A person-centered approach to examining heterogeneity and subgroups among survivors of sexual assault

What Characterizes Vulnerability? Interdisciplinary Perspectives on Service Provision for Survivors of Sexual Assault

Although research indicates that specialized sexual assault (SA) services are effective in terms of promoting postassault recovery and improving legal outcomes, little is known about how to best support survivors facing co-occurring difficulties and inequalities (e.g., preexisting mental health issues, substance abuse, poverty). This deficiency in knowledge was also expressed by service providers at Danish SA centers (SACs), who described this using the term "vulnerable survivors." Therefore, the present study aims to address this knowledge gap by exploring (a) how service providers understand vulnerability in the context of SA and (b) how service provision is currently approached for these survivors. Interviews were conducted with 18 service providers representing five professional groups (psychologists, social workers, forensic doctors, nurses, police) and analyzed using Interpretative Phenomenological Analysis. A total of eight themes emerged from the analysis, including service providers' descriptions of what characterizes vulnerability in survivors and broader perspectives on service provision for these survivors. Survivors considered least likely to attain desired supports were also those perceived to be most vulnerable with regards to risk and experiences surrounding sexual victimization (e.g., individuals with preexisting mental health issues). Service providers also believed that a large proportion of those served experience ongoing vulnerabilities that are difficult to manage within existing support models. The results thus suggest that survivors' needs cannot be met if vulnerabilities are overlooked or ignored. At the same time, the concept of vulnerability warrants caution since vulnerabilities are often placed within individual survivors, but the formal support system also appears vulnerable in its ability to meet the diverse needs and priorities of those served. The implications for SA services across the globe are discussed, including a need for more individually tailored and trauma-informed responses to SA that simultaneously address co-occurring difficulties and inequalities in survivors.

Drug-facilitated sexual assault, impaired trauma memory, and implications for mental health treatment

BACKGROUND

Sexual assault (SA) is a highly prevalent global public health problem and a robust predictor of posttraumatic stress disorder (PTSD), substance use disorder (SUD), and suicidality. A large percentage are drug or alcohol facilitated (DFSA), impairing trauma memory and affecting the application of evidence-based treatments. Despite these problems, few have investigated DFSA-specific mental health (MH) needs.

OBJECTIVE

Goals of this study were (1) to identify psychological sequelae characterizing DFSA towards explaining why symptoms have been treatment-refractory, comparing survivors with involuntary substance ingestion (forced, covert: DFSA-I), voluntary ingestion (DFSA-V), and non-DFSA; and (2) to determine how impaired trauma memory relates to the development of PTSD and depression symptoms.

METHOD

Data from a retrospective chart review of 74 adults receiving SA MH services at an outpatient trauma center are presented. The sample includes a 2-year cohort seen acutely at an urban rape treatment center. The study is one of the first to examine therapy records beyond case studies for DFSA. Logistic, Poisson, and negative binomial regression analyses of quantitative data and qualitative thematic analysis of trauma cognitions and treatment foci were conducted.

RESULTS

DFSA-V had five times greater odds of SUD, and notable substance-related self-blame compared to DFSA-I. DFSA-I had prominent relationship distress and self-blame for missing danger of perpetrator drugging. Survivors with impaired trauma memory had significantly fewer hyper-arousal and overall PTSD symptoms, and specifically less hypervigilance. No differences were found in re-experiencing symptoms.

CONCLUSION

Impaired trauma memory is common in DFSA and is associated with fewer baseline hyper-arousal and overall PTS. Despite this, DFSA issues including re-experiencing symptoms that are particularly distressing without the ability to cognitively connect the intrusions contribute to increased treatment needs. Impaired memory limits the application of evidence-based treatments, and collectively these findings call for the development of trauma-specific treatment protocols to enhance recovery for DFSA survivors.

HIGHLIGHTS

Survivors of drug-facilitated sexual assault have prominent PTSD including reexperiencing, though trauma memory may not be encoded. • Those absent trauma memory have less hyperarousal, but DFSA complications explain why it is treatment refractory and inform treatment development.

Sexual Revictimization in College Women: Mediational Analyses Testing Hypothesized Mechanisms for Sexual Coercion and Sexual Assault

A precollege history of sexual victimization predicts revictimization during college, making it important to understand the mechanisms underlying the victimization-to-revictimization pathway. The study aimed to test whether heavy episodic drinking and personal and peer hookup norms mediate revictimization for two types of unwanted sexual contact: sexual coercion (attempted and/or completed sexual assault by the use of verbal coercion) and sexual assault (attempted and/or completed sexual assault by the use of force, threats, or incapacitation). At college entry, 483 first-year college women completed self-report measures of their precollege experiences, including history of sexual victimization and health behaviors (i.e., alcohol use, personal and peer hookup norms). At the end of the first and second semesters, they also completed measures assessing incident sexual victimization. Nearly one half of women (48%) reported an experience of attempted or completed sexual coercion or assault prior to entering college; 33% endorsed sexual coercion and 15% endorsed sexual assault in their first year of college. Structural equation models demonstrated that heavy episodic drinking and personal and peer hookup norms partially mediated revictimization for sexual assault, but not for sexual coercion. Sexual coercion was the most common tactic leading to unwanted sexual contact in this sample. Alcohol use and personal and peer hookup norms mediated revictimization by force, threats, or incapacitation. In contrast, the hypothesized mediators did not explain the revictimization pathway for verbally coerced assaults. Given the prevalence of sexual coercion, research needs to identify risk factors for verbal coercion to guide prevention efforts.

Profile Analysis of Sexual Assault Experiences among Adult Women and Their Implications for Mental Health

OBJECTIVE

Extant studies indicate that just one characteristic of sexual assault cannot properly represent the whole experience of sexual assault and, especially, the severity of sexual assault. This study aimed to understand the totality of sexual assault experiences and elucidate subtypes of sexual assault victims based on the detailed characteristics of their sexual assault experiences and those relationships with mental health.

METHODS

A total of 255 adult sexual violence victims who used intervention services and a comparison group were included. Information on their sexual assault experiences was gleaned from case records data.

RESULTS

The following four distinctive profile groups were identified: "Sexual Touching" (19.6%), "Rape/Social Relation" (30.4%), "Intimate Partner Violence (IPV)" (18.8%), and "Rape/Stranger" (31.3%). The subgroups differed in terms of secondary victimization and adverse childhood experiences. The Rape/Social Relation and IPV subgroups most frequently experienced secondary victimization and childhood adversity. The four profile subgroups demonstrated different relationships with mental health outcomes, with a complicated pattern. The Rap/Social Relation and IPV subgroups scored higher on mental health problem screening measures compared to other groups. However, a considerable proportion of victims in the Sexual Touching subgroup also reported suicidal behaviors and self-injury.

CONCLUSION

Based on the results, theoretical and clinical implications were discussed.

Post-traumatic Stress Disorder in Victims of Sexual Assault With Pre-assault Substance Consumption: A Systematic Review

Background: Post-traumatic stress disorder (PTSD) and substance consumption commonly co-occur in victims of sexual assault. Substance consumption can occur pre- andi/or post-assault. Pre-assault substance consumption may have an impact on the subsequent development of PTSD. This review aims to provide an overview of current understanding of the effects of acute substance intoxication and chronic pre-assault problematic substance use on symptoms of PTSD amongst individuals who were victims of sexual assault. Methods: PsycINFO, EMBASE, and MEDLINE were searched using terms related to PTSD, sexual assault, and substance consumption. These yielded 2,121 articles, 268 of which were retrieved for more detailed evaluation and 13 of these met inclusion criteria and were appraised in full. Results: Overall, the reviewed papers supported our hypothesis that acute substance intoxication and chronic pre-assault problematic substance use are associated with fewer initial PTSD symptoms but less improvement over time, resulting in slower overall PTSD recovery. They also highlighted post-assault characterological self-blame and negative social reactions as mediators of recovery in the context of pre-assault substance consumption. Conclusions: Acute substance intoxication and chronic pre-assault problematic substance use appear to have an impact on the development of PTSD symptoms amongst victims of sexual assault. The importance of developing early interventions and routine screening and assessment for PTSD and pre-assault substance consumption is emphasized. The limited research on male victims and on substances other than alcohol is highlighted.

Victim Alcohol Intoxication During a Sexual Assault: Relations With Subsequent PTSD Symptoms

This study examines associations between women's alcohol intoxication at the time of sexual assault and posttraumatic stress disorder (PTSD) symptoms. Drawing on the dual representation theory (Brewin, Gregory, Lipton, & Burgess, 2010), we hypothesized that intoxication at the time of assault would be positively associated with both overall symptoms of PTSD and PTSD reexperiencing symptoms in particular. A total of 143 community women (ages 18-26 years; 71.3% European American) reporting sexual victimization completed questionnaires assessing severity of coercion involved in the assault, perceived level of intoxication at the time of assault, and current PTSD symptoms. Overall, results suggested that greater alcohol intoxication (but not alcohol use alone) was associated with more severe PTSD symptoms when controlling for severity of coercion. Furthermore, higher levels of victim intoxication at the time of the assault were most predictive of reexperiencing symptoms relative to the other symptom clusters.

Sexual Assault Severity and Depressive Symptoms as Longitudinal Predictors of the Quality of Women's Sexual Experiences

Depressive symptoms are one consequence of adult/adolescent sexual victimization (ASV) and are linked to sexual health. Female nonproblem drinkers (N = 419) with an ASV history participated in a one-year longitudinal study. Participants completed measures of lifetime ASV severity and four quarterly assessments of depressive symptoms, ASV severity, and sexual experience quality. Multilevel models revealed that depressive symptoms interacted with ASV severity: Women with low-lifetime ASV severity reported higher ratings of sexual pain as depressive symptoms increased. ASV reported during assessment months predicted sexual experience quality. Interventions to improve survivors' sexual experiences should consider incorporating treatment for depressive symptoms.

The Effects of Sexual Victimization History, Acute Alcohol Intoxication, and Level of Consensual Sex on Responses to Sexual Assault in a Hypothetical Scenario

Assertive resistance to sexual assault can decrease the likelihood of completed rape and its subsequent aftermath; however, this relationship may be influenced by situational characteristics. This study examined how 2 manipulated variables, level of consensual sex during an encounter and acute alcohol intoxication, along with sexual victimization history, affected women's responses to a hypothetical sexual assault scenario. Female participants were assigned to a drink condition (alcohol/control) and to a consent history condition (low/high). Path analysis found that women who were previously victimized, consumed alcohol, and who were in the high consent condition endorsed greater immobility intentions during the assault; only level of consent predicted likelihood of assertive resistance. Resistance strategies were related to subsequent responding. Results suggest that interventions should seek to decrease negative consequences by empowering women to assertively resist unwanted sexual advances.