NOTE: These summaries were written by SVPEP and are based on the original papers. The information available on this web site is provided as a public service and does not necessarily reflect the opinion of the U.S. Centers of Disease Control and Prevention, the Arizona Department of Health Services, or the University of Arizona.

Abrams, K. M., & Robinson, G. E. (1998). Stalking: Part I: An overview of the problem. Canadian Journal of Psychiatry, 43, 473-476.

This paper presents the results from the first of a two-part review on stalking. It outlines the behaviors involved, motivation of offenders, and mental health consequences for the victim. Results of an extensive literature search suggest that as many as 1 in 20 women will be stalked during her lifetime. Most victims are female while most offenders are male. Stalking behaviors range from secretive surveillance to threatening aggressive or violent acts. The majority of stalking occurrences occur in the context of failed intimate relationships. Stalkers may also exhibit erotomania or obsessional love while victims often experience anxiety, depression, guilt, helplessness, and PTSD.

Topics: Effects; stalking

Abrams, K. M., & Robinson, G. E. (1998). Stalking: Part II: Victims' problems with the legal system and therapeutic considerations. Canadian Journal of Psychiatry, 43, 477-481.

This paper presents the results from the second of a two-part review on stalking. It focuses the therapeutic tasks for victims and therapists and on victim difficulty with the legal system. Results of an extensive literature search suggest that victims experience a number of emotional consequences from being stalked. Additional stressors result from the legal system's lack of response. The authors state that treatment of victims must be handled in a comprehensive manner, with attention to education and psychotherapy.

Topics: Effects; legal responses; stalking; treatment

Ahrens, C. E., & Campbell, R. (2000). Assisting rape victims as they recover from rape: The impact on friends. Journal of Interpersonal Violence, 15, 959-986.

Providing the appropriate response to a survivor of rape can be an overwhelming challenge. Rape disclosure often occurs among friends and/or family but many supporters are as unprepared to help as the victim was unprepared for having to survive the rape in the first place. As such, helpers’ responses can vary from providing negative reactions to offering sincere emotional support. Previous research has demonstrated that negative reactions (e.g., blame, denial, rejection, critical judgments) can significantly impair a victim’s postrape functioning. In this article, a brief review of the range of affective and interpersonal responses is offered along with a discussion of victimization perspective theory. This is followed by an empirical study involving 60 friends of rape survivors. Results revealed three patterns of helping and friendship outcomes: positive responses and positive enhancement of the friendship, neutral responses with no alteration of the friendship, and negative responses (i.e., perceived distress and ineffectiveness) involving negative developments in the friendship. The authors conclude by presenting implications and applications of this information toward assisting rape survivors and their support systems.

Topics: Disclosure, effects; survivors

Amey, A. L., & Bishai, D. (2002). Measuring the quality of medical care for women who experience sexual assault with data from the National Hospital Ambulatory Medical Care Survey. Annals of Emergency Medicine, 39, 631-638.

According to CDC guidelines, victims of rape should be offered emergency contraception (EC) as well as screening and treatment for sexually transmitted diseases (STDs). The extent to which these treatments have been provided has not been assessed at a national level. This study offers a descriptive epidemiology of female rape victims receiving these particular services at emergency departments (ED) by drawing upon a nationally representative sample. These findings were then compared with CDC guidelines. Data was collected from the National Hospital Ambulatory Medical Care Survey (NHAMCS) for the years spanning 1992 to 1998. Cases were deemed as receiving EC if women were administered or prescribed drugs from the national drug class 1040 (contraceptives). Women were considered to have obtained screening for STDs if they received urinalysis tests or specific CPT procedures. Furthermore, women were considered to have received treatment if they were given prophylaxis. Findings revealed 204 sexual assault cases from a total of 182,107 ED records available. Results indicated that 20% of women received EC, 36% were screened for STDs, and 23% were screened for HIV. Of those screened, only 34% received STD treatment. Women over 18 were twice as likely to receive STD screening and treatment than those younger than 18 years. Black women were significantly more likely to be screened for STDs and more likely to receive prophylaxis than White women were. The authors conclude that a significant number of victims of sexual assault are not receiving ED medical care as recommended by CDC guidelines and may be better served by hospitals with specialized programs for sexual trauma.

Topics: Effects; medical response; racial/ethnic differences

Arata, C. M., & Burkhart, B. R. (1998). Coping appraisals and adjustment to nonstranger sexual assault. Violence Against Women, 4, 224-239.

In this study, 813 female undergraduate psychology students filled out questionnaires regarding past coercive sexual experiences in order to assess the relationship between appraisals, coping, and adjustment of nonstranger sexual assault. Symptomatic victims of sexual assault were compared to asymptomatic victims. Participants who were currently symptomatic were more likely to engage in characterological self-blame and were more likely to use coping strategies such as emotional expressiveness/social support seeking and coping activity/cognitive restructuring. Victims of rape are more likely to use characterological self-blame than are victims of other forms of sexual assault. Overall, the study showed an impact of coping and attribution on a general measure of functioning.

Topics: College; effects; survivors

Arellano, C. M., Kuhn, J. A., & Chavez, E. L. (1997). Psychosocial correlates of sexual assault among Mexican American and White non-Hispanic adolescent females. Hispanic Journal of Behavioral Sciences, 19, 446-460.

A sample of 1,121 Mexican American and White non-Hispanic adolescent females were surveyed in order to examine the rates and correlates of sexual abuse in both groups. Psychosocial characteristics of those reporting sexual abuse (mean age 16.51 years) were compared to those reporting no sexual assault history (mean age 16.57 years). The results indicated that White non-Hispanic adolescents were twice as likely to report sexual assault as compared to Mexican American adolescents. Although rates of sexual assault appeared to differ across ethnicity, ethnicity did not seem to effect the relationship between sexual assault and psychosocial outcomes of victims. In general, sexual assault victims reported more social isolation, emotional distress, and more atypical behavior, including drug and/or alcohol use. Sexual assault victims also reported problems with school adjustment and choice of friends. In addition, they were more likely to come from homes with parental substance use and family conflict.

Topics: Adolescent/high school; effects; racial/ethnic differences

Beebe, D. K., Gulledge, K. M., Lee, C. M., & Replogle, W. (1994). Prevalence of sexual assault among women patients seen in family practice clinics. Family Practice Research Journal, 14, 223-228.

This article discusses a study assessing the prevalence and characteristics of sexual assault among women patients attending two family medicine residency-training clinics. Women patients (N = 204) were asked to complete a questionnaire to identify rates and type of sexual assaults. Of the women who responded, 28.7% reported some type of sexual assault, with low percentages of them ever reporting the incident to police or seeking medical attention or counseling services. The need for family physicians to be aware of the prevalence of sexual assault in their patients, as well as understanding proper questioning, management, counseling, and referral options is addressed. The need of family physicians to receive specific training for sexual assault victims is discussed and clinical tips are included.

Topics: Effects; prevalence

Belknap, J. (1989). The sexual victimization of unmarried women by nonrelative acquaintances. In M. A. Pirog-Good & J. E. Stets (Eds.), Violence in dating relationships: Emerging social issues (pp. 205-218). New York: Praeger.

The focus of this study is to analyze the sexual victimization, by a casual or well-known acquaintance, of unmarried women 12 years of age and older. Data from the National Crime Victimization Survey is examined for the years 1973–1982. This research serves to address some of the neglected issues that apply to the rape of unmarried women; specifically, descriptions of the victims, the offenders, the offense, the response of the victims, and the degree of injury. The findings show the extent to which acquaintance rape occurs outside of the previously researched college student population. And it supports the emerging definition of date rape as a social problem. Suggestions for future research on date rape are made.

Topics: Effects; perpetration

Brener, N. D., McMahon, P. M., Warren, C. W., & Douglas, K. A. (1999). Forced sexual intercourse and associated health risk behaviors among female college students in the United States. Journal of Consulting and Clinical Psychology, 67, 252-259.

The study presented in this article analyzes data from the 1995 National College Health Risk Behavior Survey (NCHRBS) to assess the prevalence of rape among college female students. It also investigates the association between rape and health risk behaviors. This study supports the findings of a study by Koss et al. (1987) which found that about 15% of a national sample of college women had been raped since age 14. The NCHRBS uses a sample of full and part-time undergraduate students, over the age of 18, from the 148 colleges and universities who participated in the study. They were asked to answer a questionnaire about their health risk behaviors. Students were asked the question: "During your life, have you ever been forced to have sexual intercourse against your will?" Those who answered "yes" to this question were considered to have been raped. In addition, students were asked about their current use of tobacco, episodic heavy drinking, driving after drinking alcohol, and marijuana use. They were also asked about engaging in physical fighting and entertaining thoughts of suicide. Students also answered questions relating to sexual behavior. A succession of logistic analyses was done to determine the relationship between having experienced forced sexual intercourse and engaging in health risk behaviors. The results show that women who had experienced forced sexual intercourse had increased odds of engaging in each of the health-risk behaviors examined. At least two explanations exist for this type of relationship: 1) After women are raped they are more likely to engage in health-risk behaviors and 2) engaging in health-risk behaviors may increase women's vulnerability to forced sexual intercourse. The present study has several limitations that are discussed. Despite the limitations, the fact that 1 in 5 women has experienced forced sexual intercourse in her lifetime indicates the need for increased prevention efforts.

Topics: Alcohol; college; effects; prevalence; vulnerability

Campbell, R., Barnes, H. E., Ahrens, C. E., Wasco, S. M., Zaragoza-Diesfeld, Y., & Sefl, T. (1999). Community services for rape survivors enhancing psychological well-being or increasing trauma? Journal of Consulting and Clinical Psychology, 67, 847-858.

Despite the availability of community services geared toward addressing the aftermath of a sexual assault, many survivors feel as if the experience of seeking assistance from legal, medical, and mental health systems only extends the trauma (i.e., secondary victimization). This study examined the relationship between such secondary victimization and post-traumatic stress (PTS) symptoms among 102 female rape survivors. Analyses concerning social system contact and rape survivor’s psychological well-being revealed that the group most at risk for high PTSD levels postrape were survivors of nonstranger rape who had received minimal assistance from the legal or medical system and had experienced victim-blaming behaviors from system personnel. Although this group had the highest PTSD levels of all survivors in the study, they did show a decrease in their PTSD levels after obtaining continued assistance from the mental health system.

Topics: Effects; secondary victimization; victim services

Campbell, J. C., & Soeken, K. L. (1999). Forced sex and intimate partner violence: Effects on women's risk and women's health. Violence Against Women, 5, 1017-1035.

Authors examined the relationship between forced sex and women's self-esteem and health status – extending the latter concept beyond physical and emotional abuse sustained. A volunteer community sample of 159 battered women (mean age 31.6 years; 77% African American) completed interviews about forced sex by their partner (or ex-partner). Results indicate that 45.9% of the sample were sexually assaulted as well as physically abused. Other than ethnicity, there were no demographic differences between those who were forced into sex and those who were not. Additionally, there was no difference in history of child sexual abuse. However, women who were sexually assaulted reported higher scores on negative general health symptoms, gynecological symptoms, and risk factors for homicide victimization even when controlling for physical abuse and demographic variables. The authors also found that the number of sexual assaults (childhood, rape, and intimate partner) was significantly correlated with depression and body image.

Topics: Effects; survivors

Chang, B. H., Skinner, K. M., & Boehmer, U. (2001). Religion and mental health among women veterans with sexual assault experience. International Journal of Psychiatry in Medicine, 31, 77-95.

This study examines the association of religiosity, mental health functioning, and depression among women who experienced sexual assault. Using a sample of women veterans, religion was measured as attendance of religious services and subjective religious beliefs. Results suggest that religion may have a buffering effect on health in response to traumatic life events.

Topics: Effects; faith based; survivors

Connop, V., & Petrak, J. (2004). The impact of sexual assault on heterosexual couples. Sexual & Relationship Therapy, 19, 29-38.

The impact of sexual assault upon the male partners of female sexual assault victims is an under-researched area. The purpose of this study was to examine how male partners react to their partner’s sexual assault and what happens to the couples’ interactions. Participants were recruited through a sexual assault clinic and through press advertisements. Semi-structured interviews were conducted with 6 males whose previous or current partners had been sexually assaulted and with 3 females who had been sexually assaulted and had disclosed their assault to their partners. Interviews revealed that 8 of the 9 participants had a partner who had experienced acquaintance rape – or, in the case of the female participants, had been the victim of acquaintance rape. In analyzing the interviews, four themes were identified: (a) the male partner’s role in providing support, (b) communication, (c) anger and blame, and (d) the impact of the assault on the sexual relationship. Many of the male participants indicated that they felt they should put their partner’s needs first and felt exhausted by their role in supporting their partner. Men also revealed a common assumption relating to socio-cultural scripts concerning heterosexual relationships; namely, the idea that they ought to protect their women. Relationship disturbances and communication problems were also reported to have increased in the aftermath of the assault. While at times the men enunciated rape myths, they could not be categorized either as viewing the rape as a sexual act or as a violent act (as the prior research study had indicated). A final issue noted by participants was how the sexual assault increased their difficulty in performing and enjoying sexual activity. Suggested implications of the findings for service provision include the benefit of couple-based counseling and counseling to support male partners’ support needs and psychosexual issues.

Topics: Disclosure; effects; male-female relations; myths/stereotypes; survivors

Coxell, A. W., & King, M. B. (1996). Male victims of rape and sexual abuse. Sexual & Marital Therapy, 11, 297-308.

This article reviews the sexual assault of adult males. A number of myths concerning the survivors, perpetrators, and plausibility of such assaults are critically examined. Sexual assault prevalence data from 1,480 males is presented. The results from a study of coercion in gay relationships is also included. The problems that males reported after sexual assault are discussed. These problems include: PTSD, sexual problems, difficulties forming close relationships, mistrust of adult men, suicide attempts, confusion about sexual orientation, and various mood disorders. Sexual assault by females (which is comparatively rare) tends to leave men less traumatized than sexual assaults by men because these types of assaults are less likely to involve physical force and because same-sex sexual contact, which is traumatic in itself to heterosexual males, is not involved.

Topics: Effects; male rape; perpetration; survivors

Coyle, B. S., Wolan, D. L., & Van Horn, A. S. (1996). The prevalence of physical and sexual abuse in women veterans seeking care at a veterans affairs medical center. Military Medicine, 161, 588-593.

This study examines the prevalence of physical and sexual abuse in a sample of female veterans seeking care at a Veteran's Affairs Medical Center. The article discusses a military policy allowing services only for female veterans who were sexually assaulted while on duty. The study examines percentages of sexual assault in women while on active duty and occurrences of civilian rape. The authors argue that there are long-term consequences for all types of sexual abuse/assault.

Topics: Effects; military; prevalence

Darves-Bornoz, J. M., Choquet, M., Ledoux, S., Gasquet, I., & Manfredi, R. (1998). Gender differences in symptoms of adolescents reporting sexual assault. Social Psychiatry & Psychiatric Epidemiology, 33, 111-117.

While the sexual assault of children and adolescents is widely studied, there has been a lack of research examining issues related to male victims. This study reports on a nationwide survey of school-age adolescents in France. In all, 121 boys and 344 girls reported having been sexually assaulted (mean age 15.4 years). Results indicated that girls exhibited more somatic symptoms and mood disorders while boys more frequently demonstrated behavioral symptoms such as running away, suicide attempts, violent outbursts, and substance use.

Topics: Adolescent/high school; effects; male rape

Darves-Bornoz, J. M., Lepine, J. P., Choquet, M., Berger, C., Degiovanni, A., & Gaillard, P. (1998). Predictive factors of chronic post-traumatic stress disorder in rape victims. European Psychiatry, 13, 281-287.

This article addresses the need to identify empirical predictors of chronic PTSD among rape victims. The study involved 73 victims of sexual assault who were either self-referred or referred by the police to the Centre for Victims of Sexual Assault at the University Hospital in Tours, France. Participants were assessed by a psychiatrist at the onset of the study using structured interview schedules to measure psychological and behavioral attitudes as well as sexual abuse experiences. Analysis revealed that somatoform and dissociative disorders, agoraphobia, depressive and gender identity disorders, and alcohol abuse are good predictors of PTSD one year after a rape. Other good predictors of chronic PTSD, revealed by stepwise logistic regressions, were: specific characteristics of the rape (such as intrafamily rape, physical violence outside the rape, and added physical violence during the rape), early psychological and behavioral attitudes (such as low self-esteem, permanent feelings of emptiness, and running away), and early mental disorders (agoraphobia and depressive disorders). The strongest predictive model suggests that clinicians should pay particular attention to patients presenting with low self-esteem, feelings of emptiness, agoraphobia, and the experience of added physical violence during rape since these patients may be susceptible to chronic PTSD.

Topics: Effects; survivors

Donat, P., & Bondurant, B. (2003). The role of sexual victimization in women's perceptions of others' sexual interest. Journal of Interpersonal Violence, 18, 50-64.

The purpose of this study was to further understand the relationship between women’s sexual victimization experiences and their perceptions of sexual interest. In this experiment, 329 undergraduate women rated mundane dating behaviors, romantic behaviors, and sexual behaviors exhibited by both male and female actors according to their perceptions of the actor’s sexual interest. The women were divided into four groups according to their personal sexual experiences. In general, the women rated the male actor as portraying more sexual interest than the female when the actors exhibited the same type of behavior. Also, the group of women who had been sexually victimized through the use of force or threat of force rated the male actor’s behavior as portraying more sexual interest than the ratings of the group of women who had not been sexually victimized.

Topics: Alcohol; college; effects

Fitzgerald, M.M., Danielson, C.K., Saunders, B., & Kilpatrick, D.G. (2007).Youth victimization: Implications for prevention, intervention, and public policy. The Prevention Researcher, 14, 3-7. [Posted August 2007]

Key Points: Policies and practices are needed to minimize the harm of youth victimization by encouraging assessment, targeted prevention, and treatment interventions.  

Abstract: The authors review national prevalence rates of youth victimization, including: sexual, emotional or physical abuse; witnessing domestic or community violence; property crime; and excessive punishment. They note gender and race/ethnicity differences in prevalence rates as well as mental health effects. Specific recommendations for assessing risk and resiliency factors as well as screening for victimization in clinical settings are given. The authors discuss the importance of targeted interventions for specific groups, and urge adoption of an ecological model. Finally, the authors discuss how public and organizational policies can help decrease the impact of victimization and increase the availability of supportive services for youth and their families.

Topics: Adolescent/high school; effects; medical response; prevalence; prevention; racial/ethnic differences

Foa, E. B. (1997). Trauma and women: Course, predictors, and treatment. Journal of Clinical Psychiatry, 58, 25-28.

This study addresses the need for effective short-term treatments for women in the United States who have post traumatic stress disorder (PTSD) resulting from aggravated assault, rape, or non-crime trauma. This article also discusses two cognitive behavioral treatments for PTSD: prolonged exposure treatment and stress inoculation training programs. A study involving 96 female victims of sexual or aggravated assault (who met the diagnostic criteria for PTSD) was conducted to compare the efficacy of these two therapies. Stress inoculation training, prolonged exposure, and the combination of both showed immediate as well as long-term (6-month) treatment effects when compared to the control group. Prolonged exposure treatment appeared to be superior overall. The article includes a discussion of how these therapies can prevent PTSD from becoming chronic.

Topics: Effects

Frazier, P., Tashiro, T., Berman, M., Steger, M., & Long, J. (2004). Correlates of levels and patterns of positive life changes following sexual assault. Journal of Consulting and Clinical Psychology, 72, 19-30.

Research suggests that factors such as personal resources, environmental resources, coping strategies, and event appraisals affect the development of positive live changes following a traumatic event. Building on previous work, this study considered features associated with early reporting of positive life change and differential self-report patterns of positive life change over time. The study measured prior victimization and survivor ethnicity (aspects of personal resources); social support (an aspect of environmental resources); approach, avoidant, and religious coping (aspects of coping strategies); and behavioral self-blame, control over the recovery process, and taking precautions to prevent future assaults (aspects of event appraisals). The authors hypothesized that social support, approach coping, perceived control over the recovery process, taking precautions, and being African American would be associated with a greater degree of early positive life change. It was hypothesized that these same variables would also predict a more rapid increase in positive life change over time. Participants (N = 171) were recruited from female sexual assault survivors assisted at one of seven emergency rooms in the Minneapolis/St. Paul area. Respondents completed questionnaires postassault at 2 weeks, 2 months, 6 months, and 12 months. Results provided partial support for the authors’ hypotheses. Participants who reported higher initial levels of social support, approach coping, religious coping, and perceived control over the recovery process also reported higher initial levels of positive life change. Participants who reported increases over time in social support, approach coping, religious coping, perceived control over the recovery process, and taking precautions also reported increases in positive life changes over time. Limitations include a limited list of positive change variables as well as a lack of generalizability to male survivors and non-ER service consumers. Further research is needed to examine the contribution of ethnic differences, religious coping, and various control appraisals.

Topics: Effects; survivors; treatment

Goodman, L. A., Koss, M. P, & Russo, N. F. (1993). Violence against women: Physical and mental health effects: II. Research findings. Applied & Preventive Psychology, 2, 79-89.

In this article the authors use the posttraumatic stress disorder diagnosis, a frame that captures many of the disparate symptoms described by researchers, as a basis for exploring several conceptual models that have been developed to explain responses to violence. The PTSD framework is discussed in depth, with further discussion of the Psychoanalytic model, the Schema-Based model, the Behavioral Learning model, the Personal Control model, the Learned Helplessness model, and the Emotional Processing model. The need for integration of these models in order to adequately address all the symptoms of PTSD, and hence women's responses to violence, is discussed.

Topics: Effects; theory

 Heise, L., Ellsberg, M., & Gottemoeller, M. (1999). Ending violence against women. Population Reports, Series L, Number 11, 1-43.

This report provides an admirably thorough review of the various dimensions concerning violence against women across the globe. The authors begin by addressing the concept of gender-based violence, how health care providers can help, and what societal responses should entail in curbing the problem. The report discusses in detail the prevalence and ramifications of intimate partner abuse, sexual coercion, impact of violence on women’s reproductive health, threats to health and development, the role of health providers in recognizing and treating the effects of violence, and finally, an agenda for change. The report includes numerous charts presenting, for example, cross-cultural data on issues related to rates of approval of wife-beating and prevalence of forced first intercourse in various countries. The report also includes examples of posters used to educate women and increase awareness of the issues in different countries as well as several useful charts with instructions and guidelines for health care providers. This is an invaluable resource for anyone interested in understanding violence against women on a global level.

Topics: Community attitudes/responses; disclosure; effects; injury; male-female relations; marital rape; medical response; myths/stereotypes; perpetration; prevalence; prevention; racial/ethnic differences; risk; statistics; underserved populations; vulnerability

Hensley, L. G. (2002). Treatment for survivors of rape: Issues and interventions. Journal of Mental Health Counseling, 24, 331-347.

This article is a review of various issues and interventions related to counseling survivors of rape. It summarizes relevant statistics, discusses four important issues, and details four treatment modalities. The four issues discussed all relate to the experience of the rape survivor, including: 1) how sociocultural factors will influence the survivor's reaction to the rape, 2) the survivor's history of prior victimization, 3) the specific details of the assault against the survivor, and 4) how victim-blaming may affect the survivor's recovery. The treatment modalities detailed are drawn from best practices for the treatment of post-traumatic stress disorder (PTSD). The first modality detailed is psychoeducation, where the counselor provides an education about commonly experienced PTSD symptoms. The second is exposure therapy, where the counselor guides the survivor through multiple re-tellings of the assault. The third modality is Resick and Schnicke's Cognitive Processing Therapy, where the survivor's maladaptive beliefs about the assault are identified and challenged. The final modality described is actually a summary of various anxiety management techniques.

Topics: Effects; risk; treatment

Howard, D. E., & Wang, M. Q. (2005). Psychosocial correlates of U.S. adolescents who report a history of forced sexual intercourse. Journal of Adolescent Health, 36, 372-379.

This study examined the psychological and behavioral correlates of forced sexuality among high school students (N = 13, 601). Participants were given the 2001 national school-based Youth Risk Behavior Survey (YRBS). Results showed that 7.7% of high school adolescents had experienced forced sexual violence. Moreover, girls reported a 10.2% lifetime prevalence whereas boys reported a 5.1% lifetime prevalence of forced sex. Additional results yielded associations between a history of forced sexual violence and suicidal thoughts and behaviors as well as substance abuse and other risky behaviors. The authors emphasize the need for clinical applications of these findings and recognize the issue of forced sexual intercourse among adolescents as a growing public health concern.

Topics: Adolescent/high school; effects; prevalence

Isely, P. J., & Gehrenbeck-Shim, D. (1997). Sexual assault of men in the community. Journal of Community Psychology, 25, 159-166.

This study reports on an attempt to determine the extent of male sexual assault. Agencies that work with sexual assault victims (N = 172) reported contact with 3,635 men who had sought treatment for sexual assault. Most assaults occurred between the ages of 16 and 30 years and a majority of these men experienced symptoms of posttraumatic stress disorder (PTSD).

Topics: Effects; male rape

Kang, S. T., Magura, S., Laudet, A., & Whitney, S. (1999). Adverse effect of child abuse victimization among substance-using women in treatment. Journal of Interpersonal Violence, 14, 657-670.

This study examined the adverse effect of childhood sexual/physical abuse among 171 substance-abusing women with infants or young children who were admitted to the Family Rehabilitation Program in New York City. Approximately one-half of the women (51%) self-reported ever having been sexually (24%) or physically (45%) abused in their childhood. Having a history of childhood abuse experiences, particularly sexual abuse, was associated with various areas of adult life functioning. Approximately 13 months after program admission, 82% of the sample was recontacted for follow-up. No significant associations were found between childhood abuse experiences and length of retention in services. However, several significant differences in service outcomes between sexually or physically abused women and nonabused women were found. The abused women had significantly more problems relating to drug use and psychiatric/psychological adjustment at follow-up. The findings support a need for substance dependency treatment programs tailored for women who have experienced serious childhood abuse.

Topics: Alcohol; effects; risk; underserved populations

Kilpatrick, D. G., Acierno, R., Resnick, H. S., Saunders, B. E., & Best, C. L. (1997). A 2-year longitudinal analysis of the relationships between violent assault and substance use in women. Journal of Consulting & Clinical Psychology, 65, 834-847.

Women experience high levels of physical and sexual assault, the results of which have been theorized to lead to increases in substance use. Evidence from cross-sectional studies also points out that substance use may increase risk of assault. To date, the relationship between sexual assault and substance abuse remains unclear. This study reports the results of a three-wave longitudinal study in which a national sample of 3,006 women were followed for 2 years. Data was collected at each wave of the study and included questions about lifetime and new assault status, alcohol abuse, and drug use.

Topics: Alcohol; effects; vulnerability

King, M., & Woollett, E. (1997). Sexually assaulted males: 115 men consulting a counseling service. Archives of Sexual Behavior, 26, 579-588.

Data was collected on 115 male sexual assault victims who were seen at least once for face-to-face counseling. Analysis revealed that 69 men were assaulted prior to age 16 years. The average time from assault to obtaining counseling services was 16.4 years. Fifty-one men were assaulted more than once. The perpetrator was known to the victim in the majority of cases. One-hundred respondents were assaulted by one or more men. Of the sample, 88 men did not seek help at the time and only 17 men reported the assault to the police. Victims under the age of 16, who were assaulted, were more likely to report that this was their first sexual experience. Victims under the age of 16 were also more likely to delay contact with counseling and less likely to report to police. Victims assaulted by more than one person were less likely to have experienced the incident as their first sexual experience, more likely to have been assaulted by strangers, and to have suffered physical injuries.

Topics: Effects; male rape

Koss, M. P. (1994). The negative impact of crime victimization on women's health and medical use. In A. J. Dan (Ed.), Reframing women's health: Multidisciplinary research and practice (pp. 189-200). Thousand Oaks, CA: Sage Publications, Inc.

Primary care physicians are an important resource for women victimized by crime such as rape and domestic violence. However, until recently the medical community ignored this line of research. This article analyzes how crime victimization effects healthcare utilization. Victimization was found to influence the number of physician visits with multiply victimized women visiting physicians twice as much as non-victimized ones. The study also examined a sub-sample of participants whose use of healthcare could be examined before and after a crime incident. Review of healthcare records demonstrated that increases in healthcare usage followed, rather than preceded, the crime. Five ways victimization may influence health are detailed.

Topics: Community attitudes/responses; effects

Koss, M. P., & Harvey, M. R. (1991). The crime of rape. In The rape victim: Clinical and community interventions (2nd ed., pp. 1-41). Newbury Park, CA: Sage Publications, Inc.

Chapter 1: This chapter focuses on the crime of rape. Legal definitions, frequency, and causes of rape are highlighted. The authors discuss how incidence and prevalence numbers are generated.

Rape is no longer viewed exclusively from a criminal justice framework. Implications for women's health are also considered. The health burden of rape is investigated cross-culturally, focusing on its prevalence and psychological, sociocultural, somatic, and reproductive health consequences. Cross-cultural differences between normative and non-normative rape are explored. Problems such as the difficulties associated with collecting valid and reliable data, women's reluctance to report rape, and failure to accurately assess the aftereffects of rape are discussed. Conclusions focus on how research can improve the physical and mental health of women worldwide.

Topics: Effects; prevalence; statistics

Koss, M. P., Heise, L., & Russo, N. F. (1994). The global health burden of rape. Psychology of Women, [Special issue: Transformations: Reconceptualizing theory and research with women], 18, 509-537.

Rape is no longer viewed exclusively from a criminal justice framework. Implications for women's health are also considered. The health burden of rape is investigated cross-culturally, focusing on its prevalence and psychological, sociocultural, somatic, and reproductive health consequences. Cross-cultural differences between normative and non-normative rape are explored. Problems such as the difficulties associated with collecting valid and reliable data, women's reluctance to report rape, and failure to accurately assess the aftereffects of rape are discussed. Conclusions focus on how research can improve the physical and mental health of women worldwide.

Topics: Effects; prevalence; statistics

Magley, V. J., Waldo, C. R., Drasgow, F., & Fitzgerald, L. F. (1999). The impact of sexual harassment on military personnel: Is it the same for men and women? Military Psychology, 11, 283-302.

This study compared outcomes of sexual harassment for men and women utilizing data from the US Department of Defense's (1995) gender issues survey. Service members (22,372 female and 5,924 male) responded to 23 of 26 Sexual Experiences Questionnaire--Department of Defense items which were used to measure sexual harassment. Results indicate that women were more likely to experience sexual harassment than men. Results also indicated that women almost always experienced sexual harassment from men while men were somewhat more likely to experience sexual harassment from other men. Overall, sexual harassment is more impactful for women. The results also indicated that in those cases where the experiences are similar, males and females have comparable psychological, health, and job-related outcomes.

Topics: Effects; harassment; military

Molidor, C., & Tolman R. M. (1998). Gender and contextual factors in adolescent dating violence. Violence Against Women, 4, 180-194.

High school students (N = 635) were surveyed about the frequency, severity, and reaction to dating violence they had experienced. Although the overall frequency of violence did not differ by gender, if they told anyone. This study also indicated that while the frequency of violence was the same between genders, the predictors and severity of violence differed between them. The authors discuss implications for intervention.

Topics: Adolescent/high school; effects; prevalence; prevention

O'Donohue, W., Downs, K., & Yeater, E. A. (1998). Sexual harassment: A review of the literature. Aggression & Violent Behavior, 3, 111-128.

The authors review research on sexual harassment related to definitional, etiological, epidemiological, treatment, prevention issues, and effects. The authors state that while there are many controversies concerning how sexual harassment is defined, it is evident that there are subtypes of sexual harassment, including such as gender harassment, unwanted sexual attention, and sexual coercion. Existing research also indicates that women are frequently affected by sexual harassment and that verbal harassment is more common than nonverbal harassment. It is common for victims of sexual harassment to experience negative psychological, work-related, and economic consequences. Suggestions for future research are offered.

Topics: Effects; harassment; prevention

Pathe, M., & Mullen, P. E. (1997). The impact of stalkers on their victims. British Journal of Psychiatry, 170, 12-17.

This article examines the findings of a study which questioned 100 victims of stalking regarding their psychological, social, and interpersonal functioning as well as their level of risk for physical and sexual assault. Most victims experienced multiple forms of harassment including: being followed, repeatedly approached, and harassed either by mail or phone. Victims were stalked from 1 month to 20 years. Of those reporting stalking, 58 were threatened and 34 experienced physical or sexual assault. Most victims (n = 94) made major changes in their work and social lives, including changing or ceasing employment (53%) and moving back home (39%). Of the stalking victims, 83% reported increased anxiety, 55% experienced intrusive flashbacks, 37% met criteria for PTSD, and 24% acknowledged suicidal ideation. Respondents also reported appetite disturbances, depressed mood, and nightmares. Results indicate that persistent stalking results in social and psychological harm to victims. The authors also discuss the inadequacy of medical and legal response systems.

Topics: Effects; harassment; stalking

Resnick, H., Monnier, J., Seals, B., Holmes, M., Nayak, M., Walsh, J., et al. (2002). Rape-related HIV risk concerns among recent rape victims. Journal of Interpersonal Violence, 17, 746-759.

This article assesses the degree of fear and concern over contracting HIV during and after a rape assault. The study was conducted from July 1994 to September 1996. During this time researchers recruited 62 participants (ages 18 to 48 years) from postrape medical clinics. The initial interview was completed an average of 37 days after the incident and participants were paid $30 for their time and cooperation. Results of the study showed that 69.4% of those interviewed were raped by someone they did not know, 71% reported instances of verbal threats, and 82.3% feared being killed or injured during the attack. The study also revealed that 91.9% of those raped included vaginal penetration, 21.3% included oral penetration, and 9.8% included anal penetration. When participants were questioned about their fear of HIV, 69% reported being fearful during the rape that the assailant might have HIV and 92% were concerned about contracting the disease after the rape occurred. The most common reason for their concern (75.4%) over contracting HIV was that the assailant may have raped others. In addition, 64.9% reported that the assailant was a stranger. The results of this study and many others similar to it have shown us that women who are raped by a stranger are more likely to report concern about HIV than women who were raped by someone familiar to them. Of these victims, 82% reported interest in receiving more information about HIV during their postrape exam.

Topics: Effects; medical response; survivors

Saunders, B. E., Kilpatrick, D. G., Hanson, R. F., Resnick, H. S., & Walker, M. E. (1999). Prevalence, case characteristics, and long-term psychological correlates of child rape among women: A national survey. Child Maltreatment: Journal of the American Professional Society on the Abuse of Children, 4, 187-200.

A national probability sample of 4,008 adult women (aged 18–69+ years) was screened by phone for a history of completed rape in childhood using the Incident Classification Interview (Kilpatrick et al., 1989). Characteristics of child rape incidents were also assessed. Respondents were evaluated for a history of major depressive episode, posttraumatic stress disorder (PTSD), and substance use problems. This study endeavored to: (1) determine the prevalence of a history of completed rape in childhood among adult women in the United States; (2) collect incident-characteristic data about child rapes to develop a national profile of these assaults; and (3) examine the increased risk, if any, that being the victim of at least one child rape presents to women for developing PTSD, major depression, and substance use problems. Results showed that childhood rape dramatically increases risk for the development of psychological problems. The article concludes with a discussion of the implications of these results for prevention, intervention, and future research.

Topics: Effects; prevalence; prevention; risk; survivors

Sorenson, S. B. (1996). Violence against women: Examining ethnic differences and commonalities. Evaluation Review, 20, 123-145.

Drawing upon a group discussion format, this study investigated cultural differences and similarities in the options a woman perceives, the help she seeks, and the nature and scope of violence she experiences in an intimate relationship. Adult volunteer participants represented the African American, Anglo American, Asian American, and Mexican American communities. The twelve focus groups were comprised of 3 to 10 participants of the same ethnicity, gender, and current residence (i.e., shelter or community). The following central themes were addressed: intersection of gender and ethnicity, immigration as a challenge to family and cultural history, the role of social institutions, family and friends, and the range of violent experiences and their outcomes, including psychological and economic consequences. Observations relevant to research, policy, and service provision are offered.

Topics: Effects; racial/ethnic differences; vulnerability

Spitzberg, B. H. & Cupach, W. R. (2007). The state of the art of stalking: Taking stock of the emerging literature. Aggression & Violent Behavior, 12, 64-86. [Posted April 2007.]

Key Points: The article provides a thorough overview and explanation of issues related to stalking based on the current published literature.

Abstract: This meta-analysis summarizes the results of 175 studies of stalking. In addition to looking at variations in prevalence between studies, the authors considered the definitions of stalking and described the closely-related set of behaviors termed “obsessive relational intrusion.” The authors created systematic typologies of types of stalkers, stalkers’ motivations, and types of stalking behaviors. Victims’ coping responses and the effects of stalking are also categorized. The majority of stalking victims are women. Because the majority of victims (79%) were acquainted with the stalker, and because half of all stalking was related to romantic relationships, the authors recommended looking at most stalking not only as criminal behavior or psychopathology, but as a type of “relationship terrorism” similar to other types of domestic violence.

Topics: Effects; perpetration; prevalence; stalking

Thakkar, R. R. & McCanne, T. R. (2000). The effects of daily stressors on physical health in women with and without a childhood history of sexual abuse. Child Abuse & Neglect, 24, 209-221.

The focus of this study is the impact of a history of sexual abuse during childhood on the effects of daily stress and physical symptoms during adulthood among a sample of 491 female college students. The participants in the study responded to self-report questionnaires over a period of 28 consecutive days. Analysis revealed that women with a history of childhood sexual abuse are more sensitive to the effects of increased daily stress. In addition, this sensitivity is associated with their increased likelihood to report physical symptoms during the days prior to their most stressful day. However, elevated levels of physical symptoms were not reported for the days following the high-stress target days implying that daily stress has a discrete and short effect on the report of physical symptoms. In contrast, women without a history of sexual abuse during childhood show no significant association between daily stress and physical symptoms. The article concludes by proposing several possible explanations for the results found in the study, contrasts these with other studies on the same topic, and addresses certain limitations specific to the research.

Topics: Effects; survivors

Walker, E. A., Gelfand, A. N., Gelfand, M. D., Koss, M. P., & Katon, W. J. (1995). Medical and psychiatric symptoms in female gastroenterology clinic patients with histories of sexual victimization. General Hospital Psychiatry, 17, 85-92.

The authors interviewed 89 adult female gastroenterology clinic patients, classified by severity of sexual trauma and studied for differences in lifetime psychiatric diagnoses, physical abuse, and medically unexplained symptom patterns. Compared with the 46 women with less severe or no prior sexual trauma, the 43 participants with severe victimization had significantly higher lifetime and current rates of several selected psychiatric disorders and significantly higher mean numbers of lifetime psychiatric disorders, medically unexplained physical and anxiety symptoms, greater harm avoidance and dissociation scores, and increased functional disability. Logistic regression showed that main predictors of a history of severe sexual abuse were the number of medically unexplained symptoms, adult physical abuse, and lifetime dysthymic disorder.

Topics: Effects; treatment

Walker, E. A., Unutzer, J., Rutter, C., Gelfand, A., Saunders, K., VonKorff, M., Koss, M. P., & Katon, W. (1999). Costs of health care use by women HMO members with a history of childhood abuse and neglect. Archives of General Psychiatry, 56, 609-613.

This paper examined differences in annual health care use and costs in women with and without histories of childhood maltreatment. In this sample, 1225 women (ages 18–65 years), who were currently enrolled in an health maintenance organization (HMO), completed a questionnaire inquiring about childhood maltreatment in five areas: emotional, physical and sexual abuse, and emotional and physical neglect. Information on health care cost and utilization were obtained from the automated cost-accounting system of the HMO. Overall, results indicated that childhood maltreatment is significantly associated with increased adult medical care costs and visits. Participants who reported abuse or neglect had median health care costs (MHCC) $97 per year greater than women who did not report maltreatment. Furthermore, women who reported sexual abuse had MHCC $245 greater per year than women who did not report abuse and were nearly twice as likely to visit the emergency department.

Topics: Effects

Walker, J., Archer, J., & Davies, M. (2005). Effects of rape on men: A descriptive analysis. Archives of Sexual Behavior, 34, 69-80. [Posted December 2006.]

Key Points: Male victims of rape tend to react in an emotionally “controlled” way (calm, composed or subdued) immediately after the event. Long-term effects of sexual assault on men include depression, anger, anxiety, and emotional distancing from others.

Abstract: To describe the experiences of male rape victims who were not in a clinical setting, men who had been anally raped were recruited to participate in a mail-in survey. Forty men provided details of the assault, their immediate reactions, and the long-term effects. Seventy percent of the men were between the ages of 16-25 when the incident occurred. Only 10% of the rapes were committed by strangers.

Most men (87%) felt frozen fear, helplessness, or submission during the attack, although some (27%) were able to fight back at least somewhat. The majority of men reported that feeling helpless and out of control was worse than the sexual aspects of the assault. Almost all of the men reported long-term depression as a consequence of the assault, and most experienced long-term confusion about their sexual identity.

Recommendations included providing male victims the same support services offered to women, and more community education and outreach to increase awareness of the prevalence and impact of male rape.

Topics: Effects; male rape; survivors

Widom, C. S. (1989). Child abuse, neglect and adult behavior: Research design and findings on criminality, violence and child abuse. American Journal of Orthopsychiatry, 59, 355-367.

The purpose of this article is to determine the extent to which individuals engage in delinquency and adult criminal behavior based on having been abused as a child. The sample group consisted of documented cases of child abuse from 1967 through 1971 with a control group, with no history of abuse, matched by similar demographics. Subsequent juvenile and adult criminal records for both the sample group and the control group were obtained. The findings show that the sample group had higher records of adult criminal offenses than the control group, but they did not show a higher incidence of arrests for child abuse or neglect. The necessity for further research is discussed.

Topics: Effects; risk

Wyatt, G. E. (1992). The sociocultural context of African American and White American women's rape. Journal of Social Issues, 48, 77-91.

This article examines cultural and ethnic factors affecting women's reactions and adjustments to sexual assault. Fifty-five African American and White American women (aged 18–36 years), reporting 146 incidents of attempted and completed rapes, were interviewed. There were no significant ethnic differences in the prevalence of rape. African Americans in this sample were less likely to disclose sexual assault. Women in both groups experienced lasting psychological effects, including emotional distress connected to the abuse, chronic depression, mistrust of people, men in particular, and specific fears.

Topics: Effects; racial/ethnic differences; prevalence; survivors

updated 08/01/07