Effects and aftermath of rape

Physical force is not necessarily used in rape, and physical injuries are not always a consequence. Deaths associated with rape are known to occur, though the prevalence of fatalities varies considerably across the world. For victims the more common consequences of sexual violence are those related to reproductive health, mental health, and social wellbeing.

Gynecological

Common physical injuries received by rape victims include: [Eby K et al. Health effects of experiences of sexualviolence for women with abusive partners. HealthCare for Women International, 1995, 16:563–576.] [Collett BJ et al. A comparative study of women withchronic pelvic pain, chronic nonpelvic pain and those with no history of pain attending general practitioners. British Journal of Obstetrics and Gynaecology, 1998, 105:87–92.]

*vaginal bleeding or infection
*fibroids
*decreased sexual desire
*genital irritation
*pain during intercourse
*chronic pelvic pain
*urinary tract infections

Pregnancy

Pregnancy may result from rape. The rate varies between settings and depends particularly on the extent to which non-barrier contraceptives are being used. A study of adolescents in Ethiopia found that among those who reported being raped, 17% became pregnant after the rape [Mulugeta E, Kassaye M, Berhane Y. Prevalence and outcomes of sexual violence among high schoolstudents. Ethiopian Medical Journal , 1998, 36:167–174.] , a figure which is similar to the 15–18% reported by rape crisis centres in Mexico. [Evaluacio´n de proyecto para educacio´n, capacitacio´ny atencio´n a mujeres y menores de edad en materia de violencia sexual, enero a diciembre 1990. [An evaluation of a project to provide education, training and care for women and minors affected by sexual violence, January–December 1990.] Mexico City, Asociacio´n Mexicana contra la Violencia a las Mujeres, 1990.] [Carpeta de informacio´n ba´sica para la atencio´n solidaria y feminista a mujeres violadas. [Basic information file for mutually supportive feminist care for women rape victims.] Mexico City, Centro do Apoyo a Mujeres Violadas, 1985.]

A longitudinal study in the United States of over 4000 women followed for 3 years found that the national rape related pregnancy rate was 5.0% per rape among victims aged 12–45 years, producing over 32 000 pregnancies nationally among women from rape each year. [Holmes MM et al. Rape-related pregnancy: estimates and descriptive characteristics from a national sample of women. American Journal of Obstetrics and Gynecology, 1996, 175:320–324]

Experience of coerced sex at an early age reduces a woman’s ability to see her sexuality as something over which she has control. As a result, it is less likely that an adolescent girl who has been forced into sex will use condoms or other forms of contraception,increasing the likelihood of her becoming pregnant. [Jewkes R et al. Relationship dynamics and adolescent pregnancy in South Africa. Social Science and Medicine, 2001, 5:733–744] [Boyer D, Fine D. Sexual abuse as a factor in adolescent pregnancy. Family Planning Perspectives, 1992, 24:4–11.] [Roosa MW et al. The relationship of childhood sexual abuse to teenage pregnancy. Journal of Marriage and the Family, 1997, 59:119–130.] [Stock JL et al. Adolescent pregnancy and sexual risk taking among sexually abused girls. Family Planning Perspectives, 1997, 29:200–227.]

A study of factors associated with teenage pregnancy in Cape Town, South Africa, found that forced sexual initiation was the third most strongly related factor, after frequency of intercourse and use of modern contraceptives. [Jewkes R et al. Relationship dynamics and adolescent pregnancy in South Africa. Social Science and Medicine, 2001,] Forced sex can also result in unintended pregnancy among adult women. In India, a study of married men revealed that men who admitted forcing sex on their wives were 2.6 times more likely to have caused an unintended pregnancy than those who did not admit to such behavior. [Martin SL et al. Sexual behaviour and reproductive health outcomes: associations with wife abuse in India. Journal of the American Medical Association, 1999, 282:1967–1972.] Should pregnancy result from a first-time encounter it would carry a higher risk of pre-eclampsia, the condition in which the mother's body reacts adversely to the proteins of the fetus.

exually Transmitted Diseases

Violent or forced sex can increase the risk of transmitting HIV [Jenny C et al. Sexually transmitted diseases in victims of rape. New England Journal of Medicine,1990, 322:713–716.] In forced vaginal penetration, abrasions and cuts commonly occur, thus facilitating the entry of the virus through the vaginal mucosa. Adolescent girls are particularly susceptible to HIV infection through forced sex, and even through unforced sex, because their vaginal mucous membranes have not yet acquired cellular density sufficient to provide an effective barrier that develops in the later teenage years. Those who suffer anal rape are also considerably more susceptible to HIV than would be the case if the sex were not forced, since anal tissues can be easily damaged, again allowing the virus an easier entry into the body.

Being a victim of sexual violence and being susceptible to HIV share a number of risk behaviors. Forced sex in childhood or adolescence, for instance, increases the likelihood of engaging in unprotected sex, having multiple partners, participating in sex work, and substance abuse. People who experience forced sex in intimate relationships often find it difficult to negotiate condom use either because using a condom could be interpreted as mistrust of their partners or as an admission of promiscuity, or else because they fear experiencing violence from their partners. Sexual coercion among adolescents and adults is also associated with low self-esteem and depression factors that are associated with many of the risk behaviors for HIV infection.

Research on women in shelters has shown that women who experience both sexual and physical abuse from intimate partners are significantly more likely to have had sexually transmitted diseases. [Wingood G, DiClemente R, Raj A. Adverseconsequences of intimate partner abuse among women in non-urban domestic violence shelters. American Journal of Preventive Medicine, 2000, 19:270–275.]

Psychological response to rape

elf blame

Self blame is among the most common of both short- and long-term effects and functions as an avoidance coping skill that inhibits the healing process and can often be remedied by a cognitive therapy technique known as cognitive restructuring.

There are two main types of self blame: behavioral self blame (undeserved blame based on actions) and characterological self blame (undeserved blame based on character). Victims who experience behavioral self blame feel that they should have done something differently, and therefore feel at fault. Victims who experience characterological self blame feel there is something inherently wrong with them which has caused them to deserve to be assaulted.

A leading researcher on the psychological causes and effects of shame, June Tangney, lists five ways shame can be destructive:
*lack of motivation to seek care;
*lack of empathy;
*cutting themselves off from other people;
*anger;
*aggression.Tangney says shame has a special link to anger. "In day-to-day life, when people are shamed and angry they tend to be motivated to get back at a person and get revenge."

In addition shame is connected to psychological problems - such as eating disorders, substance abuse, anxiety, depression, and other mental disorders as well as problematic moral behavior. In one study over several years shame-prone kids were prone to substance abuse, earlier sexual activity, less safe sexual activity, and involvement with the criminal justice system.Tangney, June Price and Dearing, Ronda L., Shame and Guilt, The Guilford Press, 2002 ISBN 1572309873]

Behavioral self blame is associated with feelings of guilt within the victim. While the belief that one had control during the assault (past control) is associated with greater psychological distress, the belief that one has more control during the recovery process (present control) is associated with less distress, less withdrawal, and more cognitive reprocessing. [Frazier, Patricia A.; Mortensen, Heather; Steward, Jason. (2005). Coping Strategies as Mediators of the Relations Among Perceived Control and Distress in Sexual Assault Survivors. Journal of Counseling Psychology, Jul2005, Vol. 52 Issue 3, p267-278]

Counseling responses found helpful in reducing self blame are supportive responses, psychoeducational responses (learning about rape trauma syndrome) and those responses addressing the issue of blame. [Matsushita-Arao, Yoshiko. (1997). Self-blame and depression among forcible rape survivors. Dissertation Abstracts International: Section B: The Sciences and Engineering. 57(9-B). pp. 5925.] A helpful type of therapy for self blame is cognitive restructuring or cognitive-behavioral therapy. Cognitive reprocessing is the process of taking the facts and forming a logical conclusion from them that is less influenced by shame or guilt. [Branscombe, Nyla R.; Wohl, Michael J. A.; Owen, Susan; Allison, Julie A.; N'gbala, Ahogni. (2003). Counterfactual Thinking, Blame Assignment, and Well-Being in Rape Victims. Basic & Applied Social Psychology, 25 (4). p265, 9p.]

uicide

Childhood and adulthood victims of rape are more likely to attempt or commit suicide. [ Davidson JR et al. The association of sexual assault and attempted suicide within the community. Archives of General Psychiatry, 1996, 53:550–555.] [Luster T, Small SA. Sexual abuse history and problems in adolescence: exploring the effects of moderating variables. Journal of Marriage and the Family, 1997, 59:131–142.] [McCauley J et al. Clinical characteristics of women with a history of childhood abuse: unhealed wounds. Journal of the American Medical Association, 1997, 277:1362–1368.] The association remains, even after controlling for sex, age, education, symptoms of post-traumatic stress disorder and the presence of psychiatric disorders. [Nagy S, Adcock AG, Nagy MC. A comparison of risky health behaviors of sexually active, sexually abused, and abstaining adolescents. Pediatrics, 1994, 93:570–575.] [Romans SE et al. Sexual abuse in childhood and deliberate self-harm. American Journal of Psychiatry, 1995, 152:1336–1342.] [Wiederman MW, Sansone RA, Sansone LA. History of trauma and attempted suicide among women in a primary care setting. Violence and Victims, 1998, 13:3–9.] The experience of being raped can lead to suicidal behavior as early as adolescence. In Ethiopia, 6% of raped schoolgirls reported having attempted suicide. [Mulugeta E, Kassaye M, Berhane Y. Prevalence and outcomes of sexual violence among high school students. Ethiopian Medical Journal , 1998, 36:167–174.] A study of adolescents in Brazil found prior sexual abuse to be a leading factor predicting several health risk behaviours, including suicidal thoughts and attempts. [Anteghini M et al. Health risk behaviors and associated risk and protective factors among Brazilian adolescents in Santos, Brazil. Journal of Adolescent Health, 2001, 28:295–302.]

Effects of sexual assault on children

Rape and other forms of sexual assault on a child can result in both short-term and long-term harm, including psychopathology in later life.Dinwiddie S, Heath AC, Dunne MP, et al (2000). " [http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=26191 Early sexual abuse and lifetime psychopathology: a co-twin-control study.] " "Psychological Medicine", 30:41–52] Nelson EC, Heath AC, Madden PA, et al (2002). " [http://archpsyc.ama-assn.org/cgi/content/full/59/2/139 Association between self-reported childhood sexual abuse and adverse psychosocial outcomes: results from a twin study.] ," "Archives of General Psychiatry", 59:139–145] Psychological, emotional, physical, and social effects include depression,Roosa M.W., Reinholtz C., Angelini P.J. (1999). [http://findarticles.com/p/articles/mi_m0902/is_1_27/ai_54422556/print "The relation of child sexual abuse and depression in young women: comparisons across four ethnic groups,"] "Journal of Abnormal Child Psychology" 27(1):65-76.] cite journal | author = Widom, S. | coauthors = Dumont K., Czaja, S. | year = 2007 | title = A Prospective Investigation of Major Depressive Disorder and Comorbidity in Abused and Neglected Children Grown Up | journal = Archives of General Psychiatry | volume = 64 | issue = 1 | pages = 49 | doi = 10.1001/archpsyc.64.1.49 | pmid = 17199054 ; [http://www.sciencedaily.com/releases/2007/01/070102092229.htm lay summary] ] post-traumatic stress disorder,Widom C.S. (1999). [http://ajp.psychiatryonline.org/cgi/content/full/156/8/1223 "Posttraumatic stress disorder in abused and neglected children grown up,"] American Journal of Psychiatry; 156(8):1223-1229.] cite journal |url=http://pn.psychiatryonline.org/cgi/content/full/40/15/34-a |title=Dissociation Often Precedes PTSD In Sexually Abused Childre |author=Joan Arehart-Treichel |journal=Psychiatric News |date=2005-08-05 |volume=Volume 40 Number 15 |pages=p. 34 |publisher=American Psychiatric Association] anxiety,Levitan, R. D., N. A. Rector, Sheldon, T., & Goering, P. (2003). " [http://www3.interscience.wiley.com/cgi-bin/abstract/102529637/ABSTRACT?CRETRY=1&SRETRY=0 Childhood adversities associated with major depression and/or anxiety disorders in a community sample of Ontario: Issues of co-morbidity and specificity] ," Depression & Anxiety; 17, 34-42.] , eating disorders, poor self-esteem, dissociative and anxiety disorders; general psychological distress and disorders such as somatization, neurosis, chronic pain,cite journal |last=Arnow |first=B. |year=2004 |month= |title=Relationships between childhood maltreatment, adult health and psychiatric outcomes, and medical utilization. |journal=Journal of Clinical Psychiatry |volume=65 |issue=Suppl 12:10-5. |pmid = 15315472] sexualized behavior,cite book |title=Child Sexual Abuse: Intervention and Treatment Issues |first=Kathleen C. |last=Faller |year=1993 |publisher=Diane Publishing |pages=p6 |isbn=078811669X] school/learning problems; and behavior problems including substance abuse,cite journal|title=Long-term correlates of child sexual abuse: Theory and review of the empirical literature |coauthors=Melissa A. Polusny and Victoria M. Follette |publisher=Elsevier Ltd.|journal=Applied and Preventive Psychology |volume=Volume 4, Issue 3, Summer 1995, Pages 143-166] cite web |url=http://www.nida.nih.gov/NIDA_Notes/NNVol17N1/Childhood.html |title=Childhood Sex Abuse Increases Risk for Drug Dependence in Adult Women | work=NIDA Notes, National Institute of Drug Abuse, volume 17, no. 1 |publisher=National Institutes of Health |date=April, 2002] destructive behavior, criminality in adulthood and suicide. cite journal|title=The science of child sexual abuse|url=http://www.sciencemag.org/cgi/content/summary/308/5721/501 | doi = 10.1126/science.1108066 | author=Freyd, J.J., Putnam, F.W., Lyon, T.D., Becker-Blease, K. A., Cheit, R.E., Siegel, N.B., & Pezdek, K.|year=2005 |journal= Science |volume= 308|pages= p501|pmid=15845837] Dozier, M., Stovall, K.C., & Albus, K. (1999) Attachment and Psychopathology in Adulthood. In J. Cassidy & P. Shaver (Eds.). Handbook of Attachment (pp. 497-519). NY: Guilford Press, ISBN 1572308265] Kendall-Tacket, K. A., Williams, L. M., & Finkelhor. D. (1993). [http://www.eric.ed.gov/ERICWebPortal/custom/portlets/recordDetails/detailmini.jsp?_nfpb=true&_&ERICExtSearch_SearchValue_0=ED341908&ERICExtSearch_SearchType_0=eric_accno&accno=ED341908 Impact of Sexual Abuse on Children: A Review and Synthesis of Recent Empirical Studies] . Psychological Bulletin, 1993, Vol. 113, No. 1, 164-180. - also published in cite book |title=Annual progress in child psychiatry and child development 1994 |first=Margaret E. |last=Hertzig |coauthors=Ellen A. Farber |year=1994 |publisher=Psychology Press |pages=p321-356 |isbn=0876307446] [Gauthier, L., Stollak, G., Messe, L., & Arnoff, J. (1996). [http://www.eric.ed.gov/ERICWebPortal/custom/portlets/recordDetails/detailmini.jsp?_nfpb=true&_&ERICExtSearch_SearchValue_0=EJ527636&ERICExtSearch_SearchType_0=eric_accno&accno=EJ527636 Recall of childhood neglect and physical abuse as differential predictors of current psychological functioning] . Child Abuse and Neglect 20, 549-559.] cite web |url=http://www.ncptsd.va.gov/ncmain/ncdocs/fact_shts/fs_child_sexual_abuse.html |title=Child Sexual Abuse |author=Julia Whealin, Ph.D. |publisher=National Center for Posttraumatic Stress Disorder, US Department of Veterans Affairs |date=2007-05-22] Briere, J. (1992). " [http://www.johnbriere.com/methodological%20csa%20jccp%201992.pdf Methodological issues in the study of sexual abuse effects,] " Journal of Consulting and Clinical Psychology, p. 199.]

The risk of lasting psychological harm is greater if the perpetrator of the sexual assault on the child is a relative (ie, incest), or if threats or force are used. [Bulick, C. M., Prescott, C. A., & Kendler, K. S. (2001). [http://bjp.rcpsych.org/cgi/content/abstract/179/5/444 "Features of childhood sexual abuse and the development of psychiatric and substance use disorders,"] "British Journal of Psychiatry", 179, 444-449.] Incestual rape has been shown to be one of the most extreme forms of childhood trauma, a trauma that often does serious and long-term psychological damage, especially in the case of parental incest.cite book|title=Healing the Incest Wound: Adult Survivors in Therapy|last= Courtois|first=Christine A.|publisher=W. W. Norton & Company|pages=p208|year=1988|isbn= 0393313565]

econdary victimization

Rape is especially stigmatizing in cultures with strong customs and taboos regarding sex and sexuality. For example, a rape victim (especially one who was previously a virgin) may be viewed by society as being "damaged." Victims in these cultures may suffer isolation, be disowned by frien&list_uids=10606433&dopt=Abstract (Campbell et. al., 1999)] Secondary victimization is especially common in cases of drug-facilitated, acquaintance, and statutory rape.

Victim blaming

The term "Victim blaming" refers to holding the victim of a crime to be responsible for that crime, either in whole or in part. In the context of rape, it refers to the attitude that certain victim behaviors (such as flirting or wearing sexually provocative clothing) may have encouraged the assault. In extreme cases, victims are said to have "asked for it" simply by not behaving demurely.

It has been proposed that one cause of victim blaming is the "just world hypothesis". People who believe that the world is intrinsically fair may find it difficult or impossible to accept a situation in which a person is badly hurt for no reason. This leads to a sense that victims must have done something to deserve their fate. Another theory entails the psychological need to protect one's own sense of invulnerability, which can inspire people to believe that rape only happens to those who provoke the assault. Believers use this as a way to feel safer: If one avoids the behaviours of the past victims, one will be less vulnerable. A global survey of attitudes toward sexual violence by the Global Forum for Health Research shows that victim-blaming concepts are at least partially accepted in many countries. Many of the countries in which victim blaming is more common are those in which there is a significant social divide between the freedoms and status afforded to men and women.

Footnotes

References

* Tangney, June Price and Dearing, Ronda L., "Shame and Guilt," The Guilford Press, 2002
* Matsushita-Arao, Yoshiko. (1997). "Self-blame and depression among forcible rape survivors." "Dissertation Abstracts International: Section B: The Sciences and Engineering." 57(9-B). pp. 5925.
* Branscombe, Nyla R.; Wohl, Michael J. A.; Owen, Susan; Allison, Julie A.; N'gbala, Ahogni. (2003). "Counterfactual Thinking, Blame Assignment, and Well-Being in Rape Victims." "Basic & Applied Social Psychology," 25 (4). p265, 9p.
* Frazier, Patricia A.; Mortensen, Heather; Steward, Jason. (2005). "Coping Strategies as Mediators of the Relations Among Perceived Control and Distress in Sexual Assault Survivors." "Journal of Counseling Psychology," Jul2005, Vol. 52 Issue 3, p267-278
* Lamb, Sharon, "The Trouble with Blame: Victims, Perpetrators and Responsibility," Harvard Univ Press, 1999.
* Madigan, L. and Gamble, N. (1991). "The Second Rape: Society's Continued Betrayal of the Victim." New York: Lexington Books.
* Murray JD, Spadafore JA, McIntosh WD. (2005) "Belief in a just world and social perception: evidence for automatic activation." "J Soc Psychol." Feb;145(1):35-47.
* Frese, B., Moya, M., & Megius, J. L. (2004). "Social Perception of Rape: How Rape Myth Acceptance Modulates the Influence of Situational Factors." "Journal-of-Interpersonal-Violence," 19(2), 143-161.
* Pauwels, B. (2002). "Blaming the victim of rape: The culpable control model perspective." "Dissertation Abstracts International: Section B: The Sciences and Engineering," 63(5-B)
* Blumberg, M. & Lester, D. (1991). "High school and college students' attitudes toward rape." "Adolescence," 26(103), 727-729.
* Shaver, . (2002). "Attribution of rape blame as a function of victim gender and sexuality, and perceived similarity to the victim." "Journal of Homosexuality," 43(2)
* Anderson , K. J. & Accomando, C. (1999). "Madcap Misogyny and Romanticized Victim-Blaming: Discourses of Stalking in There's Something About Mary." "Women & Language," 1, 24-28.
* "The effect of participant sex, victim dress, and traditional attitudes on causal judgments for marital rape victims." (Author Abstract). Mark A. Whatley. "Journal of Family Violence" 20.3 (June 2005): p191(10).
* Kay, Aaron C., Jost, John T. & Young, Sean (2005) "Victim Derogation and Victim Enhancement as Alternate Routes to System Justification." "Psychological Science" 16 (3), 240-246.

External links

* [http://www.survivormatters.co.nr Survivor Matters] Support forum created by survivors for survivors to discuss issues and to gain support and understanding from each other
* [http://www.ibiblio.org/rcip//effectsofrape.html#pagebegin Effects of Rape]
* [http://www.pandys.org Pandora's Aquarium, an online support group, message board, and chat room devoted to recovery and healing from sexual violence]
* [http://www.who.int/violence_injury_prevention/violence/global_campaign/en/chap6.pdf World Health Organization] WHO report on sexual violence