1989 124 women presented to the Ambrose King Centre (the department of genitourinary medicine of the London Hospital) alleging rape. Sexually transmitted diseases were found in 36 (29%) women (excluding candidosis and bacterial vaginosis). The commonest organisms detected were Neisseria gonorrhoeae and Trichomonas vaginalis, each being present in 15 patients. Eleven women had genital warts. Chlamydia trachomatis was isolated in six patients, two had herpes simplex virus infection and one patient had pediculosis pubis. Serological evidence of past hepatitis B infection was detected in five women and one patient had antibodies to human immunodeficiency virus. Eighteen of the 36 women (50%) had multiple infections. Six women had abnormal cervical cytology smears, three being suggestive of cervical intraepithelial neoplasia grades II-III. Although it is rarely possible to attribute infection to an assailant, these patients require further counselling, treatment and review. Rape victims are thus a population at risk of having sexually transmitted diseases and screening should be offered.

Adolescent↗

Alcoholism and forcible rape.

Data collected from detailed autobiographies of 77 convicted rapists revealed that 50 percent of them were drinking at the time of the rape and that 35 percent were alcoholics. This strong association between alcoholism and forcible rape highlights the importance of follow-up treatment programs for the alcoholic sex offender; such programs should focus on adequate control of his drinking behavior as well as on his sexual adjustment.

Adult↗

Adaptive strategies and recovery from rape.

The authors conducted a follow-up study of 81 rape victims to analyze the effect of adaptive or maladaptive response to rape on recovery over a 4-6 year period. They found that victims recovering fastest used more adaptive strategies, including positive self-assessment; defense mechanisms of explanation, minimization, suppression, and dramatization; and increased action. Victims who had not yet recovered had more maladaptive mechanisms, such as negative self-assessments, inaction, substance abuse, and action on suicidal thoughts.

Adaptation, Psychological↗

Male rape victims: noninstitutionalized assault.

Fourteen male rape victims treated in a county hospital emergency room over a 30-month period are compared with 100 randomly selected female victims treated over the same period. The male victims as a group sustained more physical trauma, were more likely to have been a victim of multiple assaults from multiple assailants, and were more likely to have been held captive longer. They were more reluctant to reveal initially the genital component of their assault and were more likely to use denial and control their emotions in reaction to the assault. Proper diagnosis and treatment of male rape victims requires a high index of suspicion and sensititivty to the likelihood of major, hidden trauma.

Adolescent↗

"Worse than death": psychodynamics of rape victims and the need for psychotherapy.

Victims of rape routinely are acknowledged to need counseling but not psychotherapy; if psychotherapy is provided, the major focus is on preexisting psychopathology. The author examines these assumptions and presents a different formulation based solely on an in-depth examination of the many levels of the trauma. Case material reveals the typical symptoms, conflicts, and defenses found in rape victims. The author makes recommendations for psychotherapeutic technique, especially in regard to difficulties in forming a therapeutic alliance.

Adolescent↗

Self-cutting after rape.

The authors present three cases of women who began to cut themselves superficially after they had been raped. To the authors' knowledge, no such findings have been reported in the current literature on short- and long-term effects of rape.

Adolescent↗

Learning and memory in rape victims with posttraumatic stress disorder.

OBJECTIVE: Studies have shown memory deficits among combat veterans with posttraumatic stress disorder (PTSD); however, high rates of comorbid conditions, including alcoholism, make it difficult to definitively associate these findings with the PTSD diagnosis. In this study the authors examined memory functioning among rape survivors without alcoholism or substance abuse but with PTSD. METHOD: Rape victims with (N = 15) and without (N = 16) PTSD were compared to age- and education-matched nontraumatized comparison subjects (N = 16) on measures of learning and memory. RESULTS: The subjects with PTSD performed significantly worse than the other groups on delayed free recall. The deficits were ameliorated by cueing and recognition testing. CONCLUSIONS: Recall deficits in noncombat PTSD patients strengthen the theory that memory deficits are associated with the PTSD diagnosis. The deficits were mild and were not attributable to comorbid depression, anxiety, or substance abuse.

Adult↗

Forensic sexology: paraphilic serial rape (biastophilia) and lust murder (erotophonophilia).

Forensic sexology is not synonymous with either forensic psychiatry or forensic psychology. It is a specialty in its own right, and is needed in the courtroom. Paraphilic sex offenders on trial are misrepresented as being, by their own choice, psychopathic or sociopathic deviates. They are unable to explain their paraphilic criminality to either themselves or society. In a case of serial rape and serial lust murder here presented, the contributory causes are examined and differentiated as hereditary predisposition, hormonal functioning; pathological relationships, sexual abuse; and syndrome overlap with bipolar disorder, schizoid disorder, antisocial personality disorder, epilepsy, and multiple personality. The precipitating causes were differentiated as childhood head injuries, and adult head injury at age 20. Left impact trauma and sexological trauma were sequelae of the adult injury. The full range of diagnostic resources was not available for a prisoner on death row. Capital punishment has not prevented the reemergence in each new generation of serial rape and serial lust murder as an epidemiological, public health problem. Punishment is an ineffectual substitute for epidemiological research into cause, effect, and prevention.

Brain Damage, Chronic↗

Psychotherapy for the rape victim: some treatment models.

A victim of rape immediately feels an acute disruption of her life style and coping skills and a great stress on her ego. In order to achieve long-term integration, she must resolve a lack of trust of men, paranoia about her physical safety, guilt, and a grief reaction. The author reviews several models of therapy, including the traditional psychodynamic approach, the humanistic approach, and the behavioral-cognitive approach, and also some of the literature on crisis theory. She proposes a model for measuring the rape victim's recuperation--a numbered scale of adaptive behavior on which she can advance from the first stage, acute disorganization, to higher levels of behavior. Two important factors influencing the victim's recovery are symptom relief and the support of significant others.

Crisis Intervention↗

Assailants' sexual dysfunction during rape reported by their victims.

Sexual dysfunction is known to occur in a proportion of rapists during the assault. The most common dysfunctions are erectile insufficiency and absent or retarded ejaculation. The study assessed the incidence and characteristics of assailants' sexual dysfunction reported by 50 victims of rape. 20% of victims reported that their assailant experienced erectile insufficiency at some point during the assault, and a further 12% reported retarded ejaculation or failure to ejaculate by their attacker. In attacks where sexual dysfunction occurred, there was a higher incidence both of intra-rape violence and commissioning of degrading sexual activity and this behaviour was related to the onset of the dysfunction. It was felt that the pattern of behaviour reported in those attacks where rapists' sexual dysfunction occurred might reflect a typologically distinct subgroup of offender. This finding has implications both for the safety of the victim during the attack and subsequent offender assessment.

Ejaculation↗