Chapter 43 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.” 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% to 10% of violent crime, 601 of 100,000 women. It is the most underreported crime in the United States. Rape trauma syndrome occurs in virtually every case.
ETIOLOGY AND PATHOGENESIS
Causes: One fourth to one half 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. Of recurrent victims, about 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% to 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% to 25% of high school students and 20% to 50% of college students have experienced some form of sexual violence. Rape trauma syndrome can follow rape or other forms of intense physical or emotional trauma.
CLINICAL CHARACTERISTICS
Signs and Symptoms
• 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)
• Middle, or readjustment (resolution of many issues [may not be functional], flashbacks, nightmares, and phobias may develop)