Rape and Rape Trauma Syndrome

Introduction

• Description: Rape and sexual assault encompass manual, oral, and genital contact by one person without the consent of the other in a way that would be considered sexual in a consensual situation. It does not require penetration, ejaculation, force, or evidence of resistance—only the lack of consent. The legal definition varies slightly by location, but it often includes elements of fear, fraud, coercion, or threat. In some areas, the mentally incompetent, those under the influence of drugs or alcohol, or minors are deemed incapable of giving consent for any otherwise-consensual sexual activity, resulting in “statutory rape.” Sexual coercion is not the same as rape, though no less exploitative; it is conquest and control. Sexual coercion includes explicit attempts to impregnate a partner against her will, control outcomes of a pregnancy, coerce a partner to have unprotected sex, or interfere with contraceptive methods.

• Rape trauma syndrome is a well-recognized set of behaviors that occurs after a sexual assault. These responses are organized into three phases: the acute phase, lasting from hours to days; a middle or readjustment phase, lasting from days to weeks; and a final reorganization or resolution phase that involves lifelong changes.

• Prevalence: Rape constitutes 5%–10% of violent crime and affects 1 in 6 women (lifetime, 16%–19%, 3% per year) in the United States (89% completed, 11% attempted). An estimated 1.47 million rape-related physical assaults occur against women annually. It is the most underreported crime in the United States. Rape trauma syndrome occurs in virtually every case.

• Predominant Age: Any age; highest risk is at the age of 16–24 years (80% first raped <25 years, 41% <18 years)

Etiology and Pathogenesis

• Causes : One-fourth of all rapes occur at home (either the victim’s or the attacker’s), but only one-third of these involve a male intruder. Most attackers are known to the victims (13% strangers). Of recurrent victims, approximately 25% have been raped by someone well known to them, such as an ex-lover, employer, coworker, neighbor, or relative, and two-thirds are vulnerable because of mental impairment, substance abuse, or a psychiatric disorder. Weapons are used in 30%–50% of sexual assaults (handguns are most common). Approximately 50% of campus rapes occur during dates. Estimates of sexual violence occurring in the setting of a dating relationship indicate that 10%–25% of high school students and 20%–50% of college students have experienced some form of sexual violence or coercion. Rape trauma syndrome can follow rape or other forms of intense physical or emotional trauma.

• Risk Factors: History of victimization, youth, greater number of dating or sexual partners. Studies indicate that alcohol use is involved in more than half of all rapes of college students. Use of illicit drugs, including flunitrazepam (Rohypnol), 3,4-methyle-nedioxymethamphetamine (MDMA or ecstasy), ketamine, and γ-hydroxybutyrate (GHB), increase the risk of rape. Rape trauma syndrome is more common in those older than 40 years, those assaulted in their homes by a stranger, and those with a history of previous mental illness.

Signs and Symptoms

• Rape: History of nonconsensual sexual activity

  • Physical signs of sexual activity (not limited to vaginal intercourse)

  • Physical signs of trauma or coercion (including impairment resulting from drugs, alcohol, or mental abilities)

• Rape trauma syndrome—acute : Decompensation, inability to cope, volatile emotions, fear, guilt, anger, depression, and problems concentrating are common; flashbacks are frequent; ideation is often disturbed. Musculoskeletal, genital, pelvic, and/or abdominal pain, anorexia and insomnia.

  • Middle or readjustment (resolution of many issues [may not be functional], flashbacks, nightmares, and phobias may develop)

  • Reorganization (recognizes that event was an assault over which she could have no control)

Diagnostic Approach